Why We Do What We Do: Commentary on A Reciprocal‐Engagement Model of Genetic Counseling Practice

Abstract

Why do genetic counselors need a model of practice? After all, none of us walk into a counseling session in a state of panic because we do not know what we are supposed to do. Is not a model of practice simply stating the obvious? Well, not so obvious, as the three of us and the other participants learned at the Models of Practice conference organized by McCarthy Veach, Bartels and LeRoy in November 2005). The differences in viewpoints among the 25 or so participants and the difficulties we had in clearly articulating our private models was an eye opening experience. A model of practice is a way to define how we communicate and assist clients in decision-making. We can dissect what we do and how we do it by defining the tenets, goals, strategies and behaviors we use but have a difficult time articulating. The attempt to develop this model should promote avenues of research in the genetic counseling field and should improve methods of teaching genetic counseling. Along with the newly revised Definition of Genetic Counseling (Resta et al. 2006), Scope of Practice Document (www.nsgc.org), and updated Code of Ethics (NSGC 2006), a Model of Practice will further define the genetic counseling profession in achieving its goals of licensure, reimbursement, and peer recognition. The “Reciprocal Engagement” model is a result of sifting through the many insights and viewpoints provided by the conference participants (McCarthy-Veach et al. 2007). The model incorporates values and practices near and dear to the hearts of genetic counselors—client-focused information sharing, filtered through the psychosocial lenses of the client and the counselor. It is particularly refreshing in its explicit acknowledgment of the importance of the relationship between the counselor and the client, and in maintaining that fine balance between the seemingly at odds-tasks of attending to both education and counseling. Since paternalism is no longer valued in many aspects of medical care, decision-making falls to the patient, family and health care providers. Examining options, deciding together what works effectively is a challenge for all of us. The genetic counseling profession has grown up at the time that this major sea change occurred in medical practice. We, as genetic counselors, have a long experience of facilitating autonomous decision-making. If we take the example of the recent ACOG statement (2007) recommending that every obstetrician discuss with the pregnant patient no matter what her age, the options of prenatal screening and diagnostic tests, we see evidence of the sea change. We can make a huge difference in how this information is communicated, assisting patients, families and medical practitioners always cognizant of the psychosocial and ethical issues raised by the options presented. J Genet Counsel (2007) 16:729–730 DOI 10.1007/s10897-007-9118-z