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54 Cards in this Set
- Front
- Back
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Human Gene Patenting
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-Anti gene-patenting
-Supports policy encouraging open access to genetic testing |
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Predisposition Testing
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-Autonomy, justice, privacy ensured (arguments against childhood testing)
-Appropriate education pre and post testing |
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DTC Genetic Testing
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-Supports right to access
-Encourages clinical professional involvement -Company has addressed privacy, informed consent, education before and after testing -CLIA labs, referrals available to medical professionals |
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Healthcare reform
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-Urges federal legislation that would designate board-certified genetic counselors as practitioners by CMS.
-Advocates for all health plans to provide access to these essential services |
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Fetal Tissue Research
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-Supported with strict medical guidelines
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Childhood Testing
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-Clients considering a pregnancy or who have a fetus or child at-risk for an adult-onset genetic disorder should be made aware of clinically available testing technologies for that disorder.
-Prenatal testing for adult-onset genetic conditions should be offered regardless of whether or not an affected fetus would be terminated. -Decision on whether to proceed is parents to make. |
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Somatic Cell Nuclear Transfer
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-Stem cell research endorsed
-Reproductive cloning opposed |
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Adoption
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-Information should only be released to adoptive parents once the adoption is finalized, unless it is currently medically relevant
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Americans with Disability Act
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People with disabilities cant be discriminated for:
employment public services telecommunication transportation public accommodations commercial facilities |
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Affordable Care Act
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-<19 can't be denied b/c of pre-existing conditions (though can still be charged more etc); effective now.
-Similar law for adults, but not effective until 2014 |
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GINA
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-Cannot reject coverage or raise premiums based on genetic info, prohibits requiring genetic info for enrollment, this includes family history of disease
Executive Order 2000-prohibits the US government from using genetic info in hiring, promotion, discharge, and all other employment decisions -Prevents employment discrimination based on genetic information -Not covered: life insurance, disability insurance and long-term care insurance; employment provisions generally do not apply to employers with fewer than 15 employees; does not protect rates for symptomatic indviduals |
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HIPPA
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1996- Genetic information cannot be considered a pre-existing condition
2002- Limits PHI shared, allows people access to their own medical records. More focused on privacy. |
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Coping strategies/TSCM
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-problem-focused v. emotion-focused
-coping self-efficacy important -reappraisal important interventions: -broaden counselee’s views of the situation -suggest additional coping methods -help reduce emotions whose intensity interferes with thinking and planning -have patient tell their story |
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Psychological Defenses
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= unconscious mental process where difficult feelings are prevented from reaching consciousness. Most functional when operating at midlevel intensity with flexibility, adaptivity.
Repression Denial Intellectualization Displacement Identification Repression Rationalization Undoing Sublimination Reaction formation Projection *Note: Defense mechanisms are ways of coping, but not all comping mechanisms are defenses. |
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Self-esteem/Narcissistic injury
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Self esteem: based on sense of ethical/moral consistency, ability to adapt, self-worth and dignity. Also, social standing, achievements, personal/social validation.
Narcissism = unconscious experience of innate self-worth Affirm patient's skills, integrity, insights; provide support and positive self-image |
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Grief and mourning
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-Need to regain emotional control, redefine meaning/identity
-Anticipatory guidance re: diversity of grieving responses, give emotional support -Honor private mourning -Identify and address social isolation For couples: Inquire about differences in defenses, coping, expression of grief and impact on relationship. Normalize differences, reframe in terms of complementarily, discuss difficulties, offer anticipatory guidance |
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Guilt and shame
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1) Assessment
2) Expression/elaboration -Must explore inner-dialogue/beliefs, allow for confession 3) Response/intervention Guilt = help client express feelings and provide non-judgemental and empathetic response, use authority when asserted no factual basis for guilt, normalize feelings may be common, reframe (because you are responsible and love our child), limit liability (help client recognize good outcomes they controlled) Shame = validation, reframing, normalization, problem-solving, anticipatory guidance *Exploration before reassuring the counselee that it isn’t there fault. Authority may be important when reassuring clients. |
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Rolland's disease factors influencing impact on family
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1) Onset: affects time to accommodation
2) Course: continual adaptation vs. stability. 3) Outcome: anticipation of loss, structural change and death 4) Extent and nature of incapacitation-extent of stigmatization, isolation and loss 5) Degree of uncertainty or predictability |
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Client-Centered Therapy (Rogerian)
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-Unconditional positive regard
-Empathy -Genuineness |
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Developing/Reducing Emotional Intensity
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Developing: Empathetic responses, direct statements, questions
Reducing: Acknowledgement, cognitive activity, support/evoke counselee's defenses and coping mechanisms |
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Giving bad news
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-Warning shot
-Silence -Instead of going into explanation and clarification, respond to the underlying emotional needs: allow client to recover, express empathy/concern, help mobilize coping resources, give only essential information. |
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Heuristics
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-Framing= patients are more sensitive to loss than gain
-Anchoring -Availability -Representativeness -Ambiguity effect= avoidance of options with incomplete information -Confirmation bias -Omission bias= tendency to judge harmful actions as worse than equally harmful inactions. -Outcome bias -Optimism bias |
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Risk communication
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-Understand clients preexisting perception of risk
Information giving: -Natural frequency (e.g. gambling odds) with pictorial representation; believed to make patients less anxious and they better understand them -Provide negative and positive framing. *Note: Uhlmann suggests fractions and percentages. -Patients may prefer to hear risk communicated using quantitative figures, they may use qualitative descriptions to arrive at an understanding -Try to personalize risks |
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Stages of grief
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Denial/Shock
Anger/Guilt Bargaining Depression Acceptance OR: Numbness > Disorganization > Reorginization |
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Complicated grief
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Exaggerated grief
Masked grief Chronic grief Delayed grief |
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Patient Anger
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-Validate emotion, invite discussion and honor its role
-Try and understand/address source of anger -Non-defensive reflection of anger |
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Responses confused as denial
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Disbelief = information heard but can't be made sense of
-Insisting on acceptance is counterproductive, prioritize necessary information/actions, allow understanding through time, repetition, experience Deferral = accepts information, rejects implications, may postpone taking action -Acknowledge scary/difficult, help prioritize actions, mobilize resources Dismissal = devaluing source ove bad news, often with anger -Acknowledge anger, emphasize areas client does accept and carefully explore areas of disagreement, maintain nonjudgemental stance |
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Working with adolescents
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Cognitive-based therapy
-Try to change behaviors by changing thoughts/feelings -Well-suited for adolescents, because counselor teaches a specific technique Identify family/social support Use several methods to define risk, use adolescent's relationship with peers to explore risk further ("if your friend were pregnant, what advice would you give her") Long-term and short-term goal/decision-making trees |
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Patient Resistance
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-explore reasons
-some resistance may be natural/normal -empathy, focus on that resistance is self-protective -contract re: role/benefits of GC -allow involvement and control, affirm patients dignity/integrity -reflect feelings of resistance, help clients see how resistance hindering GC process -use less threatening terms |
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Working with families
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Goals: Maximize individuals who are informed, include appropriate individuals in decision-makign, recognize family roles may be realigned in times of crisis
-Many family problems can be analyzed in terms of boundaries -Ways to assist with family communication: role play, GC as conduit, help identify logistics of communication, provide education materials, reframing, psychoeducation |
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Working with women with disabilities
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-Obtain information from a reliable third party
-Minimize discussion of risks, elicit patient's feelings and attitudes to the current decision -Summarize, rephrase, verify patient's decision > make recommendation and check -Minimize use of analogies -Involve support system -Use nonjudgemental language |
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Components of informed consent
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Competence (legal term)
Information amount and accuracy (benefits/risks/alternatives) Understanding Consent (including voluntary authorization) |
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Duty to recontact
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-PCP responsible for reminding the patient to keep in touch with a genetics healthcare provider for changes in the field that may affect their care
-Geneticist is responsible for providing clinical updates only to those patients with whom they have a continuing relationship |
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Primary empathy
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Primary empathy= understanding and communicating back what a client is experiencing
-Empathetic emotions= having an emotional reaction in tune with client -Intellectual empathy= role-taking, perspective-taking Empathetic responses: Silence Minimal encouragers Paraphrase Summary Reflect content Reflect feeling Reflect both content and feeling Functions: rapport building, encourage client to continue talking, help client feel understood, clarification, problem exploration, facilitate client-risk taking |
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Advanced empathy
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advanced empathy = communicates an understanding of the underlying implicit aspects of client experiences, goes beyond the surface, tentative hypothesis
Functions: -gives client permission to express certain feelings -moves client towards self-acceptance -facilitates decision-making -provides insight and promotes change, may raise anxiety |
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Decision-making styles
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-Intuitive
-Agonizing -Delaying -Impulsive -Fatalistic -Compliant -Paralytic -Planful = may be most useful when stakes are high |
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Assisting decision-making
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-Self-efficacy, reassure that they can make best decision for themselves
-Convey understanding and acceptance -Help clients draw upon past experience -Suggest that they listen to instincts -Encourage to seek support and guidance from others -Anticipate outcomes and responses |
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Coping styles
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Confrontative
Distancing Self-controlling Accept responsibility Escape Planning Positive Reappraisal *Planning, seeking social support, positive reappraisal have greatest chance for effective coping |
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Client styles
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Intellectual
-Inductive reasoners -Deductive reasoners -Synthesizers -Confused reasoners Emotional -Spontaneous -Nonexpressive -Reserved -Explosive |
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Duty to warn/Confidentiality breach
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Disclosure may be permitted when:
-attempts to encourage patient to tell family members have failed -serious and foreseeable harm is likely to occur -at risk relatives are known -disease is preventable or treatable or medically accepted standards indicate that early monitoring will reduce the risk |
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Transference
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= unconscious way client relates to GC, often misperception occurring in the first moments, tend to be overreactions
Types: • Counselor as an ideal • Counselor as a seer (have all right answers) • Counselor as nurturer • Counselor as frusterator • Counselor as non-entity Responses: • Be careful about addressing transference, may result in more client confusion • Ask clarifying questions • Reflect transference feelings • Interpret transference |
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Countertransference
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= GC’s unconscious way of relating to client, based on history of relating to other clients, involving misperceptions and overractions
-Projective identification = Believing that your feelings are your client’s -Associative countertransference = Client’s experience causes you to tap into your inner self -Overprotective countertransference = Perceive client as needing protection -Benign countertransference = Need to be liked by client, fear of strong client affect -Rejecting countertransference = Client is needy so you create distance and become aloof -Hostile countertransference = When you dislike something about your client, create distance |
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When do you make a mental health referral?
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-intense/sustained guilt, shame, grief, depression, anxiety, social isolated, deterioration work/social life, inability to make time-sensitive decisions
-when suggesting a referral normalize efforts to cope, emphasize difficult circumstance, convey empathy versus udging |
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Confrontation
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= points out experiences contradictory to client’s self-understanding
Functions: -Help client understand behaviors and consider changing them -Challenge client to recognizes strengths/potentials -Remove barriers to goal-setting and decision-making -Do not use if client confused/distressed -Focus on changeable behavior |
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Grief interventions
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-Give permission, provide accepting atmosphere
-Normalize feelings, remind that it takes time -Allow clients to discuss grief |
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Advice giving
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-Give advice later in the session, with expertise, after building rapport and demonstrating empathy
-Offer tentatively -Emphasize decision-making process not outcome Examples: -Taking more time to make decision -Continuing conversation at home -Including spouse/other support -Clarifying a diagnosis -Getting help for substance/drug abuse |
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Self disclosure
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-Examine reasons why disclosing
-Be intentional, brief and focused -Maintain appropriate level on intimacy -Be conservative, don’t want focus on you -Know your own reactions |
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Self-involving responses
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= communications of reactions to client in the present, deal with immediate counselor-client relationship
When to use: • Session losing direction • Tension building • Trust not developed • Bad news |
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How do you respond when a patient asks- what should I do?
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-learn more about their values and goals, and provide a recommendation based on what they have said
-play what-if, and walk through the different scenarios -tell them what you would do but give the technical, ethical, psychological reasoning why |
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How do you distinguish grief depression v. clinical depression?
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Grief:
Comes in waves Have healthy self-image Responsive to support Anger may be present Clinical: Does not diminish over time, Sense of worthlessness, disturbed self image Unresponsive to support Usually no pronounced anger |
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Sings of clinical depression?
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Loss of interest in daily activities
Depressed mood Sleep disturbance Impaired thinking/concentration Changes in weight Fatigue/slowing of body Low self-esteem Less interest in sex Thoughts of death |
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How to manage ambiguous loss?
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-Manage stress
-Gather information -Give sense of control where possible -Support groups may be helpful for some -Encourage families to share their feelings |
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Culture competence- how to elicit and manage explanatory models
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-elicit model: what do you call the problem? what caused it? what does it do? how severe? how do you treat? etc.
-bridge cultural differences, find a way to connect patient's experience/expectations with those of GC -people may believe in multiple explanatory models |
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Stages of change
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Precontemplation stage
Contemplation stage Decision stage Action stage Maintenance Stage |
