‘So, what do you do?’ I reply I am a genetic counsellor. The face of the enquirer glazes over, they have no idea what that means. From now on I shall refer them to Christine Evans' excellent book. This beautifully constructed work captures the essence of genetic counselling making it an essential read for anyone working in this profession. This book will also inform those health professionals who may be considering a career in clinical genetics. Dr Evans has worked with counsellors and clinicians in a department of Medical Genetics, and her grasp of the intricacies of this speciality is impressive. As she states ‘Genetic counselling has emerged to respond to the individual seeking genetic information and has taken up the challenge of how knowledge of the genetic contribution of a disease is shared with individuals and families.’
The book has an excellent preface where the author succinctly informs the reader what to expect. This makes it a very useful work to ‘dip into’ as required. The overview of genetic counselling is thoughtfully constructed and manages to accurately describe the many components of the job. A clear picture is given to the reader of the various aspects of a genetic consultation. The possible motivation for the request for a consultation is discussed and how counsellors might elicit the patient's understanding of the disorder in the family. A typical interview is made up of many parts where communication, science and general medicine meet. Dr Evans stresses the far-reaching effect on individuals and their families of having an inherited disease. Genetic counselling differs from other medical consultations since it is about ‘knowledge and its key elements are decision-making and coping with a result’. The author stresses the psychological processes which underpin genetic counselling. She feels that individuals manage anxiety, grief and frustration differently and fall into one of three groups: mature, defensive or symptomatic.
To further the reader's understanding of individual difference in genetic counselling Dr Evans uses the model of attachment theory. The chapter contains a comprehensive and thoughtful explanation of Bowlby's theory together with associated research. This approach to counselling is innovative and exciting and will resonate with many current practitioners. This theory gives a framework for the counsellor to understand how people behave differently in their response to genetic counselling and ‘that the differences relate to the management of anxiety and grief and early attachment patterns’. The author uses her experience as a psychotherapist to further explore the role and skills of the counsellor. The importance of empathy, communication, listening skills and the use of the metaphor are discussed. Throughout the book examples and extracts from actual consultations are used to illustrate the point under discussion. This adds a richness and clarity to the text. These extracts are used in a warm yet unsentimental way which practitioners will find most thought provoking.
There are useful chapters looking at the variety of family-centred scenarios that confront the genetic counsellor. These include a helpful insight into the challenges of working with parents and children. Dr Evans looks at the influence of the nature of the disorder on the consultation and uses four specialities to illustrate this. Prenatal work forms a large part of a clinical geneticist's workload and several strategies are discussed to facilitate effective working with this client group. Huntington's disease is a condition that often challenges the counsellor to call upon all their experience in family dynamics. The author uses examples to illustrate some of the personal struggles which come into the genetic encounter. Other examples are used to explore the skills required in the fields of dysmorphology and cancer genetics. Space is also given to discuss the effect that genetic counselling has on the practitioner. Transference and counter-transference issues are explored and Evans acknowledges that this work can be both stressful and upsetting. She sees psychological supervision as ‘a central and essential part of training and on-going practice’.
This book succeeds in finding the language to describe and understand what genetic counselling is. All health professionals in the field and others wishing to learn more about effective communication with patients and their families will find reading this book a thought-provoking and stimulating experience.
