GCO 530 Module 16 Final Paper: The Three Most Important Psychosocial Skills in Genetic Counseling Example

Empathy, Contracting and Attending: The Three Skills I Will Build My Practice On

Student Name

MS in Genetic Counseling, Arizona State University

GCO 530: Genetic Counseling Fundamentals

Instructor Name

Month Day, Year

Empathy, Contracting and Attending: The Three Skills I Will Build My Practice On

Introduction

This semester introduced more than a dozen psychosocial skills, from attending behaviors and questioning to self-disclosure, advice and managing session dynamics. All of them matter, but some are foundations on which the others rest. I have chosen the three I consider most important: empathy, contracting and attending behaviors. For each, I explain the concept and its use in a session, then defend my choice and describe how I will grow.

Empathy

Empathy is the ability to understand a client's experience from their point of view and to communicate that understanding. McCarthy Veach and colleagues (2018) distinguish primary empathy, which reflects the feelings and meaning a client has expressed, from advanced empathy, which offers a tentative reading of something the client has implied but not said. Kessler (1999) argued that empathy in genetic counseling also has a moral dimension: treating clients with decency means recognizing the weight of what they are facing.

In a session, primary empathy might sound like, "You were hoping this test would bring relief, and instead it raised new questions." Advanced empathy might sound like, "I wonder whether part of what makes this so hard is that your sister doesn't know yet."

Empathy is the most important skill because the others depend on it. Rogers (1957) proposed empathic understanding as one of the core conditions of therapeutic change, and a meta-analysis of research in psychotherapy reported that clients of more empathic therapists tended to do better, a moderately strong link (r = .28) (Elliott et al., 2018). In genetic counseling, the Reciprocal-Engagement Model holds that client emotions make a difference and that the relationship is integral to the work (McCarthy Veach et al., 2007); empathy is how a counselor acts on both tenets.

Contracting

Contracting is the process of establishing a mutually agreed-upon agenda at the start of a session: learning what the client hopes to gain, explaining what the counselor plans to cover and agreeing on how the time will be used (McCarthy Veach et al., 2018). It is revisited when new concerns emerge. In a session, contracting might sound like, "Before we start, could you tell me what you most hope to leave with today? I had planned to review your family history and testing options; how does that fit with what you need?"

Contracting is among the most important skills because it protects client autonomy, a core value of the profession. Without it, the counselor's agenda fills the session. A client who came to discuss whether to tell her children about a result may leave with a detailed explanation of penetrance and no help with the question she actually had. Contracting also makes the session efficient, since time goes to the issues the client cares about.

Attending Behaviors

Attending behaviors are the verbal and nonverbal ways a counselor shows that they are listening: eye contact suited to the client's culture, an open posture, a calm tone, minimal encouragers and silence that leaves room to think (McCarthy Veach et al., 2018). In a session, attending might mean putting down the pedigree pen when a client begins to cry and waiting rather than filling the silence with information.

Attending is essential because clients judge whether it is safe to speak by watching the counselor. The best empathic statement will fail if the counselor's body says they are rushing. Attending is also the skill most easily lost under pressure; in my standardized patient session, I noticed that I looked at my notes whenever I felt unsure, which interrupted the client just as she began to share something important.

Why These Three

Together, these skills form the base of a session. Contracting establishes what the session is for, attending creates the conditions for the client to speak and empathy turns listening into understanding. Other skills, such as advanced questioning, self-disclosure and giving advice, are powerful but depend on these three. Self-disclosure without empathy can shift the focus to the counselor, and advice without contracting may answer a question the client never asked.

How I Plan to Grow

For empathy, I will practice advanced empathy statements in role plays and ask supervisors to rate them, since I tend to stay with safe reflections. For contracting, I will write the client's stated goals at the top of my notes so I can check whether the session addressed them. For attending, I will review recordings of my sessions specifically for nonverbal behavior and practice remaining silent after emotional disclosures. In clinical rotations, I will ask supervisors for feedback on one skill per week.

Conclusion

Empathy, contracting and attending are the skills on which every other part of a genetic counseling session depends. They ensure that the session belongs to the client, that the client feels heard and that information is offered in a way the client can use. Building them deliberately will be the focus of my next year of training.

References

Elliott, R., Bohart, A. C., Watson, J. C., & Murphy, D. (2018). Therapist empathy and client outcome: An updated meta-analysis. Psychotherapy, 55(4), 399-410. https://doi.org/10.1037/pst0000175

Kessler, S. (1999). Psychological aspects of genetic counseling. XIII. Empathy and decency. Journal of Genetic Counseling, 8(6), 333-343. https://doi.org/10.1023/A:1022967208933

McCarthy Veach, P., Bartels, D. M., & LeRoy, B. S. (2007). Coming full circle: A reciprocal-engagement model of genetic counseling practice. Journal of Genetic Counseling, 16(6), 713-728. https://doi.org/10.1007/s10897-007-9113-4

McCarthy Veach, P., LeRoy, B. S., & Callanan, N. P. (2018). Facilitating the genetic counseling process: Practice-based skills (2nd ed.). Springer. https://doi.org/10.1007/978-3-319-74799-6

Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95-103. https://doi.org/10.1037/h0045357