I like doing crossword puzzles with their mix of trivia and clever word play. I will never win any contests, but I am a competent puzzler (I prefer the term puzzler to it’s more high falutin’ cousins, cruciverbalist and engimatologist). Sometimes a devilish clue will stump me because it leads my mind to a very narrow interpretation of it. I have found a helpful strategy to solving the clue is to give it some benign neglect. If I let my mind stray to other things and then come back to 23-Down, the cobwebs will have fallen and in a slap-the-forehead moment the answer pops into my head. One way of distracting myself is to let my eyes wander across the newspaper page. As it happens, crossword puzzles are often on or near the same page as Advice Columnists and I find myself reading those letters from people seeking help with their woeful life situations. I am usually impressed by the counseling and psychological insights offered by the columnists and often find myself wondering what my response would be to the letter-writers (and I find myself singing the lyrics to John Prine’s wry song “Dear Abby“).
Last Saturday when I was stuck on trying to remember the city where Aga Khan’s mausoleum is located, I turned to reading “Ask Amy,” Amy Dickinson’s advice column. Although Amy did not supply me with the answer to the puzzle clue (Aswan, along the Nile in Egypt, for those of you who are also puzzlers), my attention was grabbed by a letter to Amy from – a genetic counselor. The counselor, who has chosen not to have children, asked Amy how best to respond to clients’ questions about whether the counselor has children and what decision she would make for her own child. The counselor also related a story about a recent couple who believed that the quality of care provided by their physician was compromised by that provider being childless.
My first thought was “Such questions play on our professional and personal insecurities. This genetic counselor might have been better served by peer or one-on-one supervision.” Supervision is an important part of professional growth. Although there are a few genetic counseling supervision groups, they are not particularly common, perhaps because there is no strong genetic counselor cultural tradition for them or professional requirements to participate in one. To some extent, the NSGC sponsored listservs – or Forums, as they are now called – sometimes serve that role but it’s not exactly the same thing.
My second reaction was I guess that’s a question a chatbot wouldn’t have to deal with. As Siri might say, “I am not sure that I understand that question.”
My third thought was “What would I say to that counselor if she posed the question to me?” If you are in a clinical position, no doubt you have encountered similar questions about your personal life. Before I was married, I remember the not uncommon occurrence of counseling a single parent pregnant woman who came to the session with her mother and afterwards the mother asking me on the sly “You’re such a nice a young man. Are you married?”
It is impossible for us to mirror all of our clients’ characteristics, experiences, and life situations. We can’t be all things to all people. In fact, one might argue that being too similar to our clients can result in counter-transference issues that can negatively affect the quality of our counseling. A counselor can be too empathic; sometimes the ways that we are different from our clients can give us a less biased outlook on a family’s issues.
I was not particularly happy with Amy’s advice to the genetic counselor, which was to say to the couple “We’re not here to talk about me. We’re here to talk about you. Let’s focus on your case, OK?” I think it unhelpfully dismisses the couples’ concerns. It may be what the counselor is thinking but in my view that’s not how it should be verbalized or managed. I can think of a few alternative responses, depending upon the specifics of the situation:
- “I appreciate your concerns and understand why you think a parental perspective might be helpful. But in my role with you, I am a counseling professional, not a parent. I have years of experience and professional training in working with couples in your position. My clients, whether or not they have children, often tell me how much they appreciate my expertise and insight. So I think that I can help you in meaningful ways. After meeting with me, you might want to talk to your friends and family members who have children to get their perspectives too.”
- “You mentioned that you want your care providers to be parents – why do you think you feel this way? As we go through this session, let me know when you think a parental perspective would be important to the issue at hand and let’s see if we can figure out why my not being a parent might matter.”
- “Some patients have raised this with me before. For many of them, it turned out that my perspective as a non-parent actually gave them a better understanding of their situation and helped them make what they felt to be a better decision. Let’s see if we can work together on this.”
- “I don’t have children. But I listen very closely to my patients, and I have learned a lot from them about the issues and feelings that parents face. I think you can benefit from the many insights that my patients have shared with me.”
There are no doubt other ways to respond to these patient requests for self-disclosure and you may think my suggestions are inadequate. More than one research article has been written about how much counselors should share with patients about their professional lives and how they manage such questions. In the spirit of on-line peer supervision, I would like to hear from the Good Readers of The DNA Exchange about how they would have responded to the Ask Amy letter and how they handle questions from patients that probe counselors’ personal lives.
Patients are ongoing puzzles that we must continually work on solving, whether we are beginners or graying veterans. Some of the clues they give us have obvious answers, while others are more layered and complicated. The solution for one patient’s situation may not work for the next patient puzzle. All of us need to remain open to the help and perspectives of our peers and colleagues. We cannot grow if we engage in benign neglect.
5 responses to “What Can I Say?”
What an insightful and relevant article! I often have patients ask me whether I have children (among many other personal questions), and I am never quite sure how to answer. I really liked your fourth example answer in particular, possibly because it is close to how I typically choose to answer this question. I am interested to hear how others in the field handle these questions, because I am sure that most of us get these questions quite frequently!
I also prefer answer number four. My version of #4 is “I have not experienced this myself, so I’m not sure what decision I would make if I were in your shoes. However, I can tell you what other parents who have dealt with similar situations have said to me. Let me know if you identify with one.” I happen to be a parent so even when a patient has asked “What would you do if this happened to you (or your child)?” I have typically said, “Well our overall life situations are not the same, so whatever decision I make for my family may not be right for yours.” Then I use that to launch into a series of questions related to family/spousal support, religious views, work/financial concerns, sibling dynamics, etc. which may also involve a little bit of self-disclosure or maybe using another patient as an example. I might say next “For instance, I don’t live near family, but we have some close friends we can count on. What about you?” Usually I see a light bulb at this point where they realize that everyone’s situation is unique and that means asking me more about me will not be helpful.
I like all of these. I don’t think I’ve ever gotten that question directly or in a way that felt like it was an obstacle for the counseling session, but I think any of those could work well depending on context/specifics. Helps to get at the Why behind a patient’s questions/concerns. I think this was covered pretty well in school… but it does get fuzzy, and I do think more peer supervision would help with ongoing professional issues and questions like this as well as others. Amy: 0, Bob Resta: 1.
I have used the same strategy that Kara has, but add a couple of other points: Once they leave, their decisions have no long-term impact on me but will have a lifetime impact on them. Many people strongly aver they would follow one path but when faced with the actual situation do a 180. As such, what I or anyone else believes they would do, whether married or a parent, should not play a big role in their decisions.
FYI Bob: John Prine is getting lifetime achievement award at the Grammy’s this year!