Counselling uncertainty: genetics professionals' accounts of (non)directiveness and trust/distrust

Arribas-Ayllon, Michael ORCID: https://orcid.org/0000-0003-2669-2781 and Sarangi, Srikant 2014. Counselling uncertainty: genetics professionals' accounts of (non)directiveness and trust/distrust. Health, Risk and Society 16 (2) , pp. 171-184. 10.1080/13698575.2014.884545

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Abstract

In genetic counselling, uncertainty is central to the client–professional relationship where decisions are made on the basis of risk information/assessment. For various historical reasons, genetic counsellors adopt an ethos of ‘nondirectiveness’ to communicate risk and offer support without advising their clients on what decisions to reach. However, nondirectiveness remains an ambiguous and contested concept that has acquired a negative meaning of ‘not influencing clients’ or ‘adopting an indifferent stance’. We argue that nondirectiveness also implies a positive sense of acknowledging genetic counselling as a process of influence. Drawing on interview data (n = 25) involving professionals from England and South Wales (UK), accounts of genetic testing indicate a dynamic relationship between managing uncertainty on the one hand and negotiating trust and distrust on the other. In the counselling process, trusting and distrusting are coexisting techniques of assessing clients’ motivations, expectations and reasons for genetic testing. Using rhetorical discourse analysis as our analytical approach, we identify a pattern of accounting whereby professionals justify a directive stance when they are not confident whether clients have considered the uncertainty of the situation. More than a veneer of neutrality and indifference, we argue that nondirectiveness is a technique by which genetics professionals explore whether clients can be trusted to make autonomous decisions within a climate of uncertainty. Eliciting confidence and establishing trust within the context of genetic counselling are enabling, pastoral strategies for configuring risk and emotion.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	English, Communication and Philosophy Social Sciences (Includes Criminology and Education)
Subjects:	H Social Sciences > HM Sociology P Language and Literature > P Philology. Linguistics Q Science > QH Natural history > QH426 Genetics
Uncontrolled Keywords:	risk, genetic testing, genetic risk, genetic counselling, uncertainty, nondirectiveness, trust, distrust, accounts
Publisher:	Taylor & Francis
ISSN:	1369-8575
Date of Acceptance:	20 December 2013
Last Modified:	15 Nov 2022 12:16
URI:	https://orca.cardiff.ac.uk/id/eprint/73794

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