The previous chapters have focused on different aspects of the genetic counselling encounter and have put particular emphasis on the importance of the uniqueness of the individual or family. The counsellor respects that uniqueness by offering an appropriately attuned and facilitating relationship which forms the solid core of a consultation. It determines how the consultation proceeds and is the context within which the different genetic consultations take place. There may be a single consultation where the emphasis changes at different stages of the counselling process, or several meetings with a different emphasis in each one. This chapter begins with a common framework which can be applied to all genetic counselling. It moves to focusing on how four different disorders, by their very nature and their implications, will influence the focus and process of the interview and, consequently, the emphasis placed by the counsellor.

The common denominators which apply to all consultations

Genetic counselling may appear to revolve around a central element of information both giving and receiving, but the process does not follow a straight line of an individual asking a question which is then answered. The counsellor makes a series of interventions and the way the individual or family responds will determine the subsequent direction. The counsellor is constantly observing responses and reviewing and adjusting the path of the consultation correspondingly. For instance, the process begins with a question being asked and that may take the form of a symptom, a worry, a request for information or many other forms.