In the first half of this book a framework has been presented which enables the genetic counsellor to think about genetic counselling in terms of stress theory, coping and the use of defences. It has also used attachment theory and ideas from psychotherapy to guide the counsellor'sunderstanding of the patient, the interview process and the appropriate therapeutic response. This chapter presents clinical examples to focus in more detail on extracts from clinical practice to give the reader a better feel for integrating these theoretical points.

Working with anxiety and grief

The next three examples demonstrate the importance of containing anxiety and processing grief to facilitate a different way of thinking as explained in the discussion of empathy and, in particular, Bion's work on facilitating thinking.

Working with anxiety and a changing state of mind

It is very common in genetic counselling for a patient to enter the consulting room in a highly charged emotional state and, as explained, that interferes with the ability to take in the whole picture and consider the issues comprehensively. Frequently, there will be a sense of urgency and agitation about a person whose mind cannot be still enough to process the complexities arising. As the woman in this example explains, successful genetic counselling creates a space for the patient to listen and take in information, express any relevant upset and be able to settle down to consider the issue in hand.