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Genetic Counselling Communication: A Discourse-Analytical Approach

  1. Srikant Sarangi

Published Online: 19 SEP 2013

DOI: 10.1002/9780470015902.a0005630.pub2

eLS

eLS

How to Cite

Sarangi, S. 2013. Genetic Counselling Communication: A Discourse-Analytical Approach. eLS. .

Author Information

  1. Cardiff University, Cardiff, UK

Publication History

  1. Published Online: 19 SEP 2013

Abstract

For a long time, the genetic counselling process had remained a blackbox, especially from a discourse-analytical perspective. Over the last two decades, the rich and complex communication process that constitutes the ‘hybrid’ activity of genetic counselling has been a focus of study using discourse analysis methodology. Thematically, genetic counselling encompasses topics as diverse as the natural history of a genetic disorder, aspects of (non)diagnosis and prognosis, (non)treatability, lay genetic awareness, future risks for a client and other family members, reproduction choices, psychosocial aspects of coping, the ethical and legal consequences of decisions and privacy issues concerning the disclosure/circulation of genetic information. This range of topics does not follow neat and parallel interactional trajectories; instead the topics become interweaved in an overlapping manner and are managed interactionally under given conditions, including the multiparty nature of participation in the counselling encounter. A discourse-analytical approach is an attempt to uncover the structural, interactional and thematic organisation of genetic counselling as a situated activity.

Key Concepts:

  • Genetic counselling as a communicative activity is complex and hybrid, which does not follow a simple ritual interactional routine.

  • The notion of ‘activity type’ (forms of setting) to characterise communicative events with component ‘discourse types’ (forms of talk) is a useful way to capture the dynamic and variable nature of genetic counselling across modes (face-to-face versus telephone-mediated), disease conditions as well as sociocultural settings.

  • The activity of genetic counselling can be mapped structurally, interactionally and thematically to illustrate the unique nature of the counselling process.

  • Concepts such as directiveness and nondirectiveness are part of a continuum and are manifest differently at the interactional level.

  • At a thematic level, risk and uncertainty are two sides of the same coin and the language of probability assumes significance in terms of risk explanation and risk perception.

  • The concept of risk is far more complex in genetic counselling than in other disease settings as it includes the associated ‘risk of knowing’ and the ‘risk of (non)disclosure’.

  • Negotiation of what is normal and what is abnormal can be mapped on to risk/uncertainty trajectories in genetic counselling.

  • The management of ethical and moral issues in genetic counselling requires an interaction-based situated approach in preference to the principle-based guidelines.

  • In discourse analytic terms, it is possible to distinguish between psychological and sociomoral dimensions of genetic counselling, which underpin clients' decision-making.

  • The self-other orientations (e.g. self versus other; self and other and self-as-other) are a key feature of genetic counselling.

Keywords:

  • discourse analysis;
  • activity type;
  • decision-making;
  • advice-giving;
  • risk explanation;
  • risk of knowing;
  • uncertainty;
  • probability;
  • nondirectiveness;
  • professional neutrality