Genetic Counseling and Nondirectiveness
Nondirectiveness has been a core value in genetic counseling models for over 30 years and yet there is little consensus about what it means. Nondirectiveness is a contested set of attitudes about the role a genetic counselor should play in helping a patient understand and make decisions about genetic information. Of its early advocates, Sheldon Reed – coiner of the term ‘genetic counseling’ – is the most influential. Although he never used the term ‘nondirective,’ he advocated the attitudes to which the term refers. Fine cites this passage as an articulation of his early view that comports with nondirectiveness: Reed’s view equates nondirective counseling to withholding advice about decision making. In an ongoing discussion, this articulation represents the dominant camp, one that is compatible with the teaching model of genetic counseling. Motivated by the psychotherapeutic model, Kessler along with others in the field articulate an alternative view of nondirectiveness. Seeking to define it in positive terms of what should be done, he elaborates the approach as a set of counseling skills that seek to promote the autonomy of the client. For example, genetic counselors should evaluate and point out the decision making strengths of clients. As these two understandings compete to articulate this constitutive value of the practice, recent challenges have proposed that nondirectiveness should no longer play such an important role.