NONDIRECTIVENESS IN GENETIC-COUNSELING - AN EMPIRICAL-STUDY

Nondirectiveness is considered an essential part of genetic counseling , yet there is no generally accepted definition nor data documenting i ts impact on counselees. This study is an empirical investigation of d irectiveness, using ratings Aom transcripts of consultations and compa ring these with counselor-reported and counselee-reported directivenes s, Rated directiveness was defined as advice, expressed views about or selective reinforcement of counselees' behavior, thoughts, or emotion s (advice, evaluation, and reinforcement). Analysis of 131 transcripts revealed a mean of 5.8 advice statements per consultation, 5.8 evalua tive statements, and 1.7 reinforcing statements. When asked to describ e their counseling style, none of the 11 counselors rated It as ''not at all'' directive. Half the counselees who fated a decision felt stee red by the counselor. Items of rated directiveness showed satisfactory interrater reliability (kappa = .63). Factor analysis revealed that t hey formed one factor (eigenvalue 1.72). There were no associations ei ther between counselor-reported, counselee-reported, and rated directi veness or between these measures and counselee anxiety and concern, sa tisfaction with information, or the meeting of counselees' expectation s. Rated directiveness was the only measure to be associated with othe r process measures of the consultation, being associated with longer c onsultations, more blocks of speech, more social and emotional issues being raised, and fewer concerns being followed up, advice was more li kely to be given to counselees of lower socioeconomic status and to co unselees judged by counselors to be highly concerned, Evaluative state ments were more likely to be made by counselors who had received couns eling training. These results show that genetic counseling was Plod ch aracterized-by counselors, counselees, of a standardized rating scale- as uniformly nondirective.