Does indirect speech promote nondirective genetic counseling? Results of asociolinguistic investigation

To date, research examining adherence to genetic counseling principles has focused on specific counseling activities such as the giving or withholding of information and responding to client requests for advice. We audiotaped 43 prenatal genetic counseling sessions and used data-driven, qualitative, sociolinguistic methodologies to investigate how language choices facilita te or hinder the counseling process. Transcripts of each session were prepa red for sociolinguistic analysis of the emergent discourse that included st udying conversational style, speaker-listener symmetry, directness, and oth er interactional patterns. Analysis of our data demonstrates that: 1) indir ect speech, marked by the use of hints, hedges, and other politeness strate gies, facilitates rapport and mitigates the tension between a client-center ed relationship and a counselor-driven agenda; 2) direct speech, or speakin g literally, is an effective strategy for providing information and educati on; and 3) confusion exists between the use of indirect speech and the inte nt to provide nondirective counseling, especially when facilitating client decision-making. Indirect responses to client questions, such as those that include the phrases "some people" or "most people," helped to maintain cou nselor neutrality; however, this well-intended indirectness, used to preser ve client autonomy, may have obstructed direct explorations of client needs . We argue that the genetic counseling process requires increased flexibili ty in the use of direct and indirect speech and provide new insights into h ow "talk" affects the work of genetic counselors. (C) 2001 Wiley-Liss, Inc.