Bianca arrives at the genetic counseling appointment 30 minutes late, in leg shackles, dressed in an orange prison jumpsuit, and escorted by a female guard. Due to your heavy afternoon clinic schedule and Bianca’s late arrival, you will only have about 20 minutes to meet with Bianca if you are to stay on time for the rest of your appointments. You ask the female guard to wait just outside of the counseling room while you are with Bianca as you will be collecting private health information. In the counseling room, Bianca seems agitated and wary of her surroundings. When you ask Bianca about the pregnancy, she states that she didn’t actually know she was pregnant until last week because her periods are often irregular. You ask how much she thinks she drank in the early part of the pregnancy. Bianca mentioned that while she doesn’t usually drink heavily, sometimes it happens. She seemed hazy on the details, but replied, “Sometimes I drink so I don’t think about not being able to keep a roof over my kids’ heads. When my boyfriend, Rinaldo, walked out on me, I couldn’t manage. Now my kids are in foster care.” You would typically engage the client in conversation about her psychosocial history at this time, but you are trying to stay on time for your next patient, and you decide to skip it.
What thoughts do you have about counseling a woman in shackles? How do you think you would feel (i.e. nervous, anxious, more/less empathetic, etc)?
What is your differential diagnosis? What questions are essential for eliciting the medical history?
Does Bianca have any physical, mental or emotional health illnesses? Is she under any treatment, or has she been?
Why might Bianca not want to share all the information she knows about her medical, family or pregnancy history?
What are the resources for maintaining a pregnancy, giving birth and caring for a baby when the mother is a prisoner?
What rights and resources does Bianca have in prison?
Are there support groups or education programs for pregnant women in prison? What resources for pregnant women are available specifically at Greenville?
You press on with the history taking. You explain to Bianca that you’ll also be asking her medical history questions about Rinaldo’s health. To allow Bianca to think about the questions before she answers (and maybe save time), you list the questions you will pose: “Was Rinaldo born with any birth defects, particularly any kind of heart disease? Does he have any ongoing medical concerns? How much alcohol does he typically drink and when? Is he a drug user?” Bianca seemed increasingly tense and alarmed. In a loud voice she tells the guard, “You don’t know what you’re asking about! Get me OUT of here!” The guard comes into the room and escorts Bianca out of the facility.
What thoughts and emotions might have prompted Bianca’s reaction?
Why do you think Bianca shut down when the genetic counselor asked a litany of questions about Rinaldo?
Why might Bianca be reluctant to answer the usual medical intake questions?
How might your contracting and intake procedures be modified when working with clients who are prisoners?
What strategies do you use to build trust within a genetic counseling session? Which strategies would you use in this genetic counseling session?
How does the genetic counselor’s comfort level with this patient affect the counseling agenda, the patient’s reactions and the session outcome?