Reframing and Other Counseling Interventions
A cultural assessment is best conducted as a collaborative exercise with the client. However, a genetic counselor can expect varying degrees of participation from individuals from different cultures. Not all clients will want, or be able, to articulate their problems, perspectives or questions to you with ease. When this happens, do not take it personally. Genetic counselors must recognize that client resistance may result from deeply held cultural convictions (Veach et al., 2003). Genetic counseling, a communication profession (Gettig, 2007), relies on utilizing a range of interviewing, counseling, and communication techniques.
Reframing is the reformulation of an issue in a different way than it is originally presented (Resta, 2000). In general, individuals and couples come to a professional with a relatively constricted interpretation of assessing and assigning meaning to a problem. By reframing, the professional helps the clients see their problem from a different perspective. Clients can reframe on their own, but this can be difficult. It is often the role of a third party, in this case, the genetic counselor, who will restate what the client has said in a new way. This different perspective may offer clients an opportunity to see and consider applying novel solutions to this problem (Kessler, 1997). The art of reframing is to accomplish this process without manipulating the facts of the situation; the science of reframing is doing it at the right time and with the correct results (Zaffar, 2008). A classic reframing strategy is to redefine an issue in a positive light. Additionally, reframing the issue to a matter of interest rather than a matter of values can help move the session forward. According to Zaffar (2008), “People are generally amenable to a change in their interests rather than closely-held values. While efforts to reconcile value conflicts are likely to be counterproductive, efforts to identify and clarify these conflicts can be helpful. Thereafter, if both reframe the dispute into an interest conflict and work to minimize the risk of adverse impacts rather than asking which value is more important, both parties may be able to structure satisfactory solutions.”
Another way to reframe is to change a directive response to a non-directive response. Non-directive responses do not overtly direct or lead clients; non-directive responses are designed to encourage clients to talk freely and openly about whatever they want (Sommers-Flanagan & Sommers-Flanagan, 2003). Other creative data-collecting methods, such as sharing life stories, may be useful as an assessment technique with Asian clients (Yu-Wai-Chiu & Lee, 2004). Stories and metaphors can facilitate the expression of threatening emotions with minimum risk. Every client is different, and not all forms of communication will work in every counseling session. The genetic counselor should use communication techniques that she believes are best, based on what she knows about the client and the situation, while engaging in ongoing assessment of the resulting communications.
►Exercise
Reframe the following questions and responses to use a different approach or line of inquiry while still achieving the same desired effect. Explain the reasoning behind each new approach.
Examples:
Question: Are you concerned that your family will think the baby’s birth defect is your fault?
Reframed: It’s normal to feel responsible for everything related to your baby. However, no one can prevent a rare event like this from happening. It can happen to any developing baby early in pregnancy. When this isolated birth defect happens, we don’t exactly know why. In most cases, a baby with a shortened limb is otherwise healthy. I have information about the individualized prosthesis and rehabilitation services in our city to help children with shortened limbs do what they need and want to do.
Reasoning: This response normalizes guilt and emphasizes the positive in the situation.
Statement: I want to help counsel the family to arrive at a resolution.
Reframed: I want to help educate the family to arrive at harmony.
Reasoning: This statement uses words that are more likely to have a positive connotation in the client’s culture.
Question: What is your relationship like with your parents?
Reframed: Could you tell me about views on parent-child relationships in your culture?
Reasoning: This indirect question is more subtle, and may serve as the foundation for a more direct discussion of family relationships and emotions.
Questions and Statements to Reframe:
1. Question: Have you ever been around an individual with a physical difference?
a. Reframed: ________________________________________________
b. Reasoning:________________________________________________
2. Question: It sounds like you feel guilty for the course of development of the pregnancy.
a. Reframed: ________________________________________________
b. Reasoning:________________________________________________
3. Question: How do you think people will view you because of the birth defect? How does that make you feel?
a. Reframed: ________________________________________________
b. Reasoning:________________________________________________
4. Statement: Receiving unexpected information can be difficult to process. It is very normal to be uncertain about how to respond.
a. Reframed: ________________________________________________
b. Reasoning:________________________________________________
5. Statement: Help me understand what you are going through as an Asian American family.
a. Reframed: ________________________________________________
b. Reasoning:________________________________________________
6. Statement: This birth defect was not caused by anything you did and there is nothing that you could have done to prevent it.
a. Reframed: ________________________________________________
b. Reasoning:________________________________________________
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