Training activity information
Details
Identify and work through counselling issues raised in trainee led consultations using counselling supervision
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Active listening skills
- Ability to establish a good rapport with the individual/family
- Clarification skills
- Reflection and summary skills
- Appropriate use of empathic statements
- Models of grief and loss
- Support mechanisms.
- Family communication
- Recognition of different response such as guilt and shame
- Effective use of counselling supervision.
- Reflective practice
- AGNC code of ethics
- GCRB code of conduct
- Good scientific practice
- HCPC standards of proficiency
- Issues around the counselling relationship including:
- Transference and counter transference
- Managing patient expectations
- How an appreciation of these issues can enhance the process of genetic counselling
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify the specific counselling issues raised during consultation.
- Discuss with your training officer how best to arrange and use supervision to explore interesting or challenging case dynamics.
- Draw on reflective practice and counselling theory to prepare your case an utilise supervision to explore the issues raised.
What is your prior experience of this activity?
- Think about what you already know about counselling theory and its application within genetic counselling.
- Consider possible challenges you might face during the activity, such as recognising or responding to deeper psychosocial or emotional issues experienced by patients.
- Recognise the scope of your own practice for this activity i.e. seeking advice from your Training Officer if a patient’s emotional response suggests a need for specialist psychological input, or if you feel personally impacted by the consultation.
- Acknowledge how you feel about bringing specific counselling challenges or patient dynamics to supervision for discussion.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as identifying and exploring specific counselling issues, e.g., offering unconditional positive regard, recognising grief responses, working with healthy challenge.
- Identify the specific insights you hope to gain from supervision regarding your counselling approach and working through complex patient issues.
What additional considerations do you need to make?
- Consider your previous experiences of identifying and managing psychosocial issues in consultations.
- Identify how you will document counselling issues or dynamics during the consultation to effectively bring them to supervision.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst identifying or working through a counselling issue?
- Are you encountering situations such as:
- The patient expresses an overwhelming sense of guilt or anxiety that impacts on their ability to process new information?
- You experience a notably strong or weak rapport with a patient that might indicate an underlying feature such as transference?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you adapting or changing your approach to address the issue presented?
- Consider the steps you are taking in the moment, such as shifting from an information-giving role to a supportive, active listening role; or making an internal note of the patient’s strong emotional response and specific language used for supervision reflection.
- How are you feeling in that moment? For instance, are you finding it difficult to maintain therapeutic distance while responding to intense emotional material?
- Are you feeling especially strong emotions, positive or negative, regarding the patient or their situation?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, were you able to manage the issue in the moment and identify it as a topic for subsequent counselling supervision? Are you needing support to meet the patient’s needs or process your own feelings?
- What are you learning as a result of the unexpected development? For example, are you mastering techniques such as advanced empathy, or honing your sensitivity to identifying underlying psychosocial themes that might affect how your patient responds to genetic information?
On action
What happened?
- Begin by summarising the key steps you took when identifying and attempting to address a significant counselling issue.
- Consider specific events, actions, or interactions which felt important, such as a strong emotional reaction, or use of specific language.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, use of specific counselling interventions such as immediacy, or shifting from an information-giving role to a supportive, active listening role.
- How did you feel during this experience?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience. What strengths did you demonstrate, e.g., applying specific counselling skills effectively?
- What skills and/or knowledge gaps were evident, e.g., difficulty recognising a lack of engagement, or finding it hard to hold boundaries with a patient who has a strong emotional response?
- Compare this experience against previous engagement with similar activities.
- Has your practice improved in utilising counselling supervision to work through complex issues?
- Identify any challenges you experienced, such as needing to seek advice, support or clarification on scope of practice.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to improving ability to recognise and work with specific counselling issues in consultations.
- What will you do differently next time you approach a complex counselling issue, for instance, seeking further practice or knowledge related to particular counselling approaches?
- Do you need to practise any aspect of the activity further, or address and specific areas that feels less comfortable for you, such as engaging with grief, or challenging patients?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of working through counselling issues in supervision led you to revisit your initial approach or decisions during that activity? For example, noticing a pattern in the type of patients or dynamics that you feel more/less comfortable working with, or recurrent themes in the cases you bring.
- Considering what you understand about counselling theory, managing complex emotional material, and therapeutic boundaries now, how has your counselling approach evolved through the use of supervision?
- Has discussing challenging psychosocial issues (e.g., intense guilt or trauma) or the impact of transference/countertransference on the counselling relationship with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity?
How have these experiences impacted upon current practice?
- How has reflecting back on these specific training activities shaped your approach to managing highly sensitive and complex consultations?
- Looking holistically at your training journey, how have these foundational experiences, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying counselling skills, facilitating decision-making, and using counselling supervision?
- How does this intersect with your ability to care for yourself as a healthy practitioner?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 4 |
Outcome
Use counselling supervision and multidisciplinary meetings to work through ethical and cultural issues in genomic counselling practice. |