Patients with concerns about hereditary predisposition to illness often have associated issues and distress that may be important to treat before they seek (or concurrently receive) genetic counseling and testing. It also may be necessary for patients to seek treatment before making irrevocable decisions about risk-reducing surgery.
In this approach, the therapist must understand the family history of illness; clarify a patient's level of risk; ascertain individual issues, symptoms, and attitudes and the level of associated distress; and understand the nature of family communication about illness, inherited disease predisposition, and previous losses.
The therapist should be knowledgeable about the benefits and limitations of genetic testing. Patients who approach genetic testing or counseling with reluctance or anxiety should be offered psychological consultation. However, patients who are relieved to be able to discuss family history of illness and loss with a therapist often work well with this approach.
Treatment is either short-term, long-term, or intermittent, depending on which issues related to familial and hereditary predisposition to illness surface. It also may involve the therapist consulting with a genetics professional.
The Human Genome Project (HGP)* is another important source of research that could be useful to the therapist. The HGP is the international effort to map and sequence all the genes in the human body, which is known together as the genome.
HGP researchers are deciphering the human genome in three major ways:
- determining the order, or "sequence," of all the bases in our genome's DNA;
- making maps that show the locations of genes for major sections of all our chromosomes; and
- producing linkage maps through which inherited traits (such as those for genetic disease) can be tracked over generations.
The HGP has already revealed that there are somewhere between 30,000 and 40,000 human genes. The existing and ultimate products of the HGP will give the world a resource of detailed information about the structure, organization, and function of the complete set of human genes. This information can be thought of as the basic set of inheritable "instructions" for the development and function of a human being and will be pivotal in the future of genetic counseling.
In this video, an exploration of the patient's interest in genetic testing leads to deeper discussion of an extensive family history of loss and to deep-seated feelings of guilt and unresolved maternal grief.
* Note. Available from "Introduction to the Human Genome Project" by The National Human Genome Research Institute. Retrieved January 27, 2005, from http://www.genome.gov/page.cfm?pageID=10001772
