For individuals in the U.S. & U.S. territories
In Genetic Issues, Dr. Andrea Farkas Patenaude demonstrates her approach to counseling clients who are facing the possibility of inheriting an illness or disorder from a parent or grandparent. Many disorders, such as cancer or Alzheimer's disease, may have a genetic component, making it likely that someone will inherit them. Dr. Patenaude works with clients on associated stress and anxiety and also provides information on the benefits and limitations of genetic testing.
In this session, Dr. Patenaude works with a young woman whose mother died of breast cancer. She discusses genetic testing and then helps the client begin to work through some of her grief as well as her anxiety about being diagnosed with cancer.
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
Andrea Farkas Patenaude, PhD, is the director of the Psycho-Oncology Research, Division of Pediatric Oncology at the Dana-Farber Cancer Institute and an assistant professor of psychiatry at Harvard Medical School in Boston.
Dr. Patenaude received her PhD from Michigan State University and currently focuses her research interests on psychological issues in cancer genetics, informed consent, professional education in genetics, and survivorship issues for survivors of pediatric and adult cancers.
She is a fellow of the American Psychological Association (APA) and has served as past chair of the APA Advisory Council on Genetic Issues (1998–1999). Since 1998, she has been the APA representative to and a member of the board of directors of the National Coalition of Health Professional Education in Genetics. Dr. Patenaude also serves on the National Cancer Institute Cancer Genetics Board and on editorial boards for Psycho-Oncology, Journal of Pediatric Psychology, and Children's Health Care.
Dr. Patenaude is the author of Genetic Testing for Cancer: Psychological Approaches for Helping Patients and Families (APA, 2005), as well as numerous book chapters and journal articles.
- Marteau, T., & Richards, M. (Eds.). (1996). The troubled helix: Social and psychological implications of the new human genetics. Cambridge, England: Cambridge University Press.
- Ofit, K. (1998). Clinical cancer genetics: Risk counseling and management. New York: Wiley.
- Patenaude, A. F. (2001). Genetic testing and family relationships: Mutual impact and future implications. In B. Sarason & S. Duck (Eds.), Personal relationships: Implications for clinical and community psychology (pp. 43–59). Chichester, England: Wiley.
- Patenaude, A. F. (2005). Genetic testing for cancer: Psychological approaches for helping patients and families. Washington, DC: American Psychological Association.
- Patenaude, A. F., Guttmacher, A. E., & Collins, F. S. (2002). Cancer genetic testing and psychology: New roles, new responsibilities. American Psychologist, 57, 271–282.
- Resta, R. G. (Ed.). (2000). Psyche and helix. New York: Wiley.
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