Is it Time to Introduce a Bit More "directiveness"​ in Our Counseling?

Recently I have had many conversations with my genetic counseling colleagues about one of the founding principles of our profession; non-directiveness. In these conversations, I am hearing more and more GCs express how in some situations, their directiveness has actually led to a more successful session. Have the needs of patients evolved since the time this principle was so firmly rooted in our profession?

The trend we are noticing is that patients are demanding a bit more directiveness in our counseling. It made me think a bit more about the history of why the field initially took it's roots in positioning itself as advocates of non-directive counseling. The intentions are from a good place, a place where we truly value the patients' autonomy in making their own decisions and to empower them with the information to make the best decisions for their health. But has the practice morphed into providing counseling in a way that is not so helpful in today's landscape of multiple options that patient's are faced with? Do we leave our patients more distressed when we say "well, that decision is totally up to you" when asked "what would you do?"?

We need to realize that being non-directive is not synonymous with void of having a professional opinion. Our patients seek our services for "expert advice". Quite simply, often they want to know "what would you- the expert do". The answer to this question will likely vary greatly based on the GC; as it should given that we are all individuals with vast experiences that lead us to our decisions. However, our training has or should have trained us to guide patients and direct them to decisions that fit and make sense within the context of their own lives. So really, it actually matters very little what I personally and specifically would do, but rather, what are the questions that I would ask and the process that leads me to get the answers that make the most sense.

While I think we can absolutely be non-directive when it comes to projecting our own opinions, there is certainly utility in being directive once you have drawn out what it is that the patient is truly seeking. What do you think? I would love to hear your thoughts on whether a sprinkle of directiveness is what patients may actually need.