Psychological aspects of genetic counseling. III. Management of guilt and shame.

Reactions of guilt and shame are conspicuous in the context of genetic counseling, and the relief of their distressing aspects is a widely held goal of genetic counselors. They are in a unique position to accomplish this; however, guidelines as to how one might proceed are not readily available. We have considered guilt and shame responses and have attempted to differentiate them, dynamically and developmentally, and have pointed out how each might be manifested in the course of genetic counseling. The major counseling tactics by means of which the alleviation or reduction of feelings of guilt and shame might be achieved are outlined and case illustrations are provided in which actual and potential counseling situations are explored and discussed.