Introduction
The crisis has been defined in various ways by different scholars, but the definition including three essential parts of a crisis is the most outstanding one. The three parts of the crisis include a precipitating event, a perception of the event that causes subjective distress, and the failure of a person’s usual coping methods, which causes a person to experience the precipitating event to function at a lower level than before the event (Kanel, 2010, p.2). For our woman, the precipitating event is the news of a potentially aneuploid fetus. Perception of the event that causes subjective distress is the challenge of making decisions regarding amniocentesis, and self and fetal testing for Huntington’s disease. The failure of a person’s usual coping methods is being plagued by the news of those events. The above three parts of the crisis must be recognized and identified because they form the basis of what the counselor will use to identify and assist the client to overcome the crisis.
The perception of the event is the key element in crisis intervention and forms crucial parts that differentiate crisis intervention from most other forms of counseling. Crisis intervention is different from other forms of counseling in that, it focuses on increasing the client’s functioning. Therefore, crisis intervention focuses on changing the perception of the precipitating event and acquiring new coping skills, which eventually decrease subjective distress, leading to an increase in the client’s functioning and the process of getting a client out of a crisis. Crisis intervention requires immediate intervention, since crises are threatening to those involved, and there is a time limit to the opportunity for intervention (Wright, 2003). The next part of this paper will focus on studies that can help in evaluating and creating appropriate interventions for the plagued woman.
Literature review
Aneuploidy and chromosomal instability (CIN) are common abnormalities in human cancer (Kooij, Tymstra & Berg, 2009). Alterations of the mitotic spindle checkpoint are likely to contribute to these phenotypes. Fetal aneuploidy is quite rare compared to other birth defects, and amniocentesis and chronic villus sampling historically have been the two most common methods used to detect fetal aneuploidy. These methods are invasive but currently, there have been various researches aimed at the development of noninvasive methods of diagnosing fetal aneuploidy. Amniocentesis involves the amniotic fluid being drawn from the uterus and the amniotic cells cultured as early as the second trimester of pregnancy (Miny, Tercanli &Holzgreve, 2002).
Studies have shown that, since amniocentesis is invasive, there are various risks involved including infection of the amniotic fluid, leaking of amniotic fluid, and miscarriage in serious cases (Hui & Bianchi, 2010). For medical purposes, gaining information about fetal abnormalities when there is still an opportunity for intervention is important for patient care and for implementing the public health aspects of screening policies, and has medico-legal implications too. Moreover, studies have revealed that amniocentesis can cause extreme anxiety because of fears about the normality of the baby and the risk of miscarriage; and the need for a second test at a later stage of gestation with a higher chance of finding a fetal abnormality is even more stressful and carries an additional risk of miscarriage. These concerns have to be balanced against the likelihood of detecting a chromosomal disorder (Lo, 2009).
For the woman plagued by news of potentially aneuploid fetus, the condition may be due to family genetic history, thus she should be advised in crisis intervention that though Amniocentesis pose various health risks, it is important for her to undergo it, as it will aid in patient care and accompanying healthcare implications. It is only through that test that she knows the fate of her pregnancy; the test can overturn her fears by turning out negative or confirming them thereby preparing for the next interventions. Indeed, only engaging in stress and anxiety would not solve any of her crises, but it can make the situation deteriorate further. Therefore, for immediate intervention in this crisis, the woman should take amniocentesis within the second trimester of pregnancy, since this is the most important part of crisis intervention for her case rather than being disturbed by fear of the unconfirmed matter.
Through further evaluation, our client was faced with various issues including pregnancy termination, isolation, employment and insurance discrimination, and the long-term emotional and psychological impact regarding the knowledge of her own and child’s incurable fatal condition. It is therefore clear she has a limited period for decision-making, lacks social support, and has limited financial resources. The crisis is further compounded by the news of potential compromised cognitive functioning as a result of early HD symptoms. Given the Huntington’s Disease (HD) condition, the counseling experience should be treated with extra caution, since studies have revealed that when describing it, most genetic counselors (95%) discuss the physical aspects of the condition while around 25% discussed the social aspects of life. Thus, most genetic counselors ask general questions to assess patient knowledge while a small percentage asks questions to assess personal experience (McWalter, Graham & Atzinger, 2010, P.671). Further, the studies have revealed that only about half of all genetic counselors ask simulated clients if they had thought about how they might use the results of prenatal screening (McWalter, Graham & Atzinger, 2010, P.671). Hence, to facilitate informed choices, the counselors need to engage patients in a discussion about their ability and willingness to parent a child with a disability.
Crisis intervention
According to nursing crisis intervention guidelines provided by Daisy Jane (2011), the most appropriate way to intervene in this case would involve the following steps. The first step would involve building a client-counselor relationship, defining and assessing the crisis, developing tangible goals, and an action plan to meet the goals. The second step would involve correcting any additional information to guide actions, addressing potential barriers to implementation, drawing on all strengths, which can help the patient implement the plan, and then implementing the plan. The last step would involve reviewing the actions taken and evaluating their success, and then using the counselor’s anticipatory processing of the patient’s feelings about the termination of the counseling relationship.
Based on the above steps, the whole exercise would involve focusing specifically on the crisis by going beyond the general information to include information on the client’s current emotional state. Secondly, it would involve evaluating the meaning and importance of the crisis situation from the patient’s perspective, and identifying the emotional and affective responses. The third aspect would involve breaking the crisis into small manageable issues, which can be addressed one at a time. The above three measures would help in establishing confidence and trust between the client and counselor, and breaking of crisis into small issues that would result in decreasing the client’s (her) anxiety and help her in making decisions, one at a time. Hence, she will be able to define her goals and create an action plan.
Fourthly, the counselor and patient would rollout the strategies developed during the earlier stage. Fifthly, the counselor would engage the patient to obtain additional information that highlights the individual barriers and strengths. For this, the individual barriers would mainly involve a lack of social support due to isolation, cognitive limitations, and the limited financial resources that are available. Their strengths would mainly come from the fact that she had been able to overcome past difficulties. Implementation of the whole plan would then follow. Up to this point, the counselor will have obtained sufficient medical and psychological data, identified the barriers, and understood the strengths upon which to base intervention, while the client will be in a position to meet her goals while addressing the barriers. Lastly, the counselor and the client will review the actions taken, evaluate their success, and then advise the client on HD self-testing.
Conclusion
Different clinicians and researchers rely on their own experience and knowledge of traditional counseling approaches to create and implement a specific approach for working with a given crisis. Hence, crisis intervention efforts vary from one practitioner to another but they follow professional guidelines and the precipitating event as the key element upon which the intervention will be based. In essence, most counselors have therefore discovered that the traditional long-term counseling approaches are not appropriate in dealing with the majority of crises, thus, short-term crisis intervention is more effective in many crises. Due to risks associated with invasiveness of amniocentesis and chorionic villus sampling methods, the current and future research on the development of detection methods for fetal aneuploidy and other chromosomal aberrations will focus on noninvasive laboratory techniques.
References
Hui, L., & Bianchi, D. W. (2010). Cell-free fetal nucleic acids in amniotic fluid. Human Reproduction Update, 17(3); 362–371.
Jane, D. (2011). Crisis Intervention. Web.
Kanel, K. (2010). A Guide to Crisis Intervention. Fourth edition. Belmont, CA: Cengage Learning.
Kooij, L., Tymstra T., & Berg, P. (2009). The attitude of women toward current and future possibilities of diagnostic testing in maternal blood using fetal DNA. Prenata Diagnostics, 29 (2); 164–168.
Lo, Y.M. (2009). Noninvasive prenatal detection of fetal chromosomal aneuploidies by maternal plasma nucleic acid analysis: a review of the current state of the art. BJOG, 116(2); 152–157.
Miny, P., Tercanli, S., & Holzgreve, W. (2002). Developments in laboratory techniques for prenatal diagnosis. Current Opinions in Obstetrics and Gynecology, 14(2); 161–168.
McWalter, K., Graham, L., & Atzinger, C.L., (2010). Presented Abstracts from the Twenty-Ninth Annual Education Conference of the National Society of Genetic Counselors. Journal of Genetic Counseling, 19(16).
Wright, H. M. (2003). The New Guide to Crisis & Trauma Counseling. CA: Regal Books.