Toward a therapeutic relationship: A randomized control trial of the physical environment and client-centered communication in genetic counseling

Abstract

Genetic counselors routinely provide service in many environments, including counseling-type and medical-type rooms; in this study, counseling environments are characterized by office décor that facilitates discussion around a seated table, while medical environments include an exam table and separate seating. Outside of the genetic counseling context, manipulation of the environment can influence client comfort in disclosing personal information, well-being, and overall satisfaction with clinician communication. However, there is little known about how clients experience genetic counseling in one environment versus the other and how that might influence their evaluation of genetic counselor communication. To explore the extent to which the physical environment influences client perceptions, we video recorded two simulated sessions addressing the same genetic counseling topic with two contrasting styles of communication (more and less patient-centered) in front of a greenscreen background. Videos were digitally placed in counseling and medical environments such that the same verbal and nonverbal communication was presented in the two environments, creating a total of four videos (e.g., a 2 × 2 experimental design). Participants (N = 861) were randomly assigned to observe one of the four videos and respond as if they were the client in the video (e.g., as analog clients). Overall, participants rated the less patient-centered communication more favorably (p < 0.05 across variables), contrary to our expectations. Structural equation modeling revealed that perceptions of nonverbal communication mediated the relationship between communication style and perceptions of the counselor's encouragement of participation in the session and the therapeutic bond. Results offer insight into how the physical environment might influence communication in genetic counseling, illustrating new avenues for improving client-counselor communication in this context.