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Abstract: Objectives: To examine the process of genetic counseling with the aim of observing how participants negotiate a common understanding in light of the inherent power asymmetry of a genetics health care encounter. Methods: Data from ten sessions between genetic counselors and parents of children with a genetic diagnosis were taped. Transcripts were examined using a qualitative discourse analysis approach focusing on communication features such as question design, topic initiation and control, and lexical or discourse features which could give insights into rapport building strategies. Results: Counselors tightly controlled the medical history phase in all sessions and verbally dominated the scientific information phase. More symmetric communication occurred when: (i) counselors showed flexibility with their agenda and gave parents the opportunity to share their health experience; (ii) counselors showed signs of involvement through the use of ‘rapport building’ strategies; (iii) counselors used a syllogistic approach and information was delivered at a slower pace. Conclusion: Observations from this study suggest that, when counselors focus on building rapport with parents, the human voice of the parent emerges. Examples of rapport building strategies by the counselors included adapting to the parents’ variations in knowledge, recognizing the needs of the parents, verifying their understanding, and choosing a more interactive approach to the delivery of information. Practice implications: Our findings suggest that for effective communication to occur, parents need to be provided with opportunities to be active participants in the genetic counseling encounter. [Copyright &y& Elsevier]