A Comparative Analysis of Ethical and Professional Challenges Experienced by Australian and U.S. Genetic Counselors

Ethical issues are an inevitable part of genetic counseling practice. Prior research identified 16 domains of ethical and professional challenges encountered by practitioners in the United States. In order to further validate these domains, the present study surveyed Australian genetic counselors. Sixty-three respondents rated the frequency with which they encountered each domain, and 39 individuals also provided personal anecdotes detailing their most challenging ethical and professional dilemmas. Every domain reportedly was experienced by the Australian sample. However, there were some differences between Australian respondents and U.S. genetic counselors in frequencies of domain occurrence, and in strategies recommended for resolving them. Several anecdotes illustrate challenging situations due to Australia’s geography, universal healthcare system, and the genetic counseling profession’s evolution in that country. The results generally validate domains identified for U.S. genetic counselors. They further suggest that certain ethical issues may manifest in ways unique to a given country, and therefore they must be addressed in a culturally-appropriate manner.     

Ethical and Professional Challenges Posed by Patients with Genetic Concerns: A Report of Focus Group Discussions with Genetic Counselors, Physicians, and Nurses

Ninety-seven physicians, nurses, and genetic counselors from four regions within the United States participated in focus groups to identify the types of ethical and professional challenges that arise when their patients have genetic concerns. Responses were taped and transcribed and then analyzed using the Hill et al. (1997, Counsel Psychol 25:517–522) Consensual Qualitative Research method of analysis. Sixteen major ethical and professional domains and 63 subcategories were identified. Major domains are informed consent; withholding information; facing uncertainty; resource allocation; value conflicts; directiveness/nondirectiveness; determining the primary patient; professional identity issues; emotional responses; diversity issues; confidentiality; attaining/maintaining proficiency; professional misconduct; discrimination; colleague error; and documentation. Implications for practitioners who deal with genetic issues and recommendations for additional research are given.     

Counseling Adolescents and the Challenges for Genetic Counselors

Genetic counselors may have an important role in helping the adolescent make an informed decision with regard to genetic testing and in helping them to adjust to genetic risk information. However, counseling techniques that are used with adults may not be always be suited to the adolescent population. Adolescence is a time of development during which separation from the family and formation of identity is achieved. The process of this development may impact the genetic counseling relationship. Family relationships may have a strong influence on the client's decision to have genetic testing. Additionally, it may be difficult to engage the client as adolescents may not have the ability to think abstractly and consider the short and long term consequences of genetic testing. It is helpful therefore to discuss the counseling process and techniques that may be useful when counseling these clients. This paper presents two case studies that illustrate some of the difficulties that may occur when counseling adolescents for genetic testing. The authors' have reflected on their clinical experience with these clients and this is presented here to add to the growing literature on this subject.     

A Survey of Ethical and Professional Challenges Experienced by Spanish Health-Care Professionals that Provide Genetic Counseling Services

Genetic testing is increasingly applied for diagnosis and clinical treatment. In some countries, genetic counseling services are provided by professionals with specific training in this discipline, whereas other countries have no teaching programs and counseling is offered by physicians, nurses, pharmacists or biochemists. This counseling raises more and more ethical dilemmas for health professionals at their clinics. The purpose of this study was to analyze the characteristics of Spanish professionals devoted to providing genetic counseling services and to investigate the frequency of the ethical dilemmas they face. Results from 72 survey respondents revealed this counseling is provided by an almost even number of male and female professionals, mostly physicians with many years of professional experience. The overall frequency of the ethical dilemmas encountered was not high. The most frequent dilemmas corresponded to emotional responses by patients, informed consent, uncertainty about test results, and limitations on health-care resources. The frequency of dilemmas involving discrimination and provider directiveness was very low. Additional findings, practice implications, and research recommendations are presented.     

Ethical and Professional Issues for Psychologists and Counselors Employing Biofeedback in Counseling Settings

Biofeedback training is a relatively new procedure that is being incorporated into the counseling services of psychologists and counselors. If the highest professional standards and the appropriate safeguards for clients' welfare are to be maintained, careful attention should be given to the ethical and professional issues involved. The American Psychological Association's (1977) ethical standards for psychologists are the basis of the discussion. It is hoped that the discussion will stimulate further consideration of ethical and professional issues of the clinical application of biofeedback among practitioners.     

Professional Ambivalence: Accounts of Ethical Practice in Childhood Genetic Testing

Childhood genetic testing raises complex ethical and moral dilemmas for both families and professionals. In the family sphere, the role of communication is a key aspect in the transmission of ‘genetic responsibility’ between adults and children. In the professional sphere, genetic responsibility is an interactional accomplishment emerging from the sometimes competing views over what constitutes the ‘best interests’ of the child in relation to parental preferences on the one hand, and professional judgements on the other. In the present paper we extend our previous research into parental accounts of childhood genetic testing and explore the ethical accounts of professionals in research interviews. Interviews (n = 20) were conducted with professional practitioners involved in the genetic diagnosis and management of children and their families. We first identify four inter-related themes—juxtaposition of parental rights vis-à-vis child’s autonomy, elicitation of the child’s autonomy, avoidance of parental responsibility and recognition of professional uncertainty. Then, using Rhetorical Discourse Analysis, we examine the range of discourse devices through which ethical accounts are situationally illustrated: contrast, reported speech, constructed dialogue, character and event work. An overarching device in these ethical accounts is the use of extreme case scenarios, which reconstruct dilemmas as justifications of professional conduct. While acknowledging ambivalence, our analysis suggests that professional judgement is not a simple matter of implementing ethical principles but rather of managing the practical conditions and consequences of interactions with parents and children. We conclude that more attention is needed to understand the way professional practitioners formulate judgements about ethical practice.     

Comparative Effectiveness of Student and Professional Counselors

A sample of 160 beginning freshmen, half males and half females, received six and one-half hours of academic adjustment guidance from same-sex professional counselors. Upperclassman student counselors gave equivalent guidance to all other beginning freshmen at Southwest Texas State College. A matching sample of 80 men and 80 women was subsequently drawn from the 316 freshmen receiving student-to-student counseling. Age, sex, measured scholastic ability, measured study orientation, and high school academic achievement were employed as matching variables. The four professional and eight student counselors completed 50 clock hours of identical pre-counseling training, used identical guidance materials, and followed identical counseling activity sequences. Equivalent counseling facilities were provided for all counselors. Test, questionnaire, and scholarship data were employed to evaluate the comparative effectiveness and acceptability of counseling given the professional counseled and the student counseled groups. Student counselors were found to be as effective as professional counselors on all criteria of counseling effectiveness. Furthermore, freshmen counseled by student counselors made significantly greater use of the information received during counseling, as reflected by first-semester grades and residual study problems. It was concluded that carefully selected, trained, and supervised student counselors provide a practical and productive addition to the college's guidance program.     

Managed Care: Ethical Considerations for Counselors

Key factors and trends in health care will have an impact on the ethical practice of counselors. Ethical challenges to clinical practice presented by trends in managed care are discussed in relation to the American Counseling Association (1995) Code of Ethics and Standards of Practice. Recommendations for practice are also included.     

Model Legislation for Licensed Professional Counselors

State legislated licensure for professional counselors is a critical aspect of the evolution of the counseling profession. Model licensure legislation will help promote a unified view of the profession. Model legislation for licensed professional counselors, along with a rationale for the content of said legislation, is presented.     

The Mental Status Examination: Its Use by Professional Counselors

Although not a formal psychometric instrument, the mental status examination (MSE) has been used predominantly in psychiatry, clinical psychology, and social work for several decades, but is being increasingly used by counselors in work settings requiring assessment, diagnosis, and treatment of mental disorders. The MSE is used to obtain information about the client's level of functioning and self‐presentation. Generally conducted (formally or informally) during the initial or intake interview, the MSE can also provide counselors with a helpful format for organizing objective (observations of clients) and subjective (data provided by clients) information to use in diagnosis and treatment planning.     

Dilemmas of Practice: Challenges to Program Quality Encountered by Youth Program Leaders

To create and sustain high quality youth development programs it is important to understand the challenging situations and dilemmas that emerge in program leaders’ daily work with youth. In this research the experiences of leaders in 12 programs were followed over a 2–9 month period, which led to the identification of 250 dilemma situations. Qualitative analyses identified 5 categories and 12 subcategories of dilemmas that reflected distinct types of considerations (e.g., youth’s personalities, relationships with the community). The analyses also found that the experienced leaders in the study typically responded to these dilemmas in ways that were youth-centered and that balanced multiple considerations. It is argued that researchers need to go beyond identifying features of high quality programs, and more fully examine how effective leaders create and sustain high quality in response to the challenging situations of practice.     

Ethical Guidelines for Counselors Working With Older Adults

Counselors working with older adults may encounter situations that are not directly addressed by the ethical standards of the American Counseling Association (1995). After an extensive review of the literature, the Standards Committee of the Association for Adult Development and Aging (1998) identified 3 areas of concern: older adults with cognitive impairments, older adults who are the victims of abuse, and older adults with a terminal illness. This article examines the unique needs of older adults with these concerns and proposes guidelines for counselors working with such clients.     

Challenges to Audi's Ethical Intuitionism

Robert Audi's ethical intuitionism (Audi, 1997, 1998) deals effectively with standard epistemological problems facing the intuitionist. This is primarily because the notion of self-evidence employed by Audi commits to very little. Importantly, according to Audi we might understand a self-evident moral proposition and yet not believe it, and we might accept a self-evident proposition because it is self-evident, and yet fail to see that it is self-evident. I argue that these and similar features give rise to certain challenges to Audi's intuitionism. It becomes harder to argue that there are any self-evident propositions at all, or more than just a few such propositions. It is questionable whether all moral propositions that we take an interest in are evidentially connected to self-evident propositions. It is difficult to understand what could guide the sort conceptual revision that is likely to take place in our moral theorising. It is hard to account for the epistemic value of the sort of systematicity usually praised in moral theorising. Finally, it is difficult to see what difference the truth of Audi's ethical intuitionism would make to the way in which we (fail to) handle moral disagreement.     

A Typology of Burnout in Professional Counselors

The authors used a cluster analysis procedure and the Counselor Burnout Inventory (S. M. Lee et al., 2007) to identify professional counselors' burnout types. Three clusters were identified: well‐adjusted, persevering, and disconnected counselors. The results also indicated that counselors' job satisfaction and self‐esteem were good discriminators between the 3 clusters. Implications for counselors are discussed.     

Modern Advances in Genetic Testing: Ethical Challenges and Training Implications for Current and Future Psychologists

The ethical implications for psychological practice of genetic testing are largely unexplored. Predictive testing can have a significant impact on health and well-being, and increasing numbers of individuals with knowledge of their risk for various disorders are likely to present for psychotherapy. In addition, more people will struggle with the decision of whether to obtain information regarding their genetic material. Psychologists will need to have the appropriate knowledge and clinical skills to effectively counsel this population. This article highlights the relevant ethical issues surrounding psychological treatment of individuals pursuing or considering undergoing genetic testing. These issues are extended to psychologists working in research, education, and policy domains. Recommendations for graduate training programs to facilitate current and future practitioner competence are also discussed.     

Resilience of Professional Counselors Following Hurricanes Katrina and Rita

Professional counselors who provided services to those affected by Hurricanes Katrina and Rita completed the K6+ (screen for severe mental illness), the Posttraumatic Growth Inventory, and the Professional Quality of Life Scale. Results indicated that participants who survived the hurricanes had higher levels of posttraumatic growth than participants who served as volunteers. Both volunteer and survivor‐volunteer participants were susceptible to compassion fatigue. To further resiliency, self‐care strategies were found to minimize burnout, compassion fatigue, and vicarious traumatization.