Genetic Counselling for Psychiatric Disorders: Accounts of Psychiatric Health Professionals in the United Kingdom

Genetic counselling is not routinely offered for psychiatric disorders in the United Kingdom through NHS regional clinical genetics departments. However, recent genomic advances, confirming a genetic contribution to mental illness, are anticipated to increase demand for psychiatric genetic counselling. This is the first study of its kind to employ qualitative methods of research to explore accounts of psychiatric health professionals regarding the prospects for genetic counselling services within clinical psychiatry in the UK. Data were collected from 32 questionnaire participants, and 9 subsequent interviewees. Data analysis revealed that although participants had not encountered patients explicitly demanding psychiatric genetic counselling, psychiatric health professionals believe that such a service would be useful and desirable. Genomic advances may have significant implications for genetic counselling in clinical psychiatry even if these discoveries do not lead to genetic testing. Psychiatric health professionals describe clinical genetics as a skilled profession capable of combining complex risk communication with much needed psychosocial support. However, participants noted barriers to the implementation of psychiatric genetic counselling services including, but not limited to, the complexities of uncertainty in psychiatric diagnoses, patient engagement and ethical concerns regarding limited capacity.     

A naturalistic longitudinal evaluation of counselling in primary care

This study evaluated the effectiveness of generic counselling in a primary healthcare setting during three months of counselling and followed up the patients' progress after counselling had finished for the next twenty-one months. Questionnaires were completed by patients within the Dorset Primary Care counselling service on referral to counselling and at set points afterwards. A naturally occurring waiting-list group was compared with patients receiving counselling at baseline and three months. Measurements were taken of patients' psychiatric symptomatology, quality of life (QOL) and self-esteem. Patients who received counselling made highly significant improvements compared with those on the waiting list. These improvements were maintained throughout the long-term follow-up. This would indicate that generic counselling has positive effects that can be maintained for a long period of time after counselling has been completed.     

Counselling and the schizophrenias

Schizophrenia is the collective name given to allied psychiatric disorders each of which has received a number of different professional interpretations. A primary counselling task is to help staff resolve conflicts over treatment, and give them support during their care of patients. Counselling patients and families, particularly through opportunities provided by self-help groups, is also discussed. The specialised work of genetic, psychoanalytical and behavioural counselling is considered, and stress is laid on the importance of counselling the adolescent schizophrenic for whom early help is vital to prevent deterioration. The article focuses on those areas where marriage guidance counsellors, social workers and probation officers are most likely to be consulted.     

Social Change and Marital Problems: Implications for Marriage Counselling

There are many reasons why people experience marital dissatisfaction. This paper is concerned with those who experience dissatisfaction not as a result of individual personality problems but as a result of the impact of social change on contemporary marriage. On the whole, these people are emotionally mature even if they present, initially, with 'clinical' symptoms. The paper identifies the effect of social change on such couples and suggests an approach to marriage counselling designed specifically to meet their needs. Background material is provided by a study of 40 couples seen for marriage counselling in a psychiatric clinic.     

Can pastoral counselling recover its roots in madness?

Modern pastoral counselling had its origins in North America in the experience of people, who suffered from psychiatric illnesses and who believed them to be spiritual crises, which would respond to pastoral care. In the United Kingdom many of those involved in the foundation of the pastoral care and counselling movement also worked in psychiatric hospitals. In both Europe and America pastoral counselling has largely forsaken its roots in psychiatry. However, recent research amongst mental health service users/survivors reveals how important spiritual care and counsel are and how few resources are available to provide this service from psychiatry, religious organisations or secular counselling services. The results of three research projects in Somerset are described and the significance of the recovery of pastoral counselling to fill the vacuum of spiritual care is explored.     

Counselling in primary care: a systematic review of the evidence

Primary objective: To undertake a systematic review which aimed to locate, appraise and synthesise evidence to obtain a reliable overview of the clinical effectiveness, cost‐effectiveness and user perspectives regarding counselling in primary care. Main results: Evidence from 26 studies was presented as a narrative synthesis and demonstrated that counselling is effective in the short term, is as effective as CBT with typical heterogeneous primary care populations and more effective than routine primary care for the treatment of non‐specific generic psychological problems, anxiety and depression. Counselling may reduce levels of referrals to psychiatric services, but does not appear to reduce medication, the number of GP consultations or overall costs. Patients are highly satisfied with the counselling they have received in primary care and prefer counselling to medication for depression. Conclusions and implications for future research: This review demonstrates the value of counselling as a valid choice for primary care patients and as a broadly effective therapeutic intervention for a wide range of generic psychological conditions presenting in the primary care setting. More rigorous clinical and cost‐effectiveness trials are needed together with surveys of more typical users of primary care services.     

Recognition of psychopathology with religious content by clergy members: a case vignette study

Clergy members (CMs) frequently offer support and counselling for people with mental health problems. The current study aims to obtain insight into the ability among CMs to recognise psychopathology and need for psychiatric treatment. A random sample of CMs (N?=?143) and a control sample of mental health professionals (MHPs, N?=?73), were compared as to their evaluations of four vignettes. CMs considered the psychiatric states to be related to religious or spiritual problems to a similar degree as they did for the non-psychiatric states. Sensitivity of CMs with regard to the need of psychiatric care for the psychiatric states was modest (66%) and differed significantly from MHPs (96%). Specificity of the CMs was 89%, which was significantly lower than the MHPs (97%). The CMs did recognise psychopathology with religious content but clearly to a lower extent than MHPs. Requests by CMs for education about recognising psychopathology may be considered as justified.     

How do Physicians Decide to Refer Their Patients for Psychiatric Genetic Counseling? A Qualitative Study of Physicians’ Practice

Psychiatric genetic counseling (PGC) is an emerging specialty discipline within the genetic counseling profession. A specialist PGC service was founded in 2012 in Vancouver, Canada, and though patient benefits have been demonstrated, many physicians do not regularly refer patients to the service despite awareness of its availability. We conducted a qualitative study involving semi-structured telephone interviews with Vancouver-based physicians who were aware of the PGC service to explore this phenomenon. Interviews were audio-recorded, transcribed verbatim, coded, and analysed for emergent themes. Consistent with a grounded theory approach, constant comparison was employed throughout data collection and analysis. Analyses of interviews conducted with 12 physicians revealed that referral practices were informed by perceptions about the purpose of PGC and interpretation of patient cues. Physicians perceived PGC as an information-focused intervention, and considered referral when patients explicitly expressed desire for information about recurrence risk or etiology that they felt unable to adequately address themselves. Even when physicians identified psychotherapeutic benefits of PGC, patient needs of this nature were not perceived as cues prompting referral to PGC. These data suggest that further work is necessary to position PGC in physicians’ minds as a service that could potentially benefit most individuals with psychiatric disorders and their families, and that it encompasses more than information provision. It is important to increase physicians’ awareness of the complementary role that genetic counselors can play to that of the physician in providing psychotherapeutically oriented counselling about illness etiology.     

Helping Couples Fulfill the “Highest of Life’s Goals”: Mate Selection,Marriage Counselling,and Genetic Counseling in United States

This article traces the history of modern genetic counseling to mate selection and marriage counselling practices of the early-20th century. Mate selection revolved around a belief that human heredity could be improved and genetic diseases eradicated through better breeding. Marriage counselling, though interested in reproduction, was also concerned with the emotional and psychological well-being of couples. These two practices coalesced most obviously in the work of well-known geneticist Sheldon Reed. Even as marriage and genetic counselling diverged in the post-WWII period, vestiges of these practices remain in contemporary counseling experiences with family planning and genetic screening programs. Emphasizing points of continuity between “positive” eugenic ideologies and modern genetic practices elaborates the diverse origins of genetic counseling. It also exposes how genetic counselors have become involved in genetic enterprises beyond standard clinical settings, and prods at key issues in the interaction between genetic science and social values.     

Disclosure of Genetics Research Results after the Death of the Patient Participant: A Qualitative Study of the Impact on Relatives

When a gene mutation is identified in a research study following the death of the study participant, it is not clear whether such information should be made available to relatives. We report here an evaluation of the impact on relatives of being informed of study results that detected pathogenic BRCA2 mutations in a male relative, now deceased, who had early onset (under the age of 55) prostate cancer. The breast and ovarian cancer risk was unknown to the living relatives. Qualitative analysis of interviews with thirteen relatives indicated that those who had a higher risk perception, resulting from an awareness of cancer family history or experiential knowledge of cancer in their family, tended to adjust more easily to the results. All participants believed that genetics research results of clinical significance should be fed back to relatives. Those who were fully aware of the BRCA2 results and implications for themselves felt they had benefited from the information, irrespective of whether or not they had elected for genetic testing, because of the consequent availability of surveillance programs. Initial anxiety upon learning about the BRCA2 result was alleviated by genetic counselling. Factors influencing those who have not engaged with the information included scepticism related to the relative who attempted to inform them, young age and fear of cancer. Those who had not sought genetic counselling did not attempt further dissemination, and some were not undergoing regular screening. Implications for informed consent in genetics research programs, and the requirement for genetic counselling when research results are disclosed, are discussed. Names have been changed to protect the privacy of study participants.     

Clients talk about their experience of seeking counselling

The purpose of this study was to explore the help-seeking behaviour of a sample of counselling clients using a questionnaire and follow-up, semi-structured interviews with 20 counselling clients who were seen at a walk-in, affordable counselling agency located in a mid-sized city in New Zealand. Specifically, clients were asked if they had received counselling previously, what efforts they had made to solve their problems before seeking counselling and with what success, why they chose this particular agency, their initial impression of their relationship with their counsellor, and their reactions to participating in the research. The data were analysed to ascertain themes associated with their decision-making and choices. Findings were discussed in relation to the literature on seeking counselling, how clients determine their need for counselling and the process they go through in deciding when and where to get it. Implications for counsellors are discussed.     

Responses to Marriage Counselling

The experiences of clients who received marital counselling from trained volunteer marriage guidance counsellors were investigated. Fifty-one clients from 42 marriages were interviewed and questioned about why they chose the agency, what expectations they held, what happened during counselling, how they felt about the counsellor, and what if anything was achieved through counselling. They were also asked how they had fared since. Rating scales were used after the interview to evaluate satisfaction with counselling, benefit from counselling, aspects of the counselling relationship, etc. The clients were also asked to do a card-sort of statements about counselling to determine what aspects had been valuable and disappointing. Some of the preliminary results of the study are presented and discussed.     

The experience of counselling for UK egg providers

Objective

The aim of this study was to address current gaps in knowledge regarding the appropriateness and quality of counselling provided to egg donors in the UK.

Methods

The present study used a cross-sectional, qualitative design. Semi-structured interviews were carried out with 29 UK egg donors to explore their experiences of egg donation and the counselling received.

Results

Of the 29 participants, 24 had received counselling. The remaining five did not receive counselling because they were either not accepted as a donor (n = 4) or were offered, but chose not to take up the session (n = 1). The findings are presented in relation to five themes: feeling supported via counselling; feeling well-informed; welcoming an individualised approach; the counselling setting; and thinking about the future.

Conclusion

Egg donors in this study had varying experiences of counselling offered to them as part of the egg donation process in the UK.

Implications

The findings indicate that there are some aspects of counselling in the UK that could be improved, including the routine offering of counselling throughout the egg donation process and the tailoring of counselling to meet egg donors' individual needs.     

The development of youth counselling services

Youth counselling services have sprung up in various parts of Britain over the last few years. Some have collapsed after an initial few months; others have grown steadily, though they tend still to be operating at a reasonably modest level. An analysis of their annual reports and other documents reveals considerable diversity in the nature of the services and the clientele they serve.     

Predictors and impact of psychotherapy side effects in young adults

What should we tell our younger clients—who may or may not have chosen to come to therapy—about possible risks of engaging in psychotherapy? To explore this question, we examined psychotherapy side effects in 366 young adults with a history of psychotherapy or counselling. Psychotherapy side effects were common, with 41% of participants reporting at least one. Perceived lack of control over the decision of when and how to engage in therapy was the strongest predictor of experiencing therapy side effects. Of the different kinds of side effects, feeling that therapy had gone on too long and experiencing worsening of existing symptoms were the most strongly predictive of poor therapy outcomes such as dissatisfaction with care and lower perceived improvements. Finally, there was a significant association between reporting side effects of psychiatric medications and side effects of psychotherapy, suggesting common factors that contribute to side effect experience across treatment modalities. These findings highlight the need to monitor possible side effects during psychotherapy and counselling, and to have an open dialogue with our youngest clients and their families about the likelihood for negative outcomes when they are compelled to engage in therapy.     

Introduction to the Special Issue on Genetic Counseling: A Global Perspective

This special issue of the Journal of Genetic Counseling is focused on the global genetic counselling community and includes commentaries, original research and multiple brief reports describing both established formal genetic counselling services and training programs as well as services and programs that are currently in development.     

A model of short-term counselling in primary care

Counselling in prima y care settings has received much interest throughout Britain. Many surgeries employ counsellors or psychologists as part of the primay health care team. This paper describes a model of primary care counselling using an example of a case encountered in general practice. It emphasizes the advantages of offering on-site counselling services, such as better possibilities of liaison with the referring doctor and coordination of patient care. Progress was made in seven sessions of short-term cognitive-behavioural treatment and a more stigmatizing referral (for example, to psychiatric services) was avoided. The case can be seen as an appropriate referral in the context of primay care counselling and illustrates the benefit of this approach to the treatment of psychological and social problems in general practice. Names and details have been changed to preserve confidentiality.     

Beyond resolution of presenting issues: Clients' experiences of an in‐house police counselling service

The availability of counselling services for employees has expanded significantly in recent years. However, despite an increase in appreciation of the value of counselling within the police service, there has been little research into the effectiveness of counselling with police personnel. The present study assesses an in‐house counselling service provided by the welfare and counselling department of a Scottish police force. Thirteen former clients (including both police officers and civilian support staff) were interviewed about their views on four areas of the counselling provision: how they entered counselling, the issues they brought, their experiences during counselling, and their assessment of the impact of counselling on their lives. Interviews were analysed using a grounded theory approach, which identified four main categories: initial engagement, learning by participating, experiencing moments of deep self‐examination, and moving beyond resolution of presenting problems. All of those who were interviewed appreciated the provision of a counselling service within their employment, and the majority reported that they had not only been helped to resolve their presenting problems, but had also made important gains in self‐awareness and work effectiveness. Findings are discussed in terms of implications for service delivery and future research.     

Client or patient? Contrasts between medical and counselling models of confidentiality

Conflicts can arise within counseling in primary care settings over issues of client confidentiality as perceived from a therapeutic as opposed to medical perspective. ‘Ideal types’ of counseling confidentiality and medical confidentiality are compared, according to a proposed structural model of confidentiality. In contrast with a therapeutic concept of confidentiality as an interpersonal contract between client and counsellor, a structural model of confidentiality appropriate to medical and primary care settings would include reference to crucial aspects such as risk assessment, and the sharing of client information within a multi-disciplinary team. The client-centred counselling model of confidentiality is then explored with reference to the Derbyshire Inquiry Report on the mental health care provided for a client with psychiatric problems. The limitations of adopting an exclusive client-centred counselling approach towards confidentiality in primary care settings are noted, given the requirements of the Care Programme Approach for effective risk assessment and inter-professional liaison in the care of client and patients with psychiatric problems. The potential resultant issues of counsellor and general practitioner liability are identified in relation to complaints systems and the key legal concept of vicarious liability.     

Reflections on a psychiatric placement

Abstract

During a seminar last year, I was teaching a group of counselling students on the subject of depression. One of the students asked me what I thought of referring a depressed client to a psychiatrist. I replied that in my opinion it was better to keep a person out of the psychiatric services as much as possible. This was an opinion I began to reconsider over the course of a six-month psychiatric placement, undertaken as part of an analytic psychotherapy training.