The Utility of Genetic Counseling Prior to Offering First Trimester Screening Options

In order to evaluate the utility of genetic counseling at the time of first trimester screening in patients with no previously identified genetic concerns, we reviewed family history data for 700 women seen for genetic counseling in Utah during 2005-2006. The mean maternal age was 35 years (Range: 16–47 years). The majority of patients seen were non-Jewish Caucasians (90.8%, 634/700). A three-generation pedigree was obtained from each woman by one of two certified genetic counselors and subsequently classified as “negative” (no birth defects/genetic disorders); “positive” (birth defect or genetic condition with a minimal/low risk of recurrence; additional evaluation/genetic testing during pregnancy not indicated); or “significant” (birth defect or genetic condition with an increased risk of recurrence; additional evaluation/genetic testing during the pregnancy indicated). About 72% (501/700) of the histories were negative, 19% (134/700) were positive, and about 9% (65/700) were significant. Among patients with significant family histories, 66% (n = 43) were women less than 35 years of age. We conclude that assessing a patient’s family history at the time of first trimester serum screening is a valuable resource for pregnancy management.     

Improving the Counseling Relationship

The TFA System is a practical method counselors can use to adapt theories, techniques, and their personal style to working relationships with clients.     

Implementing Group Prenatal Counseling for Expanded Noninvasive Screening Options

Recently, practices have begun integrating cell-free DNA-based noninvasive prenatal screening as a screening option for a variety of genetic conditions. According to the National Society of Genetic Counselors, the integration of cfDNA screening into clinical prenatal practice may "significantly shift the paradigm of prenatal testing and screening for all women." The purpose of this study was to determine whether group information sessions can feasibly serve as an alternative to extended one-on-one genetic counseling for the increasing number of women making decisions about prenatal testing and screening. This study assessed the effect of group genetic information sessions coupled with abbreviated counseling on pregnant women’s knowledge about and attitudes toward prenatal testing and screening.     

Value Tensions Between Evangelical Christians and Christian Counseling

The evangelical wing of the American Protestant church has maintained an uneasy and uncertain relationship with the recently emerged Christian counseling movement. Whereas many evangelical Christian groups have been able to assimilate Christian counseling into their panoply of ministry tools, significant sections of this faith group remain very suspicious and doubtful that Christian counseling can be trusted. Most of the stated reasons given by these objectors revolve around theological reservations. This article, however, suggests that an even more powerful barrier between the two groups stems from significantly different values held by each. The article enumerates several of these value differences.     

The Relationship Between Episodic and Dispositional Forgiveness,Psychosocial Development,and Counseling

The relationship between episodic and dispositional forgiveness and the resolution of Erikson's (1963) psychosocial crises were explored in this study. Participants (N = 66) completed the Enright Forgiveness Inventory ( Enright & Rique, 2004 ), Tendency to Forgive Scale ( Brown, 2003 ), and Measures of Psychosocial Development ( Hawley, 1988 ). Results are consistent with forgiveness and Eriksonian theories. Episodic forgiveness and dispositional forgiveness accounted for 8% and 10%, respectively, of the variance in global resolution of psychosocial crises. The most pronounced relationship was between both forgiveness types and Erikson's crises related to basic trust and ego integrity. Implications for counseling research, practice, and training are discussed.     

Self-Transcendence: Integrating Ends and Means in Value Counseling

Pastoral counseling is distinguished from secular counseling by “limit experiences.” These are experiences that disclose the fullness of self-transcendence—for Christians, a personal relationship with God. But the radical drive of the human spirit for self-transcendence unifies every dimension of the developing person. This drive thus forms the basis of a fundamental continuity between pastoral and secular counseling in their directions and methods, despite clear differences in boundaries, categories, and languages.     

The Relationship between the Supervision Role and Compassion Fatigue and Burnout in Genetic Counseling

Many genetic counselors provide supervision to students during their career. Previous studies have shown genetic counselors, in general, are at increased risk for developing compassion fatigue. The purpose of this study was to determine if there was a difference in compassion fatigue and burnout levels in genetic counselors who currently supervise compared to genetic counselors who do not. Genetic counselors who currently practice in a clinical setting (N = 391) completed an online survey containing demographic questions, the Professional Quality of Life Scale, the State-Trait Anxiety Inventory, and questions specific to the genetic counselor’s experiences with supervision. Overall, when controlling for trait-anxiety, the supervision role by itself was not independently associated with the risk for compassion fatigue and burnout among genetic counselors. Within supervisors, however, there were several factors which were associated with this risk. Those with less supervision experience reported more secondary traumatic stress. Those supervisors reporting less confidence had decreased compassion satisfaction. Those with less experience or less confidence in their supervision role were most likely to be at increased risk for developing compassion fatigue. Training in supervision and support for dealing with compassion fatigue and burnout may be beneficial to supervisors with less experience.     

The Relationship Between Momentary States of Therapist Self-Awareness and Perceptions of the Counseling Process

To investigate the role of momentary self-awareness, beginning therapists and their volunteer clients participated in a postsession process recall in which therapist helpfulness and momentary self-awareness were assessed along with client reactions. Therapist anxiety levels and strategies used to manage hindering self-awareness were also examined. Results suggest that momentary states of heightened therapist self-awareness may be hindering. Specifically, when therapists rated themselves as more self-aware from moment to moment during counseling sessions, they also rated themselves as more anxious before the session and their clients rated them as less helpful during the session. In addition, therapists reported using a variety of strategies to manage distracting self-awareness, including focusing on intervention planning and focusing on the client. Implications for therapist training are discussed.     

The Relationship Between the Supervisory Working Alliance and Student Self-Efficacy in Genetic Counseling Training

The purpose of this study was to determine if a genetic counseling student’s perception of the supervisory working alliance (SWA) is related to their self-efficacy on select clinical practice-based competencies (PBCs), evaluating the second tenet of the Reciprocal Engagement Model of Supervision (REM-S) from a student perspective. Second year genetic counseling students (N?=?168) completed a survey containing demographic and clinical rotation experience questions, the Supervisory Working Alliance Inventory-Trainee Form (SWAI-T), and the Genetic Counseling Self-Efficacy Scale (GCSES). Overall, the SWAI-T was significantly associated with all factors of the GCSES. Additionally, the relationship between the SWAI-T and self-efficacy was specific to those who had only one supervisor, thus highlighting the SWA may be most important under these circumstances. This serves as an important step in being able to guide supervisors toward effective methods in supervision, which may include encouraging supervisors to build a strong relationship with their supervisee in order to help strengthen the student’s confidence in their clinical skills.     

Effect of Client Expectations on the Counseling Relationship

The purpose of this study was to investigate the effect upon an initial interview of positive and negative client expectations for counseling. 30 subjects or clients were randomly assigned to 3 groups (1 positive expectation group, 1 negative expectation group, and a control group). Following a 30-minute counseling session, the counselors and clients were asked to evaluate the relationship that had been established. Despite pre-counseling differences in client expectations, no significant differences were found in the relationships established.     

College Students' Perceptions of the Relationship Between Fee and Counseling

Fee as a variable that could have an impact on college students' perceptions of counseling was explored because of the authentic concerns about college counseling centers needing to charge direct fees for their services. Participants (N = 350) represented a cross-section of potential consumers of psychological services, not just individuals currently receiving services. On an overt level, fees seemed to be less influential in counseling considerations, but were taken into account on a more covert level. This study supports the psychological literature, which suggests that fee is not the most important factor in clients' decisions to seek counseling. Implications for counselors, administrators, researchers, and program planners are discussed.     

African-American Women and the Male-Female Relationship Dilemma: A Counseling Perspective

This article focuses on the historical origin of the African-American male-female relationship dilemma and contemporary forces that have an impact on opportunities for intimacy and marriage among African-American women. Specifically, loss, communication, and stereotypes are examined as counseling issues that are relevant to African-American women in relationships. Implications for counseling and research are also discussed.     

The New Narcissist and Pastoral Counseling

Pastoral Psychology - For some time now, psychiatrists and psychotherapists have recognized that they are working with a new individual, one who no longer seems capable of experiencing a sense of...