The Life Course Perspective: a Guide for Genetic Counselors

This is the first article in a two part series about utilizing the life course perspective (LCP) in genetic counseling. LCP can be a useful tool for genetic counselors when counseling people with a known genetic mutation. Previous theories such as Protection Motivation Theory (PMT) and Common Sense Model of Self-Regulation (CSMSR) examine current reactions to a positive genetic test result. LCP extends beyond the current time to explore temporal and contextual elements of the experience. A review of research revealed, LCP has been used to study the perspective of caregivers of people with Alzheimer’s disease, referral for a family history of breast cancer, Mexican American caregivers of older adult, social class and cancer incidence and cancer and the sense of mastery. Incorporating LCP into a study explaining the experiences of people living with a positive test result for a genetic mutation such as the BRCA mutation provides a comprehensive exploration of this experience.     

Urban School-Based Family Counseling: Role Definition,Practice Applications,and Training Implications

The authors describe an expanded role for counselors in urban school settings that can improve the linkages among families, schools, and communities: school-based family counseling. The focus of this process is to assist children in becoming more successful in the classroom by increasing family and community involvement in addressing specific barriers to learning. The function of school-based family counseling, strategies, and challenges for implementation of this process; a case study of a school-based family counseling intervention; and implications for counselor training are presented. Benefits of the school-based family counseling model for diverse students, parents, schools, and communities also are discussed.     

Genetic Counseling for Early-onset Familial Alzheimer Disease in Large Aboriginal Kindred from a Remote Community in British Columbia: Unique Challenges and Possible Solutions

A novel, pathogenic presenilin 1 (PS1) mutation has recently been identified in a large Aboriginal kindred living in dispersed communities throughout British Columbia, Canada. Disseminating genetic information and ensuring that appropriate genetic counseling services are provided to all concerned relatives have posed several unique challenges. These challenges include knowledge exchange and continuity of care in a geographically remote and culturally distinct community. To our knowledge, this is the first time a specific genetic counseling approach has been needed for early-onset familial Alzheimer disease (EOFAD) in a North American Aboriginal community.     

Emotional Responses to APO E Genotype Disclosure for Alzheimer Disease

The purpose of our study is to assess the emotional responses to disclosing APO E genotype to asymptomatic older adults at increased risk for Alzheimer disease (AD). This is a longitudinal cohort study of volunteer subjects who were aged 50 years or over, asymptomatic for (AD), had a family history of AD, passed a psychological assessment, and participated in pre- and post-test genetic counseling and three follow-up visits over 10 months. We analyzed responses by three emotional constructs: depressed, worried, and relieved. Three hundred and twenty-eight subjects were screened, 76 received their APO E genotype. When emotional responses occurred it was immediate, between baseline and the 1 month follow-up. Emotional reactions did not change significantly past 1 month. Our results suggest that for emotionally stable persons, disclosing results of their APO E genotype, high risk subjects did not report more depression or worry and low risk subjects felt relieved by knowing the results. Future studies should evaluate the risks of disclosure to family members involved in the diagnostic work-up of a relative and include subjects from a broader range of emotional stability and socioeconomic background.     

CF carrier testing: Experience of relatives

Consensus exists that genetic counseling and CF carrier testing should be offered to individuals with a positive family history of CF. To learn more about their experience with genetic counseling and testing we conducted a series of structured telephone interviews and focus group discussions with individuals and couples who had undergone genetic counseling and carrier testing because of a family history of CF. Traditional genetic counseling appears to have been effective for this population. Subjects generally report having a positive counseling experience and few difficulties upon learning their carrier status. Subjects were quite knowledgeable about CF and their carrier risk and were highly motivated to seek testing. They may not be representative of all individuals with a family history of CF however. For carriers, concerns about whether and when to have children tested, and concerns about insurance implications of carrier status may emerge sometime after the initial counseling. Strategies for addressing these concerns and for providing efficient and effective education and genetic counseling for people with a family history of CF need to be developed.     

A Mother-Child, Multiple-Family, Counseling Program: Procedures and Results

The purpose of this study was to determine the effects of a family counseling program on the following variables: (a) parents' family satisfaction, perceived integration, and family congruence; (b) the number of positive and negative responses communicated among family members; and (c) an undesirable behavior exhibited by one child in the family. The sample consisted of 14 families in the experimental condition and 11 families in the control condition.
Mother and one child had responsibility for teaching other family members the principles taught during the multiple-family category sessions.
The findings indicated: (a) parents receiving family counseling increased significantly their family-satisfaction and perceived-integration scores as compared to the parents not receiving counseling; (b) families receiving counseling increased significantly the number of positive responses among them compared with the control families; (c) children receiving counseling decreased significantly the frequency of exhibiting a specific undesirable behavior; and (d) no significant differences were found between the groups of families in parents' family-congruence scores and in the number of negative responses communicated among family members.     

Systemically-Based Psychotherapeutic Techniques in Genetic Counseling

The uses of systemically-based psychotherapeutic methods in genetic counseling are discussed in the context of the origin of genetic counseling, the definition of genetic counseling, and the adjustments that one must make in order to implement these methods. Selected systemic methods which can be readily incorporated into genetic counseling are presented: use of genograms to explore family attitudes and beliefs about genetic risk, communications skills, and applications of family of origin work in genetic counseling. The need for research regarding the methodology and process of genetic counseling is presented with discussion of the need for theories of practice for genetic counseling.     

Marriage and Family Counseling

This article provides an overview of marriage and family counseling, including the growth and interest of this specialty within the American Counseling Association (ACA). Areas discussed include the evolution of marriage and family counseling within ACA, standards for training, credentialing, and unique ethical considerations when counseling couples and families.     

Family counseling: Basic concepts for ministers

Much of the time that ministers spend counseling is taken with family related issues. Yet many ministers find themselves in the difficult position of having little or no formal education or training in family counseling. This article deals with some basic issues related to problematic families and pastoral counseling that are meant to bridge the gap between having no formal training in family counseling and having advanced training and education.     

Career Counseling With Couples

As an outgrowth of the developmental and systemic trends characterizing career counseling in recent years, the role of the family has been highlighted. Nonetheless, inadequate attention has been given to incorporating family members in the career counseling setting with adult clients. This article explores a career counseling paradigm that takes into account the couple dynamics active in the adult's career choice process. Unique elements of the conjoint model, such as couple career assessment, along with directions for further study, are offered.     

Participation in Breast Cancer Genetic Counseling: The Influence of Educational Level, Ethnic Background, and Risk Perception

Genetic counseling has been suggested as a means of providing information and support to women with a family history of breast cancer. Yet women who undergo cancer genetic counseling in the United States generally consist of only a subset of those at risk, namely well-educated, upper-middle class, European American and Jewish women. We report outcomes from a study that provided a unique opportunity to determine whether women of African American, European American, Native American, or Ashkenazi Jewish ancestry have varying interest in having cancer genetic counseling. The study offered a genetic counseling session to 97 women with a family history of breast cancer who were participating in a larger interview study designed to assess attitudes toward genetic testing for breast cancer. The study offered genetic counseling free of charge to all study participants with a family history of breast cancer, removing the potential barriers of cost, the need for a physician referral, and lack of awareness of genetic counseling. Fifty women out of the 97 women offered genetic counseling (52%) accepted the offer by completing a session. Those who accepted genetic counseling had a higher educational level, a higher perceived risk of breast cancer, and were more likely to expect a positive BRCA1 or BRCA2 genetic test if they were to undergo genetic testing. When controlling for education level, there was no correlation between the participants' ethnic background and acceptance of a genetic counseling session. Outreach efforts to minority populations may increase awareness of the availability of genetic counseling and may facilitate participation by such populations.     

Dilemmas of Power and Equality in Marital and Family Counseling: Proposals for a Feminist Perspective

The author compares the assumptions and practices emerging from family systems and feminist counseling. Three major areas of convergence and divergence are examined: (a) the nature of problem definitions, (b) notions about power and appropriate sex roles in relationships, and (c) characteristics of the therapeutic relationship. A feminist perspective, which attends to societal concerns as well as issues within the nuclear family, has the potential for improving marital and family counseling. Suggestions are provided for integrating family systems and feminist concepts.     

A Re-Examination of the Current Status and Future of Family Therapy in India

Marital and family counseling has existed in India for many decades. However, the formalized discipline of marital and family counseling/therapy has its theoretical foundation in the West. The purpose of this paper is to present an overview of the need for and the current status of the practice of marriage and family therapy (MFT) in India. Based on our limited experiences we have attempted to prognosticate the future of the profession of family therapy in India by proposing a number of salient issues that we think would be useful discussion points as the development and advancement of family therapy in India is considered.     

Toward an integration of child and family therapy

Current forms of treatment for the symptomatic child are reviewed and analyzed. There are four general approaches to treatment: individual child psychotherapy, conjoint parent-child psychotherapy and counseling, parent therapy and counseling, and conjoint family therapy. Each approach has certain strengths, but in-and-of itself is an incomplete treatment mode. An integration of child and family therapy is recommended, and recent attempts at this integration are described. These include approaches which work within the framework of conjoint family therapy and those which provide concurrent child and family therapy.     

Workaholism: Bridging the Gap Between Workplace,Sociocultural, and Family Research

This article attempts to narrow the gap between the studies of workaholism and human relations/organizational development and workaholism and cross‐cultural research and family counseling. Important studies on workaholism in the cross‐cultural and family counseling fields, which are typically absent in the organizational and career research literature, are reviewed. Recommendations for future research considerations also are presented.     

A Genetic Counseling Intervention to Facilitate Family Communication About Inherited Conditions

This paper describes the development and implementation of the first intervention to facilitate family communication of genetic information based on a genetic counseling model of practice. The intervention is telephone-based and therefore designed to complement face-to-face genetic counseling consultations. It was developed by firstly reviewing the literature and a model of genetic counseling practice, leading to definition of seven core principles underpinning the intervention. A counseling framework based on these principles was developed through iterative role playing and review, tested for consistency with good practice and piloted on ten study participants. It was found to be feasible to implement and consistent with good genetic counseling practice. Implementation included training of the genetic counselors who would deliver the intervention as part of a randomized controlled trial. Noteworthy deviations from good genetic counseling practice were observed, with unexpected additional insights into the ‘black box’ of genetic counseling that may have wider implications and would benefit from further investigation. The intervention is currently being evaluated in a randomized controlled trial, to assess its impact on the number of family members attending genetic services.     

Marriage and Family Counseling in Counselor Education: National Trends and Implications

The authors report the results of a survey of 274 counselor education chairpersons asked to respond to a series of questions concerning the current status of marriage and family counseling in counselor education. Respondents indicated that marriage and family programs in counselor education are continuing to grow in popularity, identified courses most frequently employed in the training of such counselors, provided information about support that AACD could give to enhance the development of marriage and family counseling, and gave their opinions about how marriage and family counseling programs should be accredited.     

Correlates of Genetic Counseling and Testing Among Orthodox Jews

One hundred and thirty-six Orthodox Jews responded to questions about their family background, disability attitudes, and their participation in genetic counseling and testing. Findings showed that only birth order and the presence of a disabled family member correlated with increased chances of an individual going for genetic counseling/testing. Results are discussed in the context of the contemporary sociology of Orthodox Judaism, with a particular focus on better understanding the experience of having a disabled family member.     

A 40‐Year Review of Multicultural Counseling Outcome Research: Outlining a Future Research Agenda for the Multicultural Counseling Movement

This study represents a 40‐year review of multicultural counseling outcome research that has been done in the mental health professions. Particular attention is directed to the outcomes that ensue from counseling situations that are composed of counselors and clients from different racial/cultural backgrounds and identities in individual, group, and family counseling settings. Recommendations are presented for the next decade of multicultural counseling outcome research.     

Remarriage Among the Elderly: Characteristics Relevant to Pastoral Counseling

ABSTRACT

Family counseling has long been an important aspect of pastoral counseling. With recent trends toward increasing remarriage among older persons, pastoral family counseling will take on an additional dimension. This study provides information concerning motivation and attitudes toward remarriage, behavior during the interim period, adjustment to remarriage and the impact of remarriage on family relationships.