Defining Our Clinical Practice: The Identification of Genetic Counseling Outcomes Utilizing the Reciprocal Engagement Model

The need for evidence-based medicine, including comparative effectiveness studies and patient-centered outcomes research, has become a major healthcare focus. To date, a comprehensive list of genetic counseling outcomes, as espoused by genetic counselors, has not been established and thus, identification of outcomes unique to genetic counseling services has become a priority for the National Society of Genetic Counselors (NSGC). The purpose of this study was to take a critical first step at identifying a more comprehensive list of genetic counseling outcomes. This paper describes the results of a focus group study using the Reciprocal-Engagement Model (REM) as a framework to characterize patient-centered outcomes of genetic counseling clinical practice. Five focus groups were conducted with 27 peer nominated participants who were clinical genetic counselors, genetic counseling program directors, and/or outcomes researchers in genetic counseling. Members of each focus group were asked to identify genetic counseling outcomes for four to five of the 17 goals of the REM. A theory-driven, thematic analysis of focus group data yielded 194 genetic counseling outcomes across the 17 goals. Participants noted some concerns about how genetic counseling outcomes will be measured and evaluated given varying stakeholders and the long-term nature of genetic concerns. The present results provide a list of outcomes for use in future genetic counseling outcomes research and for empirically-supported clinical interventions.     

Grounded Theory in Genetic Counseling Research

The practice of genetic counseling is in need of evidence-based theoretical frameworks. Although strategies used in genetic counseling are increasingly evidence-based, the field of genetic counseling does not have a generally accepted theoretical basis for development of therapeutic interventions. We know very little about (1) what actually happens in genetic counseling and (2) the impact it has on clients and their families. A number of researchers have used a variety of approaches in an attempt to introduce some theoretical basis for genetic counseling research and practice. Other workers have used experience in their clinical practice to write theoretically about the kinds of processes that might be going on in and around genetic counseling. However, there are few studies to date, which have attempted to build theory modeling the psychosocial processes that take place in and around the genetic counseling clinic using empirical data. This paper describes a methodology (grounded theory) that is designed specifically to build theory about psychosocial processes from a strong evidence base, and explains how it can contribute to the development of practice in genetic counseling.     

Qualitative research and its place in psychological science

In discussing the place of diverse qualitative research within psychological science, the authors highlight the potential permeability of the quantitative-qualitative boundary and identify different ways of increasing communication between researchers specializing in different methods. Explicating diversity within qualitative research is facilitated, initially, through documenting the range of qualitative data collection and analytic methods available. The authors then consider the notion of paradigmatic frame and review debates on the current and future positioning of qualitative research within psychological science. In so doing, the authors argue that the different ways in which the concept of paradigm can be interpreted allow them to challenge the idea that diverse research paradigms are prima facie incommensurate. Further, reviewing the ways in which proponents of qualitative research are seeking to reconfigure the links between paradigms helps the authors to envisage how communication between research communities can be enhanced. This critical review allows the authors to systematize possible configurations for research practice in psychology on a continuum of paradigm integration and to specify associated criteria for judging intermethod coherence.     

Mental health,religion & culture

It has been found that the Muslim population in the UK seek spiritual advice from traditional faith healers for psychiatric and related problems. The important role that religious beliefs may have on perceptions of mental illness and substance misuse warrants further investigation. The aims were to examine the views of Muslims faith healers on symptoms and changes in behaviour commonly described as “psychosis” and “substance misuse”. Eight semi-structured interviews were conducted with Muslim faith healers from various backgrounds. Data were analysed according to the conventions of qualitative research using grounded theory methods. Religious conceptualisations played a key role in the understanding of both the disorders and consequently the guidance given. There were similarities and differences in the narratives given for psychosis and substance misuse. Healers expressed doubt towards other faith healers and the methods utilised by scientific means. The findings suggest a need for close collaboration between faith healers and mental health workers in order to achieve a culturally sensitive health care system.     

Counseling Military Populations: A Content Analysis of Counseling Journals From 1998 to 2018

Mental health scholarship of military populations is largely guided by researchers in psychiatry and psychology. Recent advocacy efforts have created increased opportunities for professional counselors to serve military clients, but the research within the profession has yet to be explored. A content analysis of 23 professional counseling journals from June 1998 to June 2018 was conducted to determine military population research trends. Findings indicated that counselors are researching topics similar to those of other mental health fields, such as posttraumatic stress, but are contributing to those topics conceptually rather than empirically. Topical areas in which counselors do produce more empirical studies include career counseling, and these studies relied on college student veteran populations. Suggestions for incorporating the philosophical principles of counseling into future research are provided to inform the trajectory of military scholarship in the profession.     

The Relevance of Counseling Outcome Research: Current Trends and Practical Implications

This systematic review investigated current trends in the publication sources, research focus, and methods of 365 counseling outcome studies. The results suggest that outcome research can provide a considerable knowledge base regarding numerous client concerns and various clinical interventions in individual, career, and school counseling. Counseling practitioners with a thorough knowledge of outcome research methods who use the findings appropriately will find this literature a useful adjunct to clinical decision making. Suggestions for improving the use of counseling research are offered for both practitioners and researchers.     

Response to Safran: The Development of Critical Psychoanalytic Sensibility

Jeremy D. Safran feels that my views regarding the relative merits of case studies and systematic empirical research are unnecessarily polarizing. I feel that, on the contrary, I'm offering bridges between my perspective and those of researchers on psychoanalytic process and outcome in two ways. One is through my own constructivist critique of traditional positivist case studies and theorizing based upon clinical experience. The second is through conceptualizing the place of systematic research within a constructivist paradigm. I am arguing that its place can be no different than that of case studies. Both generate possibilities for any particular analyst or analytic therapist to have in mind as he or she works with a particular patient at a particular moment. Safran locates the destructive effects of scientism with “biologically oriented researchers and cognitive therapists.” In my view, it might be convenient if the problem could be located exclusively with them, but the fact is that psychoanalytic researchers, as I demonstrate, are working largely within the same paradigm as their adversaries in the research world. That paradigm erroneously privileges systematic research as hypothesis-testing, whereas case studies are relegated to the status of anecdotal, hypothesis-generating work. I describe what I call “nonlinear constructivist learning” as the kind of “generalization” that case studies can yield and that is optimal for our field.     

Nanoethics in a Nanolab: Ethics via Participation

A participant–observer who is both informed and interested in ethical issues, and is embedded within a nanotechnology research and development facility may be able to influence the ethical awareness of researchers in nanotechnology, and tease out the societal implications of the work being conducted. Two inter-disciplinary methods were employed: (1) regular involvement in the technical and scientific research at the facility by the participant–observer, and (2) repeated interactions and discussions between the participant–observer and the scientists. As a result of this qualitative approach, an ethics questionnaire was developed and tested. This questionnaire has been incorporated into the admissions procedures for researchers as they commence use of the nanotech facility. The questionnaire highlights the importance of ethical issues in nanotechnology research and draws researchers into an engagement with possible ethical consequences and with future societal implications of their work.     

Nuance, Complexity, and Context: Qualitative Methods in Genetic Counseling Research

Because of its potential for capturing complexity and process and its focus on communicating the meaning in human action, qualitative research is rapidly gaining acceptance in a wide variety of disciplines. Various qualitative approaches to research support its potential usefulness in genetic counseling research. Formulation of research questions and selection of appropriate qualitative methods are the first step. Interviewing, narrative analysis, focus groups, ethnography/participant observation, and participatory action research are only some of the most popular techniques that may be suitable in various situations. Processes of evaluation, analysis, and even ethical issues often differ somewhat from quantitative research. This article discusses these issues and the potential value of qualitative methods for research related to genetic counseling.     

Genetic Counseling: Implications for Community Counselors

A special issue of the Journal of Health Psychology (Vol. 7, No. 2, 2002) was reviewed. The articles covered a variety of qualitative studies conducted using an interpretive phenomenological analysis method to examine the interviews with people who had received genetic testing and counseling. Implications for the broader counseling field were also presented.     

The Experience of Leader-Led Peer Supervision: Genetic Counselors' Perspectives

As we proceed through our professional lives, it is essential that we challengeourselves in order to continue to develop our genetic counseling skills. Conferences, workshops,post-graduate courses, journal clubs, and involvement in professional organizations havebecome the traditional methods of continuing education for post-graduate geneticcounselors. While these forums address the need to stay updated on scientific orinformation-based topics, there is little available to counselors to promote growth incounseling skills. A group of Boston-based genetic counselors describe how their leader-ledsupervision group has established a setting to meet the needs of its members both forsupport and continued counseling training. We outline here the evolution of this group andhow it has become a valued part of our professional lives. We feel that the model of leader-ledpeer supervision holds great value in helping genetic counselors continue to enhancetheir interpersonal skills in a supportive, safe, and challenging environment. It is our hopethat others will elect to form similar groups in their own communities, thereby creating newopportunities for growth within the genetic counseling profession.     

Encompassing experience: Meanings and methods in health psychology

Abstract

Health psychology is limited by its almost exclusive use of a positivist quantitative research paradigm, and the adoption and use of qualitative methods by health psychologists will provide increased understandings of health and illness. Qualitative methods provide a means to incorporate the social world into our research, and furnish ways to investigate the meanings of health and illness experience. We present a brief consideration of the qualitative paradigm and some important underlying issues related to its use. We describe three qualitative approaches - grounded theory, narrative analysis, and discourse analysis - chosen for their relevance and diversity. We provide illustrations of the use of each in health research, and suggest how these approaches could be utilised by health psychologists to enrich understanding in the health field. We conclude that health psychologists have a great deal to gain from joining other social science health researchers in adopting qualitative approaches in their research.     

Qualitative Research on Work–Family in the Management Field: A Review

Despite a proliferation of work–family literature over the past three decades, studies employing quantitative methodologies significantly outweigh those adopting qualitative approaches. In this paper, we intend to explore the state of qualitative work–family research in the management field and provide a comprehensive profile of the 152 studies included in this review. We synthesise the findings of qualitative work–family studies and provide six themes including parenthood, gender differences, cultural differences, family‐friendly policies and non‐traditional work arrangements, coping strategies, and under‐studied populations. We also describe how findings of qualitative work–family studies compare to those of quantitative studies. The review highlights seven conclusions in the current qualitative literature: a limited number of qualitative endeavours, findings worth further attention, convergent foci, the loose use of work–family terminology, the neglect of a variety of qualitative research approaches, quantitative attitudes towards qualitative research, and insufficient reporting of research methods. In addition, implications for future researchers are discussed.     

Qualitative sales research: an exposition of grounded theory

The dominant research paradigm in sales research involves testing theory through empirical research. Nascent or underdeveloped research areas, however, may lack or have inadequate existing theories to explain sales-related phenomena. In these cases, sales researchers require a theory-generating methodological approach. Qualitative research designs are useful in this pursuit. The purpose of this article is to provide an exposition of one such qualitative research design – grounded theory. To this end, the foundational processes of grounded theory methodology are discussed. The results of a review of grounded theory examinations conducted in sales research are also provided, and current practices utilized by sales grounded theorists are discussed. Based on this review, future directions in substantive areas and methodological practices are provided. This article aims to serve as a resource for sales scholars wishing to know what grounded theory examinations have been conducted, how to implement grounded theory research and what avenues are available for future grounded theory sales research.     

Wellness: A Review of Theory and Measurement for Counselors

Wellness is considered the paradigm of counseling and development (J. E. Myers, 1991, 1992). However, researchers have failed to agree on a definition or on the dimensional structure of wellness. Furthermore, existing quantitative wellness instruments are inadequate for capturing the complexity of wellness. The author reviews wellness theory and proposes an integrated definition of the construct. Existing wellness assessment instruments are explored along with advancements in research, theory, and measurement. Finally, implications for counseling and assessment are addressed.     

Noninvasive Prenatal Testing/Noninvasive Prenatal Diagnosis: the Position of the National Society of Genetic Counselors

The 1997 discovery of free fetal DNA in maternal plasma launched clinical researchers’ efforts to establish a reliable method for non-invasive prenatal testing for fetal genetic conditions. Various methods, including, but not limited to, massively parallel sequencing (MPS) and selective analysis of cell-free fetal DNA in maternal plasma, have recently been developed as highly sensitive and specific noninvasive screening tools for common fetal chromosome aneuploidies. Incorporating these new noninvasive technologies into clinical practice will impact the current prenatal screening paradigm for fetal aneuploidy, in which genetic counseling plays an integral role. The National Society of Genetic Counselors (NSGC) currently supports Noninvasive Prenatal Testing/Noninvasive Prenatal Diagnosis (NIPT/NIPD) as an option for patients whose pregnancies are considered to be at an increased risk for certain chromosome abnormalities. NSGC urges that NIPT/NIPD only be offered in the context of informed consent, education, and counseling by a qualified provider, such as a certified genetic counselor. Patients whose NIPT/NIPD results are abnormal, or who have other factors suggestive of a chromosome abnormality, should receive genetic counseling and be given the option of standard confirmatory diagnostic testing.