Relationship Between Counselors' Clinical Hypotheses and Client Ratings of Counselor Effectiveness

The authors assessed the relationship of counseling students' hypothesis formation skill levels to counseling effectiveness. Hypothesis rating scales were selected to assess skill in using a comprehensive range of client data, integrating multiple client dimensions, and forming questions for hypothesis testing. Results indicated that higher ratings of hypothesis formation skill were associated with higher client ratings of counselor effectiveness. A combination of four hypothesis skill ratings predicted more than 60% of the variance in total Counselor Rating Form-Short version (CRF-S) scores, and one or more hypothesis formation skills were predictive of each CRF-S subscale score.     

会谈中的当事人阻抗及工作同盟的影响因素:一项过程研究

从心理咨询过程研究视角,以38个会谈为对象,考察咨询师指导和当事人特质逆反对当事人阻抗的影响,并检验三者对工作同盟的影响。结果:指导正向预测阻抗,特质逆反则不能,二者的交互作用也不显著;阻抗负向预测工作同盟,指导则不能,二者的交互作用和中介作用都不显著,但阻抗的中介效应相对更大。结论:咨询师指导增加当事人阻抗;当事人阻抗破坏工作同盟,并在咨询师指导对工作同盟的影响过程中可能起中介作用。     

Providing a Transcultural Genetic Counseling Service in the UK

This paper uses a broad definition of culture to explore the practice of transcultural genetic counseling through three case studies. The first case involves a White genetic counselor seeing an Asian family, the second, an Asian genetic counselor seeing an Asian family and the third, a hearing genetic counselor seeing a culturally Deaf client. Boundaries, transference and countertransference reactions are considered within each transcultural encounter and the author of each case reflects in detail on their role in the client interaction and their impact on the transcultural dynamic. The cases are used to illustrate some cultural beliefs or characteristics that may challenge the genetic counselor’s expectations. The value of identifying and interpreting these differences to facilitate useful clinical work is considered. The paper debates, where possible, whether it is helpful to culturally match genetic counselor and client.     

A Method for Analyzing Videotaped Genetic Counseling Sessions

This study describes the development and evaluation of a multi-item scale for analyzing the genetic counseling process, the Manchester Observation Code (MOC) for genetic counseling. The instrument is specific to the field of genetic counseling and is designed for analysis of the communication between counselor and client. Coding is done directly from videotaped sessions. Because communication is the means by which genetic counseling is accomplished, the method measures four relevant components of communication: (1) grammatical form, (2) purpose, (3) subject, and (4) cue source. The instrument enables an observer to code the counselor's statements into these four components. Three videotaped sessions were used to measure interrater reliability, or the consistency of rating for each of the four communication domains using this method. Three videotaped sessions were also used to measure test-retest reliability, or the consistency of the designed method from one time to another. A total of 21 videotaped sessions were tested using the method. A statistical measure of reliability established consistency of the designed method; Cohen's kappa yielded 0.7 for interrater reliability and 0.79 for test-retest reliability. These findings suggest this instrument may be used to identify important elements of the genetic counseling process.     

Career counseling meets motivational interviewing: A sequential analysis of dynamic counselor–client interactions

Motivational Interviewing (MI) is a client-centered communication style with the aim to resolve client ambivalence within a change-related counseling. Its potential benefit for career counseling has been discussed by several scholars but no empirical research has investigated MI in this context so far. The current study used process measures from MI to investigate dynamic interactions within a career counseling intervention. Overall, we analyzed two videotaped sessions of 14 unique counselor–client dyads. Verbal behavior of counselors and clients were coded with two observational coding schemes from MI (one for counselors and one for clients, respectively). Behavior profiles of counselors were compared with benchmarks of good MI. Furthermore, client verbal ambivalence was compared between sessions. Finally, we conducted lag sequential analyses to analyze temporal dynamics between counselor behavior and immediate client verbal responses across N = 6883 behavioral events. Our results showed, first, behavior profiles of career counselors did significantly differ from recommended counseling benchmarks of good MI practice. Second, as assumed on the basis of past studies, client ambivalence decreased across sessions. Third, MI consistent counselor behaviors showed a positive sequential association with client positive career talk, whereas MI inconsistent counselor behaviors showed the reverse pattern. Our results suggest that counseling behaviors recommended from MI are facilitating career interventions. We discuss how trainings in MI could amend career counseling interventions and provide ethical implications when integrating MI into career counseling programs.     

Commentary on “Life as a Pregnant Genetic Counselor”

The genetic counseling role is complex. There are frequently challenges raised for the genetic counselor both personally with the client and through factors external to the genetic counselor such as the clinical setting. The pregnant genetic counselor working in a prenantal diagnosis center may be confronted by her own countertransference towards the client or by the client’s tranference. The processes of transference and countrtransference need to be clearly understood, identified and dealt with in a sensitive self aware manner to facilitate the role of communicating empathically and giving genetic information to facilitate informed client decision making. Regular professional supervision and debriefing for the genetic counselor are essential to develop professional boundaries and to develop self awareness.     

Person‐Centered Counseling: The Culture Within

The variables most related to success in counseling outcome research are the client‐counselor relationship and the personal and situational resources of the client (extratherapeutic variables). When these variables are compromised, a “specificity myth” is endorsed purporting that there are specific treatments for particular groups of people. This myth is a direct result of a shift in focus from the client to the counselor as the expert who focuses on “doing” counseling rather than “being” a counselor. Person‐centered counseling cuts to the core of therapeutic success: the relationship of the counselor‐client and the utilization of the client's resources.     

The Self of the Counselor

The counselor generally finds more difficulty in examining his “self” than in looking at the self of other counselors or of clients. On the assumption that the best display of counselor self occurs during the counseling relationship, a number of counseling excerpts are examined in an attempt to illustrate the level of counselor freedom. Counselor freedom is viewed as being related to the ability of the counselor to establish an empathic relationship with the client, to his ability to operate within the client's frame of reference, and to his ability to be genuine and honest in his relationship with the client.     

Expansion of Genetic Services Utilizing a General Genetic Counseling Clinic

We established a general genetic counseling clinic (GCC) to help reduce long wait times for new patient appointments and to enhance services for a subset of patients. Genetic counselors, who are licensed in Tennessee, were the primary providers and MD geneticists served as medical advisors. This article describes the clinic referral sources, reasons for referral and patient dispositions following their GCC visit(s). We obtained patients by triaging referrals made to our medical genetics division. Over 24 months, our GCC provided timely visits for 321 patients, allowing the MD geneticists to focus on patients needing a clinical exam and/or complex medical management. Following their GCC visit(s), over 80 % of patients did not need additional appointments with an MD geneticist. The GCC allowed the genetic counselor to spend more time with patients than is possible in our traditional medical genetics clinic. Patient satisfaction surveys (n?=?30) were very positive overall concerning the care provided. Added benefits for the genetic counselors were increased professional responsibility, autonomy and visibility as health care providers. We conclude that genetic counselors are accepted as health care providers by patients and referring providers for a subset of clinical genetics cases. A GCC can expand genetic services, complement more traditional genetic clinic models and utilize the strengths of the genetic counselor health care provider.     

A Rapid Systematic Review of Outcomes Studies in Genetic Counseling

As healthcare reimbursement is increasingly tied to value-of-service, it is critical for the genetic counselor (GC) profession to demonstrate the value added by GCs through outcomes research. We conducted a rapid systematic literature review to identify outcomes of genetic counseling. Web of Science (including PubMed) and CINAHL databases were systematically searched to identify articles meeting the following criteria: 1) measures were assessed before and after genetic counseling (pre-post design) or comparisons were made between a GC group vs. a non-GC group (comparative cohort design); 2) genetic counseling outcomes could be assessed independently of genetic testing outcomes, and 3) genetic counseling was conducted by masters-level genetic counselors, or non-physician providers. Twenty-three papers met the inclusion criteria. The majority of studies were in the cancer genetic setting and the most commonly measured outcomes included knowledge, anxiety or distress, satisfaction, perceived risk, genetic testing (intentions or receipt), health behaviors, and decisional conflict. Results suggest that genetic counseling can lead to increased knowledge, perceived personal control, positive health behaviors, and improved risk perception accuracy as well as decreases in anxiety, cancer-related worry, and decisional conflict. However, further studies are needed to evaluate a wider array of outcomes in more diverse genetic counseling settings.     

Gender Self‐Confidence and Social Influence: Impact on Working Alliance

The authors investigated the relationships between the counselor's gender self‐confidence, the counselor's use of social influence within the counseling session, and the counselor's sex in relation to the counseling relationship. These attributes were studied with regard to how deeply a therapeutic working alliance developed between the counselor and the client. Results support the importance of counselor characteristics on the counselor–client alliance. Implications for teaching, research, and practice are presented.     

Improvisation as a Meta-Counseling Skill

Counselor education tends to see the development of basic counseling and communication skills as the foundation of clinical training. Improvisation has historically and primarily been connected to theater training and as a performance mechanism. By developing skills in spontaneity and the nature of narrative (or story) one becomes more able to be in-the-moment with a client or clients and thus less anxious and more able to meet the client where they are. As such, improvisation can really be seen as a meta-counseling skill—a skill that can form a firmer foundation for the learning of the basic counseling and communication micro-skills. This article outlines the core concepts of improvisational training for counselors and includes examples of improvisational games that can specifically help in preparing counselor trainees for their future clinical work.     

Conceptualizing Genetic Counseling as Psychotherapy in the Era of Genomic Medicine

Discussions about genetic contributions to medical illness have become increasingly commonplace. Physicians and other health-care providers in all quarters of medicine, from oncology to psychiatry, routinely field questions about the genetic basis of the medical conditions they treat. Communication about genetic testing and risk also enter into these conversations, as knowledge about genetics is increasingly expected of all medical specialists. Attendant to this evolving medical landscape is some uncertainty regarding the future of the genetic counseling profession, with the potential for both increases and decreases in demand for genetic counselors being possible outcomes. This emerging uncertainty provides the opportunity to explicitly conceptualize the potentially distinct value and contributions of the genetic counselor over and above education about genetics and risk that may be provided by other health professionals. In this paper we suggest conceptualizing genetic counseling as a highly circumscribed form of psychotherapy in which effective communication of genetic information is a central therapeutic goal. While such an approach is by no means new—in 1979 Seymour Kessler explicitly described genetic counseling as a “kind of psychotherapeutic encounter,” an “interaction with a psychotherapeutic potential”—we expand on his view, and provide research evidence in support of our position. We review available evidence from process and outcome studies showing that genetic counseling is a therapeutic encounter that cannot be reduced to one where the counselor performs a simple “conduit for information” function, without losing effectiveness. We then discuss potential barriers that may have impeded greater uptake of a psychotherapeutic model of practice, and close by discussing implications for practice.     

The role of beneficence in clinical genetics: Non-directive counseling reconsidered

The popular view of non-directive genetic counseling limits the counselor's role to providing information to clients and assisting families in making decisions in a morally neutral fashion. This view of non-directive genetic counseling is shown to be incomplete. A fuller understanding of what it means to respect autonomy shows that merely respecting client choices does not exhaust the duty. Moreover, the genetic counselor/client relationship should also be governed by the counselor's commitment to the principle of beneficience. When non-directive counseling is reexamined in light of both these principles, it becomes clear that there are cases in which counselors should attempt to persuade clients to reconsider their decisions. Such attempts are consistent with non-directive counseling because, while respecting the clients' decision-making authority, they insure that clients act with full knowledge of the moral consequences of their decisions.     

Does Receiving Genetic Counseling Impact Genetic Counselor Practice?

This study was an investigation of whether genetic counselors have received genetic counseling and if so, how they believe it affects their practice. One thousand genetic counselors were mailed surveys about the nature of genetic counseling services received, impact on their clinical practice, frequency and reasons for disclosing about their receipt of counseling to their clients, and demographics. Ninety-three of the 510 respondents reported receiving genetic counseling. Of these, almost three-fourths were practicing genetic counselors while receiving services. Reasons for services include prenatal concerns, family history of cancer, and history/risk of other genetic conditions. Frequently endorsed effects on practice include increased empathy and understanding of client decisions, feeling more connected with clients, greater emphasis on psychosocial support, and sympathy. Forty-six respondents disclosed to clients about their receipt of genetic counseling. Prevalent reasons include client asked, help clients feel they are not alone, demonstrate counselor understanding, decrease client anxiety, build rapport, and normalize client feelings. Practice and research recommendations are given.     

Client Adherence to Asian Cultural Values,Common Factors in Counseling,and Session Outcome With Asian American Clients at a University Counseling Center

Based on data from 61 Asian American clients at a university counseling center, the study found that client‐perceived match on client‐counselor belief about problem etiology was related to counselor credibility, empathy, and cross‐cultural competence; the client‐counselor working alliance; session depth; and the likelihood of the client recommending the counselor to another client. An interaction effect showed that both strong match on belief about problem etiology and high client expectation for counseling success were associated with strong client‐counselor working alliance.     

A study of engagement and premature termination in a university counseling center

Differences between engaged (clients seen for at least two counseling sessions) and nonengaged clients, and between post-engaged premature terminators and clients who terminated with counselor knowledge at a university counseling center were investigated. Five practicum trainees, four professional counselors, and 308 college student clients participated. Professionals had higher rates of engagement and lower rates of premature termination than trainees. Engagement was positively associated with understanding and teaching the client and with longer intake interviews. Premature termination was associated with counselor attractiveness, expertness, and trustworthiness. These characteristics related to premature termination in opposite directions for professional and practicum counselors. Results are discussed in terms of possible different mechanisms operating at the beginning and end of counseling.     

Identifying process variables in career counseling: A research agenda

Remarkably little is known about what underlying processes and mechanisms lead to effective change in career counseling. This article examines potential reasons why career counseling process research has been infrequently conducted and provides 10 avenues from psychotherapy process research, and the limited pool of existing career counseling process research, that hold promise for advancing a productive process-research agenda in career counseling. These 10 avenues include: (a) examining the working alliance and five promising counselor techniques; (b) reconceptualizing career counseling as a process of learning, and investigating the processes that lead to effective learning; (c) investigating differences in career counseling process and outcome due to subtype membership, cultural perspectives, and other critical client attributes; (d) investigating differences in career counseling process and outcome based on counselors’ levels of self-efficacy, cultural perspectives, and other critical counselor attributes; (e) examining influential session events; (f) utilizing a common problem resolution metric for examining change across clients; (g) examining client change longitudinally to examine stability of change and functional practicality of assessed outcomes; (h) examining cognitive processes that may be mediating the career counseling process; (i) developing molecular and global taxonomies of counselor behaviors; and (j) utilizing advances in methodological approaches and statistical analyses.     

Risky Communication: Pitfalls in Counseling About Risk,and How to Avoid Them

A genetic counselor is often faced with the difficult task of conveying a set of complex and highly abstract factors associated with the client's risk of developing a familial disorder. The client is faced with the even more difficult task of making significant health-related decisions about an event which may or may not eventuate. Although there is a large corpus of research on this topic, much of the knowledge on risk communication is difficult to apply in a practical context. In this paper we draw together some insights on risk communication and decision-making under conditions of uncertainty, and apply them directly to the problem of communicating familial cancer risk. In particular, we focus on the distinction between individual risk and observed frequencies of adverse events, various framing effects, and contextualizing risk communication. We draw attention to some of the potential pitfalls in counseling about risk and offer avenues for circumventing them.