Clinical efficacy and potential mechanisms of neurofeedback

Although many psychological disorders have significant basis in neurobiological dysfunction, most treatment approaches either neglect biological aspects of the problem, or approach dysfunction through pharmacological treatment alone, which may expose individuals to negative side effects. In recent decades, neurofeedback has been promoted as an alternative approach to treating neurobiological dysfunction. Neurofeedback helps individuals gain control over subtle brain activity fluctuations through real-time rewards for pre-established target brainwave frequencies at specific cortical locations. This paper reviews the effectiveness of neurofeedback in a range of conditions, including ADHD, autism spectrum disorders, substance use, PTSD, and learning difficulties. Neurofeedback has emerged as superior or equivalent to either alternative or no treatment in many of the examined studies, suggesting it produces some effects worthy of further examination. In light of its potential to address neurobiological dysfunction directly, future research is suggested in order to refine protocols, as well as to establish effectiveness and efficacy. Potential mechanisms of neurofeedback are discussed, including global connectivity, neuroplasticity, and reinforcement of the default mode network, central executive network, and salience network.     

Functional neuroimaging of working memory in survivors of childhood brain tumors and healthy children: Associations with coping and psychosocial outcomes

Purpose: Pediatric brain tumors are the second most common cancer diagnosis in individuals under age 20 and research has documented significant neurocognitive, psychosocial, and emotional late effects. Associations among these deficits have not been adequately considered and the role of survivors’ coping with stress in relation to deficits is unknown. Further, research has yet to examine neurobiological processes related to neurocognitive, psychosocial, and emotional difficulties in survivors through the use of functional neuroimaging. Method: Questionnaire measures and functional neuroimaging were used to examine the neurocognitive, psychosocial, and emotional functioning and coping responses of survivors of pediatric brain tumors (N = 17; age 8–16) and healthy children (N = 15). Results: Survivors experienced elevated levels of psychosocial and behavioral/emotional difficulties relative to healthy controls and normative data. Increases in brain activation in prefrontal and other anterior regions in response to a working memory task were associated with better psychosocial functioning, use of engagement coping strategies, and less use of disengagement coping strategies. Regression analyses suggest coping accounts for a significant portion of the association between brain activation and behavioral/emotional functioning. Conclusions: This study extends late-effects research by examining neurobiological processes associated with psychosocial and emotional difficulties. These findings contribute to our understanding of difficulties in survivors and provide a foundation for research exploring these associations and mediators of deficits in future longitudinal studies.     

Characterization of the Practice and Attitudes of Genetic Counselors with Doctoral Degrees

Potential advantages and disadvantages of doctoral training in genetic counseling have been debated. In this study, individual interviews were conducted to characterize the practice and attitudes of genetic counselors who have achieved doctoral degrees in any field. Participants (N=31) were more likely to spend time in research and less likely to spend time in clinic than genetic counselors in general. Advantages identified by participants were consistent with theorized advantages, and included increased knowledge, wider research roles, additional opportunities and greater respect. Disadvantages identified by participants focused more on individual perspectives than previously theorized profession-wide disadvantages. These included increased time commitment and decreased patient contact. The attitudes of participants towards the development of doctoral training in genetic counseling were generally positive. The results suggest that doctoral training in genetic counseling would have more benefits than drawbacks for individuals pursuing this degree.     

Wellness Counseling: The Evidence Base for Practice

Wellness conceptualized as the paradigm for counseling provides strength‐based strategies for assessing clients, conceptualizing issues developmentally, and planning interventions to remediate dysfunction and optimize growth. Wellness counseling models have stimulated significant research that helps to form the evidence base for practice in the counseling field. The development of these models is explained, results of studies using the models are reviewed, and implications for research needed to further inform clinical practice and advocacy efforts are discussed.     

Counseling the Gifted: Past,Present, and Future Directions

In the 29 years since the last special issue in the Journal of Counseling & Development focusing on gifted individuals, there has been considerable research regarding giftedness. However, meeting the counseling needs of gifted individuals has not been on the national agenda in counselor preparation. This article outlines the status of counseling the gifted from the standpoint of both the counseling and the gifted education professions and includes recommendations for future directions for both fields.     

New Directions in Counseling Women

A revolution in counseling women is one logical outcome of recent changes in the social, political, and economic movements that have predisposed individuals to modify their life-styles and value systems. This article discusses four facets of that revolution and concludes that new counselor training programs are required to meet the needs of emerging client populations. The conclusions are supported by research that indicates (a) new sources of knowledge about the development and functioning of women clients; (b) new groups of client populations whose needs are not being met by traditional counseling strategies; (c) innovative procedures specifically tailored to the unique characteristics of these client groups; and (d) revised standards of ethical practice to ensure competent and appropriate services for all client populations. Training programs are outlined that provide guidelines for sex-fair education for all counselors and more intensively focused training for counselors who select the counseling of women clients as a career specialty.     

Client Accounts of Hope in Early Counseling Sessions: A Qualitative Study

Hope enables individuals to envision a future in which they wish to participate ( Jevne, 1994 ) and is foundational to counseling practice. However, there has been little research examining client accounts of hope in session. Using basic interpretive inquiry, this case study examines clients' accounts of hope during counseling using video‐assisted recall. Three categories emerged: hope‐fostering counseling relationship, supportive identity development, and perspective change. Implications for counseling are discussed.     

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.     

Rehabilitation Counseling: Evolution and Current Status

This article provides a brief review of the evolution and current status of rehabilitation counseling. Rehabilitation counseling practice is described along with the required competencies of rehabilitation counselors in providing services to individuals with disabilities. The professional status of the discipline is reviewed in terms of programs for educational preparation, professional associations, accreditation, regulation of practice, ethical mandates, and research. Finally, continuing challenges for the discipline are identified.     

Employability of Genetic Counselors with a PhD in Genetic Counseling

The development of a PhD in genetic counseling has been discussed for more than 20 years, yet the perspectives of employers have not been assessed. The goal of this qualitative study was to gain an understanding of the employability of genetic counselors with a PhD in genetic counseling by conducting interviews with United States employers of genetic counselors. Study participants were categorized according to one of the following practice areas: academic, clinical, government, industry, laboratory, or research. All participants were responsible for hiring genetic counselors in their institutions. Of the 30 employers interviewed, 23 envisioned opportunities for individuals with a PhD degree in genetic counseling, particularly in academic and research settings. Performing research and having the ability to be a principal investigator on a grant was the primary role envisioned for these individuals by 22/30 participants. Employers expect individuals with a PhD in genetic counseling to perform different roles than MS genetic counselors with a master's degree. This study suggests there is an employment niche for individuals who have a PhD in genetic counseling that complements, and does not compete with, master's prepared genetic counselors.     

Professional Counseling in South Africa: A Landscape Under Construction

The focus of this article is on the history, status, and trends of the counseling profession in South Africa and on the similarities with the development of the counseling profession in the United States. A need exists for South African professional counselors to refocus their research efforts to reflect the realities of the 21st century and link counseling practice and theory with global realities to suit the needs and collectivist origins (ubuntu) of the South African population.     

Publishing International Counseling Articles

This article begins with a rationale for including international articles in the Journal of Counseling & Development. Then, 2 general categories of international articles are described. First are articles that provide a general overview of counseling in a particular country. The 2nd category is more general and might involve international counseling research, counseling practice, or theoretical issues. A list of English‐language international journals is also included.     

Career Research Interests and Training of Genetic Counseling Students

Research is important to validate clinical services, provide information on the effectiveness of practice techniques, and develop the knowledge base of a clinical profession. Genetic counseling students from American Board of Genetic Counseling (ABGC) accredited training programs were surveyed to determine their career research interests and interest in pursuing a hypothetical doctoral degree in genetic counseling. Genetic counseling program directors were surveyed to assess the emphasis on research training within their programs. A substantial number (46%, n = 92) of genetic counseling students are interested in performing research in their careers and many (40%, n = 80) would pursue a doctoral degree in genetic counseling if it was available. Students and directors from programs with a thesis requirement reported a significantly higher emphasis on career research preparation than those from programs without a thesis requirement. The results of this study indicate that future genetic counselors are interested in contributing to the research base that will advance the field. This study suggests a need to strengthen research training within ABGC accredited graduate programs and explore the development of a doctoral degree option in genetic counseling.     

Vietnamese Amerasians: Predictors of Distress and Self-Destructive Behavior

There have been few empirical studies of Vietnamese Amerasians, children fathered by United States servicemen and civilians during the Vietnam War. In this study, the authors investigated pre- and postmigration variables that predict psychological distress and self-destructive behavior. The sample (N = 169) was selected from 10 cities throughout the United States. Multivariate regression analyses were used to determine the predictors of distress. Results revealed that observing traumatic events rather than actually experiencing trauma was a significant predictor of psychological distress. Participants with frequent cognitions about loss of significant people, places, or both were more likely to report psychological distress and self-destructive behavior. Implications for research and practice are discussed in relationship to cross-cultural counseling with at-risk populations, including individuals from inner cities and war-stricken environments.     

Meditative interventions and antisocial personality disorder

Empathic functioning and inhibitory control deficits are two symptoms of antisocial personality disorder (ASPD). Despite their deleterious effects, limited research exists on interventions that would ameliorate these specific symptoms. We suggest that meditative interventions may help to increase empathic functioning and inhibitory control in ASPD individuals. Using Luria’s working brain framework, we present research showing that meditative interventions influence the same brain regions associated with empathic functioning and inhibitory control. Implications for the counseling profession and directions for further research are discussed.     

Finding order and direction from chaos: a comparison of chaos career counseling and trait matching counseling

Chaos career counseling, based on the Chaos Theory of Careers (R. G. L. Pryor & J. E. H. Bright, 2003a, 2003b), was compared with trait matching career counseling and a wait list control. Sixty university students who attended the Careers Research and Assessment Service seeking career advice were randomly assigned to the chaos intervention, the trait matching intervention, or a wait list control group. Both chaos and trait matching counseling had a positive impact; however, chaos counseling had a more lasting effect. Overall, results support using the chaos counseling approach as a valid alternative to trait matching approaches. Implications for counseling practice as well as future research are discussed.     

Predicting the evolution of counseling psychology in the United States: results from a Delphi poll of academic training directors

What might the field of counseling psychology in the United States of America look like 10 years from now? In a Delphi Poll, an expert panel, consisting of 28 training directors from APA-accredited counseling psychology programs, made predictions regarding the future of counseling psychology 10 years from now in relation to three domains (core features, research and training, and professional training) and 32 specific areas within those domains. The strongest core feature of counseling psychology was viewed as a continuing commitment to issues of diversity (M = 4.64, SD = .63); the research and training theme predicted to attract the most attention in the next 10 years was a commitment to evidence-based practice (M = 4.71, SD = 1.20); and the professional training theme predicted to gain the greatest focus was attention to professional competence (M = 4.43, SD = .65). Results were compared with a previous Delphi Poll conducted in 2001, and recommendations are outlined for future research designed to contribute to the ongoing development of the field of counseling psychology.     

Taming the Brain Weasels: Reducing Self-Criticism Through Externalization and Compassion

ABSTRACT

Self-criticism is a natural process occurring across mental health disorders. When self-criticism is excessive, vulnerability to mental health disorders such as depression and anxiety increases. Compassion-focused approaches can effectively address a variety of concerns; however, highly self-critical individuals might balk at the idea of self-directed compassion due to shame, self-blame, or discomfort with positive emotions, resulting in treatment resistance. The brain weasel is an intervention strategy that uses the Narrative Therapy technique of externalization as an intermediate step toward compassion-oriented work. Through creative externalization and therapeutic humor, self-critical individuals can decenter and explore their self-critical dialogue. This article contains several ways to introduce and use the brain weasel personification in counseling.     

Mentoring Nurses in Familial Cancer Risk Assessment and Counseling: Lessons Learned From a Formative Evaluation

Background. As familial cancer genetic services moves into community practice increased numbers of trained health professionals are needed to counsel individuals seeking cancer risk information. Nurses have been targeted to provide cancer risk assessment and counseling. To help prepare nurses for this role, a 5-day training in familial cancer risk assessment and counseling followed by a long-distance mentorship to support continued skill development in the work environment was conducted by Fox Chase Cancer Center, Philadelphia, PA. Methods. Four cohorts (N = 41) have completed the training and were randomized to either an immediate or delayed mentorship. A formative evaluation assessed the nurse’s ability to consult with other genetic health professionals and build self-efficacy in counseling skills via responses to questionnaire. A post-mentorship interview evaluated the usefulness, timing and length of the mentorship. Results. For both groups, there was a statistically significant improvement in self-efficacy for all skills from baseline to 6 months and an increased number of nurses consulting with genetic health professionals. All the nurses reported the value of the mentorship and those with less cancer risk counseling experience prior to the training needed support and resources for further skill and program development. Lessons learned from this formative evaluation are provided.