22q11.2 Deletion Syndrome: Attitudes towards Disclosing the Risk of Psychiatric Illness

22q11.2 Deletion Syndrome (22q11.2DS) is a common microdeletion syndrome with multisystem features. There is a strong association with psychiatric disorders. One in every four to five patients develop schizophrenia. Despite studies showing that early diagnosis and treatment are likely to lead to improved outcome, genetic counselors may be reluctant to discuss the risk of psychiatric illness. The aim of this research was to explore parental attitudes and genetic counselors’ perspectives and practice regarding disclosure of the clinical manifestations of 22q11.2DS, particularly the risk of psychiatric illness. We delivered a questionnaire to genetic counselors via established list-serves, 54 of which were completed. We also conducted interviews with four parents of adults with 22q11.2DS and schizophrenia. The majority of counselors and parents felt that the increased risk to develop a psychiatric illness is important to disclose. However, in the initial counseling session when the diagnosis was made in infancy genetic counselors were significantly less likely to discuss the risk of psychiatric disorders compared to other later onset features such as hypothyroidism (41?% vs. 83?%, p?=?0.001). When the diagnosis of 22q11.2DS was made in infancy, counselors’ responses in regard to timing of disclosure about psychiatric illnesses were fairly evenly divided between infancy, childhood and adolescence. In contrast, for other major features of 22q11.2DS, disclosure would predominantly be in infancy. The respondents reported that the discussion of psychiatric issues with parents was challenging due to the stigma associated with mental illness. Some also noted limited knowledge about psychiatric illness and treatment. These results suggest that genetic counselors could benefit from further education regarding psychiatric illness in 22q11.2DS and best strategies for discussing this important subject with parents and patients.     

Ethical issues in genetic counseling: A comparison of M.S. counselor and medical geneticist perspectives

New technologies available in the field of medical genetics have increased the importance of responsible ethical decision-making among genetic counselors. A 1985 national survey of M.D. and Ph.D. genetic counselors assessed ethical attitudes using case scenarios designed to simulate dilemmas faced in genetic counseling (Wertz and Fletcher, 1988b). The current study focuses on attitudes of M.S. genetic counselors using similar scenarios, allowing for effective comparisons. M.S. counselors were more willing than M.D. and Ph.D. counselors to maintain patient confidentiality when screening for Huntington's Disease and occupational diseases, and a greater number would agree to counsel patients pursuing prenatal testing for sex selection. A majority of M.S. counselors would disclose an XY karyotype to a phenotypically female patient. M.S. counselors reasoned that respect for patient autonomy and patient confidentiality justified their decisions in many cases. The importance of these principles is discussed and questioned.     

Counseling in Thailand: Development From a Buddhist Perspective

The authors present historical and current accounts of the counseling profession in Thailand. In addition to the influences of Buddhism on counselor training and practices, professional issues such as licensure, professional organizations, and the relationship between counselors and other mental health professionals are summarized. The role of counselors in recent political and natural disasters is highlighted, along with the importance of adapting Western counselor training and service practices to better meet the needs of the Thai population.     

Update and Review: Cystic Fibrosis

Cystic fibrosis (CF) is one of the most commonly inherited recessive disorders in U.S. Caucasians, with a carrier frequency of approximately 1 in 29. Genetic counseling and CF mutation analysis has traditionally been offered to the affected patient and his/her extended family, in keeping with policy statements from professional organizations (ASHG, NSGC, ACOG). The target population for CF testing and counseling may be evolving after the release of the 1997 National Institutes of Health Consensus Statement, Genetic Testing for Cystic Fibrosis, which recommends that CF screening be offered to all preconceptional and pregnant couples. Genetic counseling for CF is complicated by reports of polymorphisms in the CF gene that are associated with symptoms that do not meet the diagnostic criteria for CF, such as bilateral congenital absence of the vas deferens, bronchiectasis, and idiopathic pancreatitis. To aid genetic counselors with these issues, this review explores the symptoms of CF, patient management, gene function, genetics, genotype/phenotype correlation, and genetic counseling issues.     

Independently Licensed Counselors' Work Values

Prospective clinical mental health counseling students need to know if their work values align with those of independently licensed counselors before investing their time and accumulating debt. Analyzing the work values of 463 independently licensed counselors in the United States, we found 89% expressing social (altruistic) work values and 22% expressing intrinsic work values. Independently licensed counselors want to help clients become fully functioning and self-actualized by maintaining unconditional positive regard, being congruent, and providing empathy. Clarifying these work values and their interaction can help prospective and current clinical mental health counseling students determine their future job role.     

Caretaker Psychological Factors Predicting Premature Termination of Children's Counseling

This study examines the psychological factors associated with caretakers' premature termination of counseling for their children. Data were collected on the 85 primary caretakers of 85 children in Texas who applied for counseling at community mental health centers or who received private practitioner care. The general hypothesis of the study was that scores on general hostility, intrapunitive hostility, extrapunitive hostility, paranoid ideation, depression, and anxiety would discriminate caretakers who prematurely terminated their children's counseling from both those caretakers whose children, in the judgment of the counselors, met therapeutic goals and those caretakers whose children did not meet therapeutic goals but who attended at least 10 counseling sessions. The effect size results suggest that counselors should primarily consider caretaker intrapunitive hostility when anticipating potential premature termination of counseling for children.     

Genomic Testing: a Genetic Counselor’s Personal Reflection on Three Years of Consenting and Testing

Whole exome sequencing (WES) is increasingly used in research and clinical genetics as the cost of sequencing decreases and the interpretation improves. Genetic counselors need to be prepared to counsel a diverse patient population for this complex test. This commentary is a reflection of one genetic counselor’s experiences in counseling, consenting, and returning results for clinical and research WES for over 120 participants and patients. She reflects on how she overcame the initial challenges and concerns of counseling for WES and how her counseling evolved from a teaching based counseling model to an interactive patient-center counseling model. Her insights are offered to prepare other genetic counselors for the growing use of genomic testing.     

Addressing Spiritual and Religious Issues in Counseling African Americans: Implications for Counselor Training and Practice

Addressing spiritual and religious issues in the context of counseling relationships may be beneficial to many African American clients. The authors discuss various roles and functions of spirituality and religion in the lives of many African Americans, with particular attention to the impact of these issues on their mental health functioning and willingness to seek formal mental health services. The importance of academic training programs that prepare counselors to address potential spiritual and religious issues with their clients, is also highlighted.     

Assessment of the Use and Feasibility of Video to Supplement the Genetic Counseling Process: A Cancer Genetic Counseling Perspective

Cancer genetic counselors use a variety of teaching modalities for patient education. This survey of cancer genetic counselors assessed their use of educational videos and their recommendations for content of future videos. Thirty percent of respondents use videos for patient education. Cited benefits included reinforcement of information for clients and increased counselor efficiency. Of the 70% who do not use videos, predominant barriers included the perceived lack of an appropriate video, lack of space and/or equipment, and concern that videos are impersonal. Most respondents desired a video that is representative of the genetic counseling session, but emphasized the importance of using broad information. Content considered critical included the pros and cons of genetic testing, associated psychosocial implications, and genetic discrimination. The results of this exploratory study provide data relevant for the development of a cancer genetics video for patient education, and suggestions are made based on aspects of information processing and communication theories.     

Trends in geriatric psychiatry relevant to pastoral counselors

This article is a general overview of mental disorders in the aged that stresses the complementary roles that religious and mental health professionals can play in meeting the psychological and spiritual needs of elders. Chaplains and pastoral counselors should be competent in recognizing serious psychiatric disorders in older adults and able to differentiate them from the more common and benign emotional disturbances. Both counseling and biological treatments have distinct but often overlapping roles in the treatment of mental disorders in the aged. When treating emotionally disturbed elders, religious professionals should be aware of new trends in psychotherapy and biological psychiatry that are now making the integration of secular and religious techniques more and more feasible.Funding for this study was provided by the Center for the Study of Aging and Human Development at Duke University Medical Center and by the Geriatric Research, Education, and Clinical Center of the Veterans Administration Medical Center in Durham, North Carolina.     

The Impact of Wellness‐Focused Supervision on Mental Health Counseling Practicum Students

Professional counseling organizations tout the importance of wellness for counselors and counselors‐in‐training. The authors used a wellness‐focused supervision model with mental health practicum students to assess the model's degree of treatment effect at improving students' wellness over the course of the semester. Participants' demographics included three women, one man, three European Americans, and one Latino/a. Single‐case design results revealed that ongoing wellness‐focused interventions are helpful in improving participants' level of wellness; implications for practice are provided.     

Counseling Issues for Adult Women in Career Transition

This article addresses current psychosocial issues facing women in career transition and the implications of those issues for career counselors. Specifically, psychosocial developmental trajectories, the roles of family and relationships, the importance of underlying physical and mental health issues, and sociocultural and contextual stressors are relevant for women in the midst of career change. The author discusses how career counselors can prepare for this complexity and addresses clients' current economic and social milieus. A checklist is provided to aid the career counselor in addressing the multiple issues that a new client brings to the 1st counseling encounter.     

How Might the Genetics Profession Better Utilize Social Media

Social media is a common method of communication in people’s personal lives and professional settings. Gallagher et al. (2016) recommended, “it is time for genetic counselors to embrace social media as a means of communicating with patients or other healthcare professionals.” Full members of the National Society of Genetic Counselors (NSGC) in the USA and Canada and genetics patients in Cleveland, OH, were surveyed to determine interest in using social media for patient-provider interactions. Both cohorts indicated that patient privacy and confidentiality would be a concern; however, survey results indicated patients would be interested in using social media to receive general information about genetic counseling and to learn about genetics services. Genetic counselors indicated privacy issues were not concerning if social media were to be used in this capacity. The majority of genetic counselor participants (88.7%) indicated they would welcome national guidelines for patient-provider social media use. Data from this study demonstrated that sharing what to expect at a genetic counseling appointment, defining genetic counseling, and announcing community outreach events are possible ways genetic counselors could utilize social media to communicate with and educate patients.     

Mothers’ Perspectives on Their Child’s Mental Illness as Compared to Other Complex Disorders in Their Family: Insights to Inform Genetic Counseling Practice

To facilitate the development of a therapeutic alliance in genetic counseling, it is important that the counselor understands how families might perceive the condition that constitutes the reason for the referral. Through training and professional practice, genetic counselors develop a thorough understanding of families' perceptions of the conditions that are common indications for genetic counseling. But, for referral indications that are less frequent, like serious mental illnesses, genetic counselors may feel less confident in their understanding of the family's experience, or in their ability to provide psychosocial support when serious mental illness is reported in a family history. This may impede the establishment of a therapeutic alliance. As research shows that most referrals for genetic counseling related to serious mental illness are for female first-degree family members of affected individuals, we sought to explore how this group perceives serious mental illness. To provide a frame of reference with which genetic counselors may be more familiar, we explored how women perceived serious mental illness compared to other common complex disorders in their family. We conducted semi-structured interviews with women who had a child with a serious mental illness (schizophrenia, schizoaffective disorder, bipolar disorder) and a first-degree relative with another common complex disorder (diabetes, heart disease, cancer). Interviews were transcribed and subjected to thematic analysis. Saturation was reached when nine women had participated. Serious mental illness was perceived as being more severe and as having a greater impact on the family than diabetes, heart disease, or cancer. Themes identified included guilt, stigma, and loss. Some of the most important issues that contribute to mothers' perceptions that serious mental illness is more severe than other common complex disorders could be effectively addressed in genetic counseling. Developing a heightened awareness of how family members experience a relative's mental illness may help genetic counselors to be better able to provide psychosocial support to this group, whether serious mental illness constitutes the primary reason for referral or appears in the family history during counseling for a different referral reason.     

The Effect of Honduran Counseling Practices on the North American Counseling Profession: The Power of Poverty

A team of researchers consisting of counselor education professors and doctoral‐level counseling students conducted interviews with Honduran mental health professionals, including counselors, psychologists, pastors, community developmental specialists, and psychiatrists. The purpose was to understand the counseling process and profession that exists in a developing economy. The results are focused on the pervasive effects of poverty on the profession, the training of counselors, and the nature of counseling interventions.     

Physical Activity and Exercise: Implications for Counselors

The authors address current recommendations for physical activity and health, physical activity and mental well‐being, and implications for counselors and the counseling profession. Specifically, they review a recent article (P. M. Dubbert, 2002) published in the Journal of Consulting and Clinical Psychology and examine in detail the resulting implications for counselors and the counseling profession.     

Emerging quality improvement measures in genetic counseling

The need to establish guidelines for total quality management in genetic counseling is now recognized as new genetic technologies are being introduced into genetics services and primary care. Genetic counselors have an important role in developing methods for assuring quality in the genetic counseling process. Emerging quality improvement measures as well as selected examples from the Quality Assurance Program in the Genetics Services Division at the Foundation for Blood Research are presented as examples of direct genetic counselor involvement. Suggestions for future directions of quality improvement activities for genetic counselors are discussed.     

Counseling and Human Sexuality: A Training Model

In recent years sexuality has been broadly defined as a fundamental dimension of personality. Mental health practitioners need to respond to the increased awareness of human sexuality as a vital aspect of personal development. To date, few programs or workshops assist mental health counselors in developing the necessary skills to confront sexual concerns in the counseling relationship. This article presents a counseling and human sexuality course model that provides counselors with an information base in human sexuality and assists them in exploring the emotional aspects of sexuality. This course model assumes that mental health counselors will provide a valuable service to their client populations once they have become more willing and able to explore sexual conflicts.     

Counseling Customers: Emerging Roles for Genetic Counselors in the Direct-to-Consumer Genetic Testing Market

Individuals now have access to an increasing number of internet resources offering personal genomics services. As the direct-to-consumer genetic testing (DTC GT) industry expands, critics have called for pre- and post-test genetic counseling to be included with the product. Several genetic testing companies offer genetic counseling. There has been no examination to date of this service provision, whether it meets critics’ concerns and implications it may have for the genetic counseling profession. Considering the increasing relevance of genetics in healthcare, the complexity of genetic information provided by DTC GT, the mediating role of the internet in counseling, and potential conflicts of interest, this is a topic which deserves further attention. In this paper we offer a discourse analysis of ways in which genetic counseling is represented on DTC GT websites, blogs and other online material. This analysis identified four types of genetic counseling represented on the websites: the integrated counseling product; discretionary counseling; independent counseling; and product advice. Genetic counselors are represented as having the following roles: genetics educator; mediator; lifestyle advisor; risk interpreter; and entrepreneur. We conclude that genetic counseling as represented on DTC GT websites demonstrates shifting professional roles and forms of expertise in genetic counseling. Genetic counselors are also playing an important part in how the genetic testing market is taking shape. Our analysis offers important and timely insights into recent developments in the genetic counseling profession, which have relevance for practitioners, researchers and policy makers concerned with the evolving field of personal genomics.