Spiritual Wellness for Clients With HIV/AIDS: Review of Counseling Issues

The epidemic of HIV/AIDS has resulted in an increasing population of individuals in need of counseling services: persons living with AIDS, as well as family, friends, and caregivers. The relationship between HIV/AIDS clients' counseling and spiritual issues is demonstrated by a review of salient literature. Three broad themes are used: terminal illness issues such as post-death existence and existential meaning of life, religious disenfranchisement from society or families of origin, and multicultural spiritual and religious issues. Practical recommendations for counselors and research implications are included.     

Stories of family caregivers of people with dementia in Greece: Implications for counselling

A substantial body of literature has identified high rates of burden, psychological morbidity, social isolation, health and financial difficulties among dementia caregivers. The present qualitative study adopted an Interpretive Phenomenological Analysis approach in order to explore the lived experiences of dementia family caregivers within the Greek sociocultural context. The sample was purposive and consisted of 10 women dementia family caregivers from Athens and Thessaloniki. Individual in-depth interviews were conducted and analysed according to IPA. The participants’ personal accounts included themes related to ethical/existential and cultural aspects of family caregiving; changes in family relationships; impact of the caregiving experiences; sources of support and help seeking; positive and meaningful aspects of the care experience. The research findings are discussed in the context of Gilligan’s moral psychological theory, and cultural dimensions of family caregivers. Implications for counselling interventions aiming at supporting caregivers are presented.     

Women’s Perceptions of the Personal and Family Impact of Genetic Cancer Risk Assessment: Focus Group Findings

Women with a personal or family history of breast or ovarian cancer are increasingly presenting for genetic cancer risk assessment (GCRA). To explore the personal and family impact of GCRA, four focus groups were conducted of women seen for risk assessment. Participants were 22 primarily non-Latina White women with a personal or family history of breast or ovarian cancer. Analysis of the data identified new themes related to balancing time to assimilate risk information with the need to make timely healthcare decisions, physicians’ lack of sufficient genetic knowledge, and concern for daughters regardless of the daughters’ age. Other themes related to protecting others, knowledge as empowerment, reassessing personal attribution of cancer risk, managing uncertainty, reappraising body image, and experiencing divergent family responses to communication of cancer risk and healthcare decisions. Understanding the personal and family impact of GCRA may enable genetics professionals to tailor their counseling efforts to better meet the needs of these women. Additional research is needed to extend these findings and identify interventions to support positive outcomes of GCRA.     

Supporting families of transgender children/youth: Parents speak on their experiences,identity, and views

ABSTRACT

Background: Transgender children/youth demonstrate the best possibility for resilience and positive mental health when they are part of an affirming and supportive family. To optimize families in supporting transgender children/youth, parents/caregivers need to be supported. Transgender children/youth and their families regularly navigate a myriad of challenges through society.

Aims: Within the extant literature on transgender children and youth, relatively little attention is focused on the experiences of parents/caregivers and how their close family relationships are affected. The present qualitative study addresses this gap in knowledge through its exploration of the experiences, identities, and views of parents/caregivers of transgender children/youth.

Method: The study is longitudinal and this article represents the first wave. Fourteen parents of 12 transgender children/youth, aged 6–17, participated in in-depth semistructured interviews. Participants were recruited via social media and at an on-site conference for transgender youth and their families. All children/youth had socially transitioned. Those who were eligible for puberty suppression and/or hormone therapy were receiving those. The interviews were inductively coded for themes by two coders using the constant comparative method.

Results: Participants' reports on their experiences yielded three themes: (1) transgender issues as the family's focus; (2) proactivity, child-focused: preemptive actions to prevent adverse consequences; and (3) self-care. These themes included subthemes on effective coping strategies to mitigate struggles. Three themes related to participants' identity and views emerged: (1) identity reformation, (2) self-evaluation, and (3) views of future. These themes included subthemes that reflected how participants viewed themselves, their child, and the future.

Discussion: A transgender identity in one family member affects all household members. Parents/guardians may experience guilt and self-doubt over decisions. Factors that may improve outcomes with extended family and schools include families' preemptive dissemination of information on transgender identities and explicating expectations of respect and nonintrusion. Ingrained traditions may force life-altering decisions.     

“I Didn’t Expect to Learn as Much as I Did”: Rewards of Caregiving in Young Adulthood

While much attention is given to unpaid caregivers in midlife, there is a notable gap in the literature regarding young adults in family caregiving roles. Although two out of 5 family caregivers are between the ages of 18 and 40, we know relatively little about these younger relatives providing support to ill and disabled family members. Understanding the experiences of this under-researched population is critical to effective social service provision for this new wave of caregivers. In addition, the challenges associated with caregiving are well documented, yet examining the positive aspects of caregiving is necessary to provide a balanced picture of caregiving. The purpose of this qualitative study was to explore the gains experienced by family caregivers in young adulthood. In-depth telephone interviews were conducted with a diverse sample of 22 individuals who were (or had previously been) caregivers while in young adulthood. Analysis of the data resulted in identification of four themes concerning gains experienced by young adult caregivers: a strengthening of family relationships, character growth, personal satisfaction in the care provided, and material benefit. This study sheds some understanding on rewards experienced by a subgroup of family caregivers who has received little attention—young adult caregivers.     

Attitudes Towards Prenatal Genetic Counseling,Prenatal Genetic Testing,and Termination of Pregnancy among Southeast and East Asian Women in the United States

Recognizing the heterogeneity of the Asian population with regards to acculturation, education, health awareness, and cultural values is vital for tailoring culturally sensitive and appropriate care. Prior studies show that cultural values influence perceptions of genetics within Asian populations. The reputation of the family unit factors into decisions such as pregnancy termination and disclosure of family medical history, and the nondirective model of American genetic counseling may conflict with the historical Asian model of paternalistic health care. Previous studies also provide conflicting evidence regarding correlations between education, acculturation, age, and awareness and perceptions of genetic testing. The aims of this study were to describe attitudes towards prenatal genetics among Southeast and East Asian women living in the United States for varying amounts of time and to explore sociocultural factors influencing those attitudes. Twenty-three Asian women who were members of Asian cultural organizations in the United States were interviewed via telephone about their attitudes towards prenatal genetic counseling, prenatal genetic testing, and termination of pregnancy. Responses were transcribed and coded for common themes using a thematic analysis approach. Four major themes emerged. In general, participants: (1) had diverse expectations for genetic counselors; (2) tended to weigh risks and benefits with regards to genetic testing decisions; (3) had mixed views on termination for lethal and non-lethal genetic conditions; and (4) identified cultural factors which influenced testing and termination such as lack of available resources, societal shame and stigma, and family pressure. These findings may allow prenatal genetic counselors to gain a richer, more nuanced understanding of their Asian patients and to offer culturally tailored prenatal genetic counseling.     

Stressful situations in caregiving: relations between caregiver coping and well-being

We examined ways in which caregivers cope with stressful caregiving situations and the relations between coping strategies and caregivers' psychosocial well-being. Respondents were 58 family caregivers to patients discharged from a rehabilitation hospital. Caregivers identified a recent stressful event in caregiving and indicated strategies used to cope with this event. After controlling for patients' impairment level, analyses indicated that caregivers engaging in more escape-avoidance coping reported greater depression and more conflict in their personal relationships. Those using more positive reappraisal demonstrated greater positive affect. Younger caregivers, many of whom were women, used more avoidance strategies. Results have implications for therapeutic interventions with family caregivers.     

Family Caregivers: Psychosocial Impacts and Clinical Needs

The authors describe how 3 groups of family caregivers (spouses, daughters, and sons) are affected by the caregiving role. In addition, clinical considerations and interventions for mental health professionals working with these different groups of family caregivers are discussed. A clinical case example is also presented.     

Telephone-Based Behavioral Activation for Improving Sleep Quality in Family Caregivers of People With Dementia: A Pilot Randomized Controlled Trial

Sleep disturbances are common among family caregivers of people with dementia (PWD). Although behavioral activation (BA) shows the potential to improve sleep quality, to date, evidence for this treatment’s feasibility and efficacy for family caregivers of PWD is limited. Therefore, this study pilot tested an evidence-based BA protocol for improving sleep quality in Chinese family caregivers of PWD. The BA intervention involved eight weekly individual telephone-based sessions designed to teach caregivers specific BA techniques. Sleep quality and depression were measured using the Chinese versions of the Pittsburgh Sleep Quality Index (PSQI) and Center for Epidemiologic Studies Depression (CES-D) Scale, respectively. This study also measured leisure activity, positive aspect of caregiving, caregiving burden, health status, and relationship satisfaction. All participants were asked to complete the assessments on paper at baseline and immediately after the intervention. After completing the pilot randomized controlled trial, semistructured interviews were conducted to explore participants’ experiences participating in the BA intervention. A total of 71 family caregivers of PWD (35 in the intervention group and 36 in the control group) were recruited. The majority of participants were female (n = 53, 74.65%), and their mean age was 54.07 years (SD = 10.95). Compared with controls, caregivers in the intervention group displayed significantly greater improvement in sleep quality, as well as perceptions of positive aspects of caregiving and reduction of depression. Most participants were very satisfied with the intervention. These findings suggest that individual telephone-based BA interventions are feasible, acceptable, and effective in improving sleep quality and psychological health in family caregivers of PWD. These results contribute to the literature by providing evidence for developing effective, accessible, and sustainable BA interventions for family caregivers of PWD.     

Counseling Mexican American Seniors: An Overview

This article examines assessment and counseling techniques that correspond to the sociocultural framework of Mexican American seniors. Acculturation, familial, and adaptation themes are delineated for ensuring appropriate interventions. Case vignettes elucidate these perspectives.     

Evidence-based psychological treatments for distress in family caregivers of older adults

This review identifies evidence-based psychological treatments (EBTs) for reducing distress, and improving well-being, of family members caring for an older relative with significant cognitive and/or physical impairment. Three categories of psychologically derived treatments met EBT criteria: psychoeducational programs (N = 14 studies), psychotherapy (N = 3 studies), and multicomponent interventions (N = 2 studies). Specifically, support within the psychoeducational category was found for skill-training programs focused on behavior management, depression management, and anger management and for the progressively lowered threshold model. Within the psychotherapy category, cognitive-behavioral therapy enjoys strong empirical support. Within the multicomponent category, programs using a combination of at least 2 distinct theoretical approaches (e.g., individual counseling and support group attendance) were also found to be effective. Suggestions for future research include the development of more well-integrated multicomponent approaches, greater inclusion of ethnically diverse family caregivers in research protocols, and greater incorporation of new technologies for treatment delivery.     

Caring for children with an intellectual disability: An exploratory qualitative study

This study explored family caregiver experiences of children with an intellectual disability in a rural South African day-care centre. The family caregivers (N = 15; mothers = 60%; age range = 35 to 68 years) completed in-depth interviews regarding their experiences providing care to children with intellectual disability. Data collection and analysis was done using phenomenological methods. The following themes emerged to characterise the family caregiver experiences: deeper understanding of intellectual disability; disability disclosure conditions; and social and economic support needs. Family support emerged as an important factor in the relationship between caregivers’ psychological stress and well-being.     

Intimate Violence Against Women: Trajectories for Pastoral Care in a New Millennium

This article reviews progress made in the theory and practice of pastoral care and counseling with regard to the issue of intimate violence against women since the 1970’s. It includes a comprehensive survey of sociological, psychological, and pastoral literature, and a summary of research on teaching about domestic violence in mainline Protestant seminaries. Social and theological themes, including gender, power, and social and political context, and the challenges of justice-making are traced historically. The article concludes with new recommendations for churches, pastoral caregivers, counselors, and theologians.     

FOCUS on the Family Caregiver: A Problem‐Solving Training Intervention

Problem‐solving interventions have documented effectiveness in treating distress among a variety of clientele. The authors discuss the application of training in social problem solving with family caregivers of persons who have incurred severe physical disabilities. Specifically, the authors outline training procedures (i.e., Project FOCUS) that enable counselors to assist family caregivers in developing effective problem‐solving skills that may translate to increased wellness for each caregiver, and by extension, their care recipients.     

Understanding Women in the Role of Caregivers for Older Adults in Japan

This article provides an overview of Japanese women in the role of caregivers of older family members. Cultural influence on women's identity, significance of the caregiver's role, and the struggles and rewards of being caregivers are discussed. Finally, ideas are provided for the use of arts in counseling and implications of their use are discussed.     

Specific Psychosocial Issues of Individuals Undergoing Genetic Counseling for Cancer – A Literature Review

Approximately 25 % of individuals undergoing genetic counseling for cancer experiences clinically relevant levels of distress, anxiety and/or depression. However, these general psychological outcomes that are used in many studies do not provide detailed information on the specific psychosocial problems experienced by counselees. The aim of this review was to investigate the specific psychosocial issues encountered by individuals undergoing genetic counseling for cancer, and to identify overarching themes across these issues. A literature search was performed, using four electronic databases (PubMed, PsychInfo, CINAHL and Embase). Papers published between January 2000 and January 2013 were selected using combinations, and related indexing terms of the keywords: ‘genetic counseling’, ‘psychology’ and ‘cancer’. In total, 25 articles met our inclusion criteria. We identified the specific issues addressed by these papers, and used meta-ethnography to identify the following six overarching themes: coping with cancer risk, practical issues, family issues, children-related issues, living with cancer, and emotions. A large overlap in the specific issues and themes was found between these studies, suggesting that research on specific psychosocial problems within genetic counseling has reached a point of saturation. As a next step, efforts should be made to detect and monitor these problems of counselees at an early stage within the genetic counseling process.     

Caring for the Caregivers: An Investigation of Factors Related to Well-Being Among Parents Caring for a Child with Smith-Magenis Syndrome

Smith-Magenis syndrome (SMS) is a complex disorder characterized by numerous challenges, including intellectual disability, speech delay, decreased pain sensitivity, sleep disturbances, hyperactivity, mood instability, and self-injury. Caregivers must readily adapt to the ever-changing needs of the child. Due to these demands, caregivers may encounter difficulties maintaining their own level of well-being. Thus, a total of 112 primary caregivers (i.e., parents) of individuals diagnosed with SMS responded to online questionnaires to assess demographic and psychosocial factors, such as perceptions of child health vulnerability, benefit finding, sleep behaviors, anxiety and depression symptomatology, and caregiver satisfaction and self-efficacy, which may be related to caregiver well-being. Results show that, among mothers, caregiver well-being was directly related to perceived child health vulnerability, caregiver satisfaction, and benefit finding, and a significant moderating effect was observed for depression/anxiety counseling after beginning the caregiver role on the relationship between anxiety symptomatology and caregiver well-being. Results further suggest that maternal caregivers who report high levels of anxiety but do not seek counseling fair the worst in terms of well-being. Among fathers, lower depression symptoms and greater benefit finding were related to higher levels of caregiver well-being. These data show that many factors play roles in influencing coping and well-being among SMS caregivers. Investigating these variables and relationships may reveal additional resources and interventions to assist primary caregivers.     

Living with a Rare Chronic Illness: A Phenomenological,Systemic Examination of Hemophilia Complicated by an Inhibitor

Abstract

Up to 20% of individuals with hemophilia experience the added complication of an inhibitor. An inhibitor results in severe bleeds, joint damage, impaired mobility, and even death. We conducted a focus group with eight individuals affected by inhibitors (three patients and five caregivers). Data were analyzed using the immersion/crystallization method. The following themes emerged: (a) fear and anxiety within the family, (b) social isolation of the patient, (c) unique impacts on caregivers and siblings, and (d) desired changes in treatment. Similar experiences may be common across comparable disorders that are incapacitating, acute, and relapsing in nature.     

Counseling Older Adults with Dementia: A Survey of Therapists in Massachusetts

Although much has been written about therapeutic interventions with caregivers, little is known about the counseling services that are available for victims of dementia. The present study was designed to explore community mental health center (CMHC) services and therapists' experiences in providing psychotherapy to this population in Massachusetts. Only 27 of the 36 CMHCs in the state reported providing mental health services to older adults with a dementing illness. A survey of therapists who specialized in working with older adults found that the percentage of older adult clients estimated to have dementia averaged about half of their caseload. Older persons in the early phase of a dementing illness were most frequently referred for depression and anxiety, whereas those with moderate decline were most frequently referred for management of disruptive behavior. The most common services provided to clients with dementia consisted of assessment and individual counseling. The latter finding indicates a discrepancy between what is practiced and the professional literature. Most of the psychotherapy described in the literature concerns group interventions, which were rarely provided by the mental health centers in Massachusetts. The centers tended to offer individual counseling; however, little information on how to provide this form of treatment can be found.     

Personhood,culture and family therapy

This paper argues that ideas about personhood and relationships vary cross-culturally and that although it is not always obvious or easy to discover, this variation is particularly salient to family therapy. This argument is supported by a dual definition of culture emphasizing both continuity of cultural themes (generative aspect) and the reconstitution, redefinition and change of such themes through interaction and communication (interactive aspect). The effectiveness of interventions which are isomorphic with ideas which families themselves hold about personhood is demonstrated through work with two families, one Punjabi and one Bangladeshi.