The Incorporation of Predictive Genomic Testing into Genetic Counseling Programs

This study explored whether genetic counseling programs are incorporating instruction about the applications and techniques of predictive genomic testing (PGT) based on student recollection, and whether this is perceived as adequate by those students. For the purpose of this study, PGT was defined as the use of genome-based testing to assess a person’s risk, or susceptibility, of developing a disorder with either a known or suspected genetic component. Surveys from 114 graduates were analyzed. The majority of respondents indicated that PGT was covered in their curriculum including methodology, information generated, benefits, risks, limitations, and impact on the field of genetic counseling. A statistically significant increase in incorporating information about PGT as a whole from 2008 to 2011 was also reported. The majority of respondents reported that coverage of PGT prepared them for the American Board of Genetic Counseling (ABGC) board exam (80.6 %), to interpret PGT test results (60.2 %) and to identify clinical situations warranting testing (53.1 %). Although the majority of respondents indicated learning about a wide variety of aspects surrounding PGT, many recent graduates indicated their training was less likely to cover aspects essential for the clinical application of PGT. Therefore, genetic counseling programs should place a greater emphasis on these skills, and the development of continuing education opportunities aimed at increasing genetic counselors abilities to interpret and discuss PGT tests and identify clinical situations warranting such testing may be helpful.     

Initiation of Reflective Frames in Counseling for Huntingtons Disease Predictive Testing

Genetic professionals and clients are likely to assign different meanings to the extended format of the counseling protocols for predictive testing. In order to facilitate informed, client-centered decisions about the possibility of predictive testing, counselors routinely use the question format to initiate what we call "reflective frames" that invite clients to discuss their feelings and encourage them to adopt introspective and self-reflective stances toward their own experience--spanning the past, the present, and the hypothetical future. We suggest that such initiations of reflective frames constitute a key element of counselors' nondirective stance, although the exact nature of their formulations can be complex and varied. Examining 24 Huntington's Disease (HD) clinic sessions involving 12 families in South Wales with the tools of discourse analysis, our focus in this paper is twofold: (i) to propose a classification of six types of reflective questions (e.g. nonspecific invites, awareness and anxiety, decision about testing, impact of result, dissemination, and other) and to examine their distribution across the various clinic appointments, and (ii) to investigate the scope of these questions in terms of temporal and social axes. We link our analysis to the current debate within the genetic counseling profession about the merits of reflection- versus information-focused counseling styles and the need to abide by professionally warranted and institutionally embedded counseling protocols.     

A Patient's Perspective on Genetic Counseling and Predictive Testing for Alzheimer's Disease

The availability of genetic testing for Alzheimer's disease is anticipated to be widespread in the future. As an individual at risk with a family history of Alzheimer's disease, I discuss why I sought predictive tests and how I would use the information from such tests. I relay what I learned in my genetic counseling session, my response to the counseling process, and steps I have since taken. I discuss life planning, psychological and fear of discrimination issues from a patient's perspective.     

The Complexity and Challenges of Genetic Counseling and Testing for Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is an umbrella term referring to two chronic idiopathic intestinal diseases: ulcerative colitis (UC) and Crohn’s disease (CD). Both UC and CD are characterized by immune activation that leads to symptoms, but the location, severity and behavior of the inflammation varies among individuals and in characteristic ways between UC and CD. A majority of patients with IBD are diagnosed in young adulthood, but the response to therapy is variable and difficult to predict, with some patients demonstrating a prompt and effective remission while others have continuous symptoms that do not respond to existing medical options. Surgery remains a frequent and necessary occurrence among patients with IBD, but in UC it is considered curative, while in CD only temporizing. Clinical observations, epidemiological studies, and molecular genetics have provided strong evidence that both genetic and environmental factors are important determinants for disease susceptibility. In recent years, a number of genes have been identified that associate with CD and UC, although the clinical utility of these discoveries in patients or in susceptible family members has not been determined. Nonetheless, it is hoped that these fundamental advances in our understanding of IBD will lead to better therapies for patients and prevention strategies for those who are susceptible. Effective incorporation of clinical genetic testing for IBD into practice will require appropriate education and counseling.     

Expressions of Religiosity and Spirituality among Australian 14 Year Olds

This article describes and reports on part of a research project that was carried out by three researchers, among 248 Year 6 (11 years old) and 338 Year 9 (14 years old) students in the Catholic schools of Victoria, Australia. The research set out to discover information about religious affiliation and practice among the young people, the ways in which they typically expressed spirituality, and the extent to which religious affiliation and practice did or did not provide a framework for, and nurture, their spirituality. This paper reports on the findings of the research in relation to the Year 9 students, detailing characteristics of the spirituality of the young people and demonstrating that it cannot be assumed that Church affiliation and practice nurture young peoples' spirituality. The research was introductory and provocative in that it indicates some discrepancies with other research in one of its six areas, that of religious practice. While possible reasons for this discrepancy are given, it is hoped that the research described here will provoke further and more specific studies.     

BRCA1 Testing: Genetic Counseling Protocol Development and Counseling Issues

This article discusses the genetic counseling protocols which were developed and counseling issues that have arisen in the first 2 years of evaluating a large kindred with a BRCA1 mutation. The rationale for the development of the genetic counseling protocols and specific genetic counseling visual aids are presented and discussed. The protocols and counseling aids can serve as models for other programs offering cancer susceptibility testing. The observations of study counselors about study subject concerns and responses to genetic testing at the time of the pretest and posttest counseling sessions are presented.     

Psychosocial Impact of Predictive Testing for Illness on Children and Families: Challenges for a New Millennium

Predictive testing for adult- and child-onset diseases is becoming widely available. The identification of individuals prone to develop certain illnesses is often medically advantageous in that it may afford opportunities to engage in risk reduction behaviors to detect or delay disease onset. However, sometimes the knowledge gained from these tests can be ambiguous, generate distress, and potentially affect several generations of family members. Overall, these factors create a challenging set of circumstances for persons considering genetic and other forms of predictive testing, particularly parents and children. In this article, we (1) address conceptual issues involved in determining the impact of predictive testing on child and family well-being, (2) review empirical data on this topic, and (3) provide a case example to illustrate these findings. Recommendations are made for additional psychological research on child- and family-focused outcomes associated with participation in testing, highlighting their clinical implications.     

Counseling Muslim Women: Navigating Cultural and Religious Challenges

In this article, the authors consider strategies for counseling female Muslim clients. First, they review general beliefs and practices of Muslims in the United States. Through the use of a case study, they illustrate a collaborative method of counseling Muslim women that is based on a trusting client‐counselor relationship.     

家庭认知环境与0~3岁婴幼儿发展的关系:有调节的中介效应

本研究以5914名0~3岁婴幼儿家长为问卷调查对象,考察了家庭认知环境、入托经历、努力控制对0~3岁婴幼儿发展的影响机制。研究发现：（1）婴幼儿努力控制在家庭认知环境与婴幼儿发展中具有中介效应,即家庭认知环境通过作用于努力控制而对婴幼儿发展产生影响;（2）婴幼儿是否入托在“家庭认知环境→努力控制→婴幼儿发展”这一中介路径的前半段中具有调节作用,当婴幼儿有入托经历时,家庭认知环境对婴幼儿努力控制的影响更大。     

American Counseling Association: The 50th Year Celebration of Excellence

The author selected information from personal archival files to remind and encourage readers to celebrate the American Counseling Association's (ACA) 50 years of service to the counseling profession. In a survey of ACA's history, the author notes that its presidents were a key to the organizational growth of ACA and acknowledges that during the first half century, each incoming president was dependent on the combined commitment, dedication, foresight, wisdom, and professionalization efforts of numerous members who volunteered or were chosen to share responsibility for the association's progress.     

Predictability in Testing and Counseling

The concept of predictability is examined and its relevance for testing and counseling is assessed. Two types of studies, those designed to evaluate the concept, and research on deviant achievement suggest its potential value for test research and practice. Predictability, as such, has not been investigated in counseling, although many counselors realize that while some counselees move in expected directions (not necessarily “good”), others do not. To better understand the factors involved, counselors could make predictions and later compare them with actual results. Ethical problems arise, however, when “no help” or “harm” is predicted. Several types of research having implications for prediction of predictability are reviewed.     

Condom Use and Contraception Non-Use Amongst 16-19 Year Olds: A Within Subjects Comparison

Abstract

The present study used a within subject design to examine which situation specific factors discriminated between the use of condoms and non-use of contraception in the context of preventing unwanted pregnancy. Adapting the methodology of Gold et al (1991, 1992), 215 16 to 19 year olds completed a questionnaire concerning the most recent time they had experienced sexual intercourse without using contraception (the “without contraception” encounter) and me most recent time they had experienced sexual intercourse using a condom (the “with a condom” encounter). The results showed that although past behaviour did not differentiate between the two encounters, situational factors relating to preparation for action, affect and interpersonal interaction were important. However, when analysed for men and women separately most of the differences were only found for women. In particular, the results suggest that women report non-contraception use as associated with feeling more guilty, having a partner who is less motivated to use contraception than they are, with neither themselves nor their partner raising the desire to use contraception, not expecting to have sex and not discussing contraception and not having contraception available. In contrast, for men, only the availability of contraception appeared to differentiate between the two encounters. The results are discussed in terms of the usefulness of the methodology and the associated shift in emphasis from users and non-users of contraception to use and non-use. The implications of the results in terms of health education interventions are also considered.     

Predictive Genetic Testing for Hereditary Breast and Ovarian Cancer: Psychological Distress and Illness Representations 1 Year Following Disclosure

This prospective study evaluates emotional functioning and illness representations in 68 unaffected women (34 carriers/34 noncarriers) 1 year after predictive testing for BRCA1/2 mutations when offered within a multidisciplinary approach. Carriers had higher subjective risk perception of breast cancer than noncarriers. Carriers who did not have prophylactic oophorectomy had the highest risk perception of ovarian cancer. No differences were found between carriers and noncarriers regarding perceived seriousness and perceived control of breast and ovarian cancer. Mean levels of distress were within normal ranges. Only few women showed an overall pattern of clinically elevated distress. Cancer-specific distress and state-anxiety significantly decreased in noncarriers from pre- to posttest while general distress remained about the same. There were no significant changes in distress in the group of carriers except for ovarian cancer distress which significantly decreased from pre- to posttest. Our study did not reveal adverse effects of predictive testing when offered in the context of a multidisciplinary approach.     

Counseling Adult Sex Offenders: Unique Challenges and Treatment Paradigms

Current definitions and research literature related to characteristics of adults who sexually victimize children are reviewed. Treatment issues that may confront counselors engaged in treating adults who sexually victimize children are examined, and implications for practitioners are discussed.     

Grandparents and Stepgrandparents: Challenges in Counseling the Extended-Blended Family

Remarriage of parents may bring new grandparents and stepgrandparents into the lives of children, creating new family structures and needs for adjustment. The extended-blended family may benefit from specific counseling interventions.     

Working With Dreams in Group Counseling: Advantages and Challenges

Various challenges exist in the use of dreams in group counseling. Obscure and complex dream symbols and images, intricacies of the dream interpretation process, and a lack of counselor training in dreams are among the restrictions that limit the application of dreams in groups. At the same time, dreams constitute a universal human experience that is intriguing and compelling. Dreams offer a potential in group counseling for advancing the understanding of group members, promoting cohesiveness among group participants, and stimulating therapeutic group-member interactions.     

Multicultural Counseling: A 10‐Year Content Analysis of the Journal of Counseling & Development

The emphasis on multicultural counseling during the past 20 years has influenced the increase in scholarly publications on this topic. The authors report the findings of a content analysis of 102 multicultural‐centered articles. Journal of Counseling & Development issues spanning 1990–2001 were evaluated. Findings are reported for methodology, populations discussed, applied settings, and authors' roles and institutional affiliations. Findings indicate that there has been an increase of multicultural‐focused publications since 1990 and that publications are more exploratory and developmental rather than pathology‐oriented.