Genetic Counseling—Stress, Coping, and the Empowerment Perspective

Historically one of the basic foundations of the genetic counseling process has been nondirectiveness; however, its definition and utility continues to be in question. There remains a need to develop genetic counseling interventions in order to qualify, quantify, measure, and enhance the genetic counseling process as well as to delineate the complex interactions of education and counseling that occur. We propose a framework for genetic counseling interventions utilizing an empowerment perspective and Lazarus and Folkman's adaptation of the theory of stress and coping. This model frames the genetic counseling process as one that promotes the autonomy of the individual by providing the individual with the tools required to make their own decisions and enhances coping and adjustment to the outcome of those decisions through control and mastery.     

The relationship between cerebral lateralization and cognitive ability: suggested criteria for empirical tests

Many recent investigations in cognitive neuropsychology have been devoted to a fundamental question: are individual differences in cerebral lateralization reliably associated with differences in cognitive ability? The results have been highly inconsistent and inconclusive, with some studies showing a relationship, others not. We propose that research on this question has been hampered by inadequate clarification of the criteria required for a proper test. We suggest what these criteria should be, and, for purposes of illustration, we evaluate representative tests of the lateralization--cognition hypothesis in light of these criteria. We conclude that studies that meet our criteria lend at least a modest measure of support for the hypothesis.     

Differential outcomes of skill training,group counseling,and individual cognitive therapy for persons with acquired visual impairment

As part of the Living Skills Training Program, group counseling and individual cognitive therapy were implemented to decrease psychological distress for adults with acquired visual impairment. This quasi‐experimental design study compared the outcomes of a 6‐month skill training program combined with a group counseling program (n = 37), with (n = 9) or without (n = 10) individual cognitive therapy, and with a control group (n = 42). The outcome measures were the Profile of Mood States and the Nottingham Adjustment Scale Japanese Version. The results showed that participants with low psychological distress decreased anxiety and increased acceptance of disability, even when they did not participate in group counseling. However, among the participants with high distress, they did not show any improvement without group counseling or individual therapy. The participants with high distress who engaged in group counseling showed an improving trend in attitudes toward others. Moreover, the participants who chose to engage in individual therapy in addition to group counseling showed decreased tension‐anxiety, depression, and fatigue, and significantly improved acceptance of disability. These results suggest that group counseling, combined with individual cognitive therapy, can be an effective part of rehabilitation treatment for clients who have high psychological distress.     

Extending Psychotherapeutic Strategies to People With Disabilities

In the last decade mind-body strategies have evolved to extend possible counseling approaches to persons with disabilities. Using Beatrice A. Wright's principles of attention to individual needs, respect for situational complexities, and flexibility, the authors reflect on the work of Milton H. Erickson, from which modern mind-body counseling interventions can be traced. Included are strategies to develop rapport, the therapeutic use of imagery, reframing and other paradoxical techniques, and the use of metaphor in counseling with people with disabilities.     

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.     

The Counseling Profession's Commitment to Diversity-Sensitive Counseling: A Critical Reassessment

The authors pose questions in this article that are intended to stimulate more effective strategies to ensure gender, racial, and ethnic diversity in the counseling profession. The first question addresses the implications of between-group versus within-group differences for the counseling process. The second question examines the need to expand the dialogue across all minorities. The third question asks who should conduct multicultural research. Various constituencies, including clients, practitioners, counselor educators, scholars, and researchers are affected. Inconsistencies are noted between the strategies now being used to achieve diversity and the philosophical foundations of the counseling profession itself. Seven recommendations are made.     

Development of E-Info Geneca: A Website Providing Computer-Tailored Information and Question Prompt Prior to Breast Cancer Genetic Counseling

This article describes the stepwise development of the website ‘E-info gene^ca’. The website provides counselees in breast cancer genetic counseling with computer-tailored information and a question prompt prior to their first consultation. Counselees generally do not know what to expect from genetic counseling and they tend to have a passive role, receiving large amounts of relatively standard information. Using the “intervention mapping approach,” we developed E-info gene^ca aiming to enhance counselees’ realistic expectations and participation during genetic counseling. The information on this website is tailored to counselees’ individual situation (e.g., the counselee’s age and cancer history). The website covers the topics of the genetic counseling process, breast cancer risk, meaning of being a carrier of a cancer gene mutation, emotional consequences and hereditary breast cancer. Finally, a question prompt encourages counselees to prepare questions for their genetic counseling visit.     

The Uniqueness of Similarities: Parallels of Milton H. Erickson and Carl Rogers

The philosophy and values of Carl Rogers hold a central position in the counseling profession. Today the writings and work of Milton H. Erickson are beginning to have a similar influence. Erickson's strategies and techniques have been explored from many theoretical frames of reference, but little attention has been paid to his values regarding the human condition. It is these value assumptions of Rogers and Erickson that will be examined in this article.     

Self-Disclosure as an Approach to Teaching Ethical Decision-Making

This article presents arguments for and against weight loss counseling in feminist therapy. Conflicts between feminist therapy and weight loss counseling are explored and the implications of counseling and not counseling on women's empowerment are considered. Although each case requires an individual ethical decision, the author, a feminist therapist who has done weight loss counseling in the past, concludes that the answer to the title question should, in general, be "no."     

Social Commitment and Individualism in Counseling

Counselors highly value social commitment as complementary to their primary emphasis on the welfare of the individual client. This article discusses how the primary emphasis on the individual raises for counselors the possibility of a kind of therapeutic individualism inimical to social commitment and the common good. The importance placed on social commitment in counseling and the influence of therapeutic individualism are examined. It is proposed that the already significant role of social commitment in counseling can be enhanced by clarifying the balance between the individual and social perspectives.     

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.     

Violence between Couples: Profiling the Male Abuser

The development of effective strategies for counseling abusive males has been hampered by a lack of information concerning the factors that contribute to violent episodes between couples.     

Ethics in Case Conceptualization and Diagnosis: Incorporating a Medical Model Into the Developmental Counseling Tradition

In this literature review, the author focuses on several ethical considerations in case conceptualization and diagnosis, including diagnostic training and competence. Meeting the American Counseling Association's (1995) ethical standard for diagnostic training has several ethical implications for counselors, counselor educators, and supervisors. For counselors who might struggle with how to meet their ethical responsibilities in diagnosis but who want to remain true to their developmental counseling emphases, the author discusses some of their concerns, the implications of and possible approaches to this aspect of their work. Conclusion Yalom (2002) asked a poignant question of counselors in his book, The Gift of Therapy: “If you were in personal psychotherapy or are considering it, what DSM‐IV diagnosis do you think your therapist could justifiably use to describe someone as complicated as you?” (p. 5). This question and continued dialogue about the ethics and implications of diagnosis are essential aspects of diagnostic training. Yalom's poignant and deeply personal question seems especially appropriate for increasing a counselor's empathy toward the client's sensitivity and vulnerability during the diagnostic process. Counselor educators might ask how one remains true to a developmental model of counseling while adhering to the ethical and accreditation standards of teaching the DSM's medical model of diagnosis. Counselors may also question how to use diagnosis ethically and empathically. Seligman (1999) recommended that clinicians view the DSM as one of many important sources of information about a person. Furthermore, counselors should seek to incorporate diagnostic information into a holistic context, recognizing that a diagnosis does not reflect the totality of the client. Some counselor educators have advised students to integrate the DSM model into their work with clients rather than abandoning their developmental roots (Waldo et al., 1993). Some counselors may not actually put their diagnoses in writing; Seligman believed, however, that thinking diagnostically may assist counselors in determining the best approaches to help clients and to help clients help themselves. This clinical and ethical debate about how, and in fact, whether, to integrate the medical model of the DSM and the developmental origins and distinctiveness of counseling continues. However, the CACREP (2001) standards, managed care systems, and other forces have pushed counseling professionals toward a medical model by mandating counselor knowledge and use of the DSM. Whatever a counselor's stance and behavior on client assessment and diagnosis may be, the literature presented in this review and discussion seems to suggest a need for heightened sensitivity to, preparation for, and accuracy in all facets of client assessment, especially diagnosis.     

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.     

Counseling for Dropout Prevention: Applications From Multicultural Counseling

Although high school dropout rates have declined over the past several years, rates remain high for many segments of our population. Most of the attention devoted to dropout prevention counseling has focused on group counseling or programmatic issues, whereas individual counseling has largely been ignored. This article draws on commonalities between multicultural counseling and dropout prevention to produce a general framework for individual counseling with students who have potential to drop out of high school.     

Longitudinal effects of two individual career counseling interventions on clients’ career decision-making during the COVID-19 pandemic over a 1-year follow-up

This study assessed the effects of two individual career counseling interventions during the COVID-19 pandemic over a 1-year follow-up. Participants (n = 71) engaged either in four individual humanistic–psychodynamic (during winter 2021) or cognitive career counseling (during winter 2022) sessions at a university counseling clinic. Latent growth models indicated that clients experienced a significant reduction in their career decision difficulties and psychological distress and a significant increase in their life satisfaction over sessions and the 12 months following. Clients who received cognitive career counseling sessions experienced larger effects. Results highlight the utility of individual career counseling in times of crisis.     

The Identification and Modification of Defense Mechanisms in Counseling

This article suggests considerations and strategies for identifying and modifying a client's defense mechanisms in counseling. A systematic approach to a client's mechanisms of defense contributes to therapeutic gain. Inappropriate counselor responses intensify an individual's defenses and undermine the counseling relationship. Definitions of individual defenses and indicators for identifying the mechanisms are provided. A literature review focuses on the counseling implications of the defenses. The process of defense mechanism modification is illustrated through a case example.     

DISORGANIZATION,FEAR AND ATTACHMENT: WORKING TOWARDS CLARIFICATION

In 1990, M. Main and J. Solomon introduced the procedures for coding a new “disorganized” infant attachment classification for the Ainsworth Strange Situation procedure (M.D.S. Ainsworth, M. Blehar, E. Waters, & S. Wall, 1978). This classification has received a high degree of interest, both from researchers and from child welfare and clinical practitioners. Disorganized attachment has primarily been understood through the lens of E. Hesse and M. Main's concept of “fright without solution,” taken to mean that an infant experiences a conflict between a desire to approach and flee from a frightening parent when confronted by the Strange Situation. Yet, looking back, it can be observed that the way Hesse and Main's texts were formulated and read has generated confusion; there have been repeated calls in recent years for renewed theory and clarification about the relationship between disorganization and fear. Responding to these calls, this article revisits the texts that introduced the idea of fright without solution, clarifying their claims through articulating more precisely the different meanings of the term fear. This clarified account will then be applied to consideration of pathways to infant disorganized behaviors.     

Continuity and change in the measurement of infant attachment: comment on Fraley and Spieker (2003)

R.C. Fraley and S.J. Spieker (2003) refocused attention on the important question of continuous versus categorical measurement of infant attachment. This commentary begins with a brief response to Fraley and Spieker's position. Next, it highlights the usefulness of the categorical approach by reviewing some of the major advances in the field that have been fostered by a categorical approach. These include the identification of the disorganized attachment group, the development of the concept of conditional behavioral strategies, the creation of systems for coding attachment beyond infancy, and a greater understanding of cross-generational associations. The author then makes several propositions for future research that are necessary for clarifying how best to measure infant attachment.     

The Impact of World Views on Professional Life-styling

A world view expresses the presuppositions a person makes about his or her world. These basic presuppositions center on the nature of ultimate reality, of the universe, of mankind, the meaning of death, the basis of ethics, and the meaning of human history. The four perspectives of theism, deism, agnosticism, and atheism summarize views regarding these six issues. Then the influence of each of the four perspectives on certain counseling issues that are seen as the warp and woof of a counselor's value system are analyzed. These special counseling issues are the counselor-client relationship, motives for counseling, counseling goals, the method of dealing with special problems, and the choice of counseling strategies. One implication of this analysis is that counselors-in-training should study all the perspectives and also formulate for themselves a personal counseling approach that reflects thinking on both the six world issues and the special counseling issues. The second implication of the analysis is that the authentic counselor can work with others in a climate of respect for world views that differ from his or hers. The counselor does not threaten their beliefs—even when helping them to explore, clarify, and develop personal values. Jeffry Tindall reviews the philosophical approach that Smith proposes and urges that the emphasis of counselors be focused in the philosophical area of axiology.