Scaffolding a community of competent practitioners: positioning and agency in a training program for narrative counseling

This article explores the scaffolding of learning experiences in a postgraduate program in New Zealand that offers training in narrative counseling. The authors draw on positioning theory to identify student shifts in learning, and in agency, that help build an increasingly skilled and peer-generated context for learning. We describe a selection of exercises and one key assignment, introduced in the course in a particular order, that we believe enable students to step into positions of agency which ultimately allow a competent community of learner-practitioners to emerge. We also describe a dance of positioning for ourselves as teachers in this program. We suggest that, at any given time, our own positioning is tied up with possibilities for student positioning. Acknowledging relationships of power in classrooms, we explore ways to align poststructuralist counseling practices and the teaching of these practices.     

National Ambulatory Medical Care Survey: Tobacco intervention practices in outpatient clinics

Tobacco use remains the leading cause of preventable death. The outpatient medical clinic represents an important venue for delivering evidence-based interventions to large numbers of tobacco users. Extensive evidence supports the effectiveness of brief interventions. In a retrospective database analysis of 11,827 adult patients captured in the 2005 National Ambulatory Medical Care Survey (of which 2,420 were tobacco users), we examined the degree to which a variety of patient demographic, clinical and physician-related variables predict the delivery of tobacco counseling during a routine outpatient visit in primary care settings. In 2005, 21.7% of identified tobacco users received a tobacco intervention during their visit. The probability of receiving an intervention differed by gender, geographic region and source of payment. Individuals presenting with tobacco-related health conditions were more likely to receive an intervention. Most physicians classified as specialists were less likely to intervene. The provision of tobacco intervention services appears to be increasing at a modest rate, but remains well below desirable levels. It is a priority that brief interventions be routinely implemented to reduce the societal burden of tobacco use. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Mental health of outpatient pediatric patients

The purpose of this study is to estimate the percentage of mental health problems in a pediatric outpatient Norwegian clinic. We used the Strengths and Difficulties Questionnaire to screen for mental health problems. Families of children aged 4–11 took part in the study, and 380 out of 982 possible families consented to take part, and 349 families contributed with questionnaire data. The main referral reasons for the patients were asthma, eneuresis and stomach pain. Mothers reported that 17.4% of boys and 17.8% of girls displayed mental clinical problems. The prevalence of problems did not differ significantly between somatic diagnostic groups. Although the study has low participation, it underlines the necessity of screening all pediatric patients for mental health problems. Future research in pediatric clinics should include factors of psychology because pediatric problems are not caused by somatics alone.     

Sense of agency in health and disease: a review of cue integration approaches

Sense of agency (SoA) is a compelling but fragile experience that is augmented or attenuated by internal signals and by external cues. A disruption in SoA may characterise individual symptoms of mental illness such as delusions of control. Indeed, it has been argued that generic SoA disturbances may lie at the heart of delusions and hallucinations that characterise schizophrenia. A clearer understanding of how sensorimotor, perceptual and environmental cues complement, or compete with, each other in engendering SoA may prove valuable in deepening our understanding the agency disruptions that characterise certain focal neurological disorders and mental illnesses. Here we examine the integration of SoA cues in health and illness, describing a simple framework of this integration based on Bayesian principles. We extend this to consider how alterations in cue integration may lead to aberrant experiences of agency.     

Adolescents' perceptions of outpatient mental health services

Thirty-three adolescents from three mental health service settings were interviewed regarding their perceptions of the purpose, goals, expectations, frustrations and benefits of mental health experiences. They provided satisfaction ratings and importance rankings of seven domains of satisfaction: (a) Convenient/Accessible, (b) Meeting Needs, (c) Staff Competence, (d) Personal Relationship with Staff, (e) Effectiveness of Treatment, (f) Comfort/Appropriateness of Center, and (g) Costs and Paperwork. In addition, participants completed the Client Satisfaction Questionnaire (CSQ-8). Results indicated that, in general, the adolescents were very satisfied with the services they received. Gender, race/ethnicity and treatment site were not related to satisfaction scores, nor was the adolescent's perceived choice in seeking services. Some significant gender differences were found both in terms of the rankings of satisfaction domains, as well as in the adolescents' perceptions of their reasons for initiating counseling and the perceived goals and benefits of counseling. Additional differences in perceptions of services were found for treatment site and race/ethnicity. In general, adolescents were able to generate informative, sophisticated responses to questions regarding their perceptions of mental health services, and demonstrated that they are capable of evaluating services they receive.     

Update on master's genetic counseling training programs: Survey of curriculum content and graduate analysis summary

The field of genetic counseling is a recognized specialty in medical genetics with the primary practitioners being masters degree prepared individuals. Since the inception of the first master's degree genetic counseling (MGC) training program in 1969, more than 1000 genetic counselors have graduated from established training programs in United States and Canada. The MGC programs involve a 2-year academic curriculum of both didactic course work and supervised clinical field work (clinical praticums). A recent survey of 17 existing MGC training programs (16 U.S. and 1 Canadian) reveals that MGC graduates average a total of 1349 actual contact hours (range 854–1952 hours) during their 2-year degree program course of study. Clinical experience gained through clinical practica accounts for 58% of required coursework, followed by didactic coursework in basic science (21%) and counseling (16%), respectively. A few programs also have requisite laboratory practica, which accounts for 5% of overall content hours. The 17 existing MGC programs produce approximately 100 graduates annually. Although the number of programs has grown since inception of the first MGC program in 1969, the mean number of graduates per program remains fairly constant. By year 2002, the estimated total number of master's degree trained genetic counselors will approach 2200.     

Adolescent males' view on the use of mental health counseling services

This study investigated adolescent males' view on mental health counseling. Additionally, participants were asked if they had ever used mental health counseling services, if they expected to use such services in the future, and what types of services/activities would constitute a successful counseling experience. The participants' responses indicated that they associated mental health counseling with mental illness and pathology. Eighty-eight percent of the participants reported having never used mental health counseling services. Surprisingly, 69% reported a willingness to use mental health counseling services for life's concerns. Finally, the participants identified a preference for action-oriented counseling strategies. Implications for mental health counseling practice are discussed.     

Improving the efficiency of a community mental health agency: An accountant's view

American Journal of Community Psychology -     

Family therapy training methods: minimal contact with an agency

This paper describes the development, implementation and monitoring of a family therapy training programme with several special features. Training was given to staff of a large agency at a site distant from the trainers. Because input from trainers was limited, peer-group self-directed teaching approaches were used. Formal evaluation demonstrated that the programme was successful. This report describes the concepts, methods and techniques which were employed in this programme and which can be easily used in other settings.     

Situated agency: towards an affordance-based,sensorimotor theory of action

Recent empirical findings from social psychology, ecological psychology, and embodied cognitive science indicate that situational factors crucially shape the course of human behavior. For instance, it has been shown that finding a dime, being under the influence of an authority figure, or just being presented with food in easy reach often influences behavior tremendously. These findings raise important new questions for the philosophy of action: Are these findings a threat to classical conceptions of human agency? Are humans passively pushed around by situational factors, or are there agential aspects in the way we spontaneously experience and react to situations? How can one conceptualize the pervasive influence of situational factors on human action? What are situations in the first place, and how should the influence of these situations on action be thought of? This paper sets out to develop a new conceptual repertoire for thinking about the influence of situations on action, drawing on research from ecological psychology as well as from embodied and enactive cognitive science. The key proposal is the development of a philosophical sensorimotor account of agency: Action, it is proposed, should be conceived of as constant dynamical interaction of agential and environmental factors – factors which should all be conceptualized in new ways.     

A qualitative study of citizens' experience of participating in health counseling

Individual health counseling is a form of intervention designed to minimize the effects of chronic health disease and to offer a path towards good health practices. The aim of the present study was to explore the experiences of those persons who participated in health counseling in order to assess the psychosocial significance of the counseling upon their health behavior. In addition the study was concerned with the factors which underlay peoples' decision to sign up for health counseling. The research involved 11 semi‐structured interviews with individuals who had participated in a municipality based health counseling program. Data was analyzed using Malterud's systemic text condensation and a theoretical framework around Bandura's social cognitive theory. Analysis revealed that an approach tailored to each individual with minor short‐term goals accompanied by feeling supported by the counselor produced the greatest impact on behavior. Receiving feedback from the counselor and feeling positive about the relationship were seen as essential. These aspects were also crucial in the decision to undertake health counseling. The study indicates that whether individual's sign up on their own initiative or conversely are invited to join the program has no influence upon their motivation to change their behavior. Overall the respondents demonstrated improvement in their behavior and attitudes towards their health. However, the study also indicates that this form of intervention is less or even ineffective without the support of the individual's immediate family.     

Unheard Alaska: Culturally Anchored Participatory Action Research on Sobriety with Alaska Natives

Alcohol research in Alaska Native communities has a contentious history. This project has attempted to address a critical need for research to guide alcohol abuse prevention and treatment with Alaska Natives using culturally anchored participatory action research. The process of grounding the research methodology in the culture and community is described, along with its contribution to community psychology's understanding of the importance of cultural factors. Tensions between indigenous values and ways of knowing, and Western research methodologies are delineated, along with how these tensions were resolved. Important issues that arose in doing culturally anchored participatory action research are described. These included the development of a community of inquiry, key methodological decisions, the empowerment of participants as coresearchers, and flexibility in research implementation.     

Definitions of Multicultural Competence: Frontline Human Service Providers' Perspective

In this qualitative study, the authors explored definitions of multicultural competence given by 99 frontline human service providers. The providers had no formal training in counseling but served in a helping role. Seven thematic definitions emerged: color blindness, client focused, acknowledgment of cultural differences, textbook consistent, resource driven, skills‐based, and self‐integrated. Implications for multicultural competence are discussed. En este estudio cualitativo, los autores exploraron las definiciones de competencia multicultural ofrecidas por 99 proveedores de servicios humanos de primera línea. Los proveedores no tenían una formación oficial en consejería, pero actuaban en roles de ayuda. Surgieron como resultado siete definiciones temáticas: indiferente al color, enfocada hacia el cliente, reconocimiento de diferencias culturales, libro de texto, guiada por los recursos, habilidades y autointegrada. Se discuten las implicaciones para la competencia multicultural.