Cross-cultural pastoral counseling: Method or hermeneutic?

This article explores some of the meta-questions that emerge when talking about “cross-cultural pastoral counseling.” Is it a distinct counseling method or a practical hermeneutic that prompts the counselor to examine his or her therapeutic approach? The author argues that “cross-cultural pastoral counseling” is really a hermeneutic that challenges the pastoral counselor to an ongoing evaluation of how and to what extent his or her approach to pastoral counseling may be guided by dominant social convention versus the gospel mandate of Matthew 25: 31–46 [RSV]. The article reviews relevant literature, discusses three fundamental changes (“conversions”) that are necessary for the pastoral counselor in order to do cross-cultural pastoral counseling, and presents a case illustration involving a multi-cultural pastoral counseling intervention.     

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.     

Person‐Centered Counseling: The Culture Within

The variables most related to success in counseling outcome research are the client‐counselor relationship and the personal and situational resources of the client (extratherapeutic variables). When these variables are compromised, a “specificity myth” is endorsed purporting that there are specific treatments for particular groups of people. This myth is a direct result of a shift in focus from the client to the counselor as the expert who focuses on “doing” counseling rather than “being” a counselor. Person‐centered counseling cuts to the core of therapeutic success: the relationship of the counselor‐client and the utilization of the client's resources.     

Can You Keep a (Genetic) Secret? The Genetic Privacy Movement

This paper reviews the literature on genetic privacy, especially since 1995 and the first proposal for national genetic privacy legislation. Since that time, a majority of states have passed some form of genetic privacy legislation, and efforts to pass federal legislation are ongoing. Such new laws, however, remain untested in the courts and their effects are unclear. If they fail to provide additional protections against discrimination for most people, their most significant impact may be in their ability to either diminish or enhance the power of genetic information and to influence the way individuals view themselves and others. How does “genetic exceptionalism”—the idea that genetic information is different from other types of medical information—relate to “genetic essentialism”—the idea that we are to a large extent shaped by our genes? Anthropological views on genetics and personhood bring a new perspective to this ongoing debate. Implications for counseling practices are also explored.     

Inherited Thrombophilia: Key Points for Genetic Counseling

With the evolution of medical genetics to focus on highly prevalent, multifactorial conditions, it is inevitable that genetic counselors will be called upon to participate in the evaluation and counseling of individuals with inherited thrombophilia. The purpose of this review is to educate the genetic counselor on key issues related to risk assessment and genetic counseling for hereditary thrombophilia. The information contained in this document is derived from an extensive review of the literature, as well as the author's personal expertise. Upon completion of this review, the genetic counselor will be able to: a) describe inherited and acquired risk factors for thrombosis, b) collect and interpret personal and family histories to assess risk related to hereditary thrombophilia, c) discuss the potential advantages and disadvantages of thrombophilia testing, including psychosocial aspects and implications for medical management, and d) identify educational and support resources for patients and families.     

Genetic Counseling Practice in Next Generation Sequencing Research: Implications for the Ethical Oversight of the Informed Consent Process

The potential for next generation sequencing research (NGS) to generate individual genetic results could have implications for the informed consent process and the provision of genetic counseling. We undertook a content analysis of informed consent templates and guidelines produced by Canadian institutional review boards, purposively sampling documents used by researchers to obtain consent from participants in genetics studies. Our goal was to examine the extent to which the informed consent documents addressed genetic counseling and the return of individual genetic results. Our analysis reveals that the majority of informed consent documents did not mention genetic counseling while several did not mention the return of results. We found differences in the ways in which documents addressed availability of counseling, eligibility criteria for referral to a genetic counselor, genetic counselor involvement, provision of services to family members of participants and incidental findings. From an ethical standpoint, consent documents should provide appropriate information so that participants may make an informed decision about their participation in research. The need to ensure adequate counseling for study populations in an NGS research context will necessarily involve adapting values that underlie care in genetic counseling practice. If the interests of research participants are to be truly promoted, the drafting and review of informed consent documents should give proper due to genetic counseling.     

EMPIRICAL COMPARISONS OF COUNSELOR ORIENTATIONS

The purpose of this study was to investigate counselor behaviors related to being “counseling oriented” in one's interaction with clients as opposed to being “placement oriented.” The levels of therapeutic conditions (accurate empathy, self congruence, unconditional positive regard, and intensity and intimacy of interpersonal contact) were all positively correlated with being counseling oriented (p<.01). The multiple correlation of the therapeutic conditions with being counseling oriented was .74 with accurate empathy accounting for the major portion of the variance. Further analysis of the frequency of specific counselor responses revealed that counselors who provide high therapeutic conditions, or those who are counseling oriented: (a) manifest a distinctly different pattern of responses; and, (b) are more active in the counseling relationship in terms of total responses.     

Medical Genetics and Genetic Counseling in Chile

In the South American Republic of Chile genetic counseling is not currently recognized as an independent clinical discipline, and in general is provided by physicians with training in clinical genetics. At present only one genetic counselor and 28 clinical geneticists practice in this country of over 16 million inhabitants. Pediatric dysmorphology constitutes the primary area of practice in clinical genetics. Although the country has a universal health care system and an adequate level of health care, genetic conditions are not considered a health care priority and there is a lack of clinical and laboratory resources designated for clinical genetics services. Multiple educational, cultural and financial barriers exist to the growth and development of genetic counseling services in Chile. However, during the last 10 years increased awareness of the importance of identifying individuals at risk for inherited cancer syndromes led to growing interest in the practice of cancer genetics.     

Personalized Genomic Results: Analysis of Informational Needs

Use of genomic information in healthcare is increasing; however data on the needs of consumers of genomic information is limited. The Coriell Personalized Medicine Collaborative (CPMC) is a longitudinal study investigating the utility of personalized medicine. Participants receive results reflecting risk of common complex conditions and drug—gene pairs deemed actionable by an external review board. To explore the needs of individuals receiving genomic information we reviewed all genetic counseling sessions with CPMC participants. A retrospective qualitative review of notes from 157 genetic counseling inquiries was conducted. Notes were coded for salient themes. Five primary themes; “understanding risk”, “basic genetics”, “complex disease genetics”, “what do I do now?” and “other” were identified. Further review revealed that participants had difficulty with basic genetic concepts, confused relative and absolute risks, and attributed too high a risk burden to individual single nucleotide polymorphisms (SNPs). Despite these hurdles, counseled participants recognized that behavior changes could potentially mitigate risk and there were few comments alluding to an overly deterministic or fatalistic interpretation of results. Participants appeared to recognize the multifactorial nature of the diseases for which results were provided; however education to understand the complexities of genomic risk information was often needed.     

Carl McDaniels: A Life of Transitions

Carl McDaniels has made contributions to professional counseling for nearly 40 years. He is well known for practical applications of career development theory such as the Virginia Tech Employee Career Development Program and the Virginia Career Information Delivery System, and for his theoretical formula “Career = Work + Leisure.” In this interview, he reflects on transitions in his career as a counselor and a counselor educator.     

The marriage and family counseling profession (An editorial)

Abstract

Marriage and family counseling must become an autonomous profession because it is socially necessary, open to those who are qualified to practice it and for those who need it, and consultative. Legally recognized in only five states, it is struggling through growing pains in the rat of the US. The special field of this profession is the procesr of interpersonal dynamics in the intimate setting of the family and its effects on the individual. The clinical work of the marriage and family counselor becomes “adaptive,” “therapeutic” or “maturational,” depending on different variables.     

Issues and Insights: Working With God: Managing Conservative Christian Beliefs That May Interfere With Counseling

Counselors who work with conservative Christians may ask how to respect a client's values when “God” seems to be saying something contrary to what the counselor believes is in the client's best interests. In a managed care era of decreasing choice about one's counselor, referral of such clients to a conservative Christian counselor is not always an option. “Working with God” when counseling conservative Christian clients requires counselors to understand conservative Christian beliefs. This article portrays conservative Christianity as a culture and articulates conservative Christian beliefs that may challenge the counseling process, suggesting options within the framework of these beliefs.     

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.     

Multiple-family group counseling

This article describes the innovative, short-term approach of multiple-family group counseling in which the counselor applies the principles and dynamics found in family and group counseling to the treatment of the student—in this case, the “identified client” and his family. In an attempt to provide an effective and economical therapeutic experience of practical value to the school system, several family units meet together to discuss some of the personal-social problems that adversely affect the adolescent and result in the acquisition of maladaptive behaviors within the school setting.     

Providing a Transcultural Genetic Counseling Service in the UK

This paper uses a broad definition of culture to explore the practice of transcultural genetic counseling through three case studies. The first case involves a White genetic counselor seeing an Asian family, the second, an Asian genetic counselor seeing an Asian family and the third, a hearing genetic counselor seeing a culturally Deaf client. Boundaries, transference and countertransference reactions are considered within each transcultural encounter and the author of each case reflects in detail on their role in the client interaction and their impact on the transcultural dynamic. The cases are used to illustrate some cultural beliefs or characteristics that may challenge the genetic counselor’s expectations. The value of identifying and interpreting these differences to facilitate useful clinical work is considered. The paper debates, where possible, whether it is helpful to culturally match genetic counselor and client.     

Iceland—Genetic Counseling Services

This brief report aims to give an overview of the history and current status of clinical genetics services in Iceland and specific genetic counseling considerations for Iceland’s population. Presently, there are two part time medical geneticists and one full time genetic counselor with an MSc education from Cardiff, within the Department of Genetic and Molecular Medicine, based in Iceland’s only tertiary healthcare facility, Landspitali, the National University Hospital. An oncologist (20 %) also contributes to the cancer genetic counseling service. In addition, a pediatric medical geneticist has a 25 % appointment at the Children’s Hospital. No other health care organization offers genetic counseling, and there are no private genetic counseling services.