Genetic counselling: Predicting patient outcomes

Abstract

With the rapid development of genetic testing, the demand for genetic counselling is increasing. Yet there is little known about what makes for effective or efficient genetic counselling. The aim of the current study is to determine the main factors influencing outcomes of genetic consultations. One hundred and thirty one routine consultations conducted in a regional genetics centre were audiotaped, transcribed and coded. The main predictors of outcome tested were pre-interview patient and counsellor expectations; pre-interview patient concerns; length of consultations; counsellor directiveness; and the extent to which social and emotional issues are addressed in the consultation. The main outcomes were the patient's view of the extent to which their expectations were met, their satisfaction with information provided, and concern about the problem they were referred with.

Although there were six significant correlations between the process of consultation and outcome variables, multivariate analyses revealed no significant predictors of any of the outcomes. Using multiple regression analyses, small amounts of variance in patient outcomes were predicted by patient and counsellor variables assessed before the consultation, but none was predicted by any of the process measures made of the consultation. Various explanations are considered to explain the lack of influence of process variables upon outcomes. One possible explanation for these findings is that the consultation has a minimal effect upon patient outcomes. Alternatively, the study, in design or analysis, was not sufficiently sensitive to detect the influential aspects of the consultation.     

The application of self-psychology to short-term counselling

Abstract

This article explores how key aspects of Heinz Kohut's self-psychology can inform short-term counselling work. Initially a summary is offered of Kohut's developmental theory, his understanding of the nature and causes of psychopathology and his view of the analytic cure. The application of his ideas to short-term counselling is then discussed. Specifically, it is suggested that short-term therapeutic work based on self-psychology involves a stronger emphasis on the curative aspects of the selfobject transference between client and therapist, a more limited notion of the role of interpretation, and a different understanding of working through to that of long-term self-psychological analysis.     

Signification and Pain: A Semiotic Reading of Fibromyalgia

Patients with persistent pain who lack adetectable underlying disease challenge thetheories supporting much of biomedicalbody-mind discourse. In this context,diagnostic labeling is as inherently vulnerableto the same pitfalls of uncertainty that besetany other interpretative endeavour. The endpoint is often no more than a name ratherthan the discovered essence of a pre-existentmedical condition. In 1990 a Committee of theAmerican College of Rheumatology (ACR)formulated the construct of Fibromyalgia in anattempt to rectify a situation of diagnosticconfusion faced by patients presenting withwidespread pain. It was proposed thatFibromyalgia existed as a ``specific entity',separable from but curiously able to co-existwith any other painful condition. Epistemological and semiotic analyses ofFibromyalgia have failed to find any sign,clinical or linguistic, which coulddifferentiate it from other diffusemusculoskeletal pain states. The construct ofFibromyalgia sought to define a discernablereality outside the play of language and topass it off as a natural phenomenon. However,because it has failed both clinically andsemiotically, the construct also fails the testof medical utility for the subject inpersistent pain.     

Understanding the role of hope in counselling: Exploring the intentional uses of hope

In this paper we look at various conceptual models of hope and research evidence for the integral role that hope plays in counselling. We recognize hope as a dynamic process during which counsellor and client interact in ways that can be mutually influencing and we review research that explores this reciprocal process. A model for the intentional use of hope in counselling that recognizes both implicit and explicit approaches is offered. Metaphors for hope-work that position and re-position both counsellor and client in ways that may foster hope are explored. Finally, we provide suggestions for initiating conversations in which hope can be an explicit therapeutic focus.     

Adventure based counselling,individual counselling and object relations: a critical evaluation of a qualitative study

Adventure based counselling is a short-term experiential psychotherapeutic approach, which utilises adventurous activities and being in natural environmental in order to facilitate therapeutic change in clients. The present paper critically appraises the results of a qualitative study that investigated how clients with self-reported anxiety and depression experienced participating in an innovative counselling intervention with combined individual counselling with such an adventurous outdoor transaction. Interpretative Phenomenological Analysis, as described by Smith and Osborn (2008), was used in order record and analyse the experiences of four male and six female students who were treated at the Teesside's University Counselling Service. Interviewees perceived the counselling sessions as offering a safe therapeutic space within which they could unveil their anxieties and achieve inner healing, whereas the outdoor transaction as providing an experiential venue for achieving personal change. Interviewees felt that without the outdoor transaction the therapeutic significance of the counselling process would not have reached its full potential. Likewise, without the individual counselling, the outdoor transaction would just have an entertaining event and not a venue for personal change. These findings are discussed in relation to object relations theory.     

Cultural landscapes in counselling and psychotherapy: Introduction to the Theme Section

The concept of ‘culture’ is gaining in significance within the discourse of counselling and psychotherapy, as a means of making sense of the ways in which shared identities and behaviours are constructed and maintained. The selection of papers included within this Theme Section explore different aspects of the use of the idea of culture within counselling and psychotherapy. In this introductory piece, we seek to place this work in a social and professional context.     

Openness to psychological explanations and treatment among people with Fibromyalgia versus Rheumatoid Arthritis

Objective: The classic perspective in the psychosomatic literature is that patients with medically unexplained syndromes do not acknowledge psychologically-based causes for their conditions and will not engage in psychological treatments. These assumptions were tested by contrasting the illness models and reported treatment experiences of individuals with fibromyalgia (FM), a syndrome with a currently unknown organic origin, with those of individuals with rheumatoid arthritis (RA), a ‘legitimate’ (i.e. organic) condition.

Method: 193 patients with FM and 176 with RA completed measures assessing their views about the causes of their condition, the treatments they had used and their judged effectiveness.

Results: Contrary to prediction, compared to patients with RA, patients with FM were more likely to endorse psychological causes for their condition and reported having used more psychological management approaches. Moreover, patients with FM considered psychological approaches to be more effective than narcotics.

Conclusion: These findings indicate that patients with FM do not react defensively to the implication of psychogenic causes. Rather, as a group, they tend to acknowledge both the psychosocial influences on and the effectiveness of psychological management approaches for their condition.     

The future of Canadian counselling psychology: Doctoral students

Little is known about the overall characteristics and beliefs of Canadian counselling psychology doctoral students. An online survey was administered to 43 doctoral students across all Canadian counselling psychology programmes, representing an approximate 26% response rate. Results indicated that the average age of doctoral students in the sample was about 32 years and that the majority were women (about 77% in the sample). Additionally, findings can be taken to suggest that participants were satisfied with their choice of counselling psychology as a career. The doctoral students sampled primarily practised from an integrationist theoretical standpoint and spent very little of their practice time providing formal psychological assessment services or career counselling. Participants generally intervened through individual counselling or psychotherapy and were focused on disorder treatment rather than preventative or developmental services. Curriculum changes that should be considered from the results of this study pertain to the topics of assessment, career counselling, advocacy/media skills, professional identity development and prevention/developmental interventions. The results of this study can also be taken to predict characteristics of the next generation of Canadian counselling psychologists and the future practice of counselling psychology in Canada.     

Online counselling: The experience of counsellors providing synchronous single‐session counselling to young people

Kids Help Line (KHL) is a national Australian youth counselling service that provides free online and telephone counselling. This qualitative study examines the experience of 26 online KHL counsellors. Using a focus group methodology, counsellor responses were organised into categories: privacy and an emotionally safe environment; communication through text; and time. Counsellors reported the main benefit of the online environment to be emotional safety, due to reduced client emotional proximity to the counsellor, and the main disadvantage to be that reduced emotional proximity and the absence of non‐verbal cues could result in communication problems and difficulty in accurately assessing young people's concerns. Time proved a significant issue for counsellors, as the slow speed of text exchange could limit their ability to complete interventions. Methods that enhance both the process and effectiveness of online counselling are needed. Potential solutions to the challenges faced by online counsellors are discussed.     

Outcomes in clients transitioning from in-person counselling to telehealth counselling with trainees

The onset of the 2020 COVID-19 pandemic necessitated a rapid transition of mental health services from in-person to telehealth counselling. Despite the far-reaching impact of this transition, we know little about the impact of this transition on outcomes for clients working with counsellor trainees. The present study utilised longitudinal data collected from a counselling training centre at a major U.S. university to compare client ratings of depression, anxiety and working alliance across 1) in-person services delivered (i.e. pre-pandemic) and 2) telehealth services delivered after the pandemic began (i.e. intra-pandemic) among the same group of clients. Results support our hypothesis that changes in clients' self-reports would be generally equivalent across in-person and telehealth services. Depression and anxiety symptoms decreased, and working alliance tended to increase during both in-person and telehealth care; however, these trends were only statistically significant during telehealth services. Limitations related to sample size (N = 15 clients; up to 17 sessions per client) and low statistical power are discussed. Nonetheless, this study supports the growing body of literature supporting the efficacy of telehealth counselling services. We provide suggestions for future telehealth research and discuss implications for counsellor training.     

Introducing counselling in secondary schools: A case study with reference to frame issues

Abstract

I am a deputy headteacher in a comprehensive school. I believe that the widespread re-introduction of counselling into secondary schools offers possibilities for great benefit, both in terms of the personal well-being and emotional health of students, and also in terms of academic results and other educational indicators. It is my view that, currently, this may particularly be true for boys.

This paper is a double case study: first, of the failure of a student to cope with ordinary schooling because of his emotional difficulties; and, second, of the establishment of a counselling service which resulted from his permanent exclusion from the school.

I allude to some of the theoretical issues which meshed with the practical details of establishing the counselling service, and offer some tentative conclusions about the rationale for counselling in secondary schools and the kind of model which seems most likely to be beneficial.     

Action: a bridge between vocational and mental health counselling*

A theory of goal-directed action is proposed as a conceptual link between vocational and mental health counselling. Originally emerging from the vocational counselling field, contextual action theory is presented as a critical conceptual link not only between mental health and occupational life but also between counselling practices in these domains. This specific application of goal-directed action to vocational and mental health counselling is addressed by describing counselling as goal-directed action, the five tasks of counselling it invites, and tools for supporting client goals, such as the self-confrontation interview.     

Research on embedded counselling: An emerging topic of potential importance for the future of counselling psychology

A significant proportion of the counselling that people receive takes place within informal, situated encounters between service users and practitioners in fields such as nursing, medicine, teaching and social work. However, almost all of the research that has been carried out into the process and outcomes of counselling consists of studies of formal, contracted counselling and psychotherapy based in therapy clinics and offices. The competent and effective delivery of counselling that is embedded in a primary professional role, such as that of nurse, teacher or social worker, presents considerable challenges for practitioners. Research evidence around the process and outcomes of embedded counselling represents a valuable resource that has the potential to enhance the quality of counselling conversations enacted by practitioners in health, education, social work and other professions. An overview is provided of different types of research that has been carried out into informal and embedded counselling, and of the main themes that have emerged from these studies. Suggestions are made for the further development of this field.     

Tracking trends: A longitudinal look at internship placements in counselling psychology in the United States

Efforts to track trends in internship placements across time serve the field of counselling psychology in a number of ways. But this research is qualified by its reliance upon a single source of data: the Council of Counseling Psychology Training Program (CCPTP) annual survey. This paper provides a review of the concerns related to this over-reliance, and addresses these concerns by supplementing this data source with the comprehensive data collected by the Association of Psychology and Post-doctoral Internship Centers (APPIC). Findings provide a longitudinal look at the supply and demand issue concerning internship placements, track the nature of pre-doctoral internship placements across a 30-year period of time, and generally support the validity of the CCPTP data by documenting their close correspondence to recent APPIC data.     

Introduction to the Special Section ‘Innovative counselling and psychotherapy research methods’: Defining the future of counselling and psychotherapy research

In the call for papers for this Special Issue, we sought submissions that would introduce innovative methods with the potential to shape counselling and psychotherapy research into the future. We believe that we accomplished this goal and that this issue introduces a range of valuable examples of current innovations in counselling and psychotherapy research methods. Through the review process, we encouraged authors to offer practical guidelines on how to innovatively assess and analyse change and other relevant aspects of therapy. We also guided authors to not only provide the field with an update on cutting‐edge methodology, but also describe these methods in a practice‐friendly way. As such, the Special Issue aims at becoming a building block for future practice‐friendly research in counselling and psychotherapy.     

Applying the principles and techniques of solution-focused therapy to career counselling

Career counselling aims to help clients become more effective agents in solving problems in their vocational aspects of life. To achieve this goal, theorists and practitioners are called upon to form useful helping approaches that can help clients in a more efficient and effective manner. This article proposes an alternative model toward this end by considering and adopting principles and techniques from the solution-focused therapy in career counselling practice. After a very brief introduction of the basic features of the solution-focused counselling, the paper reviews some key theoretical principles of the solution-focused therapy, and connects these principles to career counselling context. It then illustrates several solution-focused counselling techniques that are particularly applicable to career counselling intervention.     

Nature and role of traditional forms of counselling in Zambia: a case of Lusaka province

The aim of this study was to determine the nature and role of traditional forms of counselling and the scope of common problems presented to traditional counsellors in Lusaka province. It used a qualitative research methodology and deployed a holistic single-case study design with multiple embedded units of analysis. The sample consisted of 80 adult participants and one focus group interview with 8 discussants; and it was selected based on the purposive sampling method and snowball technique. Data collection was elicited through structured individual interviews and semi-structured group interview. The study revealed that traditional forms of counselling are rooted in traditional systems of knowledge and sociocultural values, customs, and practices; and they are essentially community-based and multicultural in nature.     

Family Resilience and the Management of Fibromyalgia: Implications for Family Therapists

Fibromyalgia Syndrome (FMS) is one of the most troubling rheumatic disorders for patients, significant others, and the health care providers who treat them. Responses from 150 participants provided valuable information on the relationship between family resilience and the management of fibromyalgia. Self reported family stressors, strains, and distress were significantly associated with an increase in health problems/functional disability, whereas family hardiness and family social support were associated with a decrease. Family stressors and family strains were also positively associated with the frequency of medication use. Medical family therapy interventions that consider the familial context are recommended for treatment. Additional implications for clinical practice and future research are discussed. J. Cameron Preece, PhD, Sage Health Care, PLLC, 339 Allumbaugh Street, Boise, ID 83704. Jonathan G. Sandberg, PhD, Department of Marriage and Family Therapy, Syracuse University, Syracuse, NY 13244. (jgandbe@syr.edu) Special thanks go to Linda Stone Fish, PhD, for her support and guidance throughout the study.