Shameful secrets and shame-prone dispositions: How outcome expectations mediate the relation between shame and disclosure

Shame may be a deterrent to disclosing secrets to a counselor, and shame-proneness may be associated with generalized tendencies to avoid disclosure of distress. If so, the mechanism explaining these relations might be the expected outcomes about disclosure. College students in the United States (N?=?312) thought of a shameful secret of theirs, and they rated the degree of shame they felt about the secret, their willingness to disclose the secret to a potential counselor, and their expected support from a potential counselor (i.e. outcome expectation). Participants also completed dispositional measures of shame-proneness, generalized outcome expectations about disclosure, and disclosure tendencies. Mediation analyses revealed that participants’ experiences of shame regarding their secrets predicted lower anticipated support from the counselor which predicted lower willingness to disclose the secret. This effect largely replicated at the dispositional level, such that anticipated risks of disclosure mediated the relationship between shame-proneness and disclosure tendencies. These findings suggest that counselor efforts to promote healthy client disclosure could target the client’s outcome expectations about disclosure rather than the client’s degree of shame.     

Factors Assisting Female Clients' Disclosure of Incest During Counseling

The purpose of this study was to explore specific behaviors and characteristics of counselors that relate to adult, female clients' disclosure of incest during counseling. A total of 37 female incest victims who had sought counseling within the previous 3 years completed the study. Information about disclosure of incest during counseling and perceptions of counselors' characteristics and reactions were gathered by a structured interview and the modified Barrett-Lennard Relationship Inventory. Results suggest that factors related to initial disclosure and exploration of incest are client readiness, direct questioning by the counselor, specific counselor characteristics, and positive counselor reactions to initial disclosure. Guidelines for assisting clients' disclosure of incest are presented.     

Testing Two Theoretical Explanations for the Attraction-Enhancing Effects of Self-Disclosure

The study investigated the differential ability of similarity theory and social exchange theory to predict the effects of self-disclosure in a counseling versus a friendship encounter The participants were 80 undergraduates. A 2 (counseling or friendship) × 2 (positive or negative disclosure) × 2 (relevant or irrelevant disclosure) design was used in which participants rated the videotaped self-disclosure of an individual in an initial dyadic encounter. Unequivocal support was not obtained for either of the theories, but relationship context (counselor vs. peer) influenced the effects of disclosure as measured on counselor-peer and relationship characteristics. A unique feature of the study was the use of the Client Reactions System (CRS) to measure participants' immediate reactions to self-disclosure. The CRS demonstrated both relationship context and valence of disclosure (positive or negative) effects.     

Effect of Client and Counselor Ethnicity on Preference for Counselor Disclosure

Preferences for counselor self‐disclosure based on the ethnicity of both the respondent and the counselor were examined for African American and Caucasian students. Results suggested that respondent ethnicity affected preferences for certain types of information about the counselor (personal feelings, sexual issues, professional issues, and success/failure) and that there were interaction (respondent by counselor ethnicity) effects on preference for disclosure in other areas (interpersonal relationships and success/failure). Implications for research and practice are discussed.     

The Role of Expectations in Effective Genetic Counseling

The goals for this investigation were to assess individuals' expectations for social support from genetic counselors, and to explore how these expectations influence perceptions of genetic counselor effectiveness. Two studies were conducted to address these goals. Results from the first study show that individuals most frequently expect genetic counselors to provide options and support following the disclosure of distressing test results, while data from the second study demonstrate that expectations play a significant role in individuals' assessment of genetic counselor effectiveness. These findings shed light on what individuals expect from genetic counselors following the disclosure of medically positive test results and inform how these expectations influence the success of genetic counseling sessions.     

counselor nonverbal self‐disclosure and fear of intimacy during employment counseling: an aptitude—treatment interaction illustration

This study investigated the effects of nonverbal self‐disclosure within the dynamic of aptitude—treatment interaction. Participants (N= 94) watched a video of a career counseling session aimed at helping the jobseeker to find employment. The video was then edited to display 3 varying degrees of nonverbal self‐disclosure. In conjunction with the measure of counselor assessment, the authors measured the fear‐of‐intimacy level by using the Doi and Thelen (1993) model. Results showed that when self‐disclosure does not have an effect on counselor assessment, a moderator effect due to the fear of intimacy becomes evident. Implications for research and practice are presented.     

Role of Parenting Relationship Quality in Communicating about Maternal BRCA1/2 Genetic Test Results with Children

It is known that many mothers rapidly share the results of their BRCA1/2 genetic testing with their children, especially adolescent children. What is less known is the extent to which these mothers may engage fathers in a discussion concerning genetic counseling and the anticipated disclosure of genetic test results to children, or seek shared decision making in this context. This short communication addresses this issue by first examining mothers' and fathers' discussions concerning a research study of family communication. In our view, this conversation likely served as a precursor to, and proxy indicator of, maternal receptivity to partner input regarding the genetic counseling/testing-results disclosure process. We further evaluated how the quality of the parenting relationship is associated with mothers' decisions to include or not include the child's father in this study. Finally, this report addresses potential ways in which the genetic counselor may be able to facilitate parental communication regarding the evolving process of disclosure of genetic information to children and adolescents.     

The Impact of Counselor and Participant Gender on Willingness to Discuss Relational Topics: Development of the Relationship Disclosure Scale

The current investigation examined people's willingness to disclose personal information about their intimate relationships to counselors. This was accomplished by asking 431 students to indicate how willing they would be to discuss 25 relationship topics, as measured by the newly developed Relationship Disclosure Scale (RDS), with female and male counselors. The results indicated that people's willingness to disclose their intimate relationships to counselors depended on their own gender, the gender of the counselor, and the particular relationship topics assessed by the RDS. In addition, several personality variables associated with relational-esteem and relational-consciousness were found to be associated with women's willingness to engage in relationship disclosure with male and female counselors. These findings underscore the impact of gender and personality on counseling disclosure tendencies. The discussion focuses on gender and the use of the RDS in research and counseling settings.     

Are Genetic Counselors and GLBT Patients “on the Same Page”? an Investigation of Attitudes, Practices, and Genetic Counseling Experiences

Gay, lesbian, bisexual, and transgender (GLBT) individuals comprise a growing patient population in genetic counseling, yet literature on working with this population is scarce. This study sought to investigate GLBT patient experiences in genetic counseling and genetic counselor attitudes and practices when counseling GLBT patients. Twenty-nine GLB individuals who had previously participated in genetic counseling, and 213 genetic counselors completed online surveys. No individuals identifying as transgender participated. The patient survey assessed disclosure of orientation, discrimination in genetic counseling, and quality of services received. The counselor survey assessed comfort with and attitudes about counseling GLBT patients, disclosure of counselor orientation, and whether they counsel differently with this population. Every patient denied experiencing discrimination during their session, but 17% reported their genetic counselor assumed they were heterosexual, and 45% indicated intake forms were not GLBT-inclusive. A majority of counselors (91%) reported having counseled GLBT patients and indicated they were comfortable doing so (86%), and 72% indicated no differences in their counseling approaches with GLBT patients. Few counselors (17%) received training in GLBT issues, and most (61%) desired such education. Additional findings and practice and research recommendations are presented.     

Problems in privileged communication

Although most counselors offer their clients confidentiality as a condition of the counseling relationship, they are unable to guarantee the protection of privileged communication. Even when protected by statutory provision, counselors do not have total immunity from appearance in court and disclosure of confidential information. There are exceptions to privileged communications statutes that could produce severe conflicts between a counselor's ethical and legal duties, and similar problems can occur if the counselor is faced with a defamation or malpractice suit.     

Building on an Empirical Foundation: Strategies to Enhance Good Practice

Reviews of the research literature on outcomes in counseling agree that counseling works. It is also possible to use research to identify strategies for increasing the probability of successful counseling. Such strategies include careful assessment of the client, matching the client and counselor on demographic and attitudinal variables, and maintaining a productive working alliance through open disclosure to the client of the counselor's background and procedures, inquiry into the client's experience of counseling process, and management of client resistance.     

“What Would You Do if You Were Me?” Effects of Counselor Self-Disclosure Versus Non-disclosure in a Hypothetical Genetic Counseling Session

Two prior studies suggest genetic counselors self-disclose primarily because patients ask them to do so (Peters et al., 2004; Thomas et al., 2006). However, scant research has investigated effects of counselor disclosure on genetic counseling processes and outcomes. In this study, 151 students (98 undergraduates, 53 graduates) completed one of three surveys describing a hypothetical genetic counseling session in which a patient at risk for FAP was considering whether to pursue testing or surveillance procedures. Dialogue was identical in all surveys, except for a final response to the question: “What would you do if you were me?” The counselor either revealed what she would do (Personal Disclosure), what other patients have done (Professional Disclosure), or deflected the question (No Disclosure). Imagining themselves as the patient, participants wrote a response to the counselor and indicated their perceptions of her. Participants rated the non-disclosing counselor significantly lower in social attractiveness than either disclosing counselor, and less satisfying than the professional disclosing counselor. Analysis of written responses yielded four themes: Made Decision, Sought Information, Expressed Thoughts/Feelings, and No Decision. Practice implications and research recommendations are provided.     

When the Topic is You: Genetic Counselor Responses to Prenatal Patients’ Requests for Self-Disclosure

A limited amount of research indicates patient requests play a major role in genetic counselors’ self-disclosure decisions and that disclosure and non-disclosure responses to patient requests may differentially affect genetic counseling processes. Studies further suggest patient requests may be more common in prenatal settings, particularly when counselors are pregnant. Empirical evidence is limited however, concerning the nature of patient requests. This study explored genetic counselors’ experiences of prenatal patients’ requests for self-disclosure. Four major research questions were: (1) What types of questions do prenatal patients ask that invite self-disclosure?; (2) Do pregnant genetic counselors have unique experiences with prenatal patient disclosure requests?; (3) How do genetic counselors typically respond to disclosure requests?; and (4) What strategies are effective and ineffective in responding to disclosure requests? One hundred seventy-six genetic counselors completed an online survey and 40 also participated in telephone interviews. Inductive analysis of 21 interviews revealed patient questions vary, although questions about counselor demographics are most common, and patients are more likely to ask pregnant counselors questions about their personal pregnancy decisions. Participants reported greater discomfort with self-disclosure requests during pregnancy, yet also disclosing more frequently during pregnancy. Counselor responses included personal self-disclosure, professional self-disclosure, redirection, and declining to disclose. Factors perceived as influencing disclosure included: topic, patient motivations, timing of request, quality of counseling relationship, patient characteristics, and ethical/legal responsibilities. Disclosure practices changed over time for most counselors. Additional findings, practice implications, and research recommendations are discussed.     

Is Self-Disclosure Part of the Genetic Counselor's Clinical Role?

The role of genetic counselor self-disclosure in clinical practice is unclear as there are few published investigations of this issue. In the present study, 11 genetic counselors who previously received genetic services were interviewed about their opinions and use of disclosure. Several themes were extracted from their responses. All participants reportedly disclosed to patients; however, not all disclosed their receipt of genetic services. Patient requests for self-disclosure influenced many participants’ disclosure decisions. Opinions regarding potential benefits of disclosure varied. Nearly all participants stressed the importance of self-disclosing judiciously, stating that it may be counterproductive to client goal attainment. Four individuals with expertise in genetic counseling and psychotherapy were invited to react to these themes and to provide their opinions of self-disclosure. Their views are compared to those of the present sample, and practice and research recommendations are given.     

Language Switching and Mexican Americans' Emotional Expression

This study examined the effects of counselor language switching and counselor ethnicity on bilingual Mexican American participants' emotional self‐disclosure. Counselor language (English only and Spanish with English) was crossed with counselor ethnicity (Mexican American and European American) to produce 4 treatment conditions. Judges' observations revealed that the European American counselor who language switched elicited the most emotional expression from participants. Este estudio examinó los efectos que un cambio de idioma por parte del consejero y la etnicidad del consejero tienen sobre la auto‐revelación emocional de los participantes México Americanos bilingües. El idioma del consejero (sólo inglés, y español con inglés) se combinó con su etnicidad (México Americano y Euro Americano) para generar 4 condiciones de tratamiento. Las observaciones de los jueces revelaron que el consejero Euro Americano que cambió de idioma obtuvo el mayor número de expresiones emocionales de los participantes.     

Are Norms of Disclosure of Online and Offline Personal Information Associated with the Disclosure of Personal Information Online?

This study investigated whether norms of self‐disclosure of one's online and offline identity are linked to online disclosure of personal and intimate information. We expected online disclosure of personal and intimate information to be associated with norms of online disclosure. Secondary analysis of the 2006 Pew and American Life Survey of parents and teens data set was conducted to test the study's hypotheses. A weak relationship emerged between adherence to norms supporting the disclosure of offline and online personal information. Supporting theories of computer‐mediated communication, our findings show a strong relationship between adherence to norms of online identity disclosure and the disclosure of personal information online through the posting of personal photos, videos, and an online profile.     

Consulting with teachers: a systematic approach

Many counselors need and want to reach more students through effective counsultation with teachers. While the desirability of consulting has been established in the literature, the counselor may be concerned about how to begin a consulting role and how to develop a consulting relationship with teachers. Beginning a consulting role may be simple and informal. The use of systematic procedures should aid the counselor in developing the consulting relationship. Systematic consulting procedures, along with the all-important attitude of the consultant, are illustrated through two cases.     

Gay, Lesbian, and Bisexual Patients’ Recommendations for Genetic Counselors: A Qualitative Investigation

Gay, lesbian, and bisexual (GLB) individuals comprise a growing patient population in genetic counseling. However, only one article from a genetic counseling journal provides empirical data on GLB patients' genetic counseling experiences and genetic counselor attitudes and practices regarding GLB patients. The present study, an extension of the aforementioned article, gathered further information about patients' genetic counseling experiences through semi-structured telephone interviews. Twelve of the previous study's 29 patient respondents (n?=?10 lesbian women, n?=?1 gay man, n?=?1 bisexual woman) participated. Interview questions concerned the use of medically inclusive forms, factors influencing patient disclosure, counselors' ability to relate to them, and their expectations of genetic counselors. Inductive analysis of the interviews yielded seven themes: 1) Medically inclusive forms with gender neutral terms are important; 2) Genetic counselor ability to relate to a GLB person depends more on the relationship established during the session and less on external symbols; 3) The presence of GLB-friendly symbols increases comfort when disclosing one's orientation; 4) Inclusion of the patient's partner is important and best done by encouraging their active participation in sessions; 5) When GLB patients disclose their orientation, they expect to be treated like any other patient; 6) Providers should ask about orientation if medically pertinent and the remaining discussion should take orientation into consideration; and 7) When a provider inquires about orientation it should be done in a safe and appropriate way. Illustrative quotations, genetic counseling practice implications, and research recommendations are presented.     

The Influence of Counselor Epistemology on the Helping Interview: A Qualitative Study

The relationship between certain personal qualities of a counselor and the outcomes of counseling has been well established. In this qualitative study, the authors sought to extend this understanding by examining the relationship between the personal epistemologies of counselor trainees and their interview behaviors. Five distinguishing themes emerged.