Using mediators and moderators to test assumptions underlying culturally sensitive therapies: an exploratory example

Factors hypothesized to impact Asian American responses to counseling were tested as mediators and moderators of perceived counselor credibility and working alliance. Asian and European American college students (N = 182) were assigned randomly to view simulated directive or nondirective therapy approaches. Mediation analyses examined whether ethnic group differences in initial perceptions were accounted for by therapist understandability and previous therapy experiences. Moderation analyses examined whether expectations for directive therapy, ambiguity tolerance, and resistance influenced initial perceptions across directive and nondirective counseling. Asian Americans rated the counseling approaches significantly less favorably than Europeans Americans. A significant mediation effect was found for therapist understandability, whereas a significant moderation effect was found for expectation for directive therapy on initial perceptions of counselor credibility.     

Effects of Supervisor Style and Empathy on Counselor Perceptions in Simulated Counseling

Effects of supervisor style (techniques type and counseling type) and supervisor empathy upon counselor perceptions in a supervision analogue were examined. Three groups of 14 students heard two sets of recorded client statements and responded as counselors. The two experimental (E) groups had 20-minute conferences with supervisors between the first and second sets. Controls (C) received no supervision. Counselor perceptions were measured by questionnaire responses. Although subjects supervised by an emphasis on techniques rated themselves less relaxed and less confident about the meaning of empathy than those with an emphasis on counseling, their performance on the criterion of empathy was higher. Both E groups perceived themselves as higher than C's in amount learned, but they were no higher on the performance measure. No differences were found for reactions to supervision (items given E's only) or reactions to participation in the experiment. Empathy of supervisors did not appreciably affect counselor perceptions.     

The Relationship Between Momentary States of Therapist Self-Awareness and Perceptions of the Counseling Process

To investigate the role of momentary self-awareness, beginning therapists and their volunteer clients participated in a postsession process recall in which therapist helpfulness and momentary self-awareness were assessed along with client reactions. Therapist anxiety levels and strategies used to manage hindering self-awareness were also examined. Results suggest that momentary states of heightened therapist self-awareness may be hindering. Specifically, when therapists rated themselves as more self-aware from moment to moment during counseling sessions, they also rated themselves as more anxious before the session and their clients rated them as less helpful during the session. In addition, therapists reported using a variety of strategies to manage distracting self-awareness, including focusing on intervention planning and focusing on the client. Implications for therapist training are discussed.     

Focusing on Patient Needs and Preferences May Improve Genetic Counseling for Colorectal Cancer

During cancer genetic counseling, different items which counselors consider important are discussed. However, relatively little empirical evidence exists regarding the needs and preferences of counselees. In this study needs and preferences were assessed from counselees with a personal and/or family history of colorectal cancer (CRC), who were referred for genetic counseling regarding CRC. They received a slightly modified version of the QUOTE-GENE^ca questionnaire prior to their first visit to the Hereditary Cancer Clinic. Response rate was 60 % (48/80 participants). Counselees rated the importance of 45 items assessing their needs and preferences regarding the content and process of genetic counseling. Participants rated the items regarding discussion of information about their familial CRC risk (100 %) and preventive options (98 %) as important or very important. Fewer participants rated items concerning general information on genetics as important. Sensitive communication during counseling was considered very important by a large percentage of counselees. Generally, no major differences were seen between participants in relation to individual characteristics. Our data suggest that focusing on familial CRC risk and surveillance options, in combination with sensitive communication may lead to better satisfaction with genetic counseling.     

Genetic Counseling Supervisor Competencies: Results of a Delphi Study

Clinical supervision is a critical component of genetic counseling student preparation, yet empirically-determined competencies for genetic counseling supervisors are lacking. In this study a modified, two-round Delphi method was used to gain consensus about important genetic counseling supervisor knowledge, characteristics, and skills. Program directors and assistant directors of American Board of Genetic Counseling accredited genetic counseling programs in North America (N?=?33) were invited to participate and to recruit three experienced supervisors. Seventy-four individuals completed Round 1 and, of these, 61 completed Round 2. Approximately two-thirds were clinical supervisors from prenatal, pediatrics, cancer, and adult clinics; one-third were program directors. Participants rated the importance for genetic counseling supervisors of 158 items derived from supervision literature in allied health professions. They rated 142 items (89.9 %) as highly important. Content analysis of these items yielded six supervisor competency domains: Personal traits and characteristics; relationship building and maintenance; student evaluation; student centered supervision; guidance and monitoring of patient care; and ethical and legal aspects of supervision. The results provide a basis for training genetic counseling supervisors and for further research to refine and validate supervisor competencies.     

Inclusion of Religious Behaviors and Attitudes in Counseling: Expectations of Conservative Christians

In this study of 118 religiously conservative Christians' expectations of counseling, participants were randomly assigned to 1 of 2 treatment conditions: a Christian counselor or a counselor whose religious beliefs were unknown. Participants rated their expectations for the counselor's attitude toward their religious beliefs and use of religious behaviors in counseling using the Behavior and Attitude Expectancies scale (C. Belaire & J. S. Young, 2002). Participants also rated their general expectations for counseling using the Expectations About Counseling: Brief Form (H. E. A. Tinsley, 1985). Results showed that participants expected both a Christian counselor and a counselor whose religious beliefs were unknown to be respectful and accepting of conservative Christian religious beliefs and values and to include multiple religious behaviors in counseling sessions. Participants had overall positive expectations of the counseling process.     

Comparison of two group counseling approaches to enhancing confidence in planning careers by undecided Taiwanese college women

This is a report of research comparing two approaches to enhance the career confidence of undecided female college students. 30 women who requested enrollment in career counseling were assigned to two counseling groups (a cognitive reconstructing intervention group and a career decision-making skills training group) and one no-treatment control group based on time of request. After participating in the two career counseling groups for eight sessions in a month, the female college students rated their mean confidence as increased over that of the no-treatment group. Analysis indicated that the indecisive female college students benefitted from career group counseling with an emphasis on self-efficacy and that the cognitive reconstructing intervention was more effective.     

The Effect of Nonverbal Skills Training on Counselor Trainee Nonverbal Sensitivity and Responsiveness and on Session Impact and Working Alliance Ratings

Counselor trainees (N = 18) were randomly assigned to treatment (nonverbal sensitivity) or control (empathy training) conditions. Trainees saw a recruited client before (first 2 weeks) and after (last 2 weeks) a 15-week counseling methods class. Trainees rated their sensitivity to nonverbal behaviors, counseling self-efficacy, and the extent to which they focused on client nonverbal behavior. Clients filled out the Session Evaluation Questionnaire and Working Alliance Inventory at pre- and posttesting. Trained raters viewed videotapes of the counseling sessions and rated the extent that counselors focused on client nonverbal behavior. As hypothesized, trainees in the treatment condition, when compared with those in the control condition, increased their focus on client nonverbal behaviors. In addition, clients of treatment condition counselors showed significant differences in working alliance ratings. Trainees in both conditions increased their rating of nonverbal sensitivity and self-efficacy from pre- to posttesting. Implications are discussed.     

Confidentiality of Adolescent Risk-Taking Behaviors: A Survey of Turkish School Counselors

The present study investigated school counselors’ ratings of the importance of factors in deciding to report adolescent risk-taking behaviors to parents. Turkish school counselors (N = 346) were surveyed. Differences based on gender, years of experience, level of education, attendance of a counseling ethics course, and geographic region were investigated. Mann-Whitney U and Kruskal Wallis tests were used in data analysis. Protecting the student was the highest rated factor. Women and those who took an ethics course rated protecting the student higher than others. Implications for counseling ethics training are discussed, and recommendations for future research are outlined.     

Where are the Males? Gender Differences in Undergraduates’ Interest in and Perceptions of the Genetic Counseling Profession

Genetic counseling is a female-dominated field, with women comprising about 95% of the profession (Smith et al. 2009). Greater patient choice and satisfaction may be achieved by increasing the number of male counselors, but empirical evidence about the reasons for this gender imbalance is limited. In this study 190 undergraduates (110 females, 79 males, 1 unknown) in upper division bioscience courses completed a survey assessing their knowledge and perceptions of and interest in genetic counseling as a career. There were only two significant gender differences. Females indicated significantly greater interest than males in pursuing a genetic counseling career, and they rated interpersonal skills as more integral to genetic counseling than males. Multiple regression analyses of knowledge and perceptions as possible predictors of male and female interest in pursuing a genetic counseling career yielded no significant predictors of male interest. For females, there were four significant predictors: estimated salary, career characteristics, perceptions of genetic counseling as interpersonally focused, and whether they had already chosen a career. Implications for recruiting males to the profession, and research recommendations are presented.     

Clinical Behaviors for Addressing Religious/Spiritual Issues: Do We Practice What We Preach?

To determine if counselors integrate clinical behaviors for addressing religious/spiritual issues in counseling consistent with their ratings of the importance of such behaviors, the authors conducted a national survey of American Counseling Association (ACA) members. Seventy‐eight ACA members rated the importance of and frequency with which they engaged in a set of 30 clinical behaviors that were identified in the existing literature as addressing religious/spiritual issues within counseling. Results indicated possible disparities between importance and frequency ratings. Potential barriers to counselors' utilization of religious and spiritually directed clinical behaviors were identified.     

An Analysis of Counselor Verbal Interventions in Group Counseling

This study of verbal interventions of counselors during group counseling with predelinquent urban youth revealed that of the 12 counseling skills rated, 3 accounted for 2/3 of the verbal interventions used by the counselors.     

Who Are the Next Generation of Genetic Counselors? A Survey of Students

Genetic counseling students were surveyed about their backgrounds, application process to genetic counseling programs, and career motivations and plans. Program directors from 27 accredited programs were asked to distribute 362 surveys to students. Fifty-two survey items assess demographics; sources of support for pursuing a genetic counseling career (information about genetic counseling, encouragement/discouragement from others); career motivations (reasons for applying and for becoming a genetic counselor); and career certainty. Two hundred and thirty-five usable surveys were returned (64.9% usable return rate). Most respondents were Caucasian females (mean age = 25.4 years). About 13% identified as ethnic minorities, and about one-third reported family histories of a genetic condition(s). Most respondents learned about the field in classes, and most were strongly encouraged by family and friends to pursue genetic counseling. Reasons rated as most important for becoming a genetic counselor included helping others and intellectual stimulation. Recruitment, training, and research recommendations are given.     

Counselor Predictive Skill and Rated Counselor Effectiveness

Prediction is a fundamental part of counseling. Although counselors differ in their ability to predict accurately, there is no evidence that those who predict most accurately do the best job of counseling. Using 3 different sets of case data, 14 counselors predicted whether students would graduate and whether they would keep the “major” program selected at the time of admission. 3 supervisors agreed on the counselors rated “most” or “least” effective in their work with students. Although the amount of case data available to the counselors was unrelated to predictive accuracy, the counselors rated “most” effective predicted significantly better than those rated “moderately” or “least” effective.     

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.     

The Relative Influence of Client Characteristics on the Process and Outcomes of Premarital Counseling: A Survey of Providers

To explore the influence of client characteristics in premarital counseling, a five factor model is presented that includes the social context, family-of-origin influences, individual characteristics, couple interactional processes, and motivation for attending premarital counseling. The findings demonstrate that providers believe that many client characteristics influence the degree to which couples benefit from premarital counseling. Providers rated the influence of the client characteristic factors in the following order (from most to least influential): couple interactional processes, family-of-origin influences, individual characteristics, motivation for premarital counseling, and the social context. Recommendations for future theory development, practice, and research are discussed.The findings presented in this article were part of the authors doctoral dissertation at the University of Florida.     

Inter- and intra-group variability in perceptions of behavior among Asian Americans and European Americans

Between-group and within-group differences in perceptions of behavior were examined among 74 Asian Americans and 111 European Americans. Participants rated videotaped interactions of Asian American mothers and daughters. Asian Americans, and a more homogeneous sample of Chinese Americans, perceived less maternal control and more reciprocity than did European Americans. Intra-cultural variations in perceptions were also evident, as within-group analyses revealed differences in perceptions based on the generational status of Asian Americans and the degree of multicultural experience of European Americans. Overall, findings suggest that perceptions of behavior are shaped as much by within-group differences in familiarity and experience with the target culture as by between-group differences in ethnicity. Implications for theories of child socialization, multicultural counseling, and observational research are discussed.     

Boundary Disturbances and Eating Disorder Symptoms

Female graduate students in counseling and clinical psychology retrospectively rated maternal and paternal boundaries in their families of origin. Subscales of the Eating Disorders Inventory-3 were used to assess disordered eating, including drive for thinness, body dissatisfaction, bulimia symptoms, and overall risk. Results indicated that maternal enmeshment and maternal psychological control were related to disordered eating. Further, daughters who reported that their mothers shielded them from parents’ conflict and adult concerns were less likely to report drive for thinness or bulimic tendencies. With respect to paternal boundary problems, paternal infantilization (overprotection) was significantly related to daughters’ drive for thinness.