Genomic Counseling in the Newborn Period: Experiences and Views of Genetic Counselors

As newborn screening (NBS) technology expands, genetic counselors will become more involved in counseling for NBS results, including those potentially generated from whole exome sequencing (WES) and eventually whole genome sequencing (WGS). Members of the National Society of Genetic Counselors (NSGC) responded to an online survey (n?=?208) regarding genomic counseling in the context of NBS. The majority of participants (82.1 %) did not feel prepared to counsel for WGS results from NBS. Counselors with previous WES/WGS counseling experience felt more prepared (p?=?0.005) to counsel for WGS results from NBS than those without WES/WGS experience. Overall, counselors expressed ethical and practical concerns regarding WGS in NBS, as well as a need for additional training regarding this application of the technology before it is implemented. Based on the results of this study, genetic counselors voice caution to the larger genetics community regarding expansion of NBS to incorporate genomic sequencing and advocate for additional education prior to initiating WGS into NBS.     

Cancer Risk Counseling: How Is It Different?

Fifty-six of 80 (70%) full members of the National Society of Genetic Counselors with interest in cancer genetics responded to a 1994 survey regarding their cancer risk counseling practices. This study was undertaken to describe cancer risk counselors and the services they provide and to identify possible differences from general genetic counseling that warrant further study. Of 56 respondents, 41 (75%) were providing CRC. The components of CRC programs are described. Our results found significant differences between CRC and general genetic counseling in terms of training and experience of genetic counselors providing CRC and length and number of counseling sessions per consultand. 51% of respondents had 1–2 years of working in CRC, compared to 17% with 1–2 years experience in genetic counseling (p<0.05). Over one-third had 10 or more years genetic counseling experience. Counselors were more likely to see individuals at risk for cancer for longer counseling sessions (p<0.05) and for additional sessions (p<0.05).     

Advocating for Atheist Clients in the Counseling Profession

Atheism is a controversial topic, with individuals who identify as atheist reporting high rates of discrimination. Despite increasing literature discussing religious/spiritual views and beliefs, few scholarly discussions of atheism in the counseling field can be found. Counselors need to be made aware of the issues facing atheist clients and educated on the best interventions to use in collaborative work with clients. Counselors should also be prepared to advocate for atheist clients in multiple domains. This article aims to explore the relevant literature around atheism, identify implications for counselors, and provide a path to advocacy for counselors in their work with atheist clients.     

Genetic Counselors’ Experiences with Adolescent Patients in Prenatal Genetic Counseling

Adolescents comprise a portion of women who present to genetic counselors prenatally. In this study, prenatal genetic counselors (N = 128) were surveyed regarding their perceptions of genetic counseling sessions for adolescent (ages 13–19) and adult (ages 20–34) patients. Counselors perceived differences in methods used to communicate risk information for adolescent versus adult populations. Respondents reported that it is more difficult for adolescents to understand prognostic information than adults. They also noted differences between adult and adolescent populations with respect to the people who typically accompany the patient to the session. Respondents stated that adolescents were accompanied by a parent, friend, or sibling, which differed from adults who reportedly were accompanied by a significant other, father of the pregnancy, or by no one. These findings suggest it is important to recognize that adolescent patients are in a unique stage of their development which may influence a prenatal genetic counseling session.     

Coping with the stress of pastoral counseling

Using a stratified random sample of the three membership categories of the American Association of Pastoral Counselors, this study investigated the experience of stress, related to the pastoral counseling profession, among 143 pastoral counselors and 95 of their spouses. In addition, the study examined how pastoral counselors were coping with stress by evaluating self-reported functional and dysfunctional behaviors. The data indicated that pastoral counselors and their spouses did not report high levels of stress related to the pastoral counseling profession. However, significant differences were found by work setting and age for pastoral counselors regarding the level of stress experienced. The data also indicated that pastoral counselors reported using more functional stress reduction behaviors than dysfunctional stress reduction behaviors.     

The Application of Counseling Skills in the Business and Industrial Setting

Counselors have often failed to seek employment in the business and industrial communities. It can be demonstrated, however, that counseling skills are quite applicable in business and industry settings and that the financial resources to hire counselors exist. Therefore, to encourage counselors to seek employment in business and industry, the article explores the applicability of their skills within this nontraditional setting and offers suggestions regarding the job search.     

Student Perception of Counselor Role

A semantic differential and a Thurstone-type rating scale of satisfaction with counseling were used to measure changes in the perceptions held by students regarding their high school counselors over a period of 2 years. During this time, the large suburban high school that was the locale for the study changed from a system of deans who had both counseling and disciplinary duties to a system of counselors who did not discipline students. Factor analyses and non-parametric change tests were conducted. It was found that, especially during the first year, students perceived their counselors more negatively than they had perceived their deans. Some signs of movement toward more favorable views were noted by the end of the second year. Satisfaction with counseling, however, was favorably perceived by students throughout the two years. Students tended to perceive their counselors in evaluative terms. There was no relationship between perception of counselors and satisfaction with counseling. The evidence suggests that discipline may not be the crucial variable in either student perceptions of counselors or student satisfaction with counseling.     

Cultural competency in genetic counseling

Incorporating a cross-cultural curriculum into genetic counseling training programs demonstrates a professional conviction of genetic counselors that cultural issues are important in genetic counseling. Funded by the Special Projects Fund in 1993 from the National Society of Genetic Counselors and the Kitson Fund from the Department of Social, Organizational, and Counseling Psychology, Teachers College, Columbia University, theHandbook of Cross-Cultural Genetic Counseling was developed to provide genetic counseling programs a curriculum to teach cross-cultural genetic counseling. The theoretical rationale for the development of a cultural curriculum is presented. By expanding cultural knowledge, developing an awareness of oneself and others, and increasing the repertoire of culturally relevant counseling skills within a socio-political context, genetic counselors will be able to better serve all clients seeking genetic counseling.     

Essential Elements of Genetic Cancer Risk Assessment, Counseling, and Testing: Updated Recommendations of the National Society of Genetic Counselors

Updated from their original publication in 2004, these cancer genetic counseling recommendations describe the medical, psychosocial, and ethical ramifications of counseling at-risk individuals through genetic cancer risk assessment with or without genetic testing. They were developed by members of the Practice Issues Subcommittee of the National Society of Genetic Counselors Familial Cancer Risk Counseling Special Interest Group. The information contained in this document is derived from extensive review of the current literature on cancer genetic risk assessment and counseling as well as the personal expertise of genetic counselors specializing in cancer genetics. The recommendations are intended to provide information about the process of genetic counseling and risk assessment for hereditary cancer disorders rather than specific information about individual syndromes. Essential components include the intake, cancer risk assessment, genetic testing for an inherited cancer syndrome, informed consent, disclosure of genetic test results, and psychosocial assessment. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care provider's professional judgment based on the clinical circumstances of a client.     

Spirituality and Dream Work in Counseling: Clients’ Experiences

The authors suggest that focusing on dreams in counseling may be a useful framework to explore clients’ spiritual values and beliefs. Because little is known about how spirituality and dream work are integrated in practice, the purpose of this article is to document how some counselors and clients work on spirituality and dreams. Responses of clients who focused on dreams from a spiritual perspective are described and discussed. Relevant clinical issues that counselors may encounter are identified. Recommendations are made for counselors who wish to integrate spirituality and dream work in counseling.An earlier version of this article was presented at the Semi-Annual Meeting of the Association of Mormon Counselors and Psychotherapists, Salt Lake City, Utah, April 2004.     

Publishing a Master’s Thesis: A Guide for Novice Authors

Publication of original research, clinical experiences, and critical reviews of literature are vital to the growth of the genetic counseling field, delivery of genetic counseling services, and professional development of genetic counselors. Busy clinical schedules, lack of time and funding, and training that emphasizes clinical skills over research skills may make it difficult for new genetic counselors to turn their thesis projects into publications. This paper summarizes and elaborates upon a presentation aimed at de-mystifying the publishing process given at the 2008 National Society of Genetic Counselors Annual Education Conference. Specific topics include familiarizing prospective authors, particularly genetic counseling students, with the basics of the publication process and related ethical considerations. Former students’ experiences with publishing master’s theses also are described in hopes of encouraging new genetic counselors to submit for publication papers based on their thesis projects.     

Impact of Childhood Sexual Abuse on Client Spiritual Development: Counseling Implications

The spiritual development of sexually traumatized clients is an important area of concern for counselors. In this paper, spirituality is defined, and its relevance for counselors who work with childhood sexual abuse survivors is discussed. Impact of abuse on client spirituality is described, and several suggestions are given for assessment and intervention approaches that address spiritual issues as part of the counseling process.     

Semantic Barriers in Counseling

The interpretations of certain critical terms or concepts frequently occurring in counseling interviews were compared by means of the semantic differential technique for NDEA Counseling and Guidance Institute members and high school boys and girls. 11 of 30 F tests were significant. Counselors generally rated those concepts reflecting adult values or planning for the future (e.g., parents, counseling, studying, aptitude test) as more valuable and more active than did students. The activity dimension proved to be most sensitive in differentiating between the “sets” of the counselors and students. Counselors, possibly because of greater involvement, consistently perceived more activity in the various concepts than did students. Limitations of the study and suggestions for future research are noted.     

An Assessment of the Job Relevance of the National Board for Certified Counselors Examination

The authors discuss the results of a study designed to assess nationally certified counselors' perceptions of the relevance of elements of the National Board for Certified Counselors examination to their work as counselors. Support for the validity and appropriateness of the examination in regard to perceived relevance and lack of differentiation on the basis of respondent characteristics were found.     

Genetic Cancer Risk Assessment and Counseling: Recommendations of the National Society of Genetic Counselors

These cancer genetic counseling recommendations describe the medical, psychosocial, and ethical ramifications of identifying at-risk individuals through cancer risk assessment with or without genetic testing. They were developed by members of the Practice Issues Subcommittee of the National Society of Genetic Counselors Cancer Genetic Counseling Special Interest Group. The information contained in this document is derived from extensive review of the current literature on cancer genetic risk assessment and counseling as well as the personal expertise of genetic counselors specializing in cancer genetics. The recommendations are intended to provide information about the process of genetic counseling and risk assessment for hereditary cancer disorders rather than specific information about individual syndromes. Key components include the intake (medical and family histories), psychosocial assessment (assessment of risk perception), cancer risk assessment (determination and communication of risk), molecular testing for hereditary cancer syndromes (regulations, informed consent, and counseling process), and follow-up considerations. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care provider's professional judgment based on the clinical circumstances of a client.     

Expanding Roles: A Survey of Public Health Genetic Counselors

According to the 2008 National Society of Genetic Counselors (NSGC) Professional Status Survey (PSS), 31 genetic counselor respondents reported spending at least 50% of their time in the area of public health. The NSGC Public Health Special Interest Group (PHSIG) had 49 dues-paying members in 2009. The purpose of this study was to identify the work settings and public health activities in which genetic counselors participate. A novel online survey was disseminated over the NSGC PHSIG Listserv. Forty-one percent (n = 13) of public health genetic counselor respondents worked in a university medical system, while 53% (n = 17) were grant-funded and held a non-clinical appointment. The most common public health activities included educating healthcare professionals (82%) and community members (61%), research (55%), grant writing (55%) and grant administration (36%). Most respondents (82%) reported learning certain public health skills outside of their genetic counseling training programs. Differences in work settings were found, with a significantly greater percentage of public health genetic counselors working in government agencies. Genetic counselors have opportunities to become involved in public health activities as the scope of public health genetics grows. Furthermore, genetic counseling competencies are compatible with the Institute of Medicine’s “10 Essential Public Health Services.” The NSGC and genetic counseling training programs are encouraged to offer more public health learning opportunities for genetic counselors and genetic counseling students interested in this specialty area.     

Philosophical Orientation of Counselors in Iowa Secondary Schools

Guidance and counseling in the schools lack focus and direction. Some attribute this confusion within guidance and counseling to a lack of a philosophical foundation. Little is known about the philosophical assumptions of counselors functioning in secondary schools. In this study, the counselors in the secondary schools of Iowa identified most frequently with the phenomenological orientation. The experience of the counselors was related to their philosophical orientation. Counselors with less experience subscribed to an existential orientation.     

Practice variability in prenatal genetic counseling

This study demonstrated that the content of prenatal genetic counseling sessions varied from counselor to counselor and from center to center. The study was designed to examine which specific issues were included by genetic counselors in prenatal genetic counseling sessions, and to determine which factors led genetic counselors to include or exclude this information from such sessions. Data were collected by randomly surveying 200 full, master degree members of the National Society of Genetic Counselors (NSGC). Respondents provided information by deciding which of 45 specific issues they would include in a standard prenatal genetic counseling session, and which one factor from a bank of 11 factors most accurately described the reason for this decision. The results indicated that the issues included/excluded from sessions varied widely among genetic counselors. The results also indicated that Patient Education/Informed Decision Making (34.5%) played the largest role in decision making overall, with Standard at Center/Departmental Policy (17.6%), Personal Experience/Preference (12.4%), and Applicability (10.9%) serving as the next three most important reasons for including or excluding issues from prenatal genetic counseling sessions.