Best Practices for Counselors Who Treat Posttraumatic Stress Disorder

Counselors in settings as diverse as schools, corporations, and community agencies are well aware of the numbers of people in the United States who daily come in contact with stressors that are extreme and potentially traumatic. Automobile accidents, disasters, or encounters with interpersonal violence are ubiquitous. Professional counselors, regardless of their professional identification or the settings in which they work, are very likely providing services to many people who are in distress after traumatic exposures. These counselors would benefit from knowing what other mental health professionals consider to be best practices for preventing and treating posttraumatic stress disorders (PTSDs). The purpose of this article is to summarize for counselors those best practices that have been recently developed and published by a multidisciplinary expert group (E. B. Foa, J. R. T. Davidson, & A. Frances, 1999) in their article “Treatment of Posttraumatic Stress Disorder.”     

Best Practices for Counseling Clients Experiencing Poverty: A Grounded Theory

Poverty is a pressing sociopolitical issue in the United States and worldwide. Poverty experiences have a significant effect on one’s mental health and overall wellness. Therefore, the ability to effectively serve clients experiencing poverty is critically important to professional counselors. However, there are no empirical models for counseling clients experiencing poverty. The authors present the results of a constructivist grounded theory study in which 21 professional counselors who work with clients experiencing poverty were interviewed to identify best practices for working with this population. Five major best practices are identified: (a) awareness, (b) training, (c) knowledge, (d) skills, and (e) advocacy. Implications for professional counseling are included.     

Meditation and Appropriation: Best Practices for Counselors Who Utilize Meditation

Support for meditation is found across academic communities and popular culture. Although the application of meditative practices has yielded positive treatment outcomes, larger purposes of the practice are perhaps lost in the empirically driven West, thus driving a risk of appropriation. In response, the authors outline 4 implications for best practice for counselors who aspire to engage in the culturally responsible use of meditative practices.     

Prenatal Depression: Best Practice Guidelines for Diagnosis and Treatment

The purpose of this article is to provide counselors with an overview of best practices for the treatment of women who experience prenatal depression (PND). The authors first discuss issues in the screening and diagnosis of PND. Next, the 2 most common treatments, antidepressants and psychotherapy, are reviewed and discussed in relation to current best practice guidelines. Guidelines for counselors' roles in treatment and advocacy are also provided.     

Assessment and Treatment of Insomnia in Adults: A Guide for Clinicians

Insomnia leads to disrupted sleep and daytime fatigue. Many people who have this disorder look to the medical profession for treatment; however, it has been demonstrated that psychological approaches are usually more efficacious over the long term. Furthermore, such interventions are safe, cost effective, brief, and do not require extensive expertise. The authors provide an overview of the current best practices in assessment and treatment to encourage counselors to use these techniques when treating clients with insomnia.     

Evaluating Addictions Counseling Programs: Promoting Best Practices,Accountability, and Advocacy

Program evaluation offers several benefits to addictions counselors, including identifying best practices, providing accountability to stakeholders, and advocating for minority client populations. This article reviews the benefits of addictions counseling program evaluation and outlines main steps in the evaluation process.     

At the Heart of the Pregnancy: What Prenatal and Cardiovascular Genetic Counselors Need to Know about Maternal Heart Disease

In the last decade, an increasing number of cardiac conditions have been shown to have a genetic basis. Cardiovascular genetic counseling has emerged as a subspecialty aiming to identify unaffected at-risk individuals. An important sector of this at-risk population also includes expectant mothers, in whom unique clinical challenges may arise. Genetic counselors, especially those in cardiovascular and prenatal settings, have an opportunity to identify and assist women who may benefit from cardiovascular care during pregnancy. This paper provides basic management and genetic evaluation principles for affected women, as well as guidance on identifying those who are at risk. We provide considerations for cardiac surveillance in pregnancy and the post-partum period. Finally, key psychosocial issues that appraise how to best provide support to at risk women as they make informed decisions are discussed. We propose that a team approach including cardiology, maternal fetal medicine, and genetic counseling best serves this patient population. Ongoing questions addressing an evidence based approach to cardiovascular genetic conditions in pregnancy still remain. Thus, well-designed research protocols are essential to mark progress in this area.     

Critical Ethical Issues in Online Counseling: Assessing Current Practices With an Ethical Intent Checklist

The authors used a 16‐item Ethical Intent Checklist, developed from the American Counseling Association's (1999) Ethical Standards for Internet Online Counseling, to assess the current practices of 88 online counseling Web sites. Results showed fewer than half of online counselors were following the accepted practice on 8 of the 16 items. Online counselors who identified themselves as licensed or as association members had significantly higher mean checklist scores.     

The Experience of Genetic Counselors Working with Patients Facing the Decision of Pregnancy Termination after 24 Weeks Gestation

Prenatal genetic counselors are health care professionals who counsel women making reproductive decisions which include decisions such as terminating pregnancies due to fetal anomalies. Little is known about the experiences and practices of prenatal genetic counselors working with women who have the option of termination after 24 weeks gestation. In this national survey of 168 genetic counselors who have practiced prenatal genetic counseling, we asked about their general practice patterns, including indications for which termination is offered and types of abortion care services that are coordinated by genetic counselors. We report respondents’ self-assessments of level of understanding of federal abortion law and abortion procedures. Seventy-six percent of respondents have offered and counseled on termination after 24 weeks and 93% of respondents believe it is the responsibility of the counselor to discuss this option with patients. However, one-third report that they have some or no understanding of the procedures and three-quarters report that they have some or no understanding of federal abortion law. The results of this study provide insight into knowledge and experiences of genetic counselors working with these patients, allowing for improved genetic counselor training and continuing education to provide better guidance and develop more effective means of assisting patients.     

Counselor Ethical Reasoning: Decision‐Making Practice Versus Theory

Counselors’ decision‐making processes have received little attention in the literature. The purpose of this study was to ascertain the ethical decision‐making practices of counselors working in the field. The results of a phenomenological study indicate that linear models and an orientation to professional ethical guidelines learned in graduate training serve as a foundation, yet not a practical guide, in professional ethical decision making. The authors found that 4 themes guide counselors’ ethical decision making: personal values, clients’ best interest, transparency in decision making, and perceptions of formal training and practice. Implications for practice and counselor education are provided, with recommendations for future research.     

Counselors' and Counselor Educators' Practice of Mindfulness: A Qualitative Inquiry

The Buddhist practice of mindfulness is being used more often both to help clients and to facilitate counselor effectiveness. A growing body of research supports these uses of mindfulness. Most authors also emphasize that those who teach mindfulness must also apply it themselves. However, little is known about how counselors and counselor educators incorporate mindfulness into their personal and professional lives. The current study used semistructured interviews to elicit such information from 6 counselors and counselor educators. A constant comparative method was used to analyze the data and synthesize themes. Emergent themes included practices used to cultivate mindfulness and the results of mindfulness practices.     

An Introduction to the Best Practices Section in the Journal of Counseling & Development

The authors present an introduction to the Best Practices section in the Journal of Counseling & Development. The section, announced in the fall of 2003, updates counselors on the latest research evidence to support their counseling practices. Four invited experts in the counseling profession (D. Bubenzer, J. G. Garci, T. Sexton, & J. West) discuss the role of best practices in counseling.     

Wearing Two Hats: Counselors Working as Managerial Leaders in Agencies and Schools

The authors argue that many counselors who assume managerial leadership positions within agencies or schools (e.g., head school counselor, director of outpatient services) tread into unknown territory, a phenomenon reflecting the dearth of literature within the counseling field related to effective management. This article attempts to introduce effective managerial leadership practices, drawn largely from management literature, to help guide counselors serving in managerial leadership positions in creating and maintaining vital and productive counseling programs.     

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.     

Renegotiating Sexuality Following an Acquired Disability: Best Practices for Counselors

Acquired physical disabilities are a critical issue that confronts many adults today, and they are projected to continue to increase over the next several years. For many individuals with acquired physical disabilities, the disabilities affect sexuality, thus requiring a renegotiation of disability and sexuality. This article reviews the extant literature on physical disabilities and sexuality and provides best practices for counselors to effectively address the needs of this growing population.     

Billing and Record-Keeping for Familial Cancer Risk Counseling: A National Survey

We surveyed 111 genetic counselors providing cancer risk counseling (CRC) in order to document their billing and record-keeping practices. Of the 75 respondents, billing was generally done under the supervising physician with a wide variation in charges. Follow-up telephone interviews with 28 counselors who charge patients revealed that billing was usually done using the CPT codes for consultations, and the ICD-9 diagnostic codes for cancer (if applicable), a medical complaint, or a family history of cancer code. Most counselors exclude some clinical information from the patient's medical record. In consultation notes, 81% of counselors document a discussion of genetic testing, but only 37% document the patient's actual testing decision, and only 19% document test results. In anticipation of increased referrals for CRC, data are needed on the components of a CRC visit, the amount of time required to provide CRC, patient outcomes measures, and charges and reimbursement. The feasibility and advisability of keeping results separate from the patient's medical record also needs to be addressed.     

Ethical Guidelines for Mass Trauma and Complex Humanitarian Emergencies

Issues pertaining to trauma, especially mass trauma and complex humanitarian emergencies, are explored through the lens of ethical counseling guidelines. In mass trauma, particular attention must be paid to the experiences of both survivors and counselors to enhance understanding of ethical best practices and to emphasize the importance of contextual factors in framing effective responses to trauma and humanitarian crises. Recommendations regarding ethical guidelines for counseling practice, clinical involvement, and training are offered.     

Practicum and On-the-job Ratings of School Counselors

Practicum ratings of 50 school counselors were examined in relation to administrators' subsequent on-the-job ratings of their performance. The relationship proved negligible. The practicum ratings did relate, however, to retention of cognitive material in guidance and counseling (scores on a comprehensive examination). Such a relationship did not exist between scores on the same comprehensive examination and the administrators' ratings. It was suggested that cognitive standards for counselors are probably best established and maintained by training institutions. Administrators seeking assurance of at least minimum cognitive competency in counselors ought to seek endorsement of candidates from those who observe their practicum performance.     

The Contribution of Attachment and Social Media Practices to Relationship Development

This study tested the hypothesized directional relationship that college students (N = 717; 10.1% response rate to an online survey) who score higher on measures of insecure attachment and social media practices would have lower relationship development quality scores. Structural equation modeling results indicated that participants with greater insecure attachment had lower relationship development quality (large effect size), whereas individuals with greater social media practices had higher relationship development quality scores. Implications for counselors are presented.     

Who Is at Risk for Psychological Distress in Genetic Testing Programs for Hereditary Cancer Disorders?

Presymptomatic identification of disease gene carriers is becoming an increasingly common part of the clinical management of hereditary cancer disorders. With an expected increase in the number of requests for DNA testing and the limited resources for counseling, the amount of time genetic counselors are able to spend with test candidates will decrease. It is therefore important for counselors to identify persons at risk for psychological distress. Based on a review of experiences with Huntington disease and cancer patients, we describe factors likely to evoke distress in genetic cancer candidates. We also discuss the sometimes widely different ways that test candidates and their partners respond to genetic testing. By exploring risk factors for distress in relevant domains of the research, we can offer counselors guidelines for determining who may need extra counseling.