Ethical Implications of a Critical Legal Case for the Counseling Profession: Ward v. Wilbanks

This article presents the official position of the American Counseling Association on a seminal legal case for professional counseling: Ward v. Wilbanks. The focus is on three key questions: Is it permissible to deny counseling services to a homosexual client on the basis of a counselor's values? Can referrals be made at any time a counselor wishes to do so? When is a client a client?     

A Decision‐Making Model for Addressing Problematic Behaviors in Counseling Students

Gatekeeping is the subject of continued discourse in the counseling profession. With revisions to the ACA Code of Ethics (American Counseling Association, 2014 ), recent litigation (Keeton v. Anderson‐Wiley, 2010 ; Ward v. Wilbanks, 2009 ), and focused attention on value conflicts in counseling (Francis & Dugger, 2014 ), counselor educators' role as gatekeepers is expanding. In addition to this expanding role, counselor educators are responsible for being culturally and developmentally sensitive in interpreting, applying, and enforcing the codes and standards with counseling students. This article proposes a decision‐making model that integrates feminist, multicultural, systems theory, and social‐constructivist ethical decision‐making principles to address problematic behaviors in counseling students.     

Legal and Ethical Implications of Refusing to Counsel Homosexual Clients

In 2001, a federal appeals court upheld the job termination of a counselor who requested being excused from counseling a lesbian client on relationship issues because homosexuality conflicted with the counselor's religious beliefs (Bruff v. North Mississippi Health Services, Inc., 2001). This article provides the facts of the case and the legal reasoning of the court. The authors also explore the legal and ethical issues related to this case.     

MMPI-2 and MCMI-III scores among dutch inpatient substance abusers: Assessing correspondence and cross-cultural equivalence

The Millon Clinical Multiaxial Inventory (MCMI-II and MCMI-III) and the Minnesota Multiphasic Personality Inventory (MMPI-2) were applied to 263 Dutch inpatient substance abusers with multiple psychiatric diagnoses, and the results compared with those of 306 North-American substance abusers studied by Ward (1995). We looked for structural similarity both across groups (per instrument) and across the two instruments (per sample), using principal components analysis and congruence analysis. The component structure found by Ward was partly replicated in the Dutch group, thus cross-validating the use of the two instruments with these patients. Moreover, as found by Ward, the MMPI-2 content and supplementary scales of the Dutch sample proved to be important determinants of the first three MMPI-2 components, adding to convergent validity. Questions remained about the influence of the (dis)continuity of MCMI-II and MCMI-III on the replicability of the MCMI components.     

MMPI-2 and MCMI-III scores among dutch inpatient substance abusers: Assessing correspondence and cross-cultural equivalence

The Millon Clinical Multiaxial Inventory (MCMI-II and MCMI-III) and the Minnesota Multiphasic Personality Inventory (MMPI-2) were applied to 263 Dutch inpatient substance abusers with multiple psychiatric diagnoses, and the results compared with those of 306 North-American substance abusers studied by Ward (1995). We looked for structural similarity both across groups (per instrument) and across the two instruments (per sample), using principal components analysis and congruence analysis. The component structure found by Ward was partly replicated in the Dutch group, thus cross-validating the use of the two instruments with these patients. Moreover, as found by Ward, the MMPI-2 content and supplementary scales of the Dutch sample proved to be important determinants of the first three MMPI-2 components, adding to convergent validity. Questions remained about the influence of the (dis)continuity of MCMI-II and MCMI-III on the replicability of the MCMI components.     

A review of: “The presentation of case material in clinical discourse”

Ivan Ward (ed.) (1997) The Presentation of Case Material in Clinical Discourse, London: Freud Museum Publications, 96 pp., $6.95     

Subjective and Objective Risks of Carrying a BRCA1/2 Mutation in Individuals of Ashkenazi Jewish Descent

This repeated measures study examines (1) the change in subjective risk of mutations pre- to postcounseling, (2) the accuracy of BRCAPRO estimates of mutations, and (3) the discrepancy between subjective risk and BRCAPRO estimates of mutations before and after genetic counseling. Ninety-nine Ashkenazi Jewish individuals pursued testing for BRCA1/2 mutations. Most had a personal cancer history (N = 51; family only: N = 48); and received uninformative negative results (N = 66; positives: N = 23; informative negative: N = 10). The coping strategy of defensive pessimism predicts that individuals will believe the worst case scenario to better cope with a potential negative outcome. Consistent with this, most felt they would have a mutation, if not mutations in both genes. The BRCAPRO model appeared to overestimate risk of having a mutation in this sample (p < .001). BRCAPRO overestimates notwithstanding, genetic counseling increased accuracy of subjective risk (p < .01). Individuals with a family-only cancer history had the least accurate estimates of risk (p < .05) and may need further intervention to either manage anxiety or improve knowledge.     

A Content Analysis of LGBTQ Qualitative Research in Counseling: A Ten‐Year Review

This content analysis examines the qualitative methodology used in counseling research with lesbian, gay, bisexual, transgender, and queer (LGBTQ) issues published over the last 10 years (1998–2008) in 4 counseling and counseling psychology journals (Journal of Counseling & Development, Journal of Counseling Psychology, Journal of LGBT Issues In Counseling, and The Counseling Psychologist). LGBTQ qualitative investigations in counseling research continue to be rare. Recommendations to increase the trustworthiness and scope of future LGBTQ counseling research are provided.     

Counselor Confidence and Accuracy of Prognoses of Success or Failure

This study assessed the accuracy of predictions of freshman and overall college scholastic performance made by groups of high school counselors, college advisors, and counseling psychologists from a university counseling center in relation to the confidence of these judges that their prognoses were accurate. Predictions were made from three sets of case information. The results revealed that: (1) the degree of confidence counselors indicated in their freshman and overall college “pass” predictions was appropriately related to accuracy; (2) counselor confidence in freshman “fail” predictions was not related to accuracy although the “fail” judgments tended to be more accurate than the “pass” prognoses; (3) counselor confidence in their overall “fail” predictions was not significantly related to accuracy and, unlike the results for the freshman judgments, the overall “fail” predictions were not more accurate than the “pass” predictions; (4) the amount of case data available was not related to counselor predictive accuracy.     

College Students' Perceptions of a Psychotherapist's Treatment of a Religious Issue: Partial Replication and Extension

A study of the influence of a counselor's treatment of a client's religious values, observers' religiosity, and their interaction on observers' perceptions of counseling (Morrow, Worthington, & McCullough, 1992) was partially replicated and extended. Religious beliefs were differentiated from religious values as determinants of observers' perceptions of counseling. Student observers (N = 148) viewed one of two videotaped counseling interactions in which a counselor either supported or challenged a client's religious values. Dividing observers into high and low levels of Christian belief did not result in their perceiving religiously supportive or challenging counseling differently. Dividing observers into high and low levels of religious values produced consistent differences in how they perceived religiously supportive and challenging counseling. Findings supported the theory that people with strong religious values perceive counseling differently than people with weaker religious values.     

Interest and Beliefs About BRCA Genetic Counseling Among At-Risk Latinas in New York City

Background: Latinas are less likely to use genetic services (counseling and testing) for hereditary breast and/or ovarian cancer risk compared to other ethnic groups. Meanwhile, little is known about barriers to genetic counseling among Latinas at increased risk of inherited breast cancer. Methods: A two-phase pilot study was conducted to examine interest, barriers and beliefs about BRCA genetic counseling among at-risk Latinas in New York City and explore the potential for developing a culturally-tailored narrative educational tool for use in future studies. Phase 1 included quantitative telephone interviews (N = 15) with bilingual participants with a personal diagnosis at a young age and/or family history of breast and/or ovarian cancer. Quantitative results informed development of a narrative prototype educational presentation viewed by a subset of participants (N = 10) in Phase 2 focus groups. Results: Despite barriers, including lack of awareness/knowledge, concerns related to learning cancer risks of family members, and concerns about cost/health insurance, participants reported positive attitudes, beliefs and interest in learning about BRCA genetic counseling. Further, significant increases in knowledge were demonstrated from pre-post presentation (p = 0.04). Conclusion: There is an unmet need to educate at-risk Latinas about BRCA genetic counseling. Culturally-tailored educational materials including narratives may increase knowledge about BRCA genetic counseling among this underserved group. The effectiveness of these approaches should be tested in future research with larger samples.     

Development and Evaluation of a Decision Aid About Prenatal Testing for Women of Advanced Maternal Age

Objective: To develop and evaluate a decision aid designed to prepare patients of advanced maternal age for counseling about prenatal diagnostic testing. Setting: A regional genetics center. Design: A before/after study. Interventions: Participants used an audioguided workbook to learn about options and outcomes and to clarify personal risks, values, questions, and predispositions. Subjects: 21 women of advanced maternal age and 17 spouses. Main outcome measures: Knowledge of prenatal testing alternatives, decisional conflict, level of anxiety, and acceptability of the decision aid. Results: After using the decision aid, participants had significantly reduced decisional conflict (uncertainty) and a significant increase in knowledge. There was no effect on state or trait anxiety. More than three-quarters of participants were satisfied with the length, clarity, balance, and acceptability of the decision aid. Conclusions: The decision aid shows promise as a useful aid for preparing couples for counseling.     

Science and Practice: Reconsidering the Pepinskys

Two issues from the Pepinskys' Counseling: Theory and Practice (1954)—the scientist-practitioner model of counseling and the use of scientific thinking in counseling practice—are examined in light of their current implications for the counseling profession.     

Integrating motivational interviewing in career counseling: A case study

Motivational interviewing (MI) is receiving increasing attention in the field of career counseling. However, none of the previous studies have concretely presented how this method could and why it should be integrated in career counseling. Through the use of a single case study design, this paper illustrates how a brief MI (BMI) intervention can be integrated into career counseling interventions to help resolve career dilemmas. An analysis of the interactions between the client and his counselor using the Motivational Interviewing Skills Code 2.1 illustrates why this method can be useful for career counseling. Immediate and long-term effects of the global career counseling intervention on the client's career decision-making difficulties, as well as the specific impacts of the BMI intervention, are assessed. This case study shows that the BMI approach can be integrated in a career counseling intervention to help career counseling clients overcome career dilemmas and increase their readiness to make career choices.     

The relationship between alliance ruptures and hope for change through counseling: A mixed methods study

The negative impact of alliance ruptures on clients’ experiences within the therapeutic process is well documented. One such negative influence may include clients’ hope for counseling as a helpful process. This study used a mixed methods design to explore how alliance ruptures are related to hope for change through counseling. Quantitative data (N = 105) indicated that those who experienced ruptures reported lower levels of the components of hope for change through counseling, (a) pathways and agency, and (b) goal identification. More frequent ruptures and rupture repairs were significantly related to participants’ (n = 35) pathways and agency. Phenomenological analysis of qualitative participants’ (N = 5) experiences elicited 218 meaning units grouped into four themes: disengagement and mistrust in therapy, deepened distress, questioning one’s hope for and belief in therapy, and resilience for therapy. Qualitative and quantitative data indicate that alliance ruptures are related to lower degrees of hope for change through counseling. Results suggest that clients’ perceptions of ruptures fostered disengagement and mistrust of therapists. However, when therapists act to repair ruptures, they may effectively re-engage some degree of hope for change through counseling in clients. Lastly, the role of clients’ persistence in therapy despite experiencing ruptures is discussed.     

Once More ≡

Books reviewed: Graham Ward, Theology and Contemporary Literary Theory Raymund Schwager S.J., Must there be Scapegoats? Violence and Redemption in the Bible René Latourelle and Rino Fisichella (eds), Dictionary of Fundamental Theology H. R. Mackintosh, The Person of Jesus Christ     

Of Viruses and the Mother-Child Dyad

Moralizing the Environment: Countryside change, farming and pollution, by P. Lowe, P. J. Clark, S. Seymore and N. Ward. London: UCL Press, 1997     

Relation between referential and reflexive processes: an explorative study

Referential process (RP) has been investigated in the psychotherapy domain to understand the mechanisms underlying clients’ problems and identify the process of change. RP shares some theoretical assumptions with another relevant construct in the psychotherapy domain, i.e. the reflexive process. However, the relation between RP and reflexive process has never been explored through an operational approach. This study aims at analyzing the relation between referential activity (RA), conceived as the linguistic index of RP, and two reflexive processes of different complexity, reflection and reflexivity, in a group counseling program. Audio recordings from seven group counseling sessions were analyzed through two procedures: (1) the latest Italian version of the computerized text analysis software developed for analyzing RA, and (2) the analysis of the narrative functions of reflection and reflexivity. Accordingly, reflection processes were mainly identified in the narrative excerpts by adopting the conventional procedure for RA software-based analysis and combining it with the analysis of the narrative functions. More complex processes of reflexivity were detected when the analysis of the narrative functions was combined with an innovative procedure for RA software-based analysis. Overall, these data indicated that a high level of RA is essential for activating reflexive processes of higher complexity.