Systemically-Based Psychotherapeutic Techniques in Genetic Counseling

The uses of systemically-based psychotherapeutic methods in genetic counseling are discussed in the context of the origin of genetic counseling, the definition of genetic counseling, and the adjustments that one must make in order to implement these methods. Selected systemic methods which can be readily incorporated into genetic counseling are presented: use of genograms to explore family attitudes and beliefs about genetic risk, communications skills, and applications of family of origin work in genetic counseling. The need for research regarding the methodology and process of genetic counseling is presented with discussion of the need for theories of practice for genetic counseling.     

Effectively counseling the military population: Training needs for counselors

Counselors (N = 49) interested in working with the military population described what is needed to feel competent and confident counseling this population in a mixed-methods research study. Findings suggest counselors do not believe their programs are preparing them to work with this population. Participants indicate strategies which would increase their ability to work with the military. Results provide implications for counseling programs on how they can better prepare students to work effectively with this population and increase the employment rates in serving the military.     

Case Report: Object Relations Family Therapy as a Model for Genetic Counseling

Object relations family therapy (ORFT) is a psychoanalytically based approach for the treatment of couples and families which stresses the importance of past relationships. The therapist assumes a parentlike role and provides a holding environment in which clients can explore unconscious motivations. This paper will discuss the applicability of this method to genetic counseling. The case of a couple seen for recurrent trisomies will be presented and used as an example to discuss how ORFT might serve as a framework in a genetic counseling session.     

Religious Counseling: To Be Used,Not Feared

Our society is placing more emphasis on religion and religious issues. Persons seeking counseling often request Christian counseling. Students in academic settings often express an interest in becoming Christian counselors. Often the religious aspect is left out or avoided in courses for training counselors. This article gives some specific ways in which religious issues can be used in a counseling setting using the three ps: place, personhood and philosophy.     

Genetic Counseling, Reproductive Behavior and Future Reproductive Intentions of People with Neurofibromatosis Type 1 (NF1)

Neurofibromatosis type 1(NF1) is a complex and variable inherited disorder. The complexity and variability present particular difficulty for genetic counseling. Thirty-three people with NF1 of reproductive age were interviewed about their experience of genetic counseling, their past reproductive behavior and future intentions. One third reported having had no genetic counseling or not having it until after their first child. In part, this may be due to delay in diagnosis but also indicates poor access to genetic services. Only three people had ever been offered prenatal genetic testing and only one had accepted. Although testing is still technically difficult, the greatest deterrent to uptake of prenatal testing for NF1 is the variability of the disorder. However, six of the 17 people planning future pregnancies would want a test with a view to termination if necessary. Others would welcome testing in order to be prepared but not to terminate. We discuss some of the factors which influence reproductive decision making for people with NF1 and some of the difficulties in genetic counseling in such a variable and complex disorder.     

Acculturation in Women with Mental Retardation and Its Impact on Genetic Counseling

The provision of genetic counseling to women with mild mental retardation poses many challenges, some directly related to their developmental and cognitive disabilities. Traditional genetic counseling models, in which decision-making is largely based on the understanding of factual information, are particularly affected by the intellectual limitations which characterize this population. Equally important, however, are these women's attitudes, perceptions, and behaviors related to their involuntary inclusion into a highly stigmatized social group. Common themes among these women which surface in the genetic counseling setting include the denial of mental retardation, a hierarchical perception of their own and others' disabilities, and a strong motivation to conceive and parent a child. Such attitudes and behaviors may be symptomatic of acculturation, as these women struggle to take on accepted social roles while rejecting the stigma of intellectual disability. In contrast to factual information, the counselee's ability to discuss emotions and perceptions is not necessarily hampered by her intellectual limitations. A focus on the recognition and discussion of psychosocial issues provides a more meaningful approach than traditional genetic counseling models for facilitating informed reproductive decisions among women with mental retardation.     

Diversification: Counselors' Investment in Humanity—A Student's Opinion

The author argues that diversification can be the basis of the counseling profession's investment in humanity, attempts to inspire a united stance within the profession, and maintains that counseling professionals have a responsibility to share their knowledge of and respect for embracing all people. These statements attempt to capture the perspective of one aspiring to join the ranks of many dedicated and inspiring counseling professionals. Open your eyes and look for some [person], or some work for the sake of [all people], which needs a little time, a little friendship, a little [empathy], a little sociability, a little human toil. … It is needed in every nook and corner; therefore, search and see if there is not some place where you may invest your humanity, —Albert Schweitzer (As cited in Canfield, Hansen, McCarty, & McCarty, 1997, p. 267)     

The Effect of Genetic Counseling on Knowledge and Perceptions Regarding Risks for Breast Cancer

In 1994, a clinic for cancer risk counseling was opened at Hadassah University Hospital in Jerusalem. Most of the counselees have been women who had breast cancer and/or a relative with breast cancer. In order to evaluate the effect of this counseling on women's knowledge and perceptions regarding the risks for breast cancer, a questionnaire was given before and after the counseling session to 60 healthy women who came to the clinic because they have relatives with breast cancer. According to the genetic counselors' estimations, most of these women had a significantly increased risk (compared to the general population) of developing cancer. Before counseling, the women overestimated the population risk for breast cancer, the contribution of heredity to morbidity of cancer, and their own risks to get cancer. After counseling session, they gave reduced estimates, closer to the real ones. The subjective perceptions regarding these risks were reduced after counseling, except for the perceptions regarding their relativerisks which have not changed after the counseling. About 90% of the women who came to the clinic wanted to be tested for genetic predisposition to cancer. For most of these women, the expectations that the test can rule out a genetic predisposition to cancer became more realistic after the counseling. The option to first test an affected relative was offered to all families, and a test was actually conducted in 75% of the families.     

Group counseling in a different cultural context: Several primary issues in dealing with Chinese clients

To apply group therapy or counseling, a branch of helping methodology rooted in modern Western psychology, to a culturally different context, such as the Chinese cultural environment, group counselors need to increase their awareness, knowledge, and skills that are compatible with the group climate they encounter. A group counselor needs to understand the general characteristics of the culture. The counselor should use his or her leadership quality to deal appropriately with group clients' psychological dynamics, which bear unique cultural preferences with respect to thinking, feeling, and doing. While many group counseling communication skills from a Western theoretical framework can be helpful and applicable to the Chinese group clientele, some of these skills need to be contextually modified. The counseling goal is to properly integrate Chinese cultural and therapeutic norms into the group process.He also teaches as a Sessional-Instructor in the same department.     

BRCA1 Testing: Genetic Counseling Protocol Development and Counseling Issues

This article discusses the genetic counseling protocols which were developed and counseling issues that have arisen in the first 2 years of evaluating a large kindred with a BRCA1 mutation. The rationale for the development of the genetic counseling protocols and specific genetic counseling visual aids are presented and discussed. The protocols and counseling aids can serve as models for other programs offering cancer susceptibility testing. The observations of study counselors about study subject concerns and responses to genetic testing at the time of the pretest and posttest counseling sessions are presented.     

Genetic Counseling: Clinical Geneticists' Views

Evaluation of genetic counseling requires a clear consensus about its objectives, which is not evident in published definitions and guidelines. This study aims to investigate clinical geneticists' beliefs and thoughts about their practice. Structured interviews with eight clinical geneticists addressed the aims, skills, and expectations of genetic counseling. Analysis of transcribed interviews revealed four key themes, with contradictory aspects: 1. Providing information that is objective, full, and accurate versus information that is contingent on circumstances and tailored to individual needs. 2. Eliciting emotion and dealing with it directly versus dampening down and containing emotion. 3. Communicating nondirectively versus directively. 4. Expecting to perform a range of sophisticated tasks while having minimal training in the necessary skills to achieve these. These results have implications for the nature of the professional role, the development of training required for it, and the evaluation of genetic counseling.     

Client Perceptions of the Impact of Genetic Counseling: An Exploratory Study

Twenty-eight former genetic counseling clients seen at a major Midwestern university were recruited to be interviewed about their genetic counseling experiences, including most and least helpful aspects, what they learned, how this information impacted their decision-making, and their perceptions of their genetic counselors' behaviors. Responses were inductively analyzed, and several themes were identified, including: Clients sought genetic counseling to obtain genetic-medical information; a majority accurately recalled this information; genetic counseling influenced decisions for about 50% of the sample; decision-making was affected by several extra-session factors; a majority experienced distress during the session; most perceived genetic counselor responses as nondirective and liked this approach; counselor behaviors regarded as directive involved discussion of pregnancy termination; participants disagreed about the need for and provision of genetic counselor support; most regarded the session as helpful and stated that they would seek genetic counseling again. Suggestions for addressing these issues in practice and research are given.     

The Counselor Who Is: A Critique and a Modest Proposal

In light of the essential nature of counseling as it is reflected in current theory and texts, it is submitted that a discrepancy exists between the idea of the counseling process on the one hand, and the teaching and practice of counseling on the other hand. The absolute necessity for the counselor's having a body of substantive information relating to the discipline of counseling psychology is asserted but the sufficient condition is that the counselor be (or become) the kind of person who can facilitate the therapeutic happening. Two proposals are made. A rationale for the exposure of counselors and aspirants to group-encounter experiences is given, and possible outcomes suggested. Further, in response to a basic need in our educational structure, the staffing of each large high school with a relatively independent counseling center is recommended. The function and possible ameliorative effects of such centers are described.     

Commentary: How Individual and Profession-level Factors Influence Discussion of Disability in Prenatal Genetic Counseling

Hodgson and Weil (Journal of Genetic Counseling, 2011) reports on two interactive workshops in which genetic counselors identified a broad set of counseling issues that may be impediments to promoting an adequate discussion of disability in prenatal genetic counseling. The present commentary discusses two factors that we infer underlie these counseling issues. First, countertransference concerning disability, which is normal and expected, may influence genetic counselors’ decisions about raising and exploring the complex topic of disability in prenatal genetic counseling. Second, the limited involvement of the profession of genetic counseling in the complex social and ethical issues of disability provide little guidance to the individual genetic counselor with respect to discussing disability in prenatal diagnosis counseling. We suggest both factors must be acknowledged and addressed in order to adequately implement the recommendations presented in Hodgson and Weil (Journal of Genetic Counseling, 2011) as well as other efforts to increase discussion of disability in prenatal diagnosis counseling in the service of informed decision making.     

Christian Counseling: A Synthesis of Psychological and Christian Concepts

Strong describes an approach to counseling that synthesizes psychological processes of change with theological concepts of the Christian faith. Clients are assumed to be self-directing and responsible for their behavior, including the changes that counseling is intended to facilitate. The counselor's junction is to equip clients to enable them to change. The key objectives in Christian counseling are described and the counseling process is reviewed in the light of these objectives. The author discusses the place of justification, responsibility, forgiveness, grace, sin, responsible loving, and prayer in the counseling process. Francis Mc Guire makes a response to Strong's article from a perspective that views Zen Buddhism as an integrated psychospiritual system capable of offering a critique and a complementary viewpoint. Herman Slotkin 's think piece is an attempt to define and clarify some of the language and goals of moral education and propose a civic, nonsectarian perspective regarding value and moral awareness.     

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).     

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.     

Counseling Older Adults with Dementia: A Survey of Therapists in Massachusetts

Although much has been written about therapeutic interventions with caregivers, little is known about the counseling services that are available for victims of dementia. The present study was designed to explore community mental health center (CMHC) services and therapists' experiences in providing psychotherapy to this population in Massachusetts. Only 27 of the 36 CMHCs in the state reported providing mental health services to older adults with a dementing illness. A survey of therapists who specialized in working with older adults found that the percentage of older adult clients estimated to have dementia averaged about half of their caseload. Older persons in the early phase of a dementing illness were most frequently referred for depression and anxiety, whereas those with moderate decline were most frequently referred for management of disruptive behavior. The most common services provided to clients with dementia consisted of assessment and individual counseling. The latter finding indicates a discrepancy between what is practiced and the professional literature. Most of the psychotherapy described in the literature concerns group interventions, which were rarely provided by the mental health centers in Massachusetts. The centers tended to offer individual counseling; however, little information on how to provide this form of treatment can be found.