A Leader-Led Supervision Group as a Model for Practicing Genetic Counselors

With the stage set by the overview of supervision models in the previous paper, thispaper now presents the development and evolution of a currently ongoing leader-ledsupervision group for experienced genetic counselors. I discuss the procedures forgetting started; the creation and maintenance of the contract; typical issues and themesconsidered; the format for case presentation; and the overall growth of the group and itsmembers.     

The Experience of Leader-Led Peer Supervision: Genetic Counselors' Perspectives

As we proceed through our professional lives, it is essential that we challengeourselves in order to continue to develop our genetic counseling skills. Conferences, workshops,post-graduate courses, journal clubs, and involvement in professional organizations havebecome the traditional methods of continuing education for post-graduate geneticcounselors. While these forums address the need to stay updated on scientific orinformation-based topics, there is little available to counselors to promote growth incounseling skills. A group of Boston-based genetic counselors describe how their leader-ledsupervision group has established a setting to meet the needs of its members both forsupport and continued counseling training. We outline here the evolution of this group andhow it has become a valued part of our professional lives. We feel that the model of leader-ledpeer supervision holds great value in helping genetic counselors continue to enhancetheir interpersonal skills in a supportive, safe, and challenging environment. It is our hopethat others will elect to form similar groups in their own communities, thereby creating newopportunities for growth within the genetic counseling profession.     

Reflections on the Experience of Counseling Supervision by a Team of Genetic Counselors from the UK

Despite it being generally acknowledged that counseling supervision is a vital part of the work for experienced genetic counselors and not just students, not all practising genetic counselors in the United Kingdom and Eire have access to this yet. This case study documents the supervision experience of our team of genetic counselors from Cambridge in the U.K. We document our retrospective thoughts on working practice before supervision was available in our department. We also give an overview of the individual and collective views of having one-to-one supervision only and then one year later, the impact of adding group supervision. Our ‘supervision journey’ is recorded using a practitioner-centred approach with a mixed method of data collection. Two focus group discussions and two written questionnaires were used, at different time points to gather attitudes. This paper captures experiences as our practice of supervision has evolved. This work is relevant to practising genetic counselors around the world who either do not yet have access to supervision, are planning its implementation or else are adding different types of supervision to their practice.     

Caring for the Care-Giver: The Benefit of a Peer Supervision Group

I presented the following case to my leader-led peer supervisiongroup twice as the case evolved over the course of one year. During my firstmeetings with Mr. and Mrs. M we discussed a prenatal diagnosis of a skeletaldysplasia at thirty-three weeks of pregnancy and the option of a third trimesterpregnancy termination. One year later I presented follow-up on the outcome ofthe affected pregnancy, a new pregnancy, and Mrs. M's suicide. Although bothsegments of the case were completed by the time I presented, my peersupervision group was invaluable. With the encouragement and support of groupmembers, I could openly express and process my sadness and grief for the M'ssituation and the loss of Mrs. M's life.     

A Survey of Clinical Supervision in Genetic Counseling

Three hundred and thirty-five full members of the National Society of Genetic Counselors completed a survey concerning the nature of clinical supervision for genetic counseling students. Slightly over half (54.3%, n = 182) had provided clinical supervision within the past 5 years. Of those who supervised, 66.7% had 5 years or less supervision experience, and 55% had supervised 10 or fewer students. The majority became supervisors because they enjoy teaching and contributing to the profession. Common reasons for not supervising include no local graduate program, and had never been asked to supervise. Live supervision is the most prevalent student evaluation method: every supervisor reported providing one-on-one oral feedback, and 47.3% indicated that they always provide feedback immediately following a counseling session. The most frequent challenges involve students who lack technical knowledge and who fail to incorporate feedback. Training, policy, and research implications are discussed.     

A Qualitative Investigation of Student and Supervisor Perceptions of Live Supervision in Genetic Counseling

Live supervision of genetic counseling students is critical for ensuring quality client care and student clinical skill development. However, no research has investigated students' and supervisors' experience of this primary supervision method. In this study, separate focus groups of students and supervisors discussed their perceptions of the nature and impact of live supervision. A modified Consensual Qualitative Research method (Hill et al. (1997) Couns Psychol 25:517–572) was used to analyze the data. Results suggest that live supervision is an essential and effective method that promotes student skill development and professional development for both students and supervisors. There is a lack of formal training regarding supervision; most learning is trial and error. Students worry about being evaluated, and supervisors wonder if they are providing supervision effectively. Both samples emphasized that client care should not be compromised. Participant recommendations for improving live supervision are described, and suggestions are made for future research.     

The Interface Between Countertransference and Projective Identification in a Case Presented to Peer Supervision

This case report, presented to a supervision group, is a prenatal genetic counseling casethat caused me a great deal of emotional discomfort as the events unfolded. Thediscomfort originated during my first meeting with the couple for routine preamniocentesiscounseling and continued through later encounters. This case illustrates the process ofworking through countertransference and projective identification issues that may arise ingenetic counseling.     

Report from the UK and Eire Association of Genetic Nurses and Counsellors (AGNC) Supervision Working Group on Genetic Counselling Supervision

The Association of Genetic Nurses and Counsellors (AGNC) is the professional organisation which represents genetic counsellors and genetic nurses in the United Kingdom (UK) and Eire. The AGNC recognises that genetic counselling supervision is instrumental to the practice, training and registration of genetic counsellors in the UK. The AGNC formed a Supervision Working Group, whose terms of reference were to collate information on supervision and create a list of ‘best practice’ recommendations for its genetic counsellor members. This report delivers the findings from the Supervision Working Group and has been peer reviewed by the AGNC membership in the UK and Eire and ratified by the AGNC Committee. It offers a working definition of genetic counselling supervision, gives an overview of some of the literature on supervision and concludes with practice recommendations. Group Authorship: AGNC Supervision Working Group Membership of the AGNC Supervision Working Group     

Probability Biases in Genetic Problem Solving: A Comparison of Undergraduates, Genetic Counseling Graduate Students, and Genetic Counselors

Heuristics are mental shortcuts that aid people in everyday problem-solving and decision-making. Although numerous studies have demonstrated their use in contexts ranging from consumers’ shopping decisions to experts’ estimations of experimental validity, virtually no published research has addressed heuristics use in problems involving genetic conditions and associated risk probabilities. The present research consists of two studies. In the first study, 220 undergraduates attempted to solve four genetic problems—two common heuristic problems modified to focus on genetic likelihood, and two created to study heuristics and probability rule application. Results revealed that the vast majority of undergraduates used heuristics and also demonstrated a complete misuse of probability rules. In the second study, 156 practicing genetic counselors and 89 genetic counseling students solved slightly modified versions of the genetic problems used in Study 1. Results indicated that a large percentage of both genetic counselors and students used heuristics, but the counselors demonstrated superior problem-solving performance compared to both the genetic counseling students and the undergraduates from Study 1. Research, training, and practice recommendations are presented.     

Games in Clinical Genetic Counseling Supervision

Games are defined as ongoing series of complementary ulterior transactions that are superficially plausible but have a concealed motivation to maximize pay-offs and minimize penalties for the initiator. While some games are harmless and part of socialization, others are destructive. Destructive game-playing in clinical supervision, in which game-playing (initiated by either supervisors or students) interferes with a student's realization of internship goals, has been documented in some allied healthcare professions but has not yet been studied in genetic counseling. Genetic counselors and clinical supervisors of genetic counseling students were anonymously surveyed regarding their experiences with destructive game-playing. Results show that such games do occur in genetic counseling clinical supervision. Some games are the same or similar to ones previously described in other health-care professions; others may be unique to genetic counseling. The purpose of this paper is to document these games as a first step to facilitating dialogue, understanding and awareness of them.     

Training Genetic Counselors to provide teratogen counseling

Provision of teratogen counseling requires acquisition of knowledge and skills from several disciplines. Traditionally, training in teratogen counseling has occurred on the job. We describe a formal, didactic and experiential curriculum for teratogen counseling as an integral part of the Graduate Program in Genetic Counseling leading to the master of science degree at Northwestern University. All students complete a 5-week rotation with the Coordinator of the Illinois Teratogen Information Service (TIS). This provides them with an opportunity to evaluate a spectrum of teratogen exposures, to interpret teratogen studies in a manner useful for patients, and to develop skills in assessing and addressing psychosocial issues associated with fetal exposure to potential teratogens. Students also learn first hand about how a TIS functions and when and how to refer to TIS specialists. The goal of the program is to provide genetic counseling students with the opportunity to gain experience in accessing and interpreting teratology research and in communicating teratogen information to patients and health professionals in a sensitive, effective manner.     

An explication of the National Society of Genetic Counselors (NSGC) code of ethics

This article reviews the work carried out by the NSGC ad hoc Committee on Ethical Codes and Principles between 1986 and 1991 and serves as a guide for interpreting the NSGC Code of Ethics. The NSGC Code of Ethics is written from the ethic of care perspective. It is based on the responsibilities that arise from the four primary relationships genetic counselors experience in their work: genetic counselors and themselves, their clients, their colleagues, and society. The values selected for each relationship and the resultant guidelines are explained. The Code of Ethics became effective January 1, 1992.     

Educating Genetic Counselors in Australia: Developing an International Perspective

The demand for genetic counseling services is increasing worldwide. This paper highlights the Australian experience of genetic counselor education and the history of the profession. The relevance of local factors, including the healthcare system, the education system and the small population in the evolution of the 1-year training programs are considered as an alternative model for emerging programs. The development of the education and training processes compared to that of other countries namely the United States of America (USA), the United Kingdom (UK) and Canada is discussed. The importance of international collaborations between the programs, to facilitate academic discussion and possible curriculum innovations, and to maintain professional understanding between genetic counselors is emphasized. Core genetic counseling competencies have been published for the UK and USA and an Australian set is proposed. In conclusion future directions are considered, including international issues around genetic counseling certification, reciprocity, and the potential for an Australian role in training genetic counselors in South East Asia.     

Impact of Two Clinical Peer Supervision Models on Practicing School Counselors

Two forms of clinical peer supervision were provided for a sample of 29 practicing school counselors. Pre- and posttest measures were used to assess the counselors' level of job satisfaction, counseling self-efficacy, and counseling effectiveness (including empathic responding, adaptability and flexibility in counselor response, and client behavior change). The sample was divided into 3 groups (2 treatment and 1 control). Each supervision treatment lasted 9 weeks. None of the analyses of covariance examining treatment effects were significant. However, these individually nonsignificant results showed movement in the hypothesized direction in each instance, indicating small but pervasive effects of treatment. Participants' qualitative session evaluations also supported the helpfulness of clinical peer supervision for school counselors. Implications for future research and the practice of school counselor supervision are discussed.     

Cystic Fibrosis Prenatal Screening in Genetic Counseling Practice: Recommendations of the National Society of Genetic Counselors

For over a decade, prenatal screening for cystic fibrosis (CF) has been considered a model for the integration of genetic testing into routine medical practice. Data from pilot studies and public policy discourse have led to recommendations by some professional organizations that CF screening should be offered or made available to pregnant women and their partners, and to couples planning a pregnancy. It is crucial that genetic counselors gain thorough understanding of the complexities of CF and the implications of positive test results, so that they may serve as a reliable, educated referral base and resource for health care providers and their patients. While not all pregnant women will be referred for genetic counseling prior to CF carrier testing, genetic counselors often will be asked to counsel clients after they have a positive test result, or who are found to be at increased risk. Genetic counselors can play an important role in providing accurate and current information as well as support for patients informed decisions. These recommendations were created by a multicenter working group of genetic counselors with expertise in CF and are based on personal clinical experience, review of pertinent English language medical articles, and reports of expert committees. The recommendations should not be construed as dictating an exclusive course of management, nor does the use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care providers professional judgment based on the clinical circumstances of a particular client.     

Creative Supervision for Counselors Working in a Hospice Setting

The number of individuals receiving hospice care in the United States is on the rise. Many individuals who suffer from debilitating health issues use the care of helping professionals in a hospice environment. Supervision approaches for counselors who encounter grief, loss, death, and bereavement issues in hospice settings are needed. The authors introduce three creative interventions for use with supervisees in one of the four stages of the integrative developmental model of supervision. One intervention, the “Rock Talk,” is more thoroughly explained and then demonstrated in a case illustration of a supervisee using the intervention to say goodbye to a hospice client.     

2005 National Society of Genetic Counselors Presidential Address: Raising Our Voice

This Presidential Address was given at the annual education conference of the National Society of Genetic Counselors in Los Angeles, California, USA on November 14, 2005     

Supporting Counselors After a Client Suicide: Creative Supervision Techniques

Many professional counselors will experience the loss of a client to suicide. The effects of this loss are explored in this article. The supervisor’s role in supporting a supervisee after a client’s suicide is presented. Additionally, creative interventions that can be used by supervisors to support supervisees after the loss of a client are provided. These creative techniques are theoretically grounded within the cognitive behavioral, solution-focused, and narrative paradigms.     

Genetic Counseling for Fragile X Syndrome: Recommendations of the National Society of Genetic Counselors

The National Society of Genetic Counselors' (NSGC) recommendations for fragile X syndrome (FXS) genetic counseling are intended to assist health care professionals who provide genetic counseling for individuals and families in whom the diagnosis of FXS is strongly suspected or has been made. The recommendations are the opinions of genetic counselors with expertise in FXS counseling and are based on clinical experience, a review of pertinent English language medical articles, and reports of expert committees. 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 particular client.     

The Processing Wheel: An Arts-based Intervention for Clinical Supervision

The primary goal of supervision is to promote professional growth among counselors-in-training. Art making is an under-explored method of promoting exploration and self-awareness, and thus professional growth, within the process of supervision. While outlining the literature on creativity in counselor education and implementing art into supervision, the author also includes details about her experience of infusing art into supervision. Additionally, a case example of a new specific art-based intervention, dubbed the “Processing Wheel,” is described. Finally, implications, limitations, and future directions for counselor educators are discussed.