The Nature of Generalized Anxiety in Older Primary Care Patients: Preliminary Findings

Clinical features of older primary care patients with GAD (PC-GAD; n = 22) were examined relative to older patients with GAD recruited for two academic clinical trials (M. A. Stanley, J. G. Beck, et al., 2003; J. L. Wetherell, M. Gatz, & M. G, Craske, 2003) and to a sample of older primary care patients without psychiatric diagnoses (No Dx; n = 10). Comparisons revealed similar levels of worry, anxiety, depressive symptoms, quality of life, and functional status between the PC-GAD subsample and patients recruited for academic trials, although primary care patients were older, less well educated, and more ethnically diverse. The PC-GAD subgroup, however, reported greater symptom severity, reduced quality of life, and poorer perceived general health, mental health, and vitality than the No Dx subgroup (² = .23–.43). Service utilization was not different between PC-GAD and No Dx subgroups, with the exception of psychotropic medication use. The Penn State Worry Questionnaire (PSWQ) and an abbreviated version of this measure may be useful for identifying late-life GAD in primary care. Cutoff scores of 50 and 22 on the full and abbreviated versions of the PSWQ, respectively, demonstrated excellent specificity, sensitivity, and positive predictive value. Negative predictive value was less impressive, probably as a result of high base rates for GAD in this sample.     

African Americans and High Blood Pressure: The Role of Stereotype Threat

We examined the effect of stereotype threat on blood pressure reactivity. Compared with European Americans, and African Americans under little or no stereotype threat, African Americans under stereotype threat exhibited larger increases in mean arterial blood pressure during an academic test, and performed more poorly on difficult test items. We discuss the significance of these findings for understanding the incidence of hypertension among African Americans.     

“Why am I so stuck?”: A Collaborative/Therapeutic Assessment Case Discussion

Assessors from 3 continents worked together on a single multimethod case study. Their goal was to hold the client at the center and forefront of their attitudes and thinking as each assessor focused on a specific measure or group of measures. The adult client requested a neuropsychological assessment and completed a full battery of cognitive measures as well as the MMPI–2, the Rorschach, and the Wartegg. A basic tenet of collaborative/therapeutic assessment holds that the client is a full partner in the assessment process; he or she is also seen as the final arbiter of the usefulness of the ideas derived. With that in mind, the client worked with the lead assessor to create 6 questions she wished answered by the assessment. Feedback and discussion occurred in a number of ways: through discussion sessions with the lead assessor that included extended inquiry; individualized letters from the other assessors, each addressing her 6 questions; a summary letter from the lead assessor; and a metaphorical, therapeutic story that stressed key findings from the assessment. Results converged powerfully, with similar findings from each assessor. The client stated that she felt heard and understood in the process, even by individuals who she had never met personally.     

Countering Deficits: A Grounded Theory of Success From Graduate Students of Color

The existing research on students of color in counselor education focuses on the barriers they experience, providing a deficit perspective. Using grounded theory and a critical race theory framework, we studied the racialized experiences of 19 graduate students of color in counselor education. Grounded in participants' voices, we propose a liberatory theory of academic success. Implications for promoting the success of students of color in counselor education and for future critical race theory research are discussed. Las investigaciones hasta la fecha sobre estudiantes de color en programas educativos de consejería se centran en las barreras que afrontan, lo cual ofrece un déficit de perspectiva. Usando un muestreo teórico y un marco de teoría crítica de la raza, estudiamos las experiencias racializadas de 19 estudiantes de posgrado de color en programas educativos de consejería. Basándonos en las voces de los participantes, proponemos una teoría liberatoria de éxito académico. Se discuten las implicaciones para fomentar el éxito de estudiantes de color en programas educativos de consejería y para investigaciones futuras de teoría crítica de la raza.     

When Being “Essential” Illuminates Disparities: Counseling Clients Affected by COVID‐19

The 2019 novel coronavirus (COVID‐19) has highlighted social disparities in the United States. This article examines how preexisting racial and ethnic disparities, exacerbated by COVID‐19, have negatively affected communities of color that tend to be overrepresented in lower socioeconomic groups, have limited access to health care and education, have an undocumented status, and work in jobs considered “essential.” Counselors are encouraged to use creative strategies to design and facilitate telecounseling and reduced‐ or no‐cost workshops in which attendees can participate safely. Specific cultural considerations, aspects of crisis management, and creative interventions that can be used with clients of color at an appropriate social distance are discussed. Counselors can also instill hope in their clients by promoting sociopolitical development. As the impact of COVID‐19 will be felt for years, it is crucial that counselors be prepared to address the needs of those disproportionately affected.