understanding and counseling transgender clients

Because transgender individuals experience widespread employment discrimination, counselors need to understand and be able to work with members of the gay, lesbian, bisexual, and transgender communities. The aim of this article is to help counselors become more transgender literate by (a) defining gender dysphoric disorder and related terms; (b) discussing the causes, diagnosis, and treatment of gender dysphoria; (c) highlighting career realities faced by transgender employees; (d) touching upon legal issues pertaining to transgender workers; and (e) offering a few suggestions to counselors working with transgender clients.     

The effect of visual search efficiency on response preparation: neurophysiological evidence for discrete flow

Most models assume that response time (RT) comprises the time required for successive processing stages, but they disagree about whether information is transmitted continuously or discretely between stages. We tested these alternative hypotheses by measuring when movement-related activity began in the frontal eye field (FEF) of macaque monkeys performing visual search. Previous work showed that RT was longer when visual neurons in FEF took longer to select the target, a finding consistent with prolonged perceptual processing during less efficient search. We now report that the buildup of saccadic movement-related activity in FEF is delayed in inefficient visual search. Variability in the delay of movement-related activity accounted for the difference in RT between search conditions and for the variability of RT within conditions. These findings provide neurophysiological support for the hypothesis that information is transmitted discretely between perceptual and response stages of processing during visual search.     

Evaluative Concerns and Personal Standards Perfectionism: Self-esteem as a Mediator and Moderator of Relations with Personal and Academic Needs and Estimated GPA

We examined the mediational role of self-esteem in the relation between evaluative concerns (EC) and personal standards (PS) perfectionism, and measures of personal concerns, academic concerns, and estimated grade point average (EGPA) in 386 university students. Self-esteem partially mediated the relation between EC perfectionism and students’ personal and academic concerns. EC perfectionism was a weak predictor of EGPA. PS perfectionism was not related to academic concerns. Although PS was associated with personal concerns both directly and indirectly through low levels of self-esteem in women only, these findings did not hold when controlling for EC perfectionism. PS perfectionism had a direct positive relation with EGPA. Neither PS nor EC perfectionism interacted with self-esteem to predict unique variance in personal or academic concerns or EGPA. The results are consistent with our view that a perfectionism dimension that is primarily maladaptive can be distinguished from a dimension that can be adaptive. The implications for research and treatment are considered.

Engaging Nurses in Genetics: The Strategic Approach of the NHS National Genetics Education and Development Centre

The UK government announced the establishment of an NHS National Genetics Education and Development Centre in its Genetics White Paper. The Centre aims to lead and coordinate developments to enhance genetics literacy of health professionals. The nursing program takes a strategic approach based on Ajzen’s Theory of Planned Behavior, using the UK nursing genetics competences as the platform for development. The program team uses innovative approaches to raise awareness of the relevance of genetics, working collaboratively with policy stakeholders, as key agents of change in promoting competence. Providing practical help in preparing learning and teaching resources lends further encouragement. Evaluation of the program is dependent on gathering baseline data, and the program has been informed by an education needs analysis. The challenges faced are substantial and necessitate international collaboration where expertise and resources can be shared to produce a global system of influence to facilitate the engagement of non-genetic nurses.     

Behavioral Health Consultation and Primary Care: Lessons Learned

This article provides an overview of 20 years of professional experiences with developing and implementing a model for integrating behavioral health services into primary care. The Primary Care Behavioral Health (PCBH) model is designed to provide immediate access to behavioral care for a large number of primary care patients by positioning a behavioral health consultant in the exam room area to function as a core member of the primary care team. In an initial era of discovery, the authors were directly involved in developing and testing a variety of new approaches to providing behavioral health services in general medicine. In a second era focused on feasibility, the authors worked with Kaiser Permanente, the United States Air Force and Navy, the Veteran’s Administration, and the Bureau of Primary Care to system test this innovative model of integrated care. Now in an era devoted to dissemination, the authors review the various roles formal research, system level quality improvement initiatives and stakeholder analysis play in promoting integrated care. The authors also describe current efforts to (1) create a tool that helps systems develop integration targets and (2) use the PCBH model as a platform for teaching medical residents and behavioral health providers to work together in a redesigned primary care team model.     

Transforming Our Understanding of Theories, Paradigms, & Mental Disorders: The Legacy of Donald Capps in the Field of Pastoral Care and Counseling

The life and work of Donald Capps has transformed my thinking and practice as a teacher, minister, and counselor. Incorporating his research into my clinical practice has led me to greater compassion and grace toward those clients who present with personality disorders and characterological disturbances.     

Temporal dynamics of masked word reading

The repercussions of unconscious priming on the neural correlates subsequent cognition have been explored previously. However, the neural dynamics during the unconscious processing remains largely uncharted. To assess both the complexity and temporal dynamics of unconscious cognition the present study contrasts the evoked response from classes of masked stimuli with three different levels of complexity; words, consonant strings, and blanks. The evoked response to masked word stimuli differed from both consonant strings and blanks, which did not differ from each other. This response was qualitatively different to any evoked potential observed when stimuli were consciously visible and peaked at 140ms, earlier than is usually associated with differences between words and strings and 100ms earlier than word-consonant string differences in the visible condition. The evoked response demonstrates a qualitatively distinct signature of unconscious cognition and directly demonstrates the extraction of abstract information under subliminal conditions.     

Bilateral disadvantage: lack of interhemispheric cooperation in schizophrenia

Language anomalies and left-hemisphere dysfunction are commonly reported in schizophrenia. Additional evidence also suggests differences in the integration of information between the hemispheres. Bilateral gain is the increase in accuracy and decrease in latency that occurs when identical information is presented simultaneously to both hemispheres. This study measured bilateral gain in controls (n=20) and individuals with schizophrenia (n=10) using a lexical-decision task where word or non-word judgements were made to letter strings presented in the left visual field (LVF), right visual field (RVF) or bilaterally (BVF). Language was not abnormally lateralized in the schizophrenia group. Controls exhibited the expected decrease in latency when words were presented bilaterally. This effect was not observed in the schizophrenia group who were actually disadvantaged in this condition. The lack of bilateral gain in schizophrenia is discussed as arising from differences in the connections between areas in each hemisphere that mediate language.     

Perfectionism,Hopelessness, And Suicide Ideation: Revisions to Diathesis-Stress and Specific Vulnerability Models

The current study examined variables (daily hassles, self-esteem, dispositional optimism, coping modes, and perceived social support) that could potentially moderate associations between dimensions of perfectionism and current feelings of hopelessness and suicide ideation in university students (144 women; 61 men). Our study revealed several significant findings: (1) socially prescribed perfectionism was a significant predictor of suicide ideation, interpersonal hopelessness, and achievement hopelessness for both women and men; (2) self-oriented perfectionism did not have an independent relation with any of the suicide risk outcome variables in either women or men; (3) other-oriented perfectionism was associated negatively with both current hopelessness, particularly interpersonal hopelessness, and suicide ideation in men; (4) the cluster of proposed moderators accounted for additional unique variance in all suicide risk variables in women but in achievement hopelessness only in men; (5) optimism and social hassles were unique predictors but the results varied as a function of gender and outcome; (6) each perfectionism component interacted with specific moderators to enhance or buffer the link between perfectionism and suicide risk. The findings indicate that self-oriented and other-oriented perfectionism are possibly adaptive or maladaptive under certain conditions. Implications for the development of comprehensive, multidimensional, integrated models of the perfectionism–suicide risk link and for prevention and treatment in perfectionists at risk of suicide are discussed.