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.     

Teaching symbolic-experiential family therapy: The personhood of the teacher

This article explores issues in teaching symbolic-experiential family therapy to psychiatric residents. Six controversial contextual issues that arise in teaching any school of family therapy in this setting are presented. Then, the author distinguishes between content and process dimensions in teaching symbolic-experiential family therapy. This distinction helps to clarify the muddle often attendant to attempts to teach this particular area. A major point, to paraphrase Whitaker's famous dictum, is that Teaching symbolic experiential family therapy resides in the personhood of the teacher.     

The cost of ethics legislation: a look at the Patient Self-Determination Act

The Patient Self-Determination Act (PSDA) requires hospitals to ask patients upon admission whether they have an advance directive. Although the PSDA has received extensive criticism, little attention has been paid to the cost of the law, either during its legislative course or following its implementation. Nonetheless, several tangible and intangible costs are associated with the PSDA. Such costs may be incurred by different parties. This paper examines the costs and benefits of the PSDA and illustrates the extent of some of its tangible costs. The incremental start-up cost for one institution's response to the PSDA is estimated to be $49,304 ($1.31 per admission) and the total implementation cost of the program to be $114,528. In addition, the national incremental start-up cost for hospitals to implement the PSDA is estimated to be between $43,625,114 and $101,569,922. Finally, the potential implications of the PSDA for future governmental health care ethics regulation are discussed.     

The BJGC and Guidance and Counselling in Britain 1973-85

The background to the symposium is outlined. The balance of articles over the first twelve years of the British Journal of Guidance and Counselling is analysed, identifying a number of key features and changes. Some of the general issues cross-cutting the contributions to the symposium are noted.     

A Threshold Task to Determine Help-Seeking for Deliberate Self-Injury: a Proof of Concept Study

Journal of Psychopathology and Behavioral Assessment - Those engaging in deliberate self-injury have low rates of help-seeking (HS) behaviour. There is a lack of a consolidated theory of HS and...     

The Limitations of “Vulnerability” as a Protection for Human Research Participants

Vulnerability is one of the least examined concepts in research ethics. Vulnerability was linked in the Belmont Report to questions of justice in the selection of subjects. Regulations and policy documents regarding the ethical conduct of research have focused on vulnerability in terms of limitations of the capacity to provide informed consent. Other interpretations of vulnerability have emphasized unequal power relationships between politically and economically disadvantaged groups and investigators or sponsors. So many groups are now considered to be vulnerable in the context of research, particularly international research, that the concept has lost force. In addition, classifying groups as vulnerable not only stereotypes them, but also may not reliably protect many individuals from harm. Certain individuals require ongoing protections of the kind already established in law and regulation, but attention must also be focused on characteristics of the research protocol and environment that present ethical challenges.     

Losing a father all over again: the termination of an analysis of an adolescent boy suffering from father loss

Criteria for beginning and conducting the termination phase of psychoanalysis have provoked debate and confusion from the early days of psychoanalysis. Gabbard (2009) has recently pointed to the field's tendency to cling to idealized versions of these criteria as a way to deal with disagreements. The situation becomes more complicated for child and adolescent psychoanalysts because their patients are in the midst of a developmental process at the very time they are engaged in a psychoanalytic process. The termination phase of an adolescent male suffering from father loss is presented in depth in order to provide clinical data toward further consideration of the vexing questions surrounding termination in psychoanalysis. His termination is used to examine the relative importance of losing the analyst as a transference object as against a developmental object; the meaning of action during termination; the complicating role of trauma vis-à-vis termination; and the importance of the post-termination phase of analysis. It is suggested that his termination phase demonstrates that a "good enough" termination involves the development of a self-analyzing capacity that continues to evolve and develop after termination.