Comparison of Telephone and Televideo Modes for Delivery of Genetic Counseling: a Randomized Trial

Telephone and televideo have yielded equivalent patient satisfaction and psychosocial outcomes when compared to in-person genetic counseling, yet little is known about how they compare to one another. In this randomized controlled trial, veterans received genetic counseling via telephone or traveled to a clinic to participate via encrypted televideo. Knowledge and visit satisfaction were assessed 2 weeks later. Travel time, mileage, and out-of-pocket costs were calculated for videoconferencing. Qualitative interviews were conducted with patients and counselors to assess acceptability. Of the 20 male patients randomized to telephone, 90% received counseling and provided outcomes; of the 18 randomized to televideo, 67% received counseling and 50% provided outcomes. Telephone patients answered a mean of 4.4 of eight questions correctly at baseline and 4.7 at follow-up; televideo means were 5.6 and 6.5, respectively. Satisfaction was 25.2 out of 30 for telephone and 26.9 for televideo. Televideo patients incurred a median of 2.8 h of travel time, 40 roundtrip miles, and $67.29 in costs. Patients and counselors found both modes acceptable for providing education and answering questions. Although patients liked the flexibility of telephone, counselors felt patients missed more appointments and were distracted when using telephone. A noted advantage of videoconferencing was reading body language. Further evaluation of alternative delivery modes is needed.     

A Field Guide to Cinetherapy: On Celluloid Psychoanalysis and Its Practitioners

This paper addresses the strange bedfellowship between psychoanalysis and cinema since the century's turn. Its specific focus is the idiosyncratic psychoanalysis/psychotherapy practised in mainstream cinema and television. Cinetherapists have consistently fallen into one of three categories: Dr. Dippy, a focus of derision, weirder than his patients; Dr. Evil, Hollywood's psychiatric version of the mad, bad scientist; and the unfailingly benevolent, self-sacrificing Dr. Wonderful. The prevalence of these stereotypes has waxed and waned according to shifting cultural circumstances. The study concludes with reflections on the possible impact, deleterious or otherwise, of distorted filmic images of the impossible profession.     

Exploring Genetic Counseling Communication Patterns: The Role of Teaching and Counseling Approaches

The educational and counseling models are often touted as the two primary professional approaches to genetic counseling practice. Yet, research has not been conducted to examine how these approaches are used in practice. In the present study, we conducted quantitative communication analyses of BRCA1 genetic counseling sessions. We measured communication variables that represent content (e.g., a biomedical focus) and process (e.g., passive listening) to explore whether genetic counselor approaches are consistent with prevailing professional models. The Roter Interaction Analysis System (RIAS) was used to code 167 pre-test genetic counseling sessions of members of a large kindred with an identified BRCA1 mutation. Three experienced genetic counselors conducted the sessions. Creating composite categories from the RIAS codes, we found the sessions to be largely educational in nature with the counselors and clients devoting the majority of their dialogue to providing biomedical information (62 and 40%, respectively). We used cluster analytic techniques, entering the composite communication variables and identified four patterns of session communication: Client-focused psychosocial, biomedical question and answer, counselor-driven psychosocial, and client-focused biomedical. Moreover, we found that the counselors had unique styles in which they combined the use of education and counseling approaches. We discuss the importance of understanding the variation in counselor communication to advance the field and expand prevailing assumptions.     

An investigation of monitoring for sleep-related threat in primary insomnia

In Study 1, individuals with primary insomnia (n=32) and good sleepers (n=38), recruited from a university population, completed a semi-structured interview. The interview assessed monitoring for sleep-related threat, negative thoughts and safety behaviours, at night and during the day. Compared to good sleepers, individuals with insomnia reported more frequent monitoring at night and during the day, more negative thoughts associated with monitoring at night and during the day, and the use of more safety behaviours associated with monitoring at night. A path analysis showed that the total monitoring frequency was significantly positively related to the score for total negative thoughts, which in turn, was significantly positively related to the total number of safety behaviours used. Study 2 aimed to test the generalisability of these findings in a clinical sample of individuals with primary insomnia (n=23). The results indicated that the clinical sample also engaged in monitoring for sleep-related threat, experienced negative thoughts and used safety behaviours. Further, more severe insomnia was associated with more negative thoughts and the use of more safety behaviours associated with monitoring at night. Together, these results are consistent with the proposal that monitoring for sleep-related threat functions to maintain insomnia by triggering negative thoughts and the use of safety behaviours. Future research is required to verify the proposed causal status of monitoring, using prospective designs and experimental manipulations.     

Correcting distorted perception of sleep in insomnia: a novel behavioural experiment?

Patients with primary insomnia overestimate their sleep onset latency (SOL) and underestimate their total sleep time (TST). The present study aimed to test the utility of a novel behavioural experiment designed to correct distorted perception of sleep among patients diagnosed with primary insomnia. Individuals with primary insomnia were asked to wear an actigraph and keep a sleep diary for three nights. On the following day, half were shown the discrepancy between the data recorded on the actigraph and their sleep diary (Shown-Discrepancy Group), the other half were not shown the discrepancy (No-Demonstration Group). Participants were then asked to wear the actigraph and keep a sleep diary for three further nights. Following the behavioural experiment, the Shown-Discrepancy Group estimated their SOL more accurately and reported less anxiety and preoccupation about sleep compared to the No-Demonstration Group. The theoretical and clinical implications of these findings are discussed.     

Body asymmetry affects conjugate lateral eye movement

A. H. Baker (1989) and A. H. Baker and A. I. Ledner (1990) reported that asymmetrical visual stimulation affects conjugate lateral eye movement (CLEM). In the present article, the authors explored whether asymmetrical body position similarly affects CLEM. The authors assessed CLEMs twice in a counterbalanced design. In the control (symmetric) condition, each participant sat in a completely symmetrical position facing a wall devoid of any asymmetrical features. In the experimental (asymmetrical) condition, half the participants rotated their heads 68 degrees clockwise relative to their bodies to face the experimenter, and the other half rotated their heads 68 degrees counterclockwise, also to face the experimenter. CLEM was predominantly toward the body's position in the asymmetrical condition rather than toward the body's position in the symmetrical condition.     

Some normative data on mental health professionals' attitudes about racial minorities and women

Although codes of ethics of the mental health professions and the recently developed race- and gender-specific models of counseling and psychotherapy stipulate positive and accepting attitudes toward racial minorities and women, formal assessment of these attitudes has been hindered by the absence of appropriate measurement tools and generalizable data. This study provides some normative data by reporting responses of 705 psychologists and social workers to the Quick Discrimination Index, a psychometrically sound 23-item self-report measure previously administered to several different professional groups. Analysis indicated psychologists and social workers reported particularly positive attitudes toward racial minorities and women but expressed the same racial and sex contradictions, ambivalences, and vulnerabilities reported by the general public.