Curriculum Evaluation and Assessment of Multicultural Genetic Counselor Education

Multicultural competence in genetic counseling integrates racial-cultural knowledge, awareness, and skills into clinical interventions and research practices. Researchers and educators often cite racial-cultural factors as obstacles for visible racial-cultural people seeking help. However, the professional's unfamiliarity of how his or her own racial-cultural group affiliations are influenced by the history of discrimination and oppression coupled with their lack of self-understanding of racial-cultural issues for him- or herself has also limited the effectiveness of genetic counseling. The purpose of this study is to evaluate the effectiveness of the Handbook of Cross-Cultural Genetic Counseling, a multicultural curriculum developed for genetic counselor education for increasing multicultural counseling competence. The multicultural curriculum was evaluated for its effectiveness of increasing multicultural counseling competence using a nonequivalent control group design. A participant's multicultural counseling competence was hypothesized to increase after being taught the curriculum. The curriculum was effective for increasing multicultural counseling competence. Additionally, achieved multicultural counseling competence was not influenced by when the curriculum was taught. Trend analyses measuring the longitudinal impact of the curriculum on multicultural competence were significant. Implications of the results are discussed.     

An Assessment of Ethnocultural Beliefs Regarding the Causes of Birth Defects and Genetic Disorders

With the expansion of genetic services to various cultural groups, genetic counselors encounter clients who hold diverse beliefs inscribed by their culture about health conditions. Thus, clients may attribute the cause of a birth defect or genetic condition to a culturally-based health belief. This present study was conducted as a pilot study in order to assess the beliefs about the causes of birth defects and genetic disorders held by women of different ethnocultural backgrounds. This study proposed that women who do not have a family history of a disorder will differ in their knowledge about the cause of a birth defect or genetic disorder compared to women who have an affected child. In addition, this study determined to what extent culturally-based health beliefs are attributed to being the cause of a birth defect or genetic disorder in the 1990s.     

The Effect of Genetic Counseling on Knowledge and Perceptions Regarding Risks for Breast Cancer

In 1994, a clinic for cancer risk counseling was opened at Hadassah University Hospital in Jerusalem. Most of the counselees have been women who had breast cancer and/or a relative with breast cancer. In order to evaluate the effect of this counseling on women's knowledge and perceptions regarding the risks for breast cancer, a questionnaire was given before and after the counseling session to 60 healthy women who came to the clinic because they have relatives with breast cancer. According to the genetic counselors' estimations, most of these women had a significantly increased risk (compared to the general population) of developing cancer. Before counseling, the women overestimated the population risk for breast cancer, the contribution of heredity to morbidity of cancer, and their own risks to get cancer. After counseling session, they gave reduced estimates, closer to the real ones. The subjective perceptions regarding these risks were reduced after counseling, except for the perceptions regarding their relativerisks which have not changed after the counseling. About 90% of the women who came to the clinic wanted to be tested for genetic predisposition to cancer. For most of these women, the expectations that the test can rule out a genetic predisposition to cancer became more realistic after the counseling. The option to first test an affected relative was offered to all families, and a test was actually conducted in 75% of the families.     

Genetic Counselors' Judgments of Patient Concerns: Concordance and Consequences

The aims of this prospective study were to determine (a) the concordance between patient concerns and genetic counselors' judgments of these concerns, (b) the predictors of patient and counselor judgments, and (c) the relationship between concordance and patient outcomes. Patients' and counselors' views were sought before and after 131 routine genetic consultations. Before consultations, there was concordance about level of patient concern to within one point in 63% (82/131) of consultations and about type of patient concern in 60–84% of consultations. Lack of concordance in judging level and type of concern was associated with lower satisfaction with information and higher anxiety after the consultation. The biggest predictor of counselor judgment of concern was professional background: doctors judged patients to be more concerned than did nurses. Concordance of concern was predicted by counselors' experience in genetics: less experienced counselors overestimated patient concern. Future research needs to determine whether improving judgment of concern improves patient outcome.     

Symposium Introduction: Reflexivity in Life Designing Interventions

This article introduces the Symposium on Reflexivity in Life Design Interventions. Eight articles report studies of counseling processes and client operations during life design interventions as well as client feedback during subsequent Interpersonal Process Recall interviews. The Symposium concludes with comments on and discussion of the studies.     

Role of Supportive Others in the Forgiveness Process

Forgiveness research is a focus of interpersonal relationships in counseling. This phenomenological study investigated the role of an individual's support systems in forgiveness. The research design included semistructured interviews with 11 participants. Key findings revealed that participants primarily forgave for peace of mind. Several resources used by participants were helpful in forgiveness, but use of friends, family, and therapists showed mixed results. In addition, participants wanted support systems to listen and not to give advice, and support persons need to be objective or be trained in forgiveness therapy. Recommendations for counselors who work with people struggling to forgive are provided.     

Meta‐Analysis of Counseling Outcomes for the Treatment of Posttraumatic Stress Disorder

This meta‐analysis of 152 published posttraumatic stress disorder (PTSD) clinical trials from 1990 to 2012 concluded that counseling generally produced a small to large effect of treatment across all comparison conditions at termination (d+ = 0.30 to 0.89). These gains were maintained at longest follow‐up (d+ = 0.58 to 0.86) for the wait‐list, treatment‐as‐usual, and single‐group comparisons, but not for the follow‐up placebo comparison (d+ = 0.15), probably because of the low power (j = 3 placebo studies). Clinical trial findings were synthesized using a random‐effects model. No effects of publication bias or moderating variables were evident. No difference was found between trauma‐focused and non‐trauma‐focused approaches. Implications for counseling practice and future PTSD outcome research are addressed.     

A Phenomenological Inquiry of Clients’ Meaningful Experiences in Counseling With Counselors‐in‐Training

This study is a follow‐up to Sackett, Lawson, and Burge's ( 2012 ) study that explored the meaningful experiences of clients and counselors‐in‐training (CITs). Using the previous study's themes of clients’ experiences in counseling with CITs as a launching pad, the authors examined in greater depth the meaningful experiences of clients who are in counseling with CITs through qualitative phenomenological interviews. Findings, as well as implications for counselor education, supervision, and counseling, are discussed.     

A Qualitative Analysis of Home‐Based Counselors' Experiences in a Rural Setting

This qualitative study sought to understand the experiences of home‐based counselors working in a rural setting. In‐depth interviews were conducted with 12 counselors who were asked to describe their experiences in the areas of preparedness, professional development, challenges, and gender‐specific experiences. Fourteen coding categories emerged from the interviews, which led to the findings of 3 overarching themes: shared isolation, ethical ambiguity, and the high‐intensity nature of the job. Recommendations for home‐based counselors, agencies, and professional counseling associations are discussed.     

心理咨询中的非言语行为

非言语行为一般指不包含语言内容的人际交流行为。心理咨询作为人际沟通的一门艺术,非常强调非言语行为的重要性。已有研究发现心理咨询中的非言语行为在咨询师和当事人的互动中对咨询有促进作用,同时咨询师不当的非言语行为也会阻碍心理咨询。总结前人研究发现心理咨询中非言语行为的研究现状存在实证研究不足、孤立于咨询进程进行研究等问题,并且研究方法较为单一。如果要突破目前的研究瓶颈,需要借鉴其他领域的研究方法。