Counseling Considerations for the Twice‐Exceptional Client

Counselors can be pivotal in helping families to understand the identification of twice‐exceptionality and related implications, including developing successful interventions for the school years and beyond. There are many potential counseling concerns, including bullying and peer interactions, social and emotional development, career guidance, college transition planning, and functioning in adulthood. Learning how to work with twice‐exceptional clients regarding these concerns needs to begin during training and progress throughout one's career. Recommendations for best practice are provided.     

Counseling Multiple‐Heritage Couples

Multiple‐heritage couples are one of the fastest growing client populations in the United States. These partnerships are defined by intersecting ethnic, racial, linguistic, and religious differences. They are challenged by societal perceptions, stereotypes, and other pressures associated with being in a multiple‐heritage pairing. This article discusses strengths in the multiple‐heritage union brought about by the understanding of diverse viewpoints. Finally, the article identifies specific strategies, such as couples relationship education, to resolve and confront inherent differences. Las parejas multiculturales son uno de los grupos demográficos de clientes de mayor crecimiento en los Estados Unidos. Este tipo de parejas se define por la intersección de diferencias étnicas, raciales, lingüísticas y religiosas. Sus miembros enfrentan desafíos a causa de las percepciones sociales, los esterotipos y otras presiones asociadas con tener una pareja multicultural. Este artículo discute los puntos fuertes en una unión multicultural, facilitados por la comprensión de puntos de vista diversos. Finalmente, el artículo identifica estrategias específicas, como por ejemplo la educación en relaciones de pareja, para resolver y afrontar las diferencias intrínsecas.     

The integration of science and practice: Unique perspectives from counseling psychology students

Counseling psychology training programs predominately subscribe to the scientist–practitioner training model, which emphasizes the mutual integration of science and practice. There has been extensive debate surrounding the applicability of the scientist–practitioner training model to the field of counseling psychology, and existing commentary from both trainers and trainees has documented the potential challenges to adequately integrating science and practice. In the current article, three counseling psychology doctoral students outline their experiences in a program that adheres to the scientist–practitioner training model. In particular, they describe their involvement in both clinical and scholarly related activities, their experiences with the integration of science and practice, and how the scientist–practitioner model has influenced their overall professional development. Specific examples of how the scientist–practitioner model can shape the perspectives and career goals of psychologists-in-training are reviewed.     

The stability of aspect-based career preferences and of the recommended list of occupations derived from them

Career-related preferences (e.g., team work, independence, length of training, income), which are an elaboration and extension of vocational interests, are one of the cornerstones that guide individuals to promising occupations recommended for further exploration. These preferences are informative and can serve individuals and their career counselors only if they are reliable and stable. Study 1 tested the two-week reliability of 31 career-related preferences of 213 freshman students and the two-year stability of the preferences of 132 of these students. Both the within-aspect preferred levels (e.g., only indoors most preferred, but mostly indoors also acceptable) and the importance of the aspects were elicited. The median within-participant two-week reliability was .85 for preferred levels and .64 for aspect importance; the median two-year stabilities were .75 and .51, respectively. In Study 2, the preferences elicited in Study 1 were used to derive a list of recommended occupations compatible with each participant's preferences at Time 1, Time 2 (2 weeks later), and Time 3 (2 years later), using a compensatory-model-based fit index. The percentage of identical occupations in the lists of the top ten recommended occupations was quite high — 62% for Time 1 and Time 2, and 54% for Time 1 and Time 3. The theoretical and practical implications of the reliability and stability of recommendations based on aspect-based career preferences are discussed.     

Constructionist career counseling of undergraduate students: An experimental evaluation

This study used a pretest–posttest control group design to examine the effectiveness of a six-session constructionist career counseling intervention (Savickas, 2011). It was hypothesized that relative to pre-intervention scores, the participants would demonstrate decreases in their indecision, anxiety, uncertainty, and insecurity about their career choices. Participants consisted of 50 undergraduates ranging in age from 19 to 25. They completed the Undergraduate Career Choice Survey (UCCS) and then were evenly divided into an intervention group and a control group. The intervention group received six sessions of constructionist career counseling. Each session was approximately 45 min with a total of 4 h, 30 min approximately for the six sessions. Both groups then took the UCCS again. Analyses of the data using t-tests revealed significant reductions in indecision, anxiety, uncertainty, and insecurity for the intervention group but not for the control group. The intervention group took the UCCS again eight weeks later. An ANOVA indicated that the reductions in indecision, anxiety, uncertainty, and insecurity were slightly yet significantly greater. Limitations and directions for further research were pointed out.     

Expanding the Therapy Paradigm with Queer Couples: A Relational Intersectional Lens

North American and global cultures in general—and the field of Couple and Family Therapy in particular—have made significant strides toward recognizing and validating LGBTQ identities and relationships. However, clinical assessment and conceptualization of queer couples still lack the complexity needed to encompass the issues involved in treatment. Existing literature provides clinicians a basic understanding of queer couples and the dynamics that make them unique from nonqueer couples. However, much of this knowledge has been normed on White middle‐class couples and has rarely included couples with transgender or bisexual members. This article invites clinicians and researchers to apply a feminist model of intersectionality to understand queer couples. Our proposed intersectional lens considers multiple axes of identity and power and their interrelationships (Crenshaw, 1989, 1991). We argue that intersectionality is important for understanding all identities, whether privileged or marginalized (Falicov, 2003). This application of the concept of intersectionality is unique in its relational focus, emphasizing how partners’ complex individual identities overlap with and intersect with one another. Additionally, this lens considers how the therapists’ and clients’ multidimensional identities intersect. Three case studies are presented to illustrate application of the intersectional lens. In each case, exploring the partners’ multiple social locations, their influences on one another, and the therapist's intersections of identity all proved critical to the direction of therapy.     

If We Build It … Will They Come? – Establishing a Cancer Genetics Services Clinic for an Underserved Predominantly Latina Cohort

Background: Cancer genetic counseling and testing is a standard of care option for appropriate families and can identify individuals at increased risk prior to diagnosis, when prevention or detection strategies are most effective. Despite documented efficacy of cancer risk reduction in high-risk individuals, underserved and minority individuals have a disproportionate cancer burden and limited access to genetic counseling. Methods: A needs assessment survey documented gaps in knowledge and interest in prevention. Satellite clinics were established at two indigent healthcare systems. Cancer genetics CME lectures were conducted and referral guidelines disseminated to clinicians who referred patients for counseling. Results: An increase in clinician knowledge was demonstrated post-CME and reflected by quality referrals. Eighty-eight percent of patients kept their appointments. In the predominantly Latina⁶ (n=77) clinic population, 71.4% were affected with cancer, and 17 mutation positive families were identified. Preliminary data shows a positive impact on patients' motivation and behavior. The majority has expressed satisfaction and reduction in anxiety. Conclusions: This study demonstrates feasibility and acceptability of cancer genetics services in this population, suggesting the potential to reduce cancer morbidity in underserved, high-risk families.“Latino” is the most common census term for individuals of Spanish, Mexican, Central and South American, Cuban, or Puerto Rican descent, referring to ethnicity, and is generally considered a more ethnically/culturally based term for individuals of the aforementioned groups. As this cohort is female the feminine noun “Latina” is used     

The Relationship of Nondirectiveness to Genetic Counseling: Report of a Workshop at the 2003 NSGC Annual Education Conference

Nondirectiveness has been a guiding principle for genetic counseling since the founding of the profession. However, its efficacy and appropriateness in this role have been frequently questioned. A workshop at the 2003 Annual Education Conference of the National Society of Genetic Counselors provided audience participation in a discussion of these issues. Participants presented arguments for and against nondirectiveness as a central ethos. They described complex personal transitions in adapting what they had learned about nondirectiveness during training to the realities of the workplace. There was support for flexible approaches to genetic counseling, with varying adherence to nondirectiveness, based on client and family needs and values, clinical circumstances, and desired counseling outcomes. The discussion supports the use of clinical experience, outcomes research, and the experience of other professions to move beyond nondirectiveness and more accurately identify the theoretical bases that underlie genetic counseling in the variety of circumstances in which it is currently practiced.     

A Qualitative Study of Health Professionals' Views Regarding Provision of Information About Health-Protective Behaviors During Genetic Consultation for Breast Cancer

This study aimed to explore health professionals' views and practice regarding the provision of information about health-protective behaviors (e.g., exercise, alcohol consumption, diet) during genetic consultation for breast cancer. Ten genetic counselors participated in three focus groups, and seven medical specialists were interviewed in a focus group or individually. Data was analyzed using the constant comparative method. Findings suggested that health professionals held differing, often opposing, views about the value of health-protective behaviors for women at increased risk of breast cancer. The content and extent of information provided about health-protective behaviors varied widely, and participants expressed a need to form consensus regarding information provision both within and across clinics. The main barriers to providing information regarding health-protective behaviors included the lack of research evidence regarding the impact of these factors and higher priority of other information need to be provided in the limited consultation time. Participants generally did not consider it their role to promote health-protective behaviors, and were concerned about the psychological impact of providing information about behavioral risk factors during genetic consultations.     

A Survey of Patients’ Experiences with the Cancer Genetic Counseling Process: Recommendations for Cancer Genetics Programs

In order to promote ongoing quality improvement of not only the Penn State Cancer Genetics Program, but also other cancer risk assessment programs throughout the country, we developed, piloted and conducted a survey to explore patient expectations, experiences, and satisfaction with the cancer genetic counseling process. The comprehensive survey was mailed to 340 eligible patients, 156 (45.9%) of whom returned the completed survey within the allotted time. Responses to closed-ended questions were tallied and open-ended questions were content analyzed. Major findings show that: (1) Patients were seeking cancer-related information and support throughout the cancer risk assessment process and were interested in participating in available research studies; (2) The setting in which patients are seen for cancer risk assessment may pose potential emotional ramifications; (3) Misperceptions regarding insurance discrimination and lack of insurance coverage persist; (4) Patients view the genetic counselor as responsible for updating them about new discoveries. Specific recommendations for cancer genetics programs are included.