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.     

Reducing the risk of bias in health behaviour change trials: Improving trial design,reporting or bias assessment criteria? A review and case study

Objective: It has been suggested that randomised controlled trials (RCTs) of health behaviour change (HBC) interventions are less rigorously designed than – for example– drug trials. This study presents an approach to clarifying whether this is due to poor trial design, incomplete trial reporting and/or the inappropriateness of commonly applied risk of bias assessment criteria.

Design: First, a framework of key sources of bias and common strategies for reducing bias risk is developed based on a literature review. Second, we describe the design of a multi-site RCT evaluating the cost-effectiveness of an HIV-treatment adherence intervention (case study). The choices made by the multidisciplinary team trying to minimise the risk of bias are compared against the risk of bias framework.

Main outcome measures: Implementation of common strategies for reducing the risk of bias in the case study; alternative or additional strategies applied; a justification for each deviation from the risk of bias framework.

Results: Most of the common strategies for reducing the risk of bias could be implemented. Alternative strategies were developed for minimising the risk of performance bias and contamination. Several additional, domain-specific risk of bias strategies were implemented.

Conclusions: The literature provides useful guidance for reducing the risk of bias in HBC trials. Yet, the case study suggests that HBC trial designers may face specific challenges that require alternative/additional measures for reducing the risk of bias. Using the risk of bias justification table (RATIONALE) could lead to better-designed HBC trials, more comprehensive trial reports and the data necessary for evaluating the appropriateness of commonly applied risk of bias assessment criteria to HBC trials.     

Student Service Members/Veterans’ Mental Health: Who Is at a Greater Risk for Posttraumatic Stress Symptoms on College Campuses?

Using a cross-sectional design, this study surveyed 144 students on campus who are service members and veterans to determine whether posttraumatic stress (PTS) symptoms are significantly correlated with demographic factors (e.g., age, race and marital status), risk factors (e.g., military branch and combat exposure), and resources (e.g., social support and religiosity). The results confirm previous findings on correlates of PTS symptoms, provide new information about service members on campus that are at a greater risk for PTS and highlight resources that are associated with reduced PTS symptoms. These findings not only give institutions of higher learning insight into identifying specific demographics that are at a greater risk for PTS symptoms on college campuses, but also point to ways of supporting student service members/veterans by accurately targeting existing resources to the most affected populations.     

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.     

Development of a Communication Aid to Facilitate Risk Communication in Consultations with Unaffected Women from High Risk Breast Cancer Families: A Pilot Study

The literature on risk perception in women from high-risk breast cancer families reveals persistent over-estimation of risk, even after counseling. In this study, a communication aid was designed to facilitate discussion of risk between clinical geneticists and genetic counselors and women from this high-risk population. Method: Stage 1. The aid was developed by an expert panel of clinical geneticists, genetic counselors, psychologists, an epidemiologist, an oncologist, linguists and a consumer. It was guided by the international literature on risk communication and a large multi-centre Australian study of risk communication. The 13 page full-color communication aid used varying formats of words, numbers, graphs and pie-charts to address (a) the woman’s subjective risk; (b) the population risk of breast cancer; c) the risk of inherited breast cancer; (d) the cumulative risk for women with BRCA1 and BRCA2 mutations; (e) family risk factors; (f) the woman’s suitability for genetic testing; (h) screening and management recommendations, and (i) a re-assessment of the woman’s subjective risk. Stage 2: A before–after pilot study of 38 women who were unaffected with breast cancer and were attending four Australian familial cancer clinics was undertaken. Baseline and follow-up questionnaires were completed by 27 women. Outcomes were compared to those observed in 107 similar women undergoing genetic counseling without the communication aid in 2001. Results: The risk communication aid appears to be beneficial; breast cancer genetics knowledge improved in some areas and importantly, risk perceptions improved in the cohort receiving the communication aid. Psychological measures showed no difference in anxiety or depression between the group receiving the communication aid and the comparison cohort. Women and clinicians were very positive about the usefulness of the communication aid as an adjunct to the genetic counseling consultation.     

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