Case Report: Object Relations Family Therapy as a Model for Genetic Counseling

Object relations family therapy (ORFT) is a psychoanalytically based approach for the treatment of couples and families which stresses the importance of past relationships. The therapist assumes a parentlike role and provides a holding environment in which clients can explore unconscious motivations. This paper will discuss the applicability of this method to genetic counseling. The case of a couple seen for recurrent trisomies will be presented and used as an example to discuss how ORFT might serve as a framework in a genetic counseling session.     

The Role of Schools in Outcomes for Youth: Implications for Children's Mental Health Services Research

We explore the role of schools in children's mental health services research. Recent literature has suggested that schools play an important role in delivering services to children and adolescents with emotional and behavioral problems. Research in services research, though, has taken a fairly narrow view of which dimensions of school environments are relevant for inclusion in studies. We suggest that a broader view of school environments is appropriate and potentially beneficial to the field. Using Bronfenbrenner's ecological model as a guide, we conceptualize schools as microsystems. Such an approach suggests that all aspects of school environments (treatment as well as non-treatment) are likely to influence many of the outcomes that children's mental health services research frequently targets (e.g., behavioral problems, problematic peer relationships, academic achievement, school attendance). We review literature from a variety of disciplines to suggest relevant features of schools, with particular attention to the role of peer dynamics within schools. We conclude with implications of this expanded conceptualization of schools for children's mental health services research.     

Applying Utilization Management Principles to a Comprehensive Service System for Children with Emotional and Behavioral Disorders and Their Families: A Feasibility Study

The Comprehensive Services Act for At Risk Youth and Families of Virginia (CSA), is a service, funding, and organizational reform initiative designed to improve the provision of child centered and family focused services within a community setting. We conducted this study in order to assess the feasibility of applying utilization management principles to the CSA in order to improve the appropriateness, quality, and cost effectiveness of this service delivery system. Data were gathered through focus groups, surveys, clinical profiling, and analysis of costs, and service utilization. While overall program costs increased since inception of the program, the costs per child served rose less than the rate of inflation. CSA appeared to be serving children with a high degree of emotional and behavioral difficulties. There was considerable variation among localities in placement patterns. A majority of survey and focus group respondents were willing to consider the application of utilization management principles to the CSA as long as decision making remained within localities. We concluded that there is a constructive role for utilization management approaches to improve the appropriateness and quality of services as well as enhancing efficiency in child mental health.     

Embodied Knowledge and Making Sense of Prenatal Diagnosis

Open-ended, qualitative interviews with women to whom amniocentesis was offered were analyzed to understand how women made sense of these tests. We found that women, whether tested or not, negotiated with biomedical information. They transformed it through identifiable processes, then wove it with their own instincts and beliefs and with their personal experiences, thereby creating embodied knowledge on which their decisions were based. Women who were and were not tested may have differed from each other when categorized on the basis of a final, binary choice, but they were more alike than unalike in reaching this point. The apparent importance of embodied knowledge suggests the critical role of the listening activities of the genetic counselor and of awareness of the validity and importance of women's complementary ways of knowing and doing in understanding the uses and meanings of prenatal genetic testing.     

Counseling Older Adults with Dementia: A Survey of Therapists in Massachusetts

Although much has been written about therapeutic interventions with caregivers, little is known about the counseling services that are available for victims of dementia. The present study was designed to explore community mental health center (CMHC) services and therapists' experiences in providing psychotherapy to this population in Massachusetts. Only 27 of the 36 CMHCs in the state reported providing mental health services to older adults with a dementing illness. A survey of therapists who specialized in working with older adults found that the percentage of older adult clients estimated to have dementia averaged about half of their caseload. Older persons in the early phase of a dementing illness were most frequently referred for depression and anxiety, whereas those with moderate decline were most frequently referred for management of disruptive behavior. The most common services provided to clients with dementia consisted of assessment and individual counseling. The latter finding indicates a discrepancy between what is practiced and the professional literature. Most of the psychotherapy described in the literature concerns group interventions, which were rarely provided by the mental health centers in Massachusetts. The centers tended to offer individual counseling; however, little information on how to provide this form of treatment can be found.     

消费者产品质量知觉研究

本文探讨了品牌、产地、价格、服务及消费者的知识经验对消费者产品质量知觉的影响。结果表明：１、品牌、产地、服务对消费者的产品质量知觉有显著影响;２、消费者对名牌产品的质量知觉显著高于不知名品牌,对进口产品质量知觉显著高于国产产品,对服务好的产品质量知觉显著高于服务差的产品;３、知识经验丰富的消费者的产品质量知觉易受品牌的影响,而知识经验不足的消费者的产品质量知觉易受价格、服务的影响。     

The Treatment Planning of Experienced Counselors: A Qualitative Examination

Using consensual qualitative research, the authors examined the treatment planning process of experienced counselors (N = 9). The data analysis resulted in 4 domains: assessment steps, clinical impressions, treatment factors, and treatment strategies. These domains describe the process used by experienced counselors in making clinical decisions and offer insight into the nature of clinical expertise and the need for further research on treatment planning.     

Integrating Hip‐Hop Culture and Rap Music Into Social Justice Counseling With Black Males

In this article, the author suggests that Hip‐Hop culture and rap music, in particular, can be integrated into individual counseling interactions with Black male clients to discuss the social injustices (e.g., hypercriminalization) they face. Literature examining the history of Hip‐Hop culture and how rap music has been used therapeutically with Black males is presented. The article concludes with a vignette illustrating how Elligan's ( 2000 ) rap therapy framework can help explore experiences Black male clients encounter.     

The Emergence of Counseling in Sierra Leone

Sierra Leone has endured a turbulent history, including a decadelong civil war and the devastation of Ebola virus disease. Despite the psychological consequences of such events, only limited therapeutic services are available. The authors review mental health services in Sierra Leone and document the emergence of counseling as a profession in the face of challenges. They conclude by highlighting the multiple contributions that professional counselors can make to address critical mental health needs in Sierra Leone.     

Counselor Education Students’ Perceptions of Wellness and Mental Health in African American Men: The Effects of Colorism

Colorism is discrimination based on skin tone. Skin color influences clinicians’ diagnostic impressions. The degree to which colorism influences counseling students’ clinical decision making is unknown. This study examined colorism's effect on counselor education master's students’ (N = 154) clinical decisions. Analysis of covariance failed to produce statistically significant results when comparing students’ evaluations of a male African American's mental health and wellness, when controlling for presentation management, across 4 skin tones. Counselors should include colorism in diversity training. El colorismo es la discriminación basada en el tono de la piel. El tono de la piel influye en las impresiones diagnósticas de los profesionales clínicos. Se desconoce hasta qué punto el colorismo influye en las decisiones clínicas de los estudiantes de consejería. Este estudio examinó el efecto del colorismo en las decisiones clínicas de estudiantes de maestría en educación de consejeros (N = 154). El análisis de la covarianza no produjo resultados estadísticamente significativos al comparar las evaluaciones de los estudiantes sobre la salud mental y el bienestar de un cliente afroamericano varón, controlando la gestión de la presentación de 4 tonos de piel diferentes. Los consejeros deberían incluir el colorismo en la capacitación de diversidad.