‘So you did what you wanted then’: Discourse analysis,personal agency,and psychotherapy

This paper explores issues concerning personal agency in discursive psychology and discourse analysis, with a particular emphasis on agency in terms of motivational accounts of the person. Issues are discussed in relation to the efficacy, acceptability, and accessibility of discourse analytic research for the practising psychotherapist. We suggest that such an approach may raise problems in four areas. First, we argue that without explicit theorization of the subject as language user, discourse analysis may be vulnerable to the charge of determinism. Second, theorization of the subject as language user may be required to account successfully for individual consistency and continuity of identity. Third, although claiming to critique commonsense notions of subjectivity, implicit dualist assumptions facilitate a reading of discursive psychology that is compatible with a motivational model of the person. Finally, we argue that discursive psychology itself implies a particular model of the strategically motivated language user. We conclude that, although these issues require clarification, discursive psychology and discourse analysis have much to offer psychotherapy research.     

Practice variability in prenatal genetic counseling

This study demonstrated that the content of prenatal genetic counseling sessions varied from counselor to counselor and from center to center. The study was designed to examine which specific issues were included by genetic counselors in prenatal genetic counseling sessions, and to determine which factors led genetic counselors to include or exclude this information from such sessions. Data were collected by randomly surveying 200 full, master degree members of the National Society of Genetic Counselors (NSGC). Respondents provided information by deciding which of 45 specific issues they would include in a standard prenatal genetic counseling session, and which one factor from a bank of 11 factors most accurately described the reason for this decision. The results indicated that the issues included/excluded from sessions varied widely among genetic counselors. The results also indicated that Patient Education/Informed Decision Making (34.5%) played the largest role in decision making overall, with Standard at Center/Departmental Policy (17.6%), Personal Experience/Preference (12.4%), and Applicability (10.9%) serving as the next three most important reasons for including or excluding issues from prenatal genetic counseling sessions.     

Phenotypic and genotypic heterogeneity in gaucher disease: Implications for genetic counseling

Genetic counseling for Gaucher disease is complicated by the vast degree of clinical heterogeneity encountered in the disorder. Recent advances in our understanding of the molecular genetics of Gaucher disease are particularly relevant to genetic counseling. Although the identification of mutations in the glucocerebrosidase gene has enabled genotypic screening of Gaucher patients, the ability to reliably predict patient outcome on the basis of DNA studies is often limited. An appreciation of both the spectrum of clinical manifestations in Gaucher patients and the limitations of the available genotypic information is necessary when counseling patients, families and at-risk individuals.     

Genes and family environment in familial clustering of cancer

Familial clustering of a disease is defined as the occurrence of the disease within some families in excess of what would be expected from the occurrence in the population. It has been demonstrated for several cancer types, ranging from rare cancers as the adenomatosis-coli-associated colon cancer or the Li-Fraumeni syndrome to more common cancers as breast cancer and colon cancer. Familial clustering, however, is merely an epidemiological pattern, and it does not tell whether genetic or environmental causes or both in combination are responsible for the familial clustering. Familial clustering may be due to genetic predisposition to the disease, but exposure to environmental factors — shared by members of some families, but not by members of other families — may also cause familial clustering and hence mimic genetic inheritance in the study of nuclear families. Based on assumptions regarding the individual steps in the biological process starting with exposure to carcinogens and ending with death from disseminated cancer we suggest that genetic and environmental factors may both be involved in most of these steps. The present paper focuses on research methodologies necessary to discriminate between the effect of genes and family environment in the development of cancer.     

Implications of human genome research: Impact on graduate education in genetic counseling

A conference of genetic counseling and clinical nurse specialist graduate program directors was hosted by the National Society of Genetic Counselors and funded by the Ethical, Legal, and Social Implications Program of the National Center for Human Genome Research in June 1992. One aspect of the conference addressed implications of the Human Genome Initiative for graduate education in genetic counseling. Within this paper, the topics of human variation and diversity, genetic discrimination, issues in non-directiveness, and genetic screening and policy development are reviewed and recommendations made for graduate curricula development and enhancement. In addition, suggestions are included for practicing genetic counselors.     

Update on master's genetic counseling training programs: Survey of curriculum content and graduate analysis summary

The field of genetic counseling is a recognized specialty in medical genetics with the primary practitioners being masters degree prepared individuals. Since the inception of the first master's degree genetic counseling (MGC) training program in 1969, more than 1000 genetic counselors have graduated from established training programs in United States and Canada. The MGC programs involve a 2-year academic curriculum of both didactic course work and supervised clinical field work (clinical praticums). A recent survey of 17 existing MGC training programs (16 U.S. and 1 Canadian) reveals that MGC graduates average a total of 1349 actual contact hours (range 854–1952 hours) during their 2-year degree program course of study. Clinical experience gained through clinical practica accounts for 58% of required coursework, followed by didactic coursework in basic science (21%) and counseling (16%), respectively. A few programs also have requisite laboratory practica, which accounts for 5% of overall content hours. The 17 existing MGC programs produce approximately 100 graduates annually. Although the number of programs has grown since inception of the first MGC program in 1969, the mean number of graduates per program remains fairly constant. By year 2002, the estimated total number of master's degree trained genetic counselors will approach 2200.     

THE NATURE OF PHYSICAL REALITY

Abstract. This account of the dynamical theory of chaos leads to a metaphysical picture of a world with an open future, in which the laws of physics are emergent-downward approximations to a more subtle and supple reality and in which there is downward causation through information input as well as upward causation through energy input. Such a metaphysical picture can accommodate both human and divine agency.     

Book reviews

Books reviewed:
Zoja, E. P. Transl. by Henry Martin. Abortion: Loss and Renewal in the Search for Identity.
Bomford, Rodney. The Symmetry of God.
Fisher, James. The Uninvited Guest. Emerging from Narcissism towards Marriage.
Rutzky, Jacques. Coyote Speaks: Creative Strategies for Psychotherapists Treating Alcoholics and Addicts.     

Books received

Aron, Elaine N. The Highly Sensitive Person. How to Thrive When the World Overwhelms You. David L. Smith. Approaching Psychoanalysis. An Introductory Course. Gabriella Ripa di Meana. Figures of Lightness. Anorexia, Bulimia and Psychoanalysis. Strasser, Freddie. Emotions. Experiences in Existential Psychotherapy and Life. Althusser, Louis. Writings on Psychoanalysis: Freud and Lacan. Corneau, Guy. Lessons in Love. The Transformation of Spirit through Intimacy. Moody, Harry R. & Carroll, David. The Five Stages of the Soul. For Everyone who has ever asked, ‘Is this it?’. Peterson, Jordan. B. Maps of Meaning. The Architecture of Belief.     

To Use or Not to Use: The Prenatal Genetic Technology/Worry Conundrum

We conducted an exploratory, qualitative study investigating the factors influencing the use of genetic counseling and prenatal genetic testing for two groups: pregnant women 35 years of age and over (AMA) at the time of delivery and pregnant women with an abnormal maternal serum triple screen (MSAFP3). The convenience sample consisted of 25 semistructured interviews of women/couples and 50 observations of genetic counseling sessions. Worry turned out to be the most important variable influencing decision making about prenatal genetic testing and was greater in the MSAFP3 group than in the AMA group. The women in the AMA group appeared to assign the risk of having a child with Down syndrome to their age category rather than to themselves individually, whereas, the risk perception for women with an abnormal MSAFP3 appeared to have shifted from a general population risk for pregnant women to an individual, personal risk. There was a general lack of understanding and also more misinformation about the MSAFP3 screen compared to amniocentesis. Women in both groups were torn between fear of an invasive test and worry about the health of their fetus for the rest of their pregnancy if they did not undergo amniocentesis.