Counseling Modalities Research Articles

Neural Conversational Agent for Weight Loss Counseling: Protocol for an Implementation and Feasibility Study.

Obesity is a common, serious and costly chronic disease. Current clinical practice guidelines recommend that providers augment the longitudinal care of people living with obesity with consistent support for the development of self-efficacy and motivation to modify their lifestyle behaviors. Lifestyle behavior change aligns with the goals of motivational interviewing (MI), a client-centered yet directive counseling modality. However, training health care providers to be proficient in MI is expensive and time-consuming, resulting in a lack of trained counselors and limiting the widespread adoption of MI in clinical practice. Artificial intelligence (AI) counselors accessible via the internet can help circumvent these barriers. The primary objective is to explore the feasibility of conducting unscripted MI-consistent counseling using Neural Agent for Obesity Motivational Interviewing (NAOMI), a large language model (LLM)-based web app for weight loss counseling. The secondary objectives are to test the acceptability and usability of NAOMI's counseling and examine its ability to shift motivational precursors in a sample of patients with overweight and obesity recruited from primary care clinics. NAOMI will be developed based on recent advances in deep learning in four stages. In stages 1 and 2, NAOMI will be implemented using an open-source foundation LLM and (1) few-shot learning based on a prompt with task-specific instructions and (2) domain adaptation strategy based on fine-tuning LLM using a large corpus of general psychotherapy and MI treatment transcripts. In stages 3 and 4, we will refine the best of these 2 approaches. Each NAOMI version will be evaluated using a mixed methods approach in which 10 adults (18-65 years) meeting the criteria for overweight or obesity (25.0≥BMI≤39.9) interact with NAOMI and provide feedback. NAOMI's fidelity to the MI framework will be assessed using the Motivational Interviewing Treatment Integrity scale. Participants' general perceptions of AI conversational agents and NAOMI specifically will be assessed via Pre- and Post-Interaction Questionnaires. Motivational precursors, such as participants' confidence, importance, and readiness for changing lifestyle behaviors (eg, diet and activity), will be measured before and after the interaction, and 1 week later. A qualitative analysis of changes in the measures of perceptions of AI agents and counselors and motivational precursors will be performed. Participants will rate NAOMI's usability and empathic skills post interaction via questionnaire-based assessments along with providing feedback about their experience with NAOMI via a qualitative interview. NAOMI (version 1.0) has been developed. Participant recruitment will commence in September 2024. Data collection activities are expected to conclude in May 2025. If proven effective, LLM-based counseling agents can become a cost-effective approach for addressing the obesity epidemic at a public health level. They can also have a broad, transformative impact on the delivery of MI and other psychotherapeutic treatment modalities extending their reach and broadening access. PRR1-10.2196/60361.

Sex, Alchemy, and Marriage

This article bridges the field of sex and couples therapy with Jungian psychology. By linking sex therapy to the realms of play, creativity, fantasy, imagination, and spirit, it offers fresh perspectives on sexual experiences within committed relationships. It explores matters of the unconscious and transference between romantic partners and how these relate to the relationship between an analyst and a patient. Drawing inspiration from Carl Jung’s The Psychology of the Transference, this thesis examines the psychological and erotic significance of the Rosarium Philosophorum, a collection of alchemical woodprints from the 16th century, in conjunction with Jung’s concepts. The essay amplifies Jung’s perspective by comparing it to Imago Relationship Therapy, a couples counseling modality. It posits that the Rosarium Philosophorum may provide the formula for a fulfilling, vital, erotic union. The integration of Jungian psychology with sex and couples therapy reveals a novel yet ancient framework for understanding and enhancing intimate relationships.

Inter‐modality comparison of working alliance and client satisfaction in online counselling during the COVID‐19 pandemic: An exploratory study

AbstractPurposeMental health suffered during the COVID‐19 pandemic lockdown in Scotland. While there was limited availability for face‐to‐face counselling, online counselling was available via telephone, videoconference, email, one‐to‐one chat and group basis. Existing research has failed to examine inter‐modality comparisons of client experiences of online counselling during the COVID‐19 pandemic.MethodsScottish participants (n = 94) who received online counselling during the COVID‐19 pandemic completed an online survey using quantitative methodology, which explored their experiences of one of five online counselling modalities measured by two reliable scales: the Working Alliance Inventory‐Short Revised and factor one of the Satisfaction with Therapy and Therapist Scale. Additional exploratory analysis investigated whether age, gender, choice of online counselling modality and pre‐COVID‐19 pandemic familiarity with online counselling affected these outcomes.ResultsWorking alliance and satisfaction outcomes were positively correlated. No significant differences between working alliance and satisfaction scores were found between the five modalities. Female participants, and those who received their preferred choice of counselling modality, had significantly greater working alliance than those who did not.ConclusionThese findings provide insights to clients and practitioners about the variety of synchronous and asynchronous online platforms that can facilitate good therapeutic outcomes. The importance of participant choice of counselling modality was reiterated. The broader implications of the findings and the future direction of a hybrid online and face‐to‐face counselling model were discussed.

Exploring the Depths of Human Emotion: Insights from Counseling Psychology

This study explores the intricate relationship between emotional intensity and therapeutic relationships within counseling psychology, considering diverse age groups and the influence of counseling sessions. Drawing on recent research, we investigate the practical implications of emotional dynamics, particularly in the context of telehealth counseling. Our findings reveal a significant positive correlation between emotional intensity and perceived relationship quality, highlighting the enduring impact of emotional experiences on the counseling process. The study contributes practical insights for therapists and emphasizes the need for a nuanced understanding of emotions in both traditional and digital counseling modalities.

Integrative review on career interventions with unemployed people: Nature, outcomes, and recommendations

AbstractThe study of career development among unemployed people is vital for effective institutional responses. This integrative review based on Torraco's protocol fills a literature gap by synthesizing research on interventions for this population. Seven keywords, five databases, and six eligibility criteria were defined. Among 324 articles, 36 were reviewed. Findings highlight diverse counseling modalities, emphasizing group interventions and remote delivery. Tailored approaches, including length, frequency, and social‐emotional and career dimensions, are crucial. Practical recommendations emphasize comprehensive, psychological support, goal‐oriented counseling, and postintervention assistance. These insights underscore vocational psychology's importance in addressing unemployment, impacting government policies, career services, and psychologists.

Comparing counseling outcome for college students: Metaverse and in-person approaches

ABSTRACT Objective This study compared metaverse counseling with in-person counseling, using in-person counseling as a comparison group. To achieve this, we assessed whether metaverse counseling, a novel treatment approach, is comparable to traditional in-person counseling. Method: A total of 60 participants voluntarily participated in the study. Among the participants, 28 preferred in-person counseling, whereas 32 selected metaverse counseling as their preferred treatment option. Results and Conclusion: The findings indicated no statistically significant differences in the psychological symptom change patterns between the two counseling modalities. Both metaverse and in-person counseling demonstrated a common pattern of reduced symptom levels from pre-to post-session (Metaverse counseling Cohen’s d = 1.04, In-person counseling Cohen’s d = .62), which remained stable from post-session to follow-up regardless of the chosen counseling modality. Furthermore, the study revealed that the metaverse counseling group exhibited a higher level of working alliances than the in-person counseling group. Additionally, there was a slight tendency toward higher levels of counseling satisfaction in the metaverse counseling group than in the in-person counseling group. The results of this study support the use of synchronous metaverse programs to treat college students. The implications and limitations of this study are discussed. (195 words)

SELF AND OTHERS STIGMA, FACE-TO-FACE AND ONLINE ATTITUDE, AND INTENTIONS TO SEEK COUNSELING: A STRUCTURAL EQUATION MODEL

The effect of personal and perceived stigmatization on attitudes towards counseling in face-to-face and online modalities, as well as the intent to seek school counseling, was investigated in this study. The researchers used a descriptive correlational and quasi-experimental research design to come up with a structural equation model. 439 participants completed the survey measuring self-stigma, perceived stigma, attitudes in face-to-face and online counseling, and counseling-seeking intentions. Results indicated that self-stigma and perceived stigma were negatively associated with attitudes toward face-to-face and online counseling, as well as intentions to seek counseling. Attitudes toward counseling in face-to-face modality were positively related to intentions to seek counseling, while attitudes toward online counseling did not significantly affect intentions. From this, a structural equation model was generated. It indicates that stigmatization by others predicts the stigmatization by self and influences how comfortable adolescents are with counseling in both online and face-to-face modalities. This stigmatization by self and discomfort then predicts the way adolescents place importance on the two counseling modalities which in turn predicts the level of school counseling-seeking intention they have for various concerns. These findings highlight the importance of addressing stigma to promote positive attitudes toward counseling and increase help-seeking intentions.

Healthcare Providers' Knowledge of Evidence-Based Treatment for Tobacco Dependence, DocStyles 2020.

Although smoking cessation reduces the risk of all-cause mortality, evidence-based cessation treatments are underused. This study examined healthcare provider knowledge of evidence-based cessation treatments and associations between knowledge and clinical practice characteristics. Cross-sectional survey. 2020 DocStyles. 1480 U.S. healthcare providers. Provider knowledge of availability of tobacco use disorder diagnostic criteria, clinical practice guideline availability, treatment efficacy, evidence-based counseling modalities, and medications approved by the U.S. Food and Drug Administration (FDA). Adjusted odds ratios (aORs), adjusted for personal and clinical practice characteristics. Less than half of respondents demonstrated high knowledge of availability of diagnostic criteria (36.8%), cessation treatment efficacy (33.2%), evidence-based counseling modalities (5.6%), and FDA-approved medications (40.1%). Significant differences were found between specialties: compared to internists, family physicians were less likely to have low knowledge of medications (aOR = .69, 95% CI = .53, .90) and obstetricians/gynecologists were more likely to have low knowledge of medications (aOR = 2.62, 95% CI = 1.82, 3.76). Overall, few associations between knowledge and clinical practice characteristics were identified. Most providers had low knowledge of the topics of interest, with little variation across clinical practice characteristics, indicating room for improvement. Efforts to improve provider knowledge of evidence-based treatments are an important component of a comprehensive approach to improving delivery and use of cessation interventions and increasing tobacco cessation.

집단상담자의 화상회의 집단상담 경험에 관한 질적연구

Purpose: Whilst traditional counseling has been conducted in-person, videoconferencing counseling modality was widely adopted during COVID-19. This study aims to explore the group counselors’ experiences of videoconferencing group therapy by focusing on coping experiences. Method: Participants of the study were six group counselors. They had more than three videoconferencing group therapy experiences with masters or doctoral degree in the field of counseling, and had more than 5 years of counseling experiences. In-depth interviews were conducted once or twice per participant, and were recorded and transcribed. Data were analyzed using the Constant Comparative Analysis Method. Results: Results of the study are as follows; Efforts outside of videoconferencing group therapyg, Having control over group members and groups, Utilizing technology to facilitate interaction, Intervene in difficult group members and situations, and Positive attitude toward videoconferencing group therapy. Participants' experiences of were summarized as 'understanding the pros and cons of videoconferencing group therapy and creatively coping with difficulties arising inside and outside of the group by using technology and expertise'. Conclusion: Suggestions were proposed for future videoconferencing group therapy. Finally, the implications and limitations of the study were discussed.

Comparison of interpersonal quality of contraceptive counseling delivered via telehealth versus in person

ObjectivesThis study aimed to compare the interpersonal quality of contraceptive counseling between telehealth and in-person visits. Study designPatients at a single Title X–funded clinic selected their preferred counseling modality (in person or telehealth via video or telephone) when scheduling an appointment for contraception. After counseling, we invited patients to complete a survey and recorded their desired contraceptive method. We assessed the quality of counseling using the Interpersonal Quality in Family Planning scale. We reviewed the electronic medical record to identify any subsequent clinician visit. We performed between-group comparisons using Mann-Whitney U, χ2, and Fisher exact tests. ResultsFrom March 2021 to June 2022, 360 patients were eligible to participate, and 296 (82%) completed the survey and were included in the analysis; 150 (51%) completed counseling in person, and 146 (49%) completed counseling via telehealth. In the telehealth group, 102 (70%) chose telephone, and 44 (30%) chose video. Respondent characteristics were similar between groups. The majority of respondents in both groups reported high quality of counseling, defined as a top score on the Interpersonal Quality in Family Planning scale (75.0% telehealth respondents and 80.0% in person, p = 0.30). Compared to respondents completing in-person counseling, telehealth respondents were less likely to have a subsequent clinician visit (89.0% versus 100.0%, p < 0.001). ConclusionsThe majority of respondents reported high-quality contraceptive counseling without significant difference between the modalities. However, respondents choosing telehealth were less likely to have a subsequent clinician visit. Given the higher uptake of telephone compared to video, telehealth via telephone may be more accessible or acceptable to some patients. ImplicationsContraceptive counseling via telehealth has similar high interpersonal quality when compared to traditional, in-person visits. However, barriers may exist for patients who choose telehealth contraceptive counseling to access subsequent in-person care. Utilization of telehealth for contraceptive visits may provide opportunities for more equitable health care and to expand contraceptive access.

Supporting Mental, Emotional, and Sexual Wellness for LGBTQ+ College Students: A Special Commentary

This brief commentary addresses the importance of campus-wide sexual health initiatives for lesbian, gay, bisexual, trans, queer, and other sexual and affectional identities (LGBTQ+) college students. LGBTQ+ college students in the emerging adulthood life stage are particularly susceptible to stigmatized, inequitable physical and mental healthcare, making the need for intentional and affirming support from college counselors, on-campus healthcare providers, and student affairs professionals essential. This article addresses LGBTQ+ friendly communication strategies, specific counseling modalities for work surrounding LGBTQ+ college student sexual health, implications for counselor education and supervision, as well as ongoing research priorities for college counselors. Because sexual health is relevant throughout the lifespan, we emphasize the importance of instilling strong foundational principles of consent, safety, responsibility, and joyful exploration during this phase.

A cross-country comparison of pregnant women's decision-making and perspectives when opting for non-invasive prenatal testing in the Netherlands and Belgium.

The Netherlands and Belgium have been among the first countries to offer non-invasive prenatal testing (NIPT) as a first-tier screening test. Despite similarities, differences exist in counseling modalities and test uptake. This study explored decision-making and perspectives of pregnant women who opted for NIPT in both countries. A questionnaire study was performed among pregnant women in the Netherlands (NL) (n=587) and Belgium (BE) (n=444) opting for NIPT, including measures on informed choice, personal and societal perspectives on trisomy 21, 18 and 13 and pregnancy termination. Differences between Dutch and Belgian women were shown in the level of informed choice (NL: 83% vs. BE: 59%, p<0.001), intention to terminate the pregnancy in case of confirmed trisomy 21 (NL: 51% vs. BE: 62%, p=0.003) and trisomy 13/18 (NL: 80% vs. BE: 73%, p=0.020). More Belgian women considered trisomy 21 a severe condition (NL: 64% vs. BE: 81%, p<0.001). Belgian women more frequently indicated that they believed parents are judged for having a child with trisomy 21 (BE: 42% vs. NL: 16%, p<0.001) and were less positive about quality of care and support for children with trisomy 21 (BE: 23% vs. NL: 62%, p<0.001). Differences in women's decision-making regarding NIPT and the conditions screened for may be influenced by counseling aspects and country-specific societal and cultural contexts.

A comparative study on assessment of perceived stress in common non-communicable disease

Introduction and Aim: Stress is defined as ‘a perceived strain’ experienced by either stimulating or by intimidating and depending on the appraisal, it can be either adaptive or premeditated. Long-term stress triggers high levels of cortisol which may be the reason, how stress can elevate cholesterol level. Hence this study is conducted to compare and assess the stress levels in noncommunicable diseases including type II diabetes mellitus, hypertension, hyper-cholesterolemia and thyroid disorders. Materials and Methods: The study was conducted by administering a validated perceived stress analysis questionnaire on patients attending the General Surgery department of tertiary health care centre in Mangalore to evaluate the level of stress experience. The recruited patients were clustered into type II diabetes mellitus group, thyroid group, and hypertensive group. Results: In a moderate stress level group, we observed there was a significant difference in the stress score among all the three groups. The descriptive statistics suggested that the thyroid group had lowest mean score as compared with the other two groups. Conclusion: This study concluded that suitable psychological and counseling modality treatment may be required for the people suffering from hypertension, hypercholesterolemia, thyroid disorders as well as diabetes to control the stress.

Group Work with LGBTQIA Youth Using Relational Cultural Theory: A Case Example

ABSTRACT Group counseling is an effective counseling modality with LGBTQIA clients, yet much of group counseling literature does not account for the experience of prejudice and marginalization that LGBTQIA youth encounter. Relationships with families and peers of LGBTQIA youth have a significant impact and special consideration must be taken when designing and implementing group counseling. Consequently, we argue the use of Relational Cultural Theory (RCT) in a group context can bring discussions of controlling images, social inequities, and foster growth and relational resilience. We present a case example where the tenets of RCT are explored and provide implications for counselors.

Management of learners with conduct disorders in Nkayi Rural District Primary Schools in Zimbabwe.

Zimbabwe has adopted an inclusive education system in order to address barriers to learning for children with conduct disorders. The management of learners with conduct disorders is hampered by the lack of teachers’ skills and knowledge in guidance and counselling of learners with conduct disorders. In this paper, the researcher identifies the challenges in the management of learners with conduct disorders in Nkayi District primary schools and explores suggestions on the best and convenient ways of managing these learners. A qualitative research approach and a phenomenological research design were employed in which ten teachers in rural primary schools were interviewed to solicit their views, experiences and observations on the management of learners with conduct disorders in primary schools. The study concluded that the management of learners with conduct disorders in rural primary schools may not be successful without considerate guidance and counselling modalities in schools.

A predictive model for advanced oropharyngeal cancer patients treated with chemoradiation

BackgroundTo analyze clinical characteristics in the prediction of death within 1 year in advanced oropharyngeal cancer patients treated with chemoradiation.MethodsOne hundred forty-seven advanced oropharyngeal cancer patients who underwent curative-intent chemoradiation treatment were retrospectively enrolled. The pre-treatment clinical parameters including inflammatory markers were reviewed.ResultsThe 1-year death rate for all patients was 29% [95% confidence interval (CI): 23–37%]. In multivariate logistic regression analysis, hemoglobulin (Hb) < 13.5 g/dl was an independent indicator of death within 1-year [Odds ratio (OR) 5.85, 95% CI 2.17–15.75, p < 0.001]. Systemic immune inflammation (SII) ≥ 1820 was also a significant factor for prediction of death within 1 year (OR 4.78, 95% CI 1.44–15.85, p = 0.011). We further used gander, age, Hb and SII to develop a nomogram to predict death within 1 year. The c-index of the model was 0.75 (95%CI 0.66–0.83). For patients with low nomogram score (< 14) versus high nomogram score (≥ 14), the 1-year and 2-year OS rates were 91 and 71% versus 53 and 29%, respectively. (p < 0.001). A difference in the disease persistence or recurrence rate between patients with high and low nomogram score was significant (73 and 28%, respectively; p < 0.001).ConclusionsThe pre-treatment Hb < 13.5 g/dl and SII ≥ 1820 are associated with higher risks of death within 1-year in patients with advanced oropharyngeal cancers. Nomogram can aid in patient counseling and treatment modality adjustment. The development of a more effective treatment protocol for patients with high nomogram score will be essential.

EP236: TeleKidSeq: Incorporating telehealth into clinical care of children from diverse backgrounds undergoing clinical genome sequencing

The global pandemic required healthcare institutions and clinical research programs to adapt quickly to non-traditional care models. TeleKidSeq is a pilot study that emerged from the NYCKidSeq program, an NIH-funded Clinical Sequencing Evidence-Generating (CSER) Consortium site focused on incorporating genomic medicine into the care of diverse New York City children with suspected genetic disorders. Embracing the opportunity to study the use of telehealth in delivering genomic results, TeleKidSeq will examine the impact of innovative remote genetic counseling modalities in medically underserved populations.

Fallacies in the Age of Social Media

Social media is known to be one of the finest achievements of the 21st century. However, it is no surprise that there are two sides to every coin. While there are a lot of advantages of social media in our day-to-day life it is difficult to ignore its negative consequences. As the interactions between people have increased so have the standards and expectations of people and undoubtedly, so has the mental distress that people constantly face. Multiple researches conducted on the negative impacts of social media indicate towards the downside of social media, especially it's negative footprint on people's identities, social life, mental health and emotional well-being. Although there are various modalities that have been used to identify and solve the problems that people experience with social media, there are other modalities of counseling that have the potential to be effective and helpful but have not been explored in this regard. One such modality is Logic-Based Therapy. Logic-Based Therapy and Consultation is a philosophy-based practice that aims to help identify the different emotional and behavioral ways in which people upset themselves by their own faulty thinking. LBT identifies a number of fallacies or incorrect reasonings that people use very frequently in their lives and also suggests ways in which individuals can learn to cope with these fallacies. A lot of the fallacies identified by LBT can be seen in practice through social media. This paper aims at providing an insight into the reality of social media and online presence while highlighting the most common fallacies that people commit in emotional and behavioral reasoning as identified by LBT. The paper will also explore how and why people often commit these fallacies and suggest some antidotes to combat these fallacies.

A novel walk-in clinic treatment intervention for youth presenting with anxiety and depression.

This article explores a novel, single-session treatment intervention for anxiety and depression through an externalizing process, transforming of metaphoric imagery, and shifting of underlying maladaptive emotional schemas within the Walk-in counseling setting. The purpose of this paper is to present a novel, single-session treatment protocol that is delineated through a six-stage process (or mediators of change) for the clinical population of youth presenting with anxiety and/or depression, mild-to-moderate severity. These are two of the most common presenting concerns for this population and the proposed treatment intervention is from a very brief format. A case study is used to illustrate the treatment protocol which is presented in table format and within-session description. A composite literature review was conducted with relevant works specific to single-session consultation including Walk-in clinic models to mental health treatment. The interconnected theoretical constructs both map and manualize its key clinical processes, which reflects the mechanism of change in this brief model. This proposed line of clinical research may introduce a paradigm shift towards specific treatments for specific presenting concerns in the Walk-in counseling modality for youth.

Genetic counselor use of self-involving responses in a clinical setting: A qualitative investigation.

Self-involving responses are direct expressions of genetic counselors' here-and-now feelings about/reactions to patients. Strategic, sparing use of self-involving responses may enhance practitioner genuineness, likeability, and trustworthiness, decrease patient anxiety, and increase patient trust and engagement. Conversely, they may threaten patients who are uncomfortable with emotional expression or confuse them about the counselor's intentions. Despite theorized benefits and risks, no study has explored genetic counselor self-involving responses. This study explored whether clinical genetic counselors use self-involving responses with their patients, reasons for doing so, and their perceptions of when and why the responses work well versus poorly. Two-hundred sixty-eight genetic counselors, invited via a National Society of Genetic Counselors e-blast, completed an online screening survey. Eighty-nine percent reported using self-involving responses with patients, and 17 were purposively selected to participate in semi-structured phone interviews. Thematic analysis yielded themes regarding potential benefits, risks, counselor factors and context, and patient factors related to using self-involving responses. Benefits include conveying counselor conditions for facilitating counseling process (e.g., genuineness, building rapport, focusing the session, and encouraging the patient to open-up), and counseling outcomes by validating decision-making. Risks of use include hindering counseling processes and outcomes by misperceiving patient feelings, boundary crossing, and being unduly directive. Factors, both from the counselor and the context of the session, include comfort with the technique, mastery of clinical skills, minimal knowledge of patient emotions, type of counseling session, and counselor practice specialty. Patient factors include prior rapport with the counselor, and patient emotionality and cultural background. Findings underscore the need for training about this technique. Future research could examine patients' perceptions of self-involving statements and differences in self-involvement across practice specialties and counseling modalities.