Counseling Issues Research Articles

Annual review of Asian American Psychology, 2009.

The purpose of this study was to provide a systematic and critical review of research articles on Asian American psychology that were published in 2009. A search using PsycINFO led to the identification of 134 articles, and each of these articles were evaluated in terms of its topic areas, research methodology, and findings. The results showed that the articles covered a wide array of topics, including acculturation and enculturation, adoptees, career, counseling and clinical issues, educational experiences, families, health and health-related behaviors, identity, immigrants and refugees, interpersonal relationships, lesbian/gay/bisexual/transgender/intersex/questioning, masculinity, older adults, personality, politics, psychopathology, racism, spirituality, stress and coping, violence, women, and youths. A summary of articles within these topics areas are provided. In addition, various characteristics of this body of literature are presented with their implications for future research.

Introduction to the Special Issue: Translating the Competencies for Counseling with Transgender Clients into Counseling Practice, Research, and Advocacy

This article introduces the Special Issue of the Journal of LGBT Issues in Counseling on Counseling Competency with Transgender Clients. The purpose of the special issue is to explore how counselors may use the ACA Competencies for Counseling with Transgender Clients in research, practice, advocacy, training, and supervision. A brief overview of the articles included in the special issue is provided, and the implications for the use of the counseling competencies with transgender clients are discussed.

Shifting the Counselor Role from Gatekeeping to Advocacy: Ten Strategies for Using the Competencies for Counseling with Transgender Clients for Individual and Social Change

In this article, the editors of the Special Issue of the Journal of Lesbian, Gay, Bisexual, and Transgender Issues in Counseling on Counseling Competency with Transgender Clients summarize the themes of the articles within the special issue. The authors then discuss the future implications of these themes for counseling supervision and training, practice, research, and advocacy. Included in this discussion is a review of the areas of important focus that were “missing” in the Special Issue and how the counseling field may address these gaps in the literature. The article concludes with a list of 10 critical “next steps” for the counseling profession to take to ensure the American Counseling Association's Competencies for Counseling with Transgender Clients develop a transgender-positive counseling environment.

Four sisters compound heterozygotes for the pre- and full mutation in fragile X syndrome and a complete inactivation of X-functional chromosome: implications for genetic counseling

Fragile X syndrome (FXS) is a neurodevelopmental disorder and a leading monogenic form of cognitive impairment and autism. It is the most common form of inherited mental retardation in males and a significant cause of mental retardation in females. It is caused by the instability and subsequent expansion of the CGG repeat in the promoter region of the FMR1 (fragile X mental retardation 1) gene at Xq27.3. We describe a double consanguineous family with four sisters compound heterozygotes for the full and pre-mutation CGG repeat size. The index case shows clinical features of the affected males with profound mental retardation; the other three sisters also suffer from mental retardation, ranging from mild to severe. Molecular analysis reveals very similar ranges for the CGG expansions for both chromosomes in all four sisters. The phenotypic differences observed in the index case and her sisters are the total inactivation of X premutated chromosome and the total absence of FMRP (fragile X mental retardation protein). This family case raises important issues for genetic counseling in families with consanguinity and with cases of idiopathic mental retardation.

The Level of Comfort Among Nursing Students During Sexual Counseling to Patients Who Have Chronic Medical Conditions

The aim of this study is to determine the level of comfort among nursing students during sexual counseling to patients who have chronic medical conditions. The sample of this descriptive study consisted of 161 students who study at the third and fourth years at a health college. More than half of the students reported being comfortable or a slightly comfortable during providing sexual counseling to patients who have chronic conditions. Students who are not comfortable with answering questions related to sexuality (p = 0.000), find initiating a conversation on future sexual problems with the patient is inappropriate unless the patient brings it up (p = 0.007), and nurses should not talk about sexual issues in a routine way with patients (p = 0.026) who do not feel comfortable during sexual counseling. In order to provide nursing students feeling comfortable, the issue of sexual counseling to patients who have chronic conditions should take place during the nursing education.

“Too stubborn to ever be governed by enforced insanity”: Some therapeutic jurisprudence dilemmas in the representation of criminal defendants in incompetency and insanity cases

Little attention has been paid to the importance of the relationship between therapeutic jurisprudence (TJ) and the role of criminal defense lawyers in insanity and incompetency-to-stand-trial (IST) cases. That inattention is especially noteworthy in light of the dismal track record of counsel providing services to defendants who are part of this cohort of incompetency-status-raisers and insanity-defense-pleaders. On one hand, this lack of attention is a surprise as TJ scholars have, in recent years, turned their attention to virtually every other aspect of the legal system. On the other hand, it is not a surprise, given the omnipresence of sanism, an irrational prejudice of the same quality and character of other irrational prejudices that cause (and are reflected in) prevailing social attitudes of racism, sexism, homophobia, and ethnic bigotry, that infects both our jurisprudence and our lawyering practices. Sanism is largely invisible and largely socially acceptable, and is based predominantly upon stereotype, myth, superstition, and deindividualization. It is sustained and perpetuated by our use of alleged “ordinary common sense” (OCS) and heuristic reasoning in an unconscious response to events both in everyday life and in the legal process. This paper examines the literature that seeks to apply TJ principles to the criminal law process in general, drawing mostly on the work of Professor David Wexler. It considers why the lack of attention that I have referred to already is surprising (given TJ's mandate and the fact that many TJ issues are inevitably raised in any insanity or IST case). The paper then considers why this lack of attention is not surprising, given the omnipresence of sanism. It will consider some of the actual counseling issues that might arise in these contexts, and offer some suggestions to lawyers representing clients in cases in which mental status issues may be raised. The paper concludes that we must rigorously apply therapeutic jurisprudence principles to these issues, so as to strip away sanist behavior, pretextual reasoning and teleological decision making from the criminal competency and responsibility processes, so as to enable us to confront the pretextual use of social science data in an open and meaningful way. This gambit would also allow us to address—in a more successful way than has ever yet been done—the problems raised by the omnipresence of ineffective counsel in cases involving defendants with mental disabilities.

Genetic Causes of Frontotemporal Degeneration

The purpose of this review is to provide a comprehensive update on the genetic causes of frontotemporal lobar degeneration (FTLD). Approximately 40% to 50% of patients diagnosed with FTLD have a family history of a ''related disorder,'' whereas 10% to 40% have an autosomal dominant family history for the disease. At this time, mutations occurring in 2 independent genes located on the same chromosome (MAPT and GRN) have been shown to cause the majority of cases of autosomal dominant FTLD. Specific genetic, molecular, pathological, and phenotypic variations associated with each of these gene mutations are discussed, as well as markers that may help differentiate the 2. In addition, 3 relatively rare, additional genes known to cause familial FTLD are examined in brief. Lastly, genetic counseling issues which may be important to the community clinician are discussed.

Hypertrophic cardiomyopathy: An inherited cardiac condition

Hypertrophic cardiomyopathy (HCM) is an inherited cardiac condition affecting the cardiac muscle and a major cause of sudden cardiac death (SCD) in young people and adults (Michels et al, 2007). Patients are often unaware of their condition until presenting with serious and often fatal arrhythmias or heart failure. Clinical guidelines have assisted the diagnostic process but the genetic origin of HCM raises important ethical and counselling issues. This article highlights the molecular, counselling and ethical issues related to managing patients with HCM. A case example of a woman who presented with HCM aged 39 years is used to help the reader understand how some of the broad issues relate to practice. The HCM diagnosis in this case indicated that members of her family could be carrying a genetic mutation responsible for HCM.

The New ASERVIC Competencies for Addressing Spiritual and Religious Issues in Counseling

In 2009, leaders in the Association for Spiritual, Ethical and Religious Values in Counseling (ASERVIC) developed new competencies for addressing spiritual and religious issues in counseling. This article briefly addresses the need for new ASERVIC competencies, provides an overview of the process whereby the new competencies emerged, and concludes with a listing of the new ASERVIC‐endorsed competencies.

Creating A Standard of Care for Fertility Preservation

Fertility preservation options for women are currently only routinely offered to patients who face iatrogenic fertility loss, and most options are considered experimental. The most common modalities for female fertility preservation are embryo cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation, the later two of which remain in the experimental arena. Natural fertility loss is affecting women as significantly as premature fertility loss. Increasing cancer survival and the modern reproductive trend of delaying childbearing are indications for the need and demand for fertility preservation. Advances in the field are necessary to respond to this demand and include superior cryopreservation techniques and fertility preservation technologies, customized guidelines, comprehensive care plans, and availability of more cost-efficient procedures. The obstacles to creating a standard of care for fertility preservation are as broad as the field itself. Lack of patient awareness, limited physician experience and knowledge, inadequate counseling, costs, and ethical issues are some examples of the many challenges to establishing a standard of care. With continued research and multidisciplinary collaboration, a higher quality of care may be provided to a larger patient population who wishes to maximize their fertility potential in the future. Keywords: Fertility preservation, standard of care, treatment options, challenges, assisted reproductive technology (ART), patient expectations

Reproductive outcomes in subsequent pregnancies after a pregnancy complicated by open maternal-fetal surgery (1996–2007)

The reproductive and gynecologic outcomes for women after the pregnancy complicated by open maternal-fetal surgery (OMFS) were evaluated. The retrospective review identified 93 women with OMFS from a single institution (1996-2007). Consent and questionnaires were sent to women. Institutional review board approval was obtained from the Committee for Protection of Human Subjects. The total return rate was 57.3%. Total pregnancies reported were 47, with 36 delivering after 20 weeks' gestation. The uterine dehiscence and rupture rates were 14% and 14%, respectively. Fetal anomalies occurred in 4 subsequent pregnancies. Normal conception occurred in 98% of subsequent pregnancies. Gynecologic issues were reported by 8 women, with infertility, abdominal pain, and ovarian and uterine factors. The reproductive outcomes of uterine dehiscence (14%) and rupture (14%) in a subsequent pregnancy continue to be a major counseling issue for OMFS. Fertility and gynecologic factors do not appear to be increased for women undergoing OMFS.

Motivation, physical activity and smoking cessation

Smoking remains the biggest cause of morbidity worldwide; in the UK annually, despite being completely avoidable, smoking results in around 45,000 cancer deaths and 110,000 hospital admissions [1]. Simple methods are available which health professionals can use to help smokers to stop permanently; physicians’ brief advice against smoking is effective and 2% of all those advised can be expected to stop permanently for at least 6 months [2]. Behavioural support, provided by appropriatelytrained health professionals either to smokers individually [3] or in groups [4], is more effective; smokers who are sufficiently motivated to attend these time consuming treatments have substantially better chances of achieving long term abstinence. Clearly, maximising the impact of physicians’ and other health professionals’ brief advice and also the number of smokers who access more intensive behavioural support is of utmost public health importance and three papers in this journal address provide insight into how these might be achieved. In a secondary analysis of data from a randomised controlled trial, asthma published in the present issue of Patient Education and Counseling [5], Halterman and colleagues investigated motivation to stop smoking amongst parents of children with asthma. Higher motivation is vital for smokers to fight their nicotine addiction; it increases their likelihood of seeking out and using evidence-based cessation support [6] and their odds of successfully becoming exsmokers in any one quit attempt [7]. Almost 40% of parents smoked in Halterman’s study and, in univariate analyses, previous parental quit attempts, perceiving children’s asthma control to be poor and beliefs that asthma symptoms would improve with parental smoking cessation were all associated with greater motivation. However, the only factor independently associated with parental motivation to stop smoking was a parental belief that their child’s asthma was uncontrolled. This mirrors findings in other patient groups; for example, smokers who suffer from respiratory symptoms and attribute these to their smoking are much more likely to intend stopping than thosewho experience symptoms but believe there are other causes for these [8]. A simple message for clinicians is that, where children’s asthma is not controlled and parents smoke, these adults are likely to be receptive to sensitive discussion of their smoking habit coupled with an offer of help. As problem-orientated approaches to raising [9] and giving [10]

17p13.1 microdeletion involving the TP53 gene in a boy presenting with mental retardation but no tumor

We report on the diagnosis of a 17p13.1 deletion in a 10-year-old boy. The patient presented with mild developmental delay, facial dysmorphism, joint hyperlaxity, pes planus, hypermetropia, hearing loss, and achromic patches following the Blaschko's lines on the right part of the thorax. Chromosome R-banding was normal. Array CGH using a 244 K oligonucleotide array showed a homogeneous de novo 17p13.1 microdeletion of 400 kb involving TP53 and 25 other genes, including genes involved in brain function (EFNB3, FXR2). To our knowledge, six patients presenting with a constitutional 17p13.1 microdeletion involving the TP53 gene have been reported. We discuss the phenotype of this microdeletion and the genetic counseling issues, especially regarding the risk of cancer associated with the deletion of the TP53 gene.

Genetic Counselling Issues in Cystic Fibrosis

Cystic fibrosis is a chronic condition for which genetic testing offers much for the individuals affected in terms of an early diagnosis and offers timely additional information for families with regard to family planning and prenatal testing. Genetic counselling encompasses a range of clinical issues for families and forms a complementary resource for clinicians caring for people with cystic fibrosis. This review will discuss the range of genetic information readily available to patients and families through genetic counselling.

Specialty Training in Counselor Education Programs: An Exploratory Study

We investigated the training of licensed professional counselors in Texas by focusing on how students receive expertise in specialty areas such as substance abuse, sexual concerns, domestic violence, play therapy, family therapy, and art and music therapy. A mail survey elicited responses from department chairs or program directors of community counseling programs. Results of the survey were analyzed both quantitatively and qualitatively and indicated that most participating programs offer coursework in specialty areas designed to prepare students to work with a wide variety of client issues in counseling.

61. Genetic counseling issues in the prenatal diagnosis of Fabry disease

61. Genetic counseling issues in the prenatal diagnosis of Fabry disease

Introduction to Special Issue: The School Counselor as Leader

Following more than a decade of influence by the Transforming School Counseling Initiative (Education Trust, 1998, 2007) that promoted a new vision of school counselors as assertive advocates and social activists (House & Hayes, 2002; House & Martin, 1998; Martin, 2002), professional school counselors are currently in a pivotal role to collaboratively lead school transformation at the local, state, regional, and national levels (Kaffenberger, Murphy, & Bemak, 2006). The importance of school counselors as leaders is evidenced in the ASCA National Model[R] (American School Counselor Association, 2005), wherein leadership is indicated as one of the four major themes of school counseling along with collaboration and teaming, advocacy, and systemic change. Beyond being leaders in the design, implementation, management, and evaluation of comprehensive school counseling programs, school counselors play a ubiquitous role in leading the education mission and process for the development of student academic, career, and personal/social growth. Further, as school systems become more diverse and complex, the resounding call for professional school counselors to be leaders of social justice and educational reform continues. Scholarly discourse on the role of the school counselor as an advocate and agent of social justice has been well documented (Baker & Gerler, 2004; Education Trust, 1998, 2007; Lee & Goodnough, 2007; Walker, 2006). Indeed, the preamble to ASCA's (2004) Ethical Standards for School Counselors explicates that school counselors are leaders and advocates who affirm diversity while promoting equitable access to educational resources, excellence in education, and postsecondary education for all students. Unfortunately, in spite of the focus to reform schools toward equity, the historical gaps between student groups have continued to persist (Roberts, 2004). As schools and communities continue to become more demographically diverse (Roberts), recognizing and challenging systemic oppression become key skills for school counselors in support of their advocacy for students and their efforts to remove social barriers that impede achievement (Bemak & Chung, 2005; Kiselica & Robinson, 2001; Ratts, DeKruyf, & Chen-Hayes, 2007). Preparing for the professional roles of change agent and promoter of social justice is crucial and involves a personal commitment to affirming diversity (Holcomb-McCoy & Chen-Hayes, 2007). Beyond this essential commitment, having the competencies to advocate is also critical. As editors and counselor educators, we believe that at the core of school counselor social justice practice is leadership. However, the related literature on school counselor leadership theory and practice has only recently begun to gain prominence. For example, Amatea and West-Olatunji (2007) explored the role of school counselors as leaders in high-poverty schools. In their article they illuminated the need for school counselors to collaborate with teachers and to assist school-based professionals in creating a climate of cultural acceptance while encouraging the success of all students. The focus of the article by Amatea and West-Olatunji was unique in that it underscored how school counselor leadership may positively impact access to community resources, educational outcomes, and systemic support of impoverished students. Following their lead, our intent as co-editors was to highlight, specifically, research and conceptual works dedicated to leadership in school counseling. In this special issue of Professional School Counseling, articles were selected that represent contributions to school counselor leadership theory and practice in order to stimulate further thought on the topic, as well as to motivate readers to conduct additional research on school counselor leadership. We further hope to encourage an ongoing professional dialogue about what are the salient characteristics of school counselor leadership and how counselor educators can teach and model leadership and advocacy skills in order to prepare professionals who are ready to actively participate in educational reform to benefit all students. …

Prenatal diagnosis of two different unbalanced forms of an inherited (Y;12) translocation

The identification of an unexpected structural chromosome rearrangement at prenatal diagnosis can be problematic and raises unique genetic counseling issues. We describe two consecutive prenatal cases within a family with an inherited unbalanced (Y;12) translocation and discuss the genotype-phenotype correlation. The first fetus presented with 12qter monosomy and pseudoautosomal region 2 trisomy, while the second fetus had the alternative unbalanced state. Although the first fetus had a structural heart defect, such small imbalances might not give sonographic findings, making their prenatal diagnosis difficult. However, congenital abnormalities are expected in both unbalanced forms of the translocation, including mental retardation, which could be explained by the gene dosage variation of P2RX2. To our knowledge, these are the first published cases reporting this subtype of (Y;12) translocation, in both balanced and unbalanced states.

Pregnancy after breast cancer: The importance of active counselling and planning

Aim To investigate the effect of breast cancer, its treatment and counselling on future pregnancy and fertility. Method Three hundred and four women 45 years and younger at the time of diagnosis of breast cancer were identified from one breast unit from 1997 to 2006. A questionnaire was sent to all patients asking about pregnancy, counselling and fertility issues. Results Of 304 women, 248 were still alive and not lost to follow up. The questionnaire response rate was 66% and the average follow up was 60 months. By questionnaire response, 39 women had wanted children before diagnosis, and 24 still wanted them post treatment, giving a successful pregnancy rate of 75%. Eighteen patients have become pregnant, 4 with more than one pregnancy. 107 patients were specifically counselled about fertility prior to breast cancer treatment. The mortality due to breast cancer was 10% in non-pregnant patients and 6% in patients who became pregnant after breast cancer. Conclusion Pregnancy after breast cancer does not confer a poor prognosis. A higher rate of pregnancy than expected was found after treatment, possibly due to newer treatments including fertility preservation and also possibly due to the active counselling programme in this unit. Patients should have active counselling about fertility when planning treatment and fertility conservation can then be incorporated into a treatment plan.

Prenatal Testing for Down Syndrome: Comparison of Screening Practices in the UK and USA

Prenatal testing for Down Syndrome is a topic covered in every genetic counselor's training as it constitutes the main workload of genetic counselors in prenatal settings. Most Western countries nowadays offer some type of testing for Down Syndrome. However, practices vary according to country with regards to what tests are offered, insurance coverage and the legal situation concerning the option of terminating an affected pregnancy. In view of the growing interest in international genetic counseling issues, this article aims to compare prenatal testing practices in two English-speaking countries: the United Kingdom and the United States of America. A case will be presented to highlight some of the differences in practice. The topic underlines important implications for genetic counseling practice, such as patients' understanding of testing practices, risk perception, counseling provision and impact of prenatal testing results.