Counseling Issues Research Articles

The lost children of universal access – issues in scaling-up HIV testing and counselling

This descriptive study is based upon information and data gathered from a convenience sample and review of national human immunodeficiency virus (HIV)/voluntary counselling and testing (VCT) policies; a review of existing recommended or selected tools and guidance; and informants working with HIV testing and counselling (HTC) and children at an implementation or policy level selected through purposive, snowball sampling. Questionnaires captured data on problems, strategies and legal frameworks on HTC provision to children in multiple countries and regions. The policy review of 20 high-prevalence countries revealed that while 84% distinguished identified children as a specific subgroup affected by HIV, only 35% of national policies offered details on HTC and children. Fifty-seven key informants (53% implementers, 48% policy-level) from 25 countries in four regions responded; 93% stated problems existed in the area of HTC and children and further specific guidance was needed on children in the following issues: informed consent (63.2% of respondents), child-counselling (54.4%), discrimination/stigma/child's rights (42.1%), diagnosis/laboratory issues (38.6%), disclosure (33.3%), service delivery (31%), access (29.8%), policy (23%) and confidentiality (21%). No geographic differences were found. Eighty guidance publications were reviewed that covered some of these issues. While some guidance, policies, strategies and tools have been developed around HTC and children, findings suggest that in many countries significant gaps and corresponding needs exist if children are to benefit from the move to Universal Access. Policy makers, programmers, implementers and monitoring efforts need to better directed. National policies must be updated to specify and reflect the technical and policy needs relating to diagnosis of HIV in children, and offer implementers specific directives related to consent, confidentiality and counselling needs. Stakeholders at international and country levels need to work to improve and update existing guidance; implementers must be updated in current best practices.

A Reexamination of Trends in Acute Care Psychiatric Hospitalization for Adolescents: Ethnicity, Payment, and Length of Stay

The purpose of this study was to identify current trends for adolescents in acute care psychiatric hospitalization with respect to ethnicity, insurance coverage, and length of stay. Data were collected on 89 adolescents admitted to acute care psychiatric hospitalization. Contrary to previous research, adolescent clients with Medicaid, as opposed to private insurance, had longer lengths of stay and minority youths stayed significantly longer in the hospital than did white youths. No relationship was found between either clients’ diagnosis or payment source and clients’ length of stay. Implications related to the role of managed care and multicultural issues in counseling are discussed.

Counseling chaos: Techniques for practitioners

The chaos theory of careers draws together a number of themes in current theory and research. This article applies some of these themes to career counseling. The chaos theory of careers is outlined, and a conceptual framework for understanding assessment and counseling issues that focuses on convergent and emergent qualities is presented. Three practical techniques focusing on emergent quality concepts derived from chaos theory are then detailed. It is concluded that a major ongoing challenge for career counselors is to assist clients to understand the reality and confront the challenges of living and working “on the edge of chaos.”

Walking the yellow brick road

This article uses the story of The Wonderful Wizard of Oz (L. F. Baum, 1900) as a metaphor for exploring career counseling issues related to self‐deception, loss, and the search for the “all‐knowing” expert. The dynamics of the story can be applied to both counseling practice and counselor training. Cross‐cultural issues are also considered.

Current Issues in South African Career Counselling and Availability of Teachers in Science and Technology

Employability seems to be a major consideration for prospective students' career choices. To facilitate accountable career counseling understanding of students' needs and choices of careers through research is essential. Programs for increased specific training are needed as well as improvement in basic training to meet a growing national labor crisis in South Africa.

Genetic counseling and ethical issues for autism

Exciting progress is being made in the journey toward discovery of genes conferring risk for autism and autism spectrum disorders. Currently, genetic counseling for idiopathic autism rests on clinical diagnosis and empiric risk estimates. While no genetic test for risk of autism currently exists, it is possible that such a test may emerge in the near future, and that commercial availability may precede adequate understanding of test characteristics. The complexity of multifactorial conditions like autism raises a host of ethical and counseling challenges. For families to benefit from new genetic knowledge about autism, it will be important for their practitioners to be knowledgeable about the issues, utilize appropriate educational interventions and emerging management options, and help families across the cultural spectrum cope with these challenges.

Management of women with epilepsy during pregnancy

Epilepsy is one of the most common neurological problems in pregnancy. Approximately one in 200 pregnancies is to a woman with epilepsy taking antiepileptic drugs (AEDs). For the majority of women, pregnancy proceeds without any apparent difficulties. However, there is evidence of increased risks for both mother and child. Therapeutic decisions need to take this balance of risks into account. The evidence for the risks and their limitations are reviewed in this article. The main management and counselling issues are also summarised. The aim of treatment is to avoid convulsive seizures that are harmful for both mother and child while minimising risks from the treatment of epilepsy.

Critical Ethical Issues in Online Counseling: Assessing Current Practices With an Ethical Intent Checklist

The authors used a 16-item Ethical Intent Checklist, developed from the American Counseling Association's (1999) Ethical Standards for Internet Online Counseling, to assess the current practices of 88 online counseling Web sites. Results showed fewer than half of online counselors were following the accepted practice on 8 of the 16 items. Online counselors who identified themselves as licensed or as association members had significantly higher mean checklist scores.

Sequential Down Syndrome Screening: The Importance of First and Second Trimester Test Correlations when Calculating Risk

Down syndrome screening can be particularly effective when both first and second trimester tests are performed. However, the counseling of women who have received sequential first and second trimester screening can be problematic. We evaluated an approximation where the post-test risk from the first trimester screening is used as the new a priori risk for the second trimester screening. The approximation disregards between-trimester test correlations. The Down syndrome detection rate based on the approximation (90.2%) would be close to that obtained when all correlations were considered (90.8%) but the false positive rate would be 26% higher (3.9% versus 3.1%, respectively). For any particular woman, the use of the approximation could result in highly inaccurate risks. We conclude that the correlations that exist between first and second trimester screening tests preclude the use of second trimester risks derived from the direct product of separate first and second trimester screening. Counseling issues in the delivery of sequential screening are discussed.

Identifying Best Practice Principles in Working with the Inupiat Eskimo: Building Trust and Beyond

The authors present an examination of established models on trust building issues in multicultural counseling and apply them with the Inupiat Eskimo population. Drawing on the cultural strengths of the Inupiat communities, counselors traverse challenging cultural barriers and develop positive working relationships with families and individual clients within the communities of Alaska. Cultural competence is discussed and guidelines for multicultural counseling are provided. The principles outlined in this paper, whilst developed in this instance in a particular location and cultural context, have relevance for other situations where counseling involving a minority is concerned. The overriding element is working at and maintaining trust, with this being the essential foundation upon which other counseling strategies are implemented.

The Practical Aspects of Online Counseling

This article addresses the practical aspects of online counseling, including ethics, training, supervision, technology, and competency issues. The authors discuss online counseling’s strengths and limitations and present guidelines for what types of clients and counseling psychologists may be appropriate for online counseling. To illustrate the components and skills associated with online counseling, the authors present and discuss an example of a synchronous-chat online session.

Invasive diagnostic procedures in twin pregnancies

The rising rate of multiple pregnancies and its association with advanced maternal age has expanded the need for prenatal diagnosis in twins and higher order gestations. The complexity of the invasive diagnostic procedures and the risk of loss of an unaffected twin raise significant clinical, technical and ethical issues. In this review we discuss the specific issues of early scanning, counseling and determination of chorionicity prior to invasive procedures in twins. We present the available data describing the risk associated with these procedures in twins and compare data of fetal loss rate from different studies. We also discuss the issues of fetal blood sampling and late karyotyping in twin pregnancies.

New Editor's Introduction

With this issue, I begin my term as editor of The Career Development Quarterly (CDQ). Being editor of CDQ is a great honor and an even greater responsibility. As the editor of the premier journal informing career counseling and development, I have now been given the task to both maintain the reputation and quality and, if I have a particularly good run of luck, even enhance it. A new editor's first editorial should be pithy, introducing the new editor and the new vision, as well as thanking all those whose hard work make our journal possible. I bow to that tradition. I do think that it is good for you (readers and authors) to have a little better idea of what you are getting with a new editor, and, as a counselor, I do think that a little appropriate disclosure can be useful. For those of you who do not know me, I was born a poor, gay, Cherokee boy in rural southeastern Missouri. Coming from such roots motivated me and made me appreciate what has happened in my career. Such a background, along with a strong need to provide succorance (supported by my scores on this subscale of the Edwards Personal Preference Schedule and on similar subscales of the Strong Interest Inventory, Myers-Briggs Type Indicator, and an early Kuder), led me to counseling as my career choice. My area of specific expertise in our field is multicultural career counseling, and I have published mainly in that area; however, I also have expertise in the history of and the public policy issues in career counseling, career interest assessment, international career development, organizational career development, and the teaching of career counseling. I am somewhat unusual in many ways in our career development profession and bring a variety of experiences to the editorship of CDQ that I hope will be useful. I have a strong practice background, including more than 20 years in independent practice that I hope will allow me to have sensitivity to and knowledge of articles that may be especially relevant to career development practitioners. (I hold certifications as a Master Career Counselor, Registered Professional Career Counselor [California], and National Certified Career Counselor.) I have a strong research background that I hope will allow me to select articles that advance the science and knowledge of our profession. I have a strong advocacy and social justice background that I hope will enable me to recruit and select, nurture, and mentor authors, as well as editorial board members, who reflect the broad, inclusive diversity of our world. Finally, I also have strong organizational, administrative, financial, and political skills, having been a manager and leader of people and organizations, both for-profit and intentionally not-for-profit organizations. I ought to be good at this. You, my peers, will ultimately be the judge. These organizational skills are well developed from years of service to the profession in a variety of leadership roles, from editorial responsibilities for books and special issues/sections and from leading such projects as the development of successful grant proposals as well as institutional self-study materials for accreditation. I am considered by my colleagues to be a well-organized and action-oriented person. I hear from my predecessors that these are important characteristics for editors. Most important, I am a practicing professional career counselor, organizational consultant, counselor educator, and vocational psychologist. The commitment from the previous editors has always been to preserve the nature of CDQ: It is a practice-focused journal, and each article must address the implications of the article for career counselors and other career development professionals. It is my intention to continue that critical tradition. The foregoing, then, is a natural segue to my vision. During the next 3 years, CDQ will grow dynamically in response to the needs of our field. The structure-Articles, Effective Techniques, Personal Perspectives, Reader Reactions, Brief Reports-will remain the same, but the quantity of articles appearing in those sections will increase. …

Outsiders in a White, Middle-Class System: Counselor Educators of Color in Academe

The author presents results of an exploration of the experiences of counselor educators of color, focusing on participants' relationships and interactions with the system of academe and how they are exemplified in the tenure and promotion process. Results suggest P. H. Collins's (1991) concept of the outsider academe is highly relevant. ********** Essays and narratives by faculty of color and culturally diverse faculty suggest those who differ from the White, middle-class norm experience life in academe as (e.g., Collins, 1991; James & Farmer, 1993; Mindiola, 1995). McKay (1997) described how the dynamics of the larger society, perpetuated in academe, situate European American faculty and faculty of color within systems of power and privilege: American and all Western society remain provinces in which white men, and some white women, of a particular class with particular dominant ideologies determine the nature of all of our existences. Thus, even without deliberate intentions to enforce dominance over others, the relations between whites and the other in white institutions of higher education develop and emerge out of a dynamic that reifies racist and sexist paradigms of power and powerlessness. (pp. 15-16) The counseling profession promotes in its practitioners empathy, genuineness, regard, and, increasingly; appreciation for and understanding of diversity. Yet, if the literature suggests that faculty of color generally experience life in academe, and are positioned therein, as outsiders in a White, middle-class system, what will be revealed by a study of the experiences of counseling faculty of color? R. L. Young, Chamley, and Withers (1990) found that counselor education departments reported that 90.6% of the faculty were European American, compared with 79.8% being European American in the total U.S. population. Similarly, Dinsmore and England (1996) found that 15% of counselor educators were non-White, compared with 25% being non-White in the general population. Although the hiring rate for ethnic minority faculty in counselor education has been slowly increasing, R. L. Young et al. (1990) projected that the current rate will actually perpetuate minority underrepresentation (p. 153). In addition, counselor educators of color are more likely to be nontenured or part-time faculty than are European American counselor educators (Bradley & Holcomb-McCoy, 2002; Brinson & Kottler, 1993). Difficulties in securing tenure track positions or in achieving tenure may force some faculty of color to leave academe to seek employment elsewhere. An important step in recruitment and retention of a more diverse faculty is to gain understanding of the day-to-day experiences of counselor educators of color in predominantly European American counseling departments. The counseling literature includes several articles and essays that shed some light on these experiences. For example, in their exploration of cross-cultural mentoring in counselor education, Brinson and Kottler (1993) found that cross-cultural communication and power dynamics between faculty of color and White faculty may come into play in mentoring relationships. They also discussed feelings of isolation that women and men of color may experience when working in predominantly White counselor education programs. Personal narratives by counselor educators of color that appeared in a Journal of Counseling & Development special issue on racism (e.g., Durodoye, 1999; Jackson, 1999) suggested that the experience of intentional and unintentional racism on individual and systemic levels presents ongoing challenges in the professional lives of faculty of color. However, in-depth exploration and analysis are still needed of the experiences of counselor educators of color and of the perceived and manifest consequences of these experiences. This study, which involved exploration and analysis of the intersection of ethnicity, social class, and gender in the lives of counselor educators of color, was undertaken to help fill this need. …

The School Counselor Alumni Peer Consultation Group

School counseling literature indicates that school counselors experience isolation and frustration and that partnership projects between counselors and counselor educators are potentially valuable. The author describes the school counselor alumni peer consultation group, which provides (a) support and networking opportunities for new counselors and (b) a forum for studying counseling issues and for developing strategies to solve problems. This innovative strategy for professional development and collaboration has implications both for counselor educators and for school counselors.

Examining White Counselor Trainees’ Reactions to Racial Issues in Counseling and Supervision Dyads

This study examined the reactions of White counselor trainees to hypothetical, provocative, cross-racial counseling and supervision dyads. It employed a qualitative methodology of inquiry to explore the underlying dynamics associated with cross-racial counseling and supervision dyads. Working with a sample of 8 White male and female counselor trainees, a focus group interview was conducted using vignettes that depicted racial issues in counseling and supervision situations. The focus group interview was transcribed, and themes and categories that captured the complexity of the trainees’ reactions to racially charged situations in counseling and supervision were identified. The implications of the study’s findings are discussed and direction is offered for future research in this area.

Examining the Reactions of White, Black, and Latino/a Counseling Psychologists to a Study of Racial Issues in Counseling and Supervision Dyads

Examining the Reactions of White, Black, and Latino/a Counseling Psychologists to a Study of Racial Issues in Counseling and Supervision Dyads

Women, Human Rights, and Counseling: Crossing International Boundaries

As the world becomes more globalized, psychological and counseling issues have become more pronounced. As social justice issues become illuminated on a global scale, there is increased attention to women as identified victims of social injustices and human rights violations. This article examines the role of professional counselors working with women from an international perspective with the intention to heighten awareness and understanding of the interrelationship of global women's issues and effective counseling interventions.

The Relationship Between Vocational Rehabilitation Client Outcomes and Rehabilitation Counselor Multicultural Counseling Competencies

Multicultural issues in rehabilitation counseling continue to be a focus of practice and research because of the rapidly changing racial and ethnic profiles of persons with disabilities seeking services in the United States. This study investigated the relationship between vocational rehabilitation client outcomes and the rehabilitation counselor multicultural counseling competencies of 118 rehabilitation counselors working in a large midwestern vocational rehabilitation agency. The results of this study, which used hierarchical linear modeling (HLM), suggest that the characteristics the client brings to the counseling relationship are the primary variables in explaining differences in client outcomes. Counselor multicultural competencies were not found to be significant in explaining differences in client outcomes. The findings of this study are discussed in relation to previous studies and implications for future research.

Education and Counseling of the Gifted and Talented in Germany

One of the principle reasons responsible for the fact that nurturing the gifted and talented in Germany has (once again) advanced to a pedagogic concern in the 1990’s lies in the dichotomy of equality and excellence. Are these two pedagogic goals actually incompatible, as often maintained in open discussions? After a long period of oscillation between these two poles, in the age of information a new emphasis has increasingly been placed on excellence. “It becomes more and more important for bright students to be using their abilities to stimulate this new era with economic and political productivity. But this will not happen if the current ‘laissez faire’ approach to gifted students continues into the next decade”(Gallagher, 2000, p. 691). Following a short definition of giftedness and related conceptions, arguments for gifted education stemming from the areas of learning psychology and instructional psychology will be discussed. The central problems concerning identification and programming will then be addressed in greater detail. Hypotheses will be developed, on the basis of the ATI model that gifted students need creative, stimulating learning environments. Various approaches will be presented here and discussed in the context of TIMSS and PISA. The second part of the article will deal with guidance and counseling issues with respect to the special needs of gifted children and adolescents and their social contact persons (peers, parents, teachers). In conclusion, German program evaluation, studies in the fields of gifted education, counseling and nurturing giftedness and talent will be presented. The outcomes of these studies and their consequences for improvements for the quality of gifted and talented education and counseling in Germany will be discussed. Excellence is one of the most important educational-psychological challenges of the new century.