Counseling Modalities Research Articles

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.

Optimized preoperative determination of nerve of origin in patients with vestibular schwannoma

In vestibular schwannoma (VS) patients hearing outcome and surgery related risks can vary and depend on the nerve of origin. Preoperative origin differentiation between inferior or superior vestibular nerve may influence the decision on treatment, and the selection of optimal treatment and counselling modalities. A novel scoring system based on functional tests was designed to predict the nerve of origin for VS and was applied to a large number of consecutive patients. A prospective, double blind, cohort study including 93 patients with suspected unilateral VS was conducted at a tertiary referral centre. Preoperatively before tumor resection a functional test battery [video head-impulse test (vHIT) of all semicircular canals (SCC)], air-conducted cervical/ocular vestibular evoked myogenic potential tests (cVEMP, oVEMP), pure-tone audiometry, and speech discrimination was applied. Sensitivity and specificity of prediction of intraoperative finding by a preoperative score based on vHIT gain, cVEMP and oVEMP amplitudes and asymmetry ratios was calculated. For the prediction of inferior vestibular nerve origin, sensitivity was 73% and specificity was 80%. For the prediction of superior vestibular nerve origin, sensitivity was 60% and specificity was 90%. Based on the trade-off between sensitivity and specificity, optimized cut-off values of − 0.32 for cVEMP and − 0.11 for oVEMP asymmetry ratios and vHIT gain thresholds of 0.77 (anterior SCC), 0.84 (lateral SCC) and 0.80 (posterior SCC) were identified by receiver operator characteristic curves. The scoring system based on preoperative functional tests improves prediction of nerve of origin and can be applied in clinical routine.

OP312 - A tale of two years: effects of a shift in genetic counseling modality on genetic testing uptake and follow-through

OP312 - A tale of two years: effects of a shift in genetic counseling modality on genetic testing uptake and follow-through

Relational counselling as a psychosocial intervention for dementia: Qualitative evidence from people living with dementia and family members

Counselling and other psychotherapeutic interventions can be offered to people with dementia and their caregivers, to treat specific conditions or symptoms (e.g. affective disorders such as depression). Psychotherapeutic interventions also offer the opportunity for individuals with dementia and their families/caregivers to engage in psychological support for a wide range of presentations. However, little is known about how those within this demographic who receive these interventions perceive the experience. This study aimed to understand the experiences of individuals with dementia or caring for someone with dementia, before and after a 12-week relational counselling intervention delivered through a third sector organisation within England. Semi-structured interviews were completed with participants (29 pre-intervention and 25 post-intervention). Framework analysis was conducted, with four main themes identified; expectations and outcomes of counselling, emotional impact of life with dementia, appraisals of identity and importance of therapeutic relationship. Participants reported that counselling interventions addressed a range of needs and concerns that they had, enabling them to reassess and reconsider these. Specific training is needed before therapists deliver therapeutic interventions with people with dementia, to ensure that appropriate support is provided for those with more severe cognitive impairment or who may have fluctuating capacity. Future research should explore the experiences of people with dementia and their caregivers, across different counselling modalities, to establish the appropriateness and effectiveness of relational counselling.

The role of positive thinking: a study of telehealth supportive counseling for alcohol abusers

Alcohol abuse is one of the main causes of health problems in the world. In response to these alcohol-related health consequences, telehealth supportive counseling has emerged, offering new strategies of dealing with addition problems. Most of telehealth supportive counseling strategies are focused on coping more precisely with positive and negative thinking.
 The aim of presented study was to examine the relationships between positive thinking, and other coping strategies inherent to human thinking, to refuse alcohol. For this purpose, a total of 232 people participated in the study, all of them were users of a telehealth supportive counseling in Brazil. A batch of questionnaires was employed. This included the sociodemographic information, IDHEA-AD scores and the Coping Behaviours Inventory (CBI-20).
 After an analysis of mediation, the results indicated that the relationship between negative and positive thinking might be mediated by the assertiveness to refuse. These results suggest that this type of supportive counseling modality might be helpful for users and health professionals. More research is needed to examine the innumerable possibilities of the telehealth tools using as a strategy to deal with the coping variables related to quitting alcohol use.

Family Planning in Liver Transplant: Patient and Provider Knowledge and Practices.

Fertility is often impaired in adolescents and women with cirrhosis, but it is rapidly restored after liver transplantation (LT). Early and unplanned pregnancies confer increased risks to maternal, fetal, and graft health, underscoring the need for reproductive counseling. However, data on reproductive practices or counseling in the LT setting are limited. An anonymous online Qualtrics (Provo, UT) survey was sent to transplant patients and providers to gauge knowledge and practices surrounding contraception and pregnancy. Eligible participants included transplant patients aged 14-45years and their transplant providers. Patient response was 50.0% (74/148), 14 of whom were pre-LT patients and 60 of whom were post-LT patients. Counseling occurred in 37% of patients prior to transplant and 82% after transplant. Most patients (86%) considered family planning a high priority in their transplant care. Contraception- and pregnancy-specific counseling was provided by LT providers in 60% and 44% of patients, respectively. The most desired mode of counseling by patients was in-person discussion with an LT provider (89%). Despite most post-LT patients receiving counseling, only 41% used contraception during the first year after LT, of whom 32% relied on high failure methods. Of the 31/43 (72.1%) provider responses, 96% voiced interest in additional reproductive education. Most providers (90%) correctly advised that patients delay pregnancy during the first year after LT, although misconceptions about safety of estrogen and intrauterine devices were selected by 53% and 42%, respectively. Some favored resources by providers were educational pamphlets in clinic (88%) and automated note templates to prompt family planning inquiry (72%). Transplant patients and providers have key deficiencies in their knowledge of contraception and corresponding practices. Most post-LT patients receive counseling, yet contraception practices are inadequate for preventing unplanned pregnancy. Discussion with transplant providers was the most favored counseling modality by patients, underscoring our critical role in optimizing post-LT reproductive care.

College students' attitudes, stigma, and intentions toward seeking online and face-to-face counseling.

To investigate differences in public stigma, self-stigma, attitudes (value and discomfort), and intentions to seek help between online and face-to-face counseling. To identify a difference in the relationship between these variables and both counseling modalities. An online survey completed by 538 college students from one university in the Southeastern United States. The sample included 412 females and 126 males with a mean age of 20.21 years (standard deviation [SD] = 1.26). Significantly higher levels of self-stigma and discomfort toward online counseling were reported. Significantly higher value and intentions were reported toward face-to-face counseling. Self-stigma was positively related to public stigma, value was negatively related to self-stigma, and intentions toward seeking help was positively related to value. Results suggest face-to-face counseling is seen as a more favorable method of service delivery compared to online counseling. Value toward online counseling is an important predictor for seeking this type of help.

Introducing Mind Mapping as a Creative Counseling Modality

ABSTRACT Mind Mapping is a creative modality that is recognized and adopted internationally by governments, major corporations, and academic institutions but remains relatively obscure in the mental health literature. The authors draw from the research of Tony Buzan and examine the importance of Mind Mapping and its relevance as a creative tool that counselors can incorporate into their counseling repertoire. Step-by-step guidelines are provided for creating a Mind Map and an example of a practical application of the Mind Mapping is offered.

Art therapy as counseling modality to help delinquent students

<p>The purpose of this psycho-educational group counseling is to provide knowledge and information to target groups on their delinquent problems. Delinquent is an attitude that violates the law that society does not accept but not serious. Delinquent problems are often associated with adolescents either in primary school or high school. The participants were 26 students from one of the private schools in Selangor which are from form two and three. The process of selecting participants is through discussions with the school counselor, and the participants are those who have identified disciplinary records involved in delinquency issues. The researchers conducted four group counseling sessions. Participants were divided into three groups according to their disciplinary problems. The module used in this program is art therapy through “LEPAS” approach or known as <em>Luah Emosi Positifkan Akal Sihat</em>. The participants aware of their emotions and realize that what are they doing (disciplinary issues) is wrong and should be stopped as the results of the involvements in this psycho-educational program. The implications of this program are directed to the counseling practitioners whose can use the art approach in dealing with school discipline cases.</p>

Motivational interviewing to promote long-acting reversible contraception among Rwandan couples wishing to prevent or delay pregnancy

Few family-planning programs in Africa base demand creation and service delivery on theoretical models. Motivational interviewing is a counseling modality that facilitates reflection on the benefits and disadvantages of a health outcome to encourage behavior change. We evaluate a couples-focused joint family-planning and HIV counseling intervention using motivational interviewing to enhance uptake of long-acting reversible contraception (Paragard copper intrauterine device or Jadelle hormonal implant) among Rwandan couples. In this experimental study, couples receiving care at 8 government health clinics in Kigali, the capital city, were referred from a parent study of couples who did not want more children or wanted to wait at least 2 years for their next pregnancy. Long-acting reversible contraception methods were offered on site following joint HIV testing and family-planning counseling. At the first follow-up visit 1 month after enrollment in the parent study, couples who had not yet chosen a long-acting reversible contraception method were interviewed separately using motivational interviewing and then brought together and again offered long-acting reversible contraception. Following motivational interviewing, 78 of 229 couples (34%) requested a long-acting reversible contraception method (68 implant and 10 intrauterine device). Long-acting reversible contraception uptake after motivational interviewing was associated with the woman being Catholic (vs Protestant/Muslim/other, adjusted odds ratio, 2.87, 95% confidence interval, 1.19-6.96, P= .019) or having an income (vs no income, adjusted odds ratio, 2.54, 95% confidence interval, 1.12-5.73, P= .025); the couple having previously discussed long-acting reversible contraception (adjusted odds ratio, 8.38, 95% confidence interval, 2.54-27.59, P= .0005); either partner believing that unplanned pregnancy was likely with their current method (adjusted odds ratio, 6.67, 95% confidence interval, 2.77-16.11, P< .0001); or that they might forget to take or make an appointment for their current method (adjusted odds ratio, 4.04, 95% confidence interval, 1.32-12.34, P= .014). Neither partner mentioning that condoms also prevent HIV/sexually transmitted infection was associated with long-acting reversible contraception uptake (adjusted odds ratio, 2.86, 95% confidence interval, 1.17-7.03, P= .022), as was the woman citing long-term duration of action of the implant as an advantage (adjusted odds ratio, 5.41, 95% confidence interval, 1.86-15.76, P= .002). The woman not listing any side effects or disadvantages of implants was associated with long-acting reversible contraception uptake (adjusted odds ratio, 5.42, 95% confidence interval, 2.33-12.59, P < .0001). Clinic location (rural vs urban), couple HIV status, and concerns about negative economic effects of an unplanned pregnancy were significant in bivariate but not multivariate analysis. Encouraging couples to reflect on the benefits and disadvantages of long-acting reversible contraception methods, the likelihood of unplanned pregnancy with their current contraception, and the impact of an unplanned pregnancy is an effective motivational interviewing technique in family-planning counseling. One third of couples who did not want a pregnancy for at least 2 years but had not chosen a long-acting reversible contraception method when provided with standard family-planning counseling did so after motivational interviewing. Involving the male partner in family-planning discussions facilitates joint decision making about fertility goals and contraceptive choice. Combining family planning and joint HIV testing for couples allows targeted focus on dual-method use with discordant couples, who are advised to use condoms for HIV/sexually transmitted infection prevention along with a more effective contraceptive for added protection against unplanned pregnancy.

Adolescent Experiences in Wilderness Therapy: A Systematic Review of Qualitative Studies

ABSTRACT Wilderness therapy with adolescents is emerging as a bonafide counseling modality, both in terms of practice and research evidence. The researchers bring together qualitative literature to identify the meaningful elements for adolescent clients and their families who participate in wilderness therapy. This review describes the search and selection process and the resultant nine included studies to provide an initial synthesis of the methods and findings of this literature. Most studies used small samples with interviews as the primary data-gathering tool. The studies included common themes of family functioning, improved communication and relationships, person-environment connection and experiential components, transitions, and changes to the self-concept. The systematic review concludes with suggestions for future research and implications for practitioners.

Patient-Specific 3-Dimensional Modeling and Its Use for Preoperative Counseling of Patients Undergoing Hip Arthroscopy

Background:Femoroacetabular impingement (FAI) represents complex alterations in the bony morphology of the proximal femur and acetabulum. Imaging studies have become crucial in diagnosis and treatment planning for symptomatic FAI but also have limited patient understanding and satisfaction. Exploration of alternative patient counseling modalities holds promise for improved patient understanding, satisfaction, and ultimately for outcomes.Purpose:To compare perceived understanding of functional anatomy and FAI pathomorphology among patients counseled with routine computed tomography (CT), generic hip models, and a 3-dimensional (3D) model printed in accordance with a patient’s specific anatomy.Study Design:Cohort study; Level of evidence, 2.Methods:A prospective randomized analysis of patients presenting with radiographically confirmed FAI was conducted between November 2015 and April 2017. Patients were randomized into groups that received preoperative counseling with CT imaging alone, a generic human hip model, or a haptic 3D model of their hip. All groups were subjected to a novel questionnaire examining patient satisfaction and understanding on a variety of topics related to FAI. Data were compared with bivariate and multivariate analyses. Statistical significance was determined as P < .05.Results:Thirty-one patients were included in this study (25 men, 6 women). Ten patients were randomized to the CT-only group, 11 to the generic hip model group, and 10 to receive custom 3D-printed models of their hips. Patients preoperatively counseled with isolated CT imaging or a generic hip model reported greater understanding of their pathophysiology and the role of surgical intervention when compared with those counseled with haptic 3D models (P = .03). At final follow-up, patients counseled with the use of isolated CT imaging or haptic 3D models reported greater increases and retention of understanding as compared with those counseled with generic hip models alone (P = .03).Conclusion:Preoperative counseling with haptic 3D hip models does not appear to favorably affect patient-reported understanding or satisfaction with regard to FAI when compared with the use of CT imaging alone. Continued research into alternative counseling means may serve to further improve patient understanding and satisfaction on this complex anatomic phenomenon.

Examining U.S. and Japanese College Students’ Differences in Psychological Distress: the Mediating Roles of Valued Action and Experiential Avoidance

Acceptance and Commitment Therapy (ACT) is a counseling modality that features values clarification interventions. However, a well-established ACT-consistent measure of values for practitioners and researchers is lacking. The present study, therefore, examined an exploratory measure called the Valued Time and Difficulty Questionnaire (VTDQ; Wilson et al. 2010) and investigated the possible explanatory role of multiple ACT constructs on psychological distress. Obtained cross-national differences with a sample of 188 U.S. and 223 Japanese students were consistent with previous research. Moreover, a multiple mediator model revealed significant indirect effects of VTDQ subscale scores for time and difficulty on the association between culture and symptoms.

Does Patient Education Augment Pelvic Floor Physical Therapy Preparedness and Attendance? A Randomized Controlled Trial.

The objective of this study was to evaluate patient attendance and preparedness for pelvic floor physical therapy (PFPT) after comparing standard counseling versus standard counseling plus an educational video. A randomized controlled trial of 200 patients in a Female Pelvic Medicine and Reconstructive Surgery practice was performed in a tertiary care referral center. Participants were randomized to 1 of 2 educational modalities after being prescribed PFPT. Women either received standard handout counseling or enhanced video counseling. A sample size of 96 per group (N = 192) was needed to detect a 20% difference in PFPT attendance corresponding to a priori estimates of 50% compliance for the standard counseling group (handout) versus 70% compliance for the enhanced counseling group (handout plus video). Compliance data were assessed at least 3 months after the initial referral to determine attendance at PFPT. Sixty-five percent of patients attended at least 1 PFPT visit, whereas 46.5% completed therapy. There was no difference between the standard and enhanced counseling groups in PFPT attendance (P = 0.056) or in completion of half the recommended visits (P = 0.17). Similarly, level of preparedness after viewing the assigned counseling modality did not differ between standard and enhanced counseling groups. For each additional completed visit, the odds of successfully completing PFPT increased by approximately 38% (odds ratio, 1.38; 95% confidence interval, 1.19-1.59). The addition of enhanced patient counseling did not improve patient preparedness or odds of attending PFPT. Adherence behaviors surrounding PFPT attendance are multifactorial and require further qualitative research to elucidate barriers to PFPT attendance.

Operationalizing the Reciprocal Engagement Model of Genetic Counseling Practice: a Framework for the Scalable Delivery of Genomic Counseling and Testing.

With the advent of widespread genomic testing for diagnostic indications and disease risk assessment, there is increased need to optimize genetic counseling services to support the scalable delivery of precision medicine. Here, we describe how we operationalized the reciprocal engagement model of genetic counseling practice to develop a framework of counseling components and strategies for the delivery of genomic results. This framework was constructed based upon qualitative research with patients receiving genomic counseling following online receipt of potentially actionable complex disease and pharmacogenomics reports. Consultation with a transdisciplinary group of investigators, including practicing genetic counselors, was sought to ensure broad scope and applicability of these strategies for use with any large-scale genomic testing effort. We preserve the provision of pre-test education and informed consent as established in Mendelian/single-gene disease genetic counseling practice. Following receipt of genomic results, patients are afforded the opportunity to tailor the counseling agenda by selecting the specific test results they wish to discuss, specifying questions for discussion, and indicating their preference for counseling modality. The genetic counselor uses these patient preferences to set the genomic counseling session and to personalize result communication and risk reduction recommendations. Tailored visual aids and result summary reports divide areas of risk (genetic variant, family history, lifestyle) for each disease to facilitate discussion of multiple disease risks. Post-counseling, session summary reports are actively routed to both the patient and their physician team to encourage review and follow-up. Given the breadth of genomic information potentially resulting from genomic testing, this framework is put forth as a starting point to meet the need for scalable genetic counseling services in the delivery of precision medicine.

Practitioner Perspectives on Animal-Assisted Counseling

The field of animal-assisted counseling (AAC) is burgeoning. However, there is a paucity of research on the perspectives of mental health practitioners regarding its practice and the experience and training needed to effectively utilize AAC with clients. The purpose of this study was to explore how practitioners perceive AAC and its role in clinical settings. Perceptions of 300 mental health practitioners were assessed using a researcher-developed survey instrument. Findings indicated that a majority of practitioners (91.7%) view AAC as a legitimate counseling modality. Practitioners identified client age ranges and the top five clinical issues that would benefit from AAC. While only 12.0% of respondents had received training in AAC, 57.0% of respondents reported interest in receiving AAC training. Respondents identified types of AAC education, training, and supervision that would be sufficient for clinicians to utilize AAC. The findings from this study contribute to the emerging literature on AAC.

Family planning knowledge and contraceptive use among resettled African refugee women

Objectives: We aimed to compare demographic characteristics, family planning knowledge and method use among Somali and Congolese refugee women after third country resettlement. Methods: After conducting focus groups to evaluate baseline family planning conceptualizations, a quantitative survey was developed. Community leaders and snowball referrals were used to recruit participants. The survey was administered to resettled Somali and Congolese refugee women aged 18–55 via telephone. Bicultural, externally located interpreters carried out the survey in participants' native languages. Results: We surveyed 148 women; 81 participants (55%) self-identified with the resettled Somali population and 67 (45%) self-identified with the resettled Congolese population. There were no significant differences in age, gravidity, household size, marital status or time since resettlement. Method knowledge was lower among Somali than among Congolese participants (27% vs. 61% were able to name a method, p<.001). Congolese participants were more likely to be using (32% vs. 11%, p=.004) or have ever used (50% vs. 40%, p<.001) contraceptives, utilized a broader method mix (nine vs. four method types) and were more willing to consider use of long-acting reversible methods. Congolese participants cited delay of first birth, birth spacing and birth limiting as appropriate uses for contraception; Somali women cited only birth spacing. Commonly identified barriers to modern method use included inability to obtain methods and religious reasons. Conclusions: Resettled African refugee women demonstrate limited knowledge and use of modern family planning methods. Development of culture-specific education materials and counseling modalities that respect cultural beliefs is paramount to increasing modern family planning access and utilization among these populations.

New Directions for Engaging Patients on Weight Management for General Pediatricians

Successful management of pediatric overweight and obesity remains very challenging, particularly in a busy primary care setting. Numerous barriers exist for both patients and providers. Comprehensive counseling directed at improved dietary habits, increased exercise, and decreased screen time is not always practical. It is crucial to elicit a genuine recognition of the child’s obesity as a health problem and obtain a sincere, nonjudgmental commitment to change from the patient as well as parents and other household members. Providers may benefit from learning and utilizing motivational interviewing (MI) as a tool to interact with adolescents and families. In addition, the use of ubiquitous venues such as social media and text messaging, as well as newer health apps may increase continuity and engagement with adolescents and families. Taken together, the traditional modalities of diet, exercise, and screen time counseling, combined with MI and new engagement strategies, such as close follow-up via phone, social media or text provide more opportunities for primary care providers to tighten the belt on the obesity epidemic.

What Else Can You Do With Philosophy Besides Teach?

This article traces the rise of philosophical counseling in the United States, from its roots in the applied philosophy movement to the establishment of the National Philosophical Counseling Association, including a code of ethical standards for practitioners and a program for certification of philosophical counselors. The article demonstrates, through a brief discussion of the philosophical counseling modality of Logic-Based Therapy (LBT), how individuals who have Masters or Ph.D.’s in philosophy can become certified members of this burgeoning new profession.

The Treatment of Substance Use Disorders in Ukraine

This article examines the prevalence and consequences of alcohol and other drug (AOD) use in Ukraine, and the counseling modalities and resources that are available to address the issue. The authors consider the need for a suitable service initiative involving intensive outpatient AOD counseling, focusing on the North American Intensive Outpatient Program (IOP; Wise, American Journal of Orthopsychiatry, 73, 405–410, 2003b) as well as the likely challenges and solutions to implementing such a model.