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The heart of counseling : counseling skills through therapeutic relationships
\"More than any other text on the market, The Heart of Counseling is effective in helping students to understand the importance of therapeutic relationships and to develop the qualities that make the therapeutic relationships they build with clients the foundation of healing. In these pages, students come to see how all skills arise from and are directly related to the counselor's development and to building therapeutic relationships. Student learning ranges from therapeutic listening and empathy to structuring sessions, from explaining counseling to clients and caregivers to providing wrap-around services, and ultimately to experiencing therapeutic relationships as the foundation of professional and personal growth. The Heart of Counseling includes: extensive case studies and discussions applying skills in school and agency settings skill-based specificity for abstract concepts of change through therapeutic relationship exploration of counseling theories and tasks within and extending from core counseling skillsvideos that bring each chapter to life test banks, instructor's manuals, syllabi, and guidance for learning-outcomes assessments for professors \"-- Provided by publisher.
Book
A tailored approach to informing relatives at risk of inherited cardiac conditions: results of a randomised controlled trial
If undetected, inherited cardiac conditions can lead to sudden cardiac death, while treatment options are available. Predictive DNA testing is therefore advised for at-risk relatives, and probands are currently asked to inform relatives about this. However, fewer than half of relatives attend genetic counselling. In this trial, we compared a tailored approach to informing relatives, in which probands were asked whether they preferred relatives to be informed by themselves or by the genetic counsellor, with current practice. Our primary outcome was uptake of genetic counselling in relatives in the first year after test result disclosure. Secondary outcomes were evaluation of the approach and impact on psychological/family functioning measured 3 (T1) and 9 (T2) months post-disclosure via telephone interviews and questionnaires. We included 96 probands; 482 relatives were eligible for counselling and genetic testing. We observed no significant difference in uptake of genetic counselling between the control (38%) and the intervention (37%) group (p = 0.973). Nor were there significant differences between groups in impact on family/psychological functioning. Significantly more probands in the tailored group were satisfied (p = 0.001) and felt supported (p = 0.003) by the approach, although they also felt somewhat coerced to inform relatives (p < 0.001) and perceived room for improvement (p < 0.001). To conclude, we observed no differences in uptake and impact on family/psychological functioning between the current and tailored approach, but probands in the tailored group more often felt satisfied. Further research on barriers to relatives attending genetic counselling and on how to optimize the provision of a tailored approach is needed.
Journal Article
A randomized experimental study to test the effects of discussing uncertainty during cancer genetic counseling: different strategies, different outcomes?
Uncertainty is increasingly discussed during genetic counseling due to innovative techniques, e.g., multigene panel testing. Discussions about uncertainty may impact counselees variably, depending on counselors’ communication styles. Ideally, the discussion of uncertainty enables counselees to cope with uncertainty and make well-informed decisions about testing. We examined the impact of how counselors convey uncertainty and address counselees’ uncertainty, and explored the role of individual characteristics. Therefore, a randomized controlled experiment using videos was conducted. Former counselees (N = 224) viewed one video depicting a genetic consultation about multigene panel testing. The extent of counselors’ communication of uncertainty (comprehensive vs. the essence) and their response to counselees’ uncertainty expressions (providing information vs. providing space for emotions vs. normalizing and counterbalancing uncertainty) were systematically manipulated. Individual characteristics, e.g., uncertainty tolerance, were assessed, as well as outcome variables (primary outcomes: feelings of uncertainty and information recall). No effects were found on primary outcomes. Participants were most satisfied when the essence was communicated, combined with providing information or providing space responses (p = 0.002). Comprehensive information resulted in less perceived steering toward testing (p = 0.005). Participants with lower uncertainty tolerance or higher trait anxiety were less confident about their understanding when receiving comprehensive information (p = 0.025). Participants seeking information experienced less uncertainty (p = 0.003), and trusted their counselor more (p = 0.028), when the counselor used information providing responses. In sum, the impact of discussing uncertainty primarily depends on individual characteristics. Practical guidelines should address how to tailor the discussion of uncertainty.
Journal Article
Enhancing Multicultural and Social Justice Competencies in Canadian Counselling Psychology Training
Multicultural (MC) and social justice (SJ) training have been areas of exploration within the field of counseling psychology and have gained continual traction within the supporting Canadian literature. This article provides a critique of the current ways in which MC and SJ training are understood within the field of counseling psychology, how they are taught, and how this training is taken up and perceived by graduate students. We discuss the importance of counseling psychology continuing to move beyond dichotomizing MC and SJ competencies from foundational counseling competencies, to expand past traditional strategies of pedagogy, and to further commit to engaging in practices of decolonization, community involvement, and ongoing faculty training. Recommendations for instructors and graduate training programs are made to support more critical systemic dialogs for the advancement of an MC and SJ agenda in Canadian counseling psychology programs.
Une formation en matière de multiculturalisme (MC) et de justice sociale (JS) constitue un domaine d'exploration au sein du domaine de la psychologie du counseling et continue de faire des adeptes, comme en témoigne la littérature connexe au Canada. Cet article fournit une critique des façons actuelles dont la formation en MC et en JS est comprise dans le domaine de la psychologie du counseling, de la façon dont ces notions sont enseignées et de la façon dont cette formation est utilisée et perçue par les diplômés. Nous discutons de l'importance pour la psychologie du counseling de dépasser la dichotomisation des compétences en MC et JS et des compétences fondamentales en counseling, d'élargir les stratégies de pédagogie au-delà des modèles traditionnels et de s'engager davantage envers les pratiques de décolonisation, la participation communautaire et la formation continue des membres du corps professoral. Les recommandations relatives à des programmes de formation pour les professeurs et les diplômés visent à soutenir des dialogues systémiques plus critiques afin d'améliorer la situation du MC et de la JS au sein des programmes de psychologie du counseling au Canada.
Public Significance Statement
This article is a critical review of the literature that pertains to multicultural and social justice training in Canadian counseling psychology. It contextually examines MC and SJ principles in light of its history, and in its training, application, and reception in the field. This article offers suggestions and recommendations to enhance MC and SJ training in counseling psychology and to recommit to social justice initiatives in the field.
Journal Article
The breast cancer genetic testing experience: probing the potential utility of an online decision aid in risk perception and decision making
Background
Despite the association of pathogenic variants (PVs) in cancer predisposition genes with significantly increased risk of breast cancer (BC), uptake of genetic testing (GT) remains low, especially among ethnic minorities. Our prior study identified that a patient decision aid,
RealRisks,
improved patient-reported outcomes (including worry and perceived risk) relative to standard educational materials. This study examined patients’ GT experience and its influence on subsequent actions. We also sought to identify areas for improvement in
RealRisks
that would expand its focus from improved GT decision-making to understanding results.
Methods
Women enrolled in the parent randomized controlled trial were recruited and interviewed. Demographic data was collected from surveys in the parent study. Interviews were conducted, transcribed, and coded to identify recurring themes. Descriptive statistics were generated to compare the interviewed subgroup to the original study cohort of 187 women.
Results
Of the 22 women interviewed, 11 (50%) had positive GT results, 2 (9.1%) with a
BRCA1/2
PV, and 9 (40.9%) with variants of uncertain significance (VUS). Median age was 40.5 years and 15 (71.4%) identified as non-Hispanic. Twenty (90.9%) reported a family history of BC, and 2 (9.1%) reported a family history of
BRCA1/2
PV. The emerging themes included a preference for structured communication of GT results and the need for more actionable knowledge to mitigate BC risk, especially among patients with VUS or negative results. Few patients reported lifestyle changes following the return of their results, although they did understand that their behaviors can impact their BC risk.
Conclusions
Patients preferred a structured explanation of their GT results to facilitate a more personal testing experience. While most did not change lifestyle behaviors in response to their GT results, there was a consistent call for further guidance following the initial discussion of GT results. Empowering patients, especially those with negative or VUS results, with the context to internalize the implications of their results and form accurate risk perception represents a powerful opportunity to optimize subsequent risk management strategies. Informed by this study, future work will expand
RealRisks
to include the return of results and decision support to navigate concrete next steps.
Journal Article