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Background Young gay and bisexual men disproportionately experience depression, anxiety, and substance use problems and are among the highest risk group for HIV infection in the U.S. Diverse methods locate the source of these health disparities in young gay and bisexual men’s exposure to minority stress. In fact, minority stress, psychiatric morbidity, substance use, and HIV risk fuel each other, forming a synergistic threat to young gay and bisexual men’s health. Yet no known intervention addresses minority stress to improve mental health, substance use problems, or their joint impact on HIV risk in this population. This paper describes the design of a study to test the efficacy of such an intervention, called ESTEEM (Effective Skills to Empower Effective Men), a 10-session skills-building intervention designed to reduce young gay and bisexual men’s co-occurring health risks by addressing the underlying cognitive, affective, and behavioral pathways through which minority stress impairs health. Methods This study, funded by the National Institute of Mental Health, is a three-arm randomized controlled trial to examine (1) the efficacy of ESTEEM compared to community mental health treatment and HIV counseling and testing and (2) whether ESTEEM works through its hypothesized cognitive, affective, and behavioral minority stress processes. Our primary outcome, measured 8 months after baseline, is condomless anal sex in the absence of PrEP or known undetectable viral load of HIV+ primary partners. Secondary outcomes include depression, anxiety, substance use, sexual compulsivity, and PrEP uptake, also measured 8 months after baseline. Discussion Delivering specific stand-alone treatments for specific mental, behavioral, and sexual health problems represents the current state of evidence-based practice. However, dissemination and implementation of this one treatment-one problem approach has not been ideal. A single intervention that reduces young gay and bisexual men’s depression, anxiety, substance use, and HIV risk by reducing the common minority stress pathways across these problems would represent an efficient, cost-effective alternative to currently isolated approaches, and holds great promise for reducing sexual orientation health disparities among young men. Trial registration Registered October 10, 2016 to ClinicalTrials.gov Identifier: NCT02929069 .

Drawing on the ideas of Michael White and David Epston, this fully revised, extended and updated Second Edition incorporates the progression of their thinking over the past five years and introduces developments initiated by other narrative therapists worldwide. New material has been added around counseling for post-traumatic reactions, couples conflict and a sense of personal failure.

Wellness conceptualized as the paradigm for counseling provides strength‐based strategies for assessing clients, conceptualizing issues developmentally, and planning interventions to remediate dysfunction and optimize growth. Wellness counseling models have stimulated significant research that helps to form the evidence base for practice in the counseling field. The development of these models is explained, results of studies using the models are reviewed, and implications for research needed to further inform clinical practice and advocacy efforts are discussed.

Early diagnosis and treatment are necessary to prevent lifestyle-related diseases among high-risk individuals. This study aimed to examine the impact of counselor characteristics on clinic visits among individuals at high risk for lifestyle-related diseases. A total of 8975 patients aged 40 to 74 years with lifestyle-related comorbidities, who underwent an annual health checkup and received health counseling, were included in this study. Data intervention timing, mode of counseling, number of counseling sessions, and explanation methods were collected. We assessed the impact of counselor characteristics, including profession (public health nurse, clinical nurse, and nutritionist), age, and years of counseling experience, on counseling outcomes. The probability ratios (95% confidence intervals) of clinic visits were 1.22 (1.11–1.35) for public health nurses and 1.04 (0.90–1.20) for nurses compared with nutritionists. After adjustment for participant and counselor characteristics and initial timing, mode, and number of counseling sessions, the corresponding probability ratios (95% confidence intervals) were 1.16 (1.05–1.29) and 1.12 (0.95–1.31), respectively. Counselor age and years of experience did not influence clinic visits of the target population. Public health nurses were more effective in increasing clinic visits among the target population owing to their profession-specific knowledge, skills, and experience.

The importance of dialogical space and its various forms, useful in philosophical counseling, has been emphasized in recent discourse. The discourse primarily focuses on various aspects of the exchange between the counselee and the counselor in the form of external dialogue. This paper, drawing insights from Hubert Hermans, broadens the discourse into the domain of Agentive Reason, which includes the internal dialogue of the counselee, comprising various I-positions. By engaging with the associated network of the counselee’s “I-positions,” the counselor expands the counselee’s internal domain, thereby facilitating the counseling process. This paper aims to show that this process is best served when the counselor is able to cultivate his/her dialogical relationship with the counselee towards forming a metaposition from where the organization of existing and new I-positions can be seen, questioned, restructured, and most importantly, acted upon. This paper seeks to demonstrate this prospect through a symbolic exploration of Bhagavad Gītā in the form of a dialogical space. It examines how Arjuna’s agentive crisis, echoed in his internal dialogical tension of many maladaptive I-positions, is addressed by extending his dialogical self to Kṛṣṇa’s positions and counter-positions, leading the interaction to a dialogical metaposition in Arjuna’s external domain. The goal is not to establish Kṛṣṇa as a philosophical counselor or to present his discourse with Arjuna as a treatise on philosophical counseling. Rather, the intent is to encourage exploration of the symbolic representation underlying the Gītā, which helps us decipher various dialogical metapositions in the external domain that may correspond with the positions, needs, and emotions in the counselee’s internal domain. This has a threefold purpose: first, to recognize the open boundaries of the dialogical self; second, to examine the instrumental role of the counselor in negotiating these boundaries when they are closed in self-defense; and third, to introduce the concepts of Informed Ignorance and Agentive Reason.

How do counselors reach out to individuals who are reluctant to seek counseling services? To answer this question, the authors examined the research on the psychological help‐seeking barriers from counseling, clinical and social psychology, as well as social work and psychiatry. Specific avoidance factors that have been identified in the mental health literature; important variations in the setting, problem type, demographics, and cultural characteristics that can influence the degree to which avoidance factors affect professional help‐seeking decisions; and suggestions for overcoming these avoidance factors are discussed.

Background To protect human health, it is important to improve climate-resilience and mitigate climate change and environmental degradation. Health systems can contribute to this by providing climate-resilient and sustainable health services. One example of such a health service is climate-sensitive health counselling (CSHC), which is defined as communication with patients about climate change and health issues within clinical settings. In this study, we explore how physicians in Germany conduct CSHC and what supports them in doing so with the purpose to better conceptualize CSHC and give recommendations on how to support its implementation. Methods We conducted semi-structured qualitative interviews in 2021 with 18 German physicians mainly working in the outpatient sector, who were already conducting CSHC or thought about doing so. The interviews were audio-recorded and transcribed verbatim. A mixed deductive and inductive approach of qualitative content analysis was used for the analysis, supported by NVivo software. The deductive analysis part was guided by the framework on CSHC, and by work on factors that influence the implementation of patient-centered communication. Results The way in which participants conducted CSHC was broadly aligned with the existing framework for CSHC. With regard to the frameworks’ three content areas (’health impacts and adaptation’, ‘healthy and sustainable lifestyles’ and ‘climate action and policy’), there was an emphasis on lifestyle counselling in this sample. Furthermore, a fourth content area on clinical-decision making was discussed. The most important communication strategies mentioned fitted to principles of patient-centered communication. Enabling factors for implementing CSHC were mentioned on all pre-defined levels (physician, patient, relationship and health system factors). Developing an inner attitude, positive experienced patient response and being aware of touchpoints for CSHC were mentioned as physician factors supporting implementation of CSHC by participants. Conclusions This study demonstrates that participating physicians already implement CSHC as a sustainable healthcare service. As physician factors seem to be important enabling factors for implementing CSHC, we argue that training physicians in medical curricula and continued medical education are important to support implementation of CSHC. Reflections about the own attitude towards climate change and health and teaching about patient-centered communication strategies could be important elements of such trainings. Future research should consider the expansion of the CSHC framework with regard to clinical decision-making and validate or expand the framework for different medical specializations.

In Sweden, as well as in an international context, professionals are urged to acquire knowledge about possible health effects of female genital cutting (FGC) in order to tackle prevention and care in relation to the practice. While professionals are guided by policies and interventions focusing on medical effects of FGC, some scholars have cautioned that many popular beliefs about health risks rest on inconclusive evidence. The way professionals understand and respond to health information about FGC has in this context largely been left unexamined. This article aims to provide a qualitative exploration of how professionals in Sweden approach adolescent sexual and reproductive healthcare encounters in relation to acquired knowledge about FGC, using menstrual pain as an empirical example. The analysis shows that there was a tendency in counselling to differentiate young migrant women’s menstrual complaints from ordinary menstrual pain, with professionals understanding pain complaints either in terms of FGC or as culturally influenced. The study shows how professionals navigated their various sources of knowledge where FGC awareness worked as a lens through which young women’s health complaints were understood. Biomedical knowledge and culture-specific expectations and assumptions regarding menstrual pain also informed counselling. Finally, the article discusses how FGC awareness about health risks was used constructively as a tool to establish rapport and take a history on both menstrual pain and FGC. The analysis also recognises potential pitfalls of the approaches used, if not based in well-informed policies and interventions in the first place.

Background Globally, a fifth of the children continue to face chronic undernutrition with a majority of them situated in the Low- and Middle-Income Countries (LMIC). The rising numbers are attributed to aggravating factors like limited nutrition knowledge, poor feeding practices, seasonal food insecurity, and diseases. Interventions targeting behaviour change may reduce the devastating nutrition situation of children in the LMICs. Objective For the co-design of a Behaviour Change Communication (BCC) intervention for young children in rural Kenya, we aimed to identify the experiences, barriers, facilitators, and preferences of caregivers and stakeholders regarding nutrition and health counselling. Design We employed a qualitative study design and used a semi-structured interview guide. The in-depth interviews were recorded, transcribed, and analysed using content analysis, facilitated by the software NVivo. Setting Health and Demographic Surveillance System (HDSS) area in Siaya County, rural Kenya. Participants We interviewed 30 caregivers of children between 6 and 23 months of age and 29 local stakeholders with experience in implementing nutrition projects in Kenya. Results Nutrition and health counselling (NHC) was usually conducted in hospital settings with groups of mothers. Barriers to counselling were long queues and delays, long distances and high travel costs, the inapplicability of the counselling content, lack of spousal support, and a high domestic workload. Facilitators included the trust of caregivers in Community Health Volunteers (CHVs) and counselling services offered free of charge. Preferences comprised (1) delivering of counselling by CHVs, (2) offering individual and group counselling, (3) targeting male and female caregivers. Conclusion There is a disconnect between the caregivers’ preferences and the services currently offered. Among these families, a successful BCC strategy that employs nutrition and health counselling should apply a community-based communication channel through trusted CHVs, addressing male and female caregivers, and comprising group and individual sessions.