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PubMed2006

Exploring genetic counseling communication patterns: the role of teaching and counseling approaches.

The educational and counseling models are often touted as the two primary professional approaches to genetic counseling practice. Yet, research has not been conducted to examine how these approaches are used in practice. In the present study, we conducted quantitative communication analyses of BRCA1 genetic counseling sessions. We measured communication variables that represent content (e.g., a biomedical focus) and process (e.g., passive listening) to explore whether genetic counselor approaches are consistent with prevailing professional models. The Roter Interaction Analysis System (RIAS) was used to code 167 pre-test genetic counseling sessions of members of a large kindred with an identified BRCA1 mutation. Three experienced genetic counselors conducted the sessions. Creating composite categories from the RIAS codes, we found the sessions to be largely educational in nature with the counselors and clients devoting the majority of their dialogue to providing biomedical information (62 and 40%, respectively). We used cluster analytic techniques, entering the composite communication variables and identified four patterns of session communication: Client-focused psychosocial, biomedical question and answer, counselor-driven psychosocial, and client-focused biomedical. Moreover, we found that the counselors had unique styles in which they combined the use of education and counseling approaches. We discuss the importance of understanding the variation in counselor communication to advance the field and expand prevailing assumptions.

Adult↗

PubMed2001

From nurse-centered health counseling to empowermental health counseling.

The main goals of this study were to examine aspects of the delivery and reception of advice and questions in interaction between nurses and patients and to describe linguistic features that constructed nurse-centered and empowermental health counseling. The research data, 38 health counseling sessions, were videotaped, transcribed verbatim, and analyzed by using an adaptation of conversational analysis. During nurse-centered discussions, the nurses' advice did not correspond to the patients' need for information. These counseling sessions began with check-up questions about the patients' condition and continued with factual questions about their illnesses and health care measures. During empowering health counseling, the nurses made use of the patients' knowledge of their circumstances and supported the patients' ability to reflect on their health behavior. Questioning and advising strategies were found to be crucial for building up empowermental conversation and enhancing the impact of health counseling.

Adolescent↗

PubMed2002

Telephone counseling in psychosocial oncology: a report from the Cancer Information and Counseling Line.

Providing psychosocial counseling services to cancer patients and their significant others by telephone is emerging as an alternative to traditional (in-person) counseling programs in psychooncology. In this paper, data are reported describing the clients of such a program that has been in continuous operation since 1981: the Cancer Information and Counseling Line (CICL) of the AMC Cancer Research Center. An examination of call record forms completed between 1 June 1998 and 30 May 1999 (N = 1627) revealed that the vast majority of callers were female (77%), non-Hispanic White (77%), with at least some college education (62%). Only 27% were cancer patients/survivors, compared to 43% who were spouses, other relatives and friends of cancer patients/survivors, and 16% who were symptomatic callers. Breast cancer was by far the most frequently mentioned cancer site (30%). Although initial topics of inquiry were dominated by requests for medical information (77%), with only a small percentage of callers initially requesting psychosocial support and counseling (12%), by the time, the call was completed, 67% had received some form of psychosocial support and/or counseling. Recommendations for future research are discussed within the context of this review.

Adult↗

PubMed2001

The congregational setting of pastoral counseling: a study of pastoral counseling theorists from 1949-1999.

Examines, through content analysis, the major authors in the field of pastoral counseling since 1949 with the goal to determine the degree to which pastoral counseling theory in the second half of the twentieth century attended to the context of parish ministry. Reports on trends in the field's orientation and notes that a particular viewpoint, or range of viewpoints, has driven the core of pastoral counseling theory and methodology. Attempts to answer the question, Does the literature of pastoral counseling address the counseling situations typically encountered by congregational pastors and provide an adequate methodology suited to the context of parish ministry?

Bibliometrics↗

PubMed2006

Health counseling for women in the absence of financial barriers: comparing reported counseling rates of women in the United States and Israel.

This study compares rates of health counseling for women in the United States and Israel and identifies factors affecting counseling rates, based on a weighted sample of 2,257 US and 848 Israeli women. In both countries, fewer than half of the women reported speaking with a physician about any of a set of preventive counseling topics (e.g., smoking, diet, exercise) during the year preceding the survey. However, US women reported significantly higher rates of health counseling than did Israeli women, even among specific risk groups (e.g., smokers). Multivariate analysis revealed that "country" had an independent effect after controlling for demographic factors. This paper highlights structural and functional barriers to counseling that persist in the Israeli system in the absence of financial barriers and discusses ways to overcome them.

Adult↗

PubMed1986

Genetic counseling of asymptomatic carriers in a primary care setting. The effectiveness of screening and counseling for beta-thalassemia trait.

In a prospective, controlled, stratified, experimental effectiveness study of screening and counseling, 25 000 consecutive adults were screened for thalassemia trait. Eight hundred forty-three adults had a mean corpuscular volume less than 77 fL; 192 (22% of those with microcytosis) had hemoglobin A2 greater than 3.5%, proving beta-thalassemia trait. Video-program, neutral-educational, and patient-centered counseling methods produced equal levels of learning, retention, psychologic impact, and effects on life adjustment immediately and at 2 and 10 months after counseling. Ninety-nine percent of the patients told other persons about the counseling, and 43% had 106 others screened. Factors related to having someone else screened included plans to have children (p less than 0.002), being younger (p less than 0.0025), better education (p less than 0.05), and having high knowledge of thalassemia (p = 0.05). For maximum effectiveness, screening and counseling programs should focus on patients for whom a positive result has high significance.

Adolescent↗

PubMedDate not supplied

The effects of standard care counseling or telephone/in-person counseling on beliefs, knowledge, and behavior related to mammography screening.

PURPOSE/OBJECTIVES: To determine the most effective methods of increasing mammography adherence while also considering ease of intervention delivery in evolving healthcare systems. DESIGN: Experimental. SETTING: Women from a health maintenance organization and a large general medicine practice. SAMPLE: Women 50-85 years of age who had not had breast cancer and did not have a mammogram within the last 15 months. METHODS: Once consent and baseline information were obtained, women were randomized to receive in-person, telephone, or no mammography counseling. MAIN RESEARCH VARIABLES: Mammography adherence, perception of susceptibility to breast cancer, and benefits, barriers to, and knowledge of mammography. FINDINGS: Compared to standard care, telephone counseling was more than twice as effective at increasing mammography adherence, whereas in-person counseling resulted in almost three times the mammography adherence postintervention. Both telephone and in-person counseling are successful in changing perceived susceptibility, knowledge, barriers, and benefits. CONCLUSION: Both telephone and in-person counseling interventions were successful in changing beliefs, which, in turn, increased mammography adherence. IMPLICATIONS FOR NURSING PRACTICE: Interventions based on altering beliefs are effective for increasing mammography adherence.

Aged↗

PubMed1975

The interaction between counseling and methadone in the treatment of narcotic addicts: the challenge of the counseling relationship.

Despite the real and symbolic inportance of methadone to the drug addict, the counseling relationship is still central to the rehabilitative process. This paper discusses the unique aspects of counseling relationships in methadone programs due to the interaction of the physiological and counseling components of treatment. A point of view is presented which emphasizes the need for an open and honest discussion of the worker's role and the expectations of the program early in the treatment process as a means of establishing a therapeutic contract. Affirmation of the authority inherent in the worker's role, and in the structure of the program, lends structure to the counseling relationship and facilitates the rehabilitative process. The contract will also help the patient clarify his personal goals of treatment. It has been noted that methadone can speed up the rehabilitative process because it allows the addict to shift his attention away from the craving for drugs. While counseling staff view methadone as a tool to help patients achieve physiological stability so that psychosocial rehabilitation can occur, patients often view methadone as the primary component of treatment. This differing view of the role of methadone in treatment can lead to conflicts between patients and counselors. The skill of the counselor lies in helping the patients move away from a singular concentration on the drug (methadone), by encouraging a longer point of view and the first steps in the process of personal and social rehabilitation.

Attitude↗

PubMed1984

Screening and genetic counseling for beta-thalassemia trait in a population unselected for interest: comparison of three counseling methods.

We have assessed the effects of screening and genetic counseling for beta-thalassemia trait on knowledge, attitudes, and behavior in a prospective, controlled study of randomly selected adult members of a health maintenance organization. We report here that knowledge of manifestations and of inheritance of thalassemia, previously reported to be high immediately after counseling, were well maintained at 2 and 10 months following counseling. There was no detectable impairment of self-concept. Marital adjustment improved, and sexual activity increased significantly. Mood, assessed immediately before and after counseling, showed no undesirable changes. A patient-structured counseling method, designed to minimize negative psychological effects via discussion of feelings, was not superior to conventional and programmed methods, described in our previous reports, in terms of learning or attitude change.

Adolescent↗

PubMed2000

[Process of institutional child guidance counseling reflected by the Central Continuing Education of the Federal Conference for Child Guidance Counseling].

The Bundeskonferenz für Erziehungsberatung (bke) is the federation for child guidance and family-counseling in Germany. Members are the working groups for child guidance and family-counseling of the Länder, where the employees of the child guidance are organized. The federation was founded in 1962. It is sponsored by the Federal Ministry for Family, Seniors, Women and Youth. Further education for professional youth workers is central mission of bke. The constitution of the federation lais down these contents. Every autumn the bke publishes the program for further education for the following year in a brochure called Zentrale Weiterbildung--the program for child guidance, family counseling and youth counseling. A special Kommission Zentrale Weiterbildung acquires the contents of the program for further education und selects the referents. Since 1968 the Zentrale Weiterbildung of Bundeskonferenz für Erziehungsberatung offers events for professional youth workers in child guidance, family counseling. The program for further education contributes the quality of the institution of child guidance. After a time with above average use of the program for further education with therapeutical focal point, the orientation of the program changes to child and youth services. A constant number of counselors use the program. Beside the change of contents there was a change to effectiveness of contents and a reduction of participants.

Adolescent↗

PubMed2003

Nondirectiveness and its lay interpretations: the effect of counseling style, ethnicity and culture on attitudes towards genetic counseling among Jewish and Bedouin respondents in Israel.

To evaluate the effects of ethnicity, culture, and counseling style on the interpretation of nondirectiveness in genetic counseling, a questionnaire containing premarital and prenatal case vignettes in two versions (pessimistic/optimistic) was administered to 281 Jewish and 133 Bedouin respondents. The first study population was comprised of Jewish students enrolled in a university and a community college in the Negev (southern part of Israel). The second study population was comprised of Muslim-Bedouin college students from the same area. The majority of Jewish respondents interpreted the nondirective message as intended by counselors, while the majority of Bedouin respondents did not. Counseling style was found to have a statistically significant effect on the interpretation of the general role of counseling. Gender and susceptibility were not found to have a significant effect on interpretation. Group differences are analyzed through a cultural lens in which different interpretive norms can generate expectations for either nondirectiveness or directiveness.

Arabs↗

PubMed1984

Perception of theoretically derived counseling approaches as a function of preference for counseling orientation.

Examined the relationship between preference for major counseling orientations and perception of counselor behavior in theoretically derived counseling interviews. Seventy-seven undergraduate students viewed demonstration interviews by Rogers and Lazarus, rated the counselor behavior on the Counselor Rating Form, and were assessed in their endorsement of seven major counseling orientations. A regression analysis performed on the preference scores for seven counseling orientations (predictors) in response to the counselor perception scores on the Counselor Rating Form showed a significant relationship only between the client-centered orientation and Rogers. Lazarus was not predicted from any of the seven orientations. Additional analysis of the Counselor Rating Form data revealed that Lazarus was perceived as more expert, attractive, and trustworthy than Rogers. The results are discussed in relation to previous studies.

Adult↗

PubMed1998

How to develop one's counseling--demonstration of the use of single-case studies as a practical tool for evaluating the outcomes of counseling.

The physical activity patterns of eight single cases of back patients are described across a series of counseling sessions and a 12-month follow-up. The cases demonstrate the variability of physical activity during the counseling period due to random influences in the patient's life and the possibility of total relapse of more complicated activity types after counseling. The simple behaviors like proper sitting, standing or lifting are shown to be better maintained in spite of the random influences in the patient's life. The single-case study method is demonstrated to serve as a practical tool for evaluating one's counseling in the promotion of health-related physical activity.

Adult↗

PubMedDate not supplied

Infertility counselling: the ISSUE experience of setting up a telephone counselling service.

This paper explores the role of telephone counselling for people experiencing fertility problems. It examines the first nine months of the evening telephone counselling service offered by ISSUE (The National Fertility Association). Records of the service were analysed for number, duration and nature of calls. The results suggest that there is significant demand for such a service and that this demand has grown in line with availability. All counsellors working on the service were interviewed. Qualitative analysis of the interviews generated key themes concerning gender and culture, supervision and training, counselling process issues, boundaries and managerial issues. In addition, specific issues about counselling in the field of reproductive medicine were highlighted. Findings are discussed in relation to implications for service provision in this area of health care.

Counseling↗

PubMed1998

Overview of the Activity Counseling Trial (ACT) intervention for promoting physical activity in primary health care settings. Activity Counseling Trial Research Group.

Counseling by health care providers has the potential to increase physical activity in sedentary patients, yet few studies have tested interventions for physical activity counseling delivered in health care settings. The Activity Counseling Trial (ACT) is a 5-yr randomized clinical trial to evaluate the efficacy of two primary care, practice-based physical activity behavioral interventions relative to a standard care control condition. A total of 874 sedentary men and women, 35-75 yr of age, have been recruited from primary care physician offices at three clinical centers for 2 yr of participation. They were randomly assigned to one of three experimental conditions that vary, in a hierarchical fashion, by level of counseling intensity and resource requirements. The interventions, which are based on social cognitive theory and the transtheoretical model, are designed to alter empirically based psychosocial mediators that are known to be associated with physical activity. The present paper describes the theoretical background of the intervention, the intervention methods, and intervention training and quality control procedures.

Adult↗

PubMed2003

Negotiation in type 2 diabetes counseling: from problem recognition to mutual acceptance during lifestyle counseling.

Negotiation, an essential communication activity in lifestyle counseling, has rarely been studied at the micro level of interaction. Furthermore, the evidence for interpersonal negotiation to occur in counseling practice is inconclusive. In this study, the authors describe how negotiation focused on lifestyle changes was produced in nurse-patient interaction. The research data, 73 videotaped diabetes counseling situations, were analyzed using conversation analysis. The process of negotiation consisted of recognizing the problems in the patients' health behavior, offering proposals as solutions to the problems, and reaching an agreement on them. Negotiation had characteristics similar to those mentioned in the literature, but there were also prominent inadequacies. The authors suggest that nurses might need to become more aware of their counseling practices in routine situations through conscious effort for self-evaluation. In addition, further research would be required to demonstrate the effectiveness of negotiation for facilitating changes in patients' health behavior.

Aged↗

PubMed1991

Training family practice and internal medicine residents to counsel patients who smoke: improvement and retention of counseling skills.

This investigation builds on an earlier study by describing the final results of a training program that teaches internal medicine and family practice residents to counsel patients to stop smoking. In this study, 198 residents participated in a three-hour training program which included small group discussion and role-playing exercises. Videotaped observations of role-playing performances were used to assess behavioral outcomes related to counseling skills for 104 residents who completed pre-, immediate post-, and long-term follow-up testing. The present findings support previous results that show the training program has a significant positive effect on physician smoking cessation counseling skills. A subsample of residents continued to exhibit improved counseling skills one year after the initial educational interventions, suggesting that these skills can be retained over time.

Counseling↗

PubMed1977

No-red-tape counseling for clients alienated from traditional services. Walk-in counseling center. Minneapolis, Minnesota.

Since 1969 the Walk-In Counseling Center in Minneapolis has offered free, no-red tape counseling to individuals and families alienated from traditional services. All counseling is provided by teams of mental health professionals who volunteer their services. The emphasis is on crisis and short-term counseling with a maximum of ten sessions. The center was established mainly to serve young drug abusers, but the clientele has diversified to include individuals of all ages and socioeconomic groups. The center also conducts an active consultation and education program with more than 200 community groups a year.

Adolescent↗