A Population at Risk: Counseling Sexual Minorities with a Serious Mental Illness

Sexual minorities are at a greater risk for experiencing a serious mental illness (SMI) compared to heterosexuals, and sexual minorities suffering from a SMI experience stigma and discrimination that leads to a greater need for counseling services. Current research does not address the needs of sexual minorities with a SMI and how to prepare counselors to work with this population, as most sexual minorities with a SMI find that counseling services do not meet their unique needs. The purpose of this transcendental phenomenological study, grounded in a Husserlian philosophical and minority stress model conceptual framework, was to explore the experiences and perceptions of counselors who provide counseling services to sexual minorities with a SMI. Data were collected from 6 participants using semistructured interviews and followed a thematic data analysis process, ensuring thematic saturation. The results of this study highlighted many themes regarding the unique needs of sexual minorities with a SMI such as multiple minority stressors, negative counseling experiences, and the impact of family, as well as counselors’ perceptions regarding the lack of preparation in graduate school to work with sexual minorities with a SMI. Study findings may improve counselors’ understanding of the needs of sexual minorities with a SMI so they may provide more effective counseling services. This study also highlights the importance of training counselors to work with this population and may support the efforts of counselor educators

The Experiences of Counselor Educators Transitioning to Online Teaching

A growing trend in counselor education is to accommodate technological change with more online academic opportunities. Slow to emerge in the counselor education literature is information about how instructors have negotiated the change. This study highlights the experiences of six counselor educators from across the United States who transitioned from teaching counseling courses in the classroom to teaching them online. Four themes of common experience emerged from the data: (a) high expectations and low support from university leaders, (b) limits to transitional enthusiasm among counseling faculty, (c) solutions for transitional success, and (d) support essential for the transition. Results of this study confirm a need for greater attention to the transitional process and increased opportunities for experience and university support

Predicting Students\u27 Spiritual and Religious Competence Based on Supervisor Practices and Institutional Attendance

Counseling students report a lack of competence in spiritual and religious integration (SRI). As such, counselor educators and supervisors (CES) and students want to understand how to develop SRI competence. Although past research highlights SRI dialogue in training, there exists no clear understanding about the role of faculty supervisor SRI on perceived student competence. The supervision models used to inform the study included (a) the integrated developmental model, (b) the discrimination model, and (c) the spirituality in supervision model (SACRED). The purpose of this study is to determine if master’s-level graduate counseling student perceptions of faculty supervisor SRI practices predicts student perceived spiritual competence when considering attendance in faith-based and non-faith-based institutions accredited by the Council for Accreditation of Counseling and Related Education Programs (CACREP). A review of existing literature supports the use of a quantitative, cross-sectional design. An online survey was distributed to students (n = 59) in master’s-level CACREP counseling programs, currently in field experience, to measure perceived SRI in supervision and perceived SRI competence. A multiple linear regression reveals a statistically significant predictive relationship between supervisor SRI and perceived student competence as measured by the Spiritual and Religious Competence Assessment and the Spiritual Issues in Supervision Scale. These results inform CES about the importance of SRI and student ability to work with the spiritual and religious beliefs of clients. On this basis, it is recommended that supervisors focus on SRI in supervision. Future research should focus on additional factors related to SRI competence during counselor training

Intersectionality Pedagogy in the Classroom: Experiences of Counselor Educators

The role of intersectionality in counselor education and supervision has not been formally addressed by researchers in the preparation of counselors in training. Traditional ways of teaching multicultural and diversity issues in counseling include compartmentalized discussions about social identities, but do not incorporate intersectionality despite its significance in describing how individuals move through the world. The method of inquiry used to collect and analyze data was heuristic in nature due to the focus on contextual experiences of the participants as well as the researcher. The results showed how seven CES faculty members’ personal and professional experiences influenced their incorporation of intersectionality in their multicultural pedagogy. The extent to which intersectionality plays a role in understanding multicultural counseling education and experiences of faculty members is explored in this article

Conflict in the Multicultural Counseling Classroom: Counselor Educators’ Experiences

We gathered data from counselor educators to study their experiences with emotionally charged exchanges while teaching multicultural counseling. We then used descriptive phenomenology and an ecological systems framework to reveal the emotions counselor educators experienced and the outcomes of the exchanges. We discuss the implications of our findings for counselor preparation programs and educators

Students’ Experiences of In-person and Online Clinical Residencies: A Qualitative Study

Online counselor education programs have continued to grow in popularity. There is limited current research about residency experiences of counseling students. The coronavirus pandemic has forced counselor educators to move traditionally face to face residencies to the online platform. Our study explores the experiences of counseling students who attended both online and face to face residency using an in-depth phenomenological interviewing. Four major themes emerged including (a) self-care, (b) faculty interactions, (c) student connections, and (d) counselor identity and future practice. One narrative highlights the participant’s experiences

Integration of Sequence Data from a Consanguineous Family with Genetic Data from an Outbred Population Identifies PLB1 as a Candidate Rheumatoid Arthritis Risk Gene

Integrating genetic data from families with highly penetrant forms of disease together with genetic data from outbred populations represents a promising strategy to uncover the complete frequency spectrum of risk alleles for complex traits such as rheumatoid arthritis (RA). Here, we demonstrate that rare, low-frequency and common alleles at one gene locus, phospholipase B1 (PLB1), might contribute to risk of RA in a 4-generation consanguineous pedigree (Middle Eastern ancestry) and also in unrelated individuals from the general population (European ancestry). Through identity-by-descent (IBD) mapping and whole-exome sequencing, we identified a non-synonymous c.2263G>C (p.G755R) mutation at the PLB1 gene on 2q23, which significantly co-segregated with RA in family members with a dominant mode of inheritance (P = 0.009). We further evaluated PLB1 variants and risk of RA using a GWAS meta-analysis of 8,875 RA cases and 29,367 controls of European ancestry. We identified significant contributions of two independent non-coding variants near PLB1 with risk of RA (rs116018341 [MAF = 0.042] and rs116541814 [MAF = 0.021], combined P = 3.2×10−6). Finally, we performed deep exon sequencing of PLB1 in 1,088 RA cases and 1,088 controls (European ancestry), and identified suggestive dispersion of rare protein-coding variant frequencies between cases and controls (P = 0.049 for C-alpha test and P = 0.055 for SKAT). Together, these data suggest that PLB1 is a candidate risk gene for RA. Future studies to characterize the full spectrum of genetic risk in the PLB1 genetic locus are warranted

Genome-Wide Association Study and Gene Expression Analysis Identifies CD84 as a Predictor of Response to Etanercept Therapy in Rheumatoid Arthritis

Anti-tumor necrosis factor alpha (anti-TNF) biologic therapy is a widely used treatment for rheumatoid arthritis (RA). It is unknown why some RA patients fail to respond adequately to anti-TNF therapy, which limits the development of clinical biomarkers to predict response or new drugs to target refractory cases. To understand the biological basis of response to anti-TNF therapy, we conducted a genome-wide association study (GWAS) meta-analysis of more than 2 million common variants in 2,706 RA patients from 13 different collections. Patients were treated with one of three anti-TNF medications: etanercept (n = 733), infliximab (n = 894), or adalimumab (n = 1,071). We identified a SNP (rs6427528) at the 1q23 locus that was associated with change in disease activity score (ΔDAS) in the etanercept subset of patients (P = 8×10-8), but not in the infliximab or adalimumab subsets (P>0.05). The SNP is predicted to disrupt transcription factor binding site motifs in the 3′ UTR of an immune-related gene, CD84, and the allele associated with better response to etanercept was associated with higher CD84 gene expression in peripheral blood mononuclear cells (P = 1×10-11 in 228 non-RA patients and P = 0.004 in 132 RA patients). Consistent with the genetic findings, higher CD84 gene expression correlated with lower cross-sectional DAS (P = 0.02, n = 210) and showed a non-significant trend for better ΔDAS in a subset of RA patients with gene expression data (n = 31, etanercept-treated). A small, multi-ethnic replication showed a non-significant trend towards an association among etanercept-treated RA patients of Portuguese ancestry (n = 139, P = 0.4), but no association among patients of Japanese ancestry (n = 151, P = 0.8). Our study demonstrates that an allele associated with response to etanercept therapy is also associated with CD84 gene expression, and further that CD84 expression correlates with disease activity. These findings support a model in which CD84 genotypes and/or expression may serve as a useful biomarker for response to etanercept treatment in RA patients of European ancestry. © 2013 Cui et al

Genetics of rheumatoid arthritis contributes to biology and drug discovery

A major challenge in human genetics is to devise a systematic strategy to integrate disease-associated variants with diverse genomic and biological datasets to provide insight into disease pathogenesis and guide drug discovery for complex traits such as rheumatoid arthritis (RA)1. Here, we performed a genome-wide association study (GWAS) meta-analysis in a total of >100,000 subjects of European and Asian ancestries (29,880 RA cases and 73,758 controls), by evaluating ~10 million single nucleotide polymorphisms (SNPs). We discovered 42 novel RA risk loci at a genome-wide level of significance, bringing the total to 1012–4. We devised an in-silico pipeline using established bioinformatics methods based on functional annotation5, cis-acting expression quantitative trait loci (cis-eQTL)6, and pathway analyses7–9 – as well as novel methods based on genetic overlap with human primary immunodeficiency (PID), hematological cancer somatic mutations and knock-out mouse phenotypes – to identify 98 biological candidate genes at these 101 risk loci. We demonstrate that these genes are the targets of approved therapies for RA, and further suggest that drugs approved for other indications may be repurposed for the treatment of RA. Together, this comprehensive genetic study sheds light on fundamental genes, pathways and cell types that contribute to RA pathogenesis, and provides empirical evidence that the genetics of RA can provide important information for drug discovery

Integration of sequence data from a consanguineous family with genetic data from an outbred population identifies PLB1 as a candidate rheumatoid arthritis risk gene

Integrating genetic data from families with highly penetrant forms of disease together with genetic data from outbred populations represents a promising strategy to uncover the complete frequency spectrum of risk alleles for complex traits such as rheumatoid arthritis (RA). Here, we demonstrate that rare, low-frequency and common alleles at one gene locus, phospholipase B1 (PLB1), might contribute to risk of RA in a 4-generation consanguineous pedigree (Middle Eastern ancestry) and also in unrelated individuals from the general population (European ancestry). Through identity-by-descent (IBD) mapping and whole-exome sequencing, we identified a non-synonymous c.2263G>C (p.G755R) mutation at the PLB1 gene on 2q23, which significantly co-segregated with RA in family members with a dominant mode of inheritance (P = 0.009). We further evaluated PLB1 variants and risk of RA using a GWAS meta-analysis of 8,875 RA cases and 29,367 controls of European ancestry. We identified significant contributions of two independent non-coding variants near PLB1 with risk of RA (rs116018341 [MAF = 0.042] and rs116541814 [MAF = 0.021], combined P = 3.2×10-6). Finally, we performed deep exon sequencing of PLB1 in 1,088 RA cases and 1,088 controls (European ancestry), and identified suggestive dispersion of rare protein-coding variant frequencies between cases and controls (P = 0.049 for C-alpha test and P = 0.055 for SKAT). Together, these data suggest that PLB1 is a candidate risk gene for RA. Future studies to characterize the full spectrum of genetic risk in the PLB1 genetic locus are warranted. © 2014 Plenge et al