Examining the Relationship Between Chinese International Students’ Acculturation

Home , Cultural contracts

Examining the Relationship between Chinese International Students’ Acculturation,

Ethnic Identity, Language Proficiency, and Their Attitudes toward Seeking

Professional Counseling Services

Jiaqi Li, M.Ed.

A Dissertation

COUNSELOR EDUCATION

Submitted to the Graduate Faculty of Texas Tech University in Partial Fulfillment of the Requirements for the Degree of

DOCTOR OF PHILOSOPHY

Approved

Dr. Aretha Marbley, Chair

Dr. Loretta Bradley

Dr. William Lan

Dr. Dominick Casadonte

Interim Dean of the Graduate School

December 2013

Texas Tech University, Jiaqi Li, December, 2013

Acknowledgments

The doctoral dissertation is a time consuming and arduous task. I express my deep gratitude to Dr. Aretha Marbley, my committee chairperson, for her support, guidance, and encouragement during the dissertation process. I also offer my thanks to Dr. Loretta

Bradley for her insight and meticulous edits of this manuscript. I wish to thank Dr.

William Lan for lending his statistical expertise to this research.

I would like to extend my gratitude to Dr. Charles Crews and Dr. Janet Froeschle for the opportunity to study under you and work with you as a research assistant.

Thanks to pastor Robert Sea and friends at Lubbock Chinese Church. This would not have been possible without your prayers and encouragement.

Thanks to my mother. I cannot make it without your love and support.

Texas Tech University, Jiaqi Li, December, 2013

TABLE OF CONTENTS

ACKNOWLEDGMENTS ...... ii ABSTRACT ...... vi LIST OF TABLES ...... viii LIST OF FIGURES ...... ix CHAPTER I: INTRODUCTION ...... 1 Background ...... 1 International Students and Mental Health Services ...... 3 Theoretical Framework ...... 5 Statement of the Research ...... 6 Purpose of the Study ...... 7 Research Questions ...... 9 Hypothesis...... 10 Limitations, Delimitations, and Assumptions ...... 10 Definitions of Key Terms ...... 11 CHAPTER II: REVIEW OF LITERATURE ...... 14 Conceptual Framework ...... 14 Phase 1: The Emergence of Mental Health Problems ...... 15 Student Sojourners in the United States...... 16 Cultural Shock ...... 18 Homesickness ...... 21 Acculturation...... 23 Acculturative Stress ...... 25 Acculturation Theory ...... 27 Ethnic Identity ...... 30 Language Proficiency ...... 33 PHASE 2: Help-Seeking Behavior ...... 34 Underutilization of Mental Health Services ...... 35 Help-Seeking Theory ...... 37 Barriers to Help-Seeking Behavior ...... 39

iii

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Misconception ...... 39 Loss of face ...... 40 Individualism and collectivism ...... 42 Alternative resources ...... 43 Summary ...... 44 CHAPTER III: METHODOLOGY ...... 46 Introduction ...... 46 Participants ...... 47 Instruments ...... 48 Demographic Information Survey ...... 48 Measure of English Proficiency ...... 48 Suinn-Lew Asian Self-Identity Acculturation Scale ...... 51 Multigroup Ethnic Identity Measure ...... 54 Attitudes toward Seeking Professional Psychological Help ...... 55 Procedure ...... 56 Data Analysis ...... 56 Summary ...... 59 CHAPTER IV: RESULTS ...... 61 Introduction ...... 61 Survey Response Rate...... 62 Sample Demongraphics ...... 63 Data Analysis ...... 64 Data Screening ...... 64 Reliability Analysis ...... 65 Research Question 1 ...... 65 Research Question 2 ...... 67 Research Question 3 ...... 69 Summary ...... 74 CHAPTER V: DISCUSSION ...... 75 Introduction ...... 75 Summary of the Study ...... 75

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Ethnic Identity and Help-Seeking Attitudes ...... 76 Assimilation and Help-Seeking Attitudes ...... 78 Limitations ...... 80 Implications for Practice ...... 81 Recommendations for Future Research ...... 83 REFERENCES ...... 85 APPENDIX A ...... 98 APPENDIX B ...... 99 APPENDIX C ...... 100 APPENDIX D ...... 105 APPENDIX E ...... 107 APPENDIX F...... 109 APPENDIX G ...... 110 APPENDIX H ...... 111 APPENDIX I ...... 112

Texas Tech University, Jiaqi Li, December, 2013

ABSTRACT

In the 2010-2011 academic year, among the 723,277 international students studying on campuses in the United States, 50% were from Asian countries, with China and India representing the two largest proportions of students (Institute of International

Education, 2011). China was the leading place of origin for international students, with

157,558 students studying in the U.S., accounting for more than 21.8% of the total international student population (Institute of International Education, 2011). Recent studies in the literature have indicated that Asian international students faced a series of intercultural and intergroup issues unique to their culture of origin, including culture shock, academic struggles, language barriers, emotional adjustment problems, lack of social support, perceived discrimination, and geographic distance from family and friends

(Berry, 1997; Berry, Phinney, Sam, & Vedder, 2006; Furnham & Bochner, 1986; Sue &

Sue, 2007). Further, Asian international students experiencing psychological problems underutilized mental health services because of their attitudes toward seeking professional counseling help (Marbley, 2011; Sue & Sue, 2007; Tung, 2011). A review of literature revealed that there was a gap between Asian international students and mental health practitioners. As a result, the study reported herein was designed to analyze the gap between Asian international students and mental health practitioners. Specifically, the following research questions were pursued: (a) Are the levels of acculturation, ethnic identity, and English proficiency of Chinese international students significant predictors of their attitudes toward seeking professional counseling services? (b) Among the three potential predictors, is there any significant predictor of Chinese international students’ attitudes toward seeking professional counseling services? (c) How are the Chinese

Texas Tech University, Jiaqi Li, December, 2013 international students’ attitudes toward seeking professional counseling services different across various acculturation levels? The participants for the study were Chinese international students pursuing their graduate degrees in a large southwestern research institution in the United States. To address the above questions, the following statistical analyses were computed: (a) a multiple regression analysis evaluating the relationship between Chinese international students’ acculturation, ethnic identity, and language proficiency and their attitudes toward seeking professional counseling services; (b) a one- way analysis of variance (ANOVA ) examining how the Chinese international students’ attitudes toward seeking professional counseling were different across various acculturation strategies.

vii

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LIST OF TABLES

3.1 Research Questions, Hypotheses, and Data Analysis ...... 58

4.1 Descriptive Statistics for Age, Residence Periods, and TOEFL ...... 63

4.2 Descriptive Statistics for DV and IV used in the Multiple Regression Analysis ...... 65

4.3 ANOVA Summary Table ...... 66

4.4 Coefficients for Predictors ...... 67

4.5 ANOVA Summary Table ...... 68

4.6 Coefficients for Predictors ...... 69

4.7 Scoring Table ...... 70

4.8 Descriptive Statistics for Acculturation Strategies ...... 71

4.9 ANOVA Summary Table ...... 72

5.0 Multiple Comparisons ...... 73

viii

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LIST OF FIGURES

2.1 A Framework for Acculturative Stress Research ...... 26

2.2 Acculturation Patterns of Immigrant Groups and of the Larger Society ...... 29

2.3 Terms Used for Four Orientations ...... 32

3.1 TOEFL iBT Performance Rubric for Test Takers ...... 49

Texas Tech University, Jiaqi Li, December, 2013

CHAPTER I

INTRODUCTION

Background

With the rapid development of global economies, the affordability and accessibility of international transportation, and the advent of and global access to the

Internet, an increasing number of international students choose to continue their education in colleges and universities across the United States. These trends have greatly impacted the acculturation experiences of international individuals and brought international students new and different challenges, new living experiences, and a potpourri of unexpected and unanticipated consequences including acculturative stress, cross-cultural adjustment problems, and depression (Wang & Mallinckrodt, 2006; Yang

& Saumure, 2006; Ye, 2006; Yeh & Inose, 2003). According to Berry (1997), acculturation experiences usually consist of factors such as ethnic identity and language proficiency, which may be tools to help better explain the complexity, range, and depth on international students’ experiences.

In the 2010-2011 academic year, among the 723,277 international students studying on campuses in the United States, 50% are from Asian countries, with China and India representing the two largest proportions of students (Institute of International

Education, 2011). China was the leading place of origin for international students, with

157,558 students studying in the United States, accounting for more than 21.8% of the total international student population (Institute of International Education, 2011). The top

10 countries of origin of international students in the U.S. were China (157,558), India

(103,895), South Korea (73,351), Canada (27,546), Taiwan (24,818), Saudi Arabia

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(22,704), Japan (21,290), Vietnam (14,888), Mexico (13,713), and Turkey (12,184). The top three U.S. states hosting international students were California (96,535), New York

(78,888), and Texas (61,636) (Institute of International Education, 2011).

Sam and Berry (2006) indicated that an increasing number of international students were experiencing acculturative stress and cross-cultural adjustment problems.

Because the majority of international students were from Asian countries, they faced a series of intercultural and intergroup issues unique to their culture of origin, including culture shock, academic struggles, language barriers, emotional adjustment problems, lack of social support, perceived discrimination, and geographic distance from family and friends (Berry, 1997; Berry, Phinney, Sam, & Vedder, 2006; Furnham & Bochner, 1986;

Sue & Sue, 2007; Wang & Mallinckrodt, 2006; Wang & Sun, 2009; Yan & Berliner,

2009). Specifically, Furnham and Trezise (1983) concluded that there were three factors that had a significant effect on international students’ adaptation to host cultures: (a) cultural distance (e.g., ethnic identity), (b) personal development issues (e.g., acculturation), and (c) academic challenges (e.g., language proficiency). Moreover, acculturation, ethnic identity, and language proficiency were likely to determine whether international students succeeded in adjusting to local campus cultures where a lack of adjustment may lead to poor academic performance and even students dropping out. On the other hand, successful cultural adjustment would contribute to the students’ personal enrichment and academic achievement. Berry (1977) explained engagement with the host culture as cultural assimilation. Students who were more inclusively assimilated with the local culture did better in their studies (Sam & Berry, 2006; Ward & Kennedy, 1993).

According to Parr, Bradley, and Bingi (1992), international students reported the most

Texas Tech University, Jiaqi Li, December, 2013 positive feelings during their first year and less positive feelings during the second year, with an increase of positive feelings again in the remaining two years in the United States.

Unfortunately, despite their challenges and distress, international students often did not seek professional help. Moreover, recent studies and literature have revealed that the underutilization of mental health services by international students has not gotten better

(Chang & Chang, 2004; Zhang & Dixon, 2003).

International Students and Mental Health Services

The underutilization of mental health services by international students has been well documented (Austin, Carter, & Vaux, 1990; Li, Liu, Wei, & Lan, 2013; Sam &

Berry, 2006; Tung, 2011; Ye, 2006). A rapid increase in the international student population in recent years has still not produced a greater perception of need by mental health services for international students (Ramos-Sanchez & Atkinson, 2009). More specifically, as far as international students who experience psychological problems are concerned, they have a very low frequency rate of visiting campus counseling services and seeking professional help, even if most universities in the United States provide free counseling services. Hereto, many scholars tried to understand international students’ underutilization of mental health services in terms of cultural values and help-seeking behaviors (Marbley, 2011; Rogler, Malgady, & Rodriguez, 1989; Sue & Sue, 2007; Tung,

2011). Tung (2011) indicated that international students from Asian countries underutilize counseling services, and their help-seeking behaviors are greatly limited by the cultural stigma associated with mental illness, attitudes toward seeking mental health professionals, and emotional expression. From the perspective of clients, Marbley (2011) indicated there were two aspects relevant to help-seeking behavior: “(a) the extent to

Texas Tech University, Jiaqi Li, December, 2013 which people of color, in relation to their needs, underutilize mental health services; and

(b) the interrelationships among the factors that explain underutilization (p. 15).” Saint

Arnault (2009) attributed help-seeking behavior to individual and societal influence, and classified it as being influenced by five factors: (a) perception and labeling, (b) causal attributions, (c) social significance, (d) availability of resources, and (e) exchange rules.

According to Saint Arnault’s research result (2009), Chinese international student clients’ help-seeking behaviors may be culturally and correspondingly categorized as five factors such as misconception of mental disorder and counseling (e.g., perception and labeling), loss of face (e.g., causal attributions), individualism and collectivism (e.g., social significance), alternative resources (e.g., availability of resources), and the language barrier (e.g., exchange rules) in this study. From the perspective of counselors, Sue and

Sue (2007) stated that there are three major potential barriers to effective multicultural therapy: (a) class-bound values (e.g., strict adherence to time schedule and seeking long- range solutions), (b) language bias or misunderstanding (e.g., use of standard English communication), and (d) culture-bound values (e.g., individual centered, verbal and emotional expressiveness). For professional counselors, the class-bound and culture- bound value discrepancy rooted in individualism, to some extent prevents them from providing effective clinical help to traditional Asian international students from collectivist cultures. Further, Asian international students’ unfamiliarity with mental health services has sometimes created language barriers for international Chinese students leading to misunderstanding between Chinese speaking clients and English- speaking mental health practitioners.

Texas Tech University, Jiaqi Li, December, 2013

Theoretical Framework

This study will use Rogler, Malgady, and Rodriguez’s (1989) hypothetical framework as a theoretical research lens to examine the barriers that affect international students’ decisions to pursue counseling services. These scholars developed this conceptual framework to organize clinical service mental health research on Hispanics based on a hypothetical temporal sequence composed of five phases. The framework examines successive experiences of an individual with a mental disorder, beginning with the emergence of the psychological problem and ending with the post-treatment period

(Rogler et al., 1989). The experiences are divided into five phases, each of which represents a significant developmental progression. The five-phase structure includes: (a) emergence of mental health problem, (b) help-seeking behavior, (c) evaluation of mental health, (d) psychotherapeutic services, and (e) post-treatment adjustment. Based on the above structure, the study reported herein will focus on discussing the emergence of mental health problems among Chinese international students, and their help-seeking behaviors.

The following is a detailed description of the five-phase structure: (a) phase one of the framework deals with the emergence of mental health problems among immigrants and other issues related to their experience as ethnically and racially marginalized people;

(b) phase two introduces help-seeking efforts, which may or may not lead this group to mental health services. It examines factors involved in underutilization and alternative resources such as the family, friends, and other support systems; (c) phase three deliberates the literature related to cultural identity and bias in mental health measurements and assessment; (d) phase four identifies existing factors influencing the

Texas Tech University, Jiaqi Li, December, 2013 mental health diagnosis of immigrants, such as lack of multicultural counselors; (e) phase five focuses on the termination of treatment and how a client resumes his or her social role within the family and the workplace. In the current study, two phases are included: (a) phase one, the emergence of mental health problems, and (b) phase two, help-seeking behavior. In each of the sections, the emergence of mental health problems among

Chinese international students and the barriers to the delivery of effective mental health services to the population are identified and discussed.

Statement of the Research Problem

Mental health of ethnically and racially marginalized people is always a salient topic for scholars. However, research on that population’s mental health needs, especially with regard to Asian international students, is fairly limited (Berry, 1997; Rogler,

Malgady, & Rodriguez, 1989; Sue & Sue, 2007). As far as most researchers and practitioners are concerned, there are two possible reasons why Asian international students underutilize mental health services (Austin, Carter, & Vaux, 1990; Hyun, Quinn,

Madon, & Lustig, 2007; Tung, 2011; Wu, 2011). First, there are such factors as socioeconomic status, language barriers, acculturation issues, and the stigma of seeking mental health resources (Garcia, 2008). In addition, stereotypes associated with minority status and ethnic identity can impede Asian international students from seeking counseling to some extent. Research has shown that Asian international students are not inclined to seek mental health counseling services and consider seeking psychological services untrustworthy (Sue & Sue, 2007). Moore and Constantine (2005) stated that

Asian international students prefer to seek help and support from their families and close friends instead of counseling centers. Secondly, counseling centers at predominantly

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White institutions have few persons of color on staff and lack culturally competent or bilingual practitioners (Sanchez & King-Toler, 2007). Such staffing in mental health services aggravates the underutilization issue. For instance, Asian international students might think that mental health practitioners in predominantly White institutions will lack the cultural competency needed to help them and communicate effectively with them.

As one typical representative group among Asian international students, Chinese international students are characterized by higher levels of collectivism, self-discipline, emotional restraint, a family-centered mindset, and the expectation of top-down, one-way communication from an authority figure (Sue & Sue, 2007). They attempt to deal with their psychological issues by “denying the existence of problems, suppressing disturbing emotions, avoiding morbid thoughts, and keeping busy with constructive activities” (Wu,

2011, p. 2). For many Chinese international students who are suffering from psychological problems, those ethnic tendencies, higher levels of collectivism, restraint of feelings, family centeredness, one-way communication from authority figure to person, and self-discipline naturally impede them from seeking professional counseling services

(Wu, 2011). Accordingly, this study chose Chinese international students as the target group.

Purpose of study

Many research studies have been conducted to explore the relationships between

Asian international students’ adjustment to their new surroundings and their mental health; however, few have investigated the relationship between Asian international students’ acculturation, ethnic identity, language proficiency, and their attitudes toward seeking professional counseling. Many studies have shown that although there is a large

Texas Tech University, Jiaqi Li, December, 2013 and growing population of Chinese international students in the United States, few of them seek professional counseling services for their psychological problems (Tung, 2011;

Wang & Sun, 2009; Wu, 2011; Ye, 2006;). Resulting from this gap in the existing research, the primary purpose of this study is to examine the relationship between

Chinese international students’ acculturation, ethnic identity, language proficiency, and their attitudes toward seeking help from mental health professionals. As a response to

Multicultural Counseling Competencies (Sue, Arredondo, & McDavis, 1992), the second purpose of the study is to help culturally skilled counselors gain useful “knowledge and information about Chinese international students who experience stress and other psychological issues and their attitudes toward seeking counseling,” “understand how race, culture, ethnicity, and so forth may affect personality formation, vocational choices, manifestation of psychological disorders, help seeking behavior, and the appropriateness or inappropriateness of counseling approaches,” and have knowledge about

“sociopolitical influences that impinge upon the life of racial and ethnic minorities” (p.

485). The third purpose is to advocate that counselor educators and mental health practitioners pay more attention to mental health problems of Chinese, Asian, and other international students and their attitudes toward seeking counseling services in the United

States. Accordingly, the current study will attempt to bridge the gap between Asian international students and mental health practitioners.

In sum, the current study investigates the barriers to providing effective mental health services to Chinese international students. The primary focus of the study is on phase 1 and phase 2 within Rogler, Malgady, and Rodriguez’s (1989) research framework and the discussion of social and cultural factors that influence mental health

Texas Tech University, Jiaqi Li, December, 2013 care delivery to Chinese international students. The major purpose of this study is to examine the relationship between Chinese international students’ acculturation, language proficiency, ethnic identity, and their attitudes toward seeking professional counseling services. Also, the study will examine how the Chinese international students’ acculturation strategies affect their attitudes toward seeking professional counseling.

Research Questions

The present study is based on the following research questions:

1. Are acculturation, ethnic identity, and the English proficiency of Chinese

international students significant predictors of their attitudes toward seeking

professional counseling services?

2. Among the three potential predictors, is there any significant predictor of Chinese

international students’ attitudes toward seeking professional counseling services?

3. How are the Chinese international students’ attitudes toward seeking professional

counseling services different across various acculturation strategies?

Hypothesis

1. Acculturation, ethnic identity, and English proficiency will be statistically

significant predictors for attitude toward seeking professional counseling services

among Chinese international students.

2. There will be at least one significant predictor for Chinese international students’

attitudes toward seeking professional counseling services among acculturation,

ethnic identity, and English proficiency.

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3. There will be a statistically significant difference in Chinese international students’

attitudes toward seeking professional counseling between different acculturation

strategies.

Limitations, Delimitations, and Assumptions

This study was limited by the number and cooperating participants in the sample.

The participants were students from a research institution in the southwestern Texas region of the United States. Thus, the current study was only generalizable to the Chinese international student population in this area and could not necessarily be applied to every

Chinese international student living in the wider United States. Portions of this research relied heavily on self-report instruments. Therefore, it was uncertain whether participants would present themselves in a more favorable manner once they were informed about the purpose of the current research.

Three assumptions were used in this dissertation. First, a large body of studies has shown strong relationships between individuals’ mental health and their attitudes toward seeking professional counseling among international students and immigrants (Kim &

Omizo, 2003; Kung, 2003; Marbley, 2011; Sue & Sue, 2007; Zhang & Dixon, 2003;

Zhang, Snowden, & Sue, 1998). These studies indicate, meanwhile, the effects of acculturation (Berry, 1997, 2006; Berry, Phinney, Sam, & Vedder, 2006), ethnic identity

(Helms, 1993; Phinney, 1992), and language proficiency (Brown & Levinson, 1987; Sue

& Sue, 2007) on mental health are complex and not well understood. I therefore assumed that acculturation, ethnic identity, and language proficiency of Chinese international students were significant predictors of their attitudes toward seeking professional counseling services. The second assumption was that all participants in the study were

Texas Tech University, Jiaqi Li, December, 2013 deliberate and honest in their responses. I also assumed that all participants understood the content of the questions. The third assumption was that the researcher was adequately trained to conduct the research and analyze the results.

Definitions of Key Terms

For the purpose of this study, the following definitions are offered:

Acculturation

According to the International Organization for Migration, the definition of acculturation is: “The progressive adoption of elements of a foreign culture (ideas, words, values, norms, behaviors, institutions) by persons, groups or classes of a given culture. The partial or total adaptation is caused by contacts and interactions between different cultures through migration and trade relations” (2004, p. 5).

Acculturation Strategies

Acculturation strategies refer to the ways immigrants prefer to live in plural societies contact situations (Berry, 1977). Immigrants work out strategies with respect to two dimensions: home cultural maintenance and host culture adoption. Berry (1970, 1977) classified acculturation strategies under four domains, including assimilation, integration, separation, and marginalization.

Acculturative Stress

According to Berry (2006), acculturative stress is “a response by people to life events that are rooted in intercultural contact” (p. 43).

Attitudes Toward Seeking Professional Psychological Help Scale-Short Form

(ATSPPHS-SF; Appendix D; Fischer & Farina, 1995) is a 10-item unidimensional scale,

Texas Tech University, Jiaqi Li, December, 2013 which is based on Fischer and Turner’s (1970) 29-item scale for measuring attitudes toward seeking professional psychological help.

Culture Shock

Bochner (2006) defined culture shock as the sojourners’ reactions that result from anxiety, feelings of disorientation, and confusion. This kind of reaction varies according to the situation of an individual’s adaptation.

English Proficiency

This refers to individuals’ ability to understand, speak, read, and write non-native language, the extent to which they are proficient in English, and the frequency with which they use it.

Ethnic Identity

Ethnic identity refers to “a sense of group or collective identity based on one’s perception that he or she shares a common heritage with a particular racial group” (Helms,

1993, p. 3).

Loss of Face

This refers to loss of social integrity in interpersonal relationships among Asian

Americans (Sue & Morishima, 1982).

Resident Time

In this article, a resident time is the amount of time a Chinese international student stays in a university in the United States.

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Suinn-Lew Asian Self-Identity Acculturation Scale

The Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA; Appendix B), developed by Suinn, Richard- Figueroa, Lew, and Vigil (1987), is a widely used acculturation measure for Asians and Asian Americans.

Texas Tech University, Jiaqi Li, December, 2013

CHAPTER II

LTERATURE REVIEW

Conceptual Framework

Rogler, Malgady, and Rodriguez (1989) developed a conceptual framework to sort through fragmented multicultural literature on Hispanic immigrants and their mental health issues. Their framework provides an overview of important issues and different perspectives on mental health research regarding the migration of people of color, beginning with the emergence of the mental health problem and ending with the post- treatment period. More specifically, the model provides researchers a full-scale perspective on societal and cultural factors influencing mental health problems of immigrants in their acculturation process. As a result, this model is considered “an excellent theoretical framework for attempting to understand the phenomena of underutilization, premature termination, and reports of negative outcomes as they relate to the complexity of experiences of people of color with mental health services”

(Marbley, 2011, p. 8). More importantly, this conceptual framework has proven to be an appropriate framework to use for organizing research on other ethnic groups and people of color (Rogler, Malgady, & Rodriguez, 1989), such as Asians and Asian Americans,

African Americans, and Native Americans (Leong & Lau, 2001; Marbley, 2011).

Based on a hypothetical temporal sequence, the conceptual framework consists of five phases: (a) the emergence of mental health problems, (b) help-seeking behavior, (c) the evaluation of mental health, (d) psychotherapeutic services, and (e) post-treatment adjustment. The primary focus of this study was on the first two phases within the conceptual framework and identification and discussion of the relationships among

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Chinese international students’ acculturation, ethnic identity, language proficiency, and their attitudes toward seeking professional counseling. This chapter includes with the following subsections: (a) the emergence of mental health problems, and (b) help-seeking behavior.

Phase 1: The Emergence of Mental Health Problems

Phase 1 of the Rogler, Malgady, and Rodriguez (1989) model emphasizes the risk factors that result in the emergence of mental health problems in Hispanic and other populations. Due to the diverse methodologies used to study mental illness in the previous research, Rogler, Malgady, and Rodriguez (1989) indicated that the most appropriate approach is the one that may cover “a diversity of sociocultural and economic factors” (p. 14). As a result, researchers need to use a framework to provide clues to the comparative distribution of mental health problems and estimate “the extent to which a population utilizes mental health resources” (p. 14). The framework, accordingly, serves as a future direction of mental health development and research (Rogler, Malgady, &

Rodriguez, 1989).

Phase 1 of the study reported herein discusses the emergence of mental health problems among international student sojourners, especially Chinese international students. This phase consists of three important parts. First, international student sojourners in the United States are shown to be ethnically and racially marginalized.

Second, the chapter delineates culture shock and homesickness, which are considered the main factors affecting the mental health of international student sojourners. Last, acculturation, ethnic identity and language proficiency are described.

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Student Sojourners in the United States

According to the Institute of International Education (2011), 213,490 international students were enrolled in a U.S. institution in the fall of 2010, which represented an increase of 5.7% over the previous year. There were 296,574 graduate and 291,439 undergraduate international students between 2010 and 2011(Institute of International

Education, 2011). In 2011, the top five places of origin for international students in the

United States were China, which comprised 21.8% of total, India (14.4%), South Korea

(10.1%), Canada (3.8%), and Taiwan (3.4%). Students from these five nations made up

53.5% of all international students in the U.S. (Institute of International Education, 2011).

Based on the surveys and statistical reports from national and related institutes over the last 10 years, there is an obvious indication that the number of international students will continue to rise in the future. Specifically, the largest portion of international students will be from Asian countries such as India, South Korea, and China.

The trend of Chinese students traveling to study abroad gradually emerged after

1979. The combination of China’s economic growth and traditionally strong attitudes toward education (Greenhalgh & Edwin, 2005) has made it possible for many Chinese parents to send their children abroad for a better education. Although most of these parents are not unusually wealthy, they are willing to spend their entire life savings or even borrow from friends and relatives to finance their children’s studies abroad (Fong,

2008). Because of flexible visa and free tuition policies (Fong, 2008), a large number of

Chinese international students ranked some European countries as their first choice for studying abroad between 1980 and 2000. These students have become a major source of revenue for the educational institutions in European countries. As far as many Chinese

Texas Tech University, Jiaqi Li, December, 2013 parents are concerned, the opportunity to study in the United States usually belongs to those intellectual elite students who come from prestigious universities in China and are lucky enough to survive under the strict student visa policy. In the last ten years (2003-

2013), however, the U.S. government has gradually eased the restrictions on student visas, allowing more Chinese students to obtain a visa and fulfill their dreams of studying in the

United States. The economic and sociocultural influences of student sojourners on their host culture have become a major research interest (Bochner, 2006).

International students bring elements of diversity to American universities and enrich campus culture. However, a review of the recent literature has shown that Asian international students have difficulty integrating into the academic and social environment at predominantly White institutions (PWI) in the United States (Li, Liu, Wei,

& Lan, 2013; Sato & Hodge, 2009). The psychological well-being and academic performance of Asian international students can be greatly affected by these adjustment challenges if the culture of their home country is completely different from that of the host country. In order to change such cross-cultural challenges, researchers categorize international students as sojourners or student sojourners and place emphasis on their psychological and behavioral adaptation. Bochner (2006) defined the term sojourner as

“an individual who travels abroad to attain a particular goal within a specified period of time” (p. 181). Compared with immigrants or refugees, sojourners belong to a typical population with distinct characteristics. First, they will stay in the host country for a short period of time and then return to their country of origin. During the sojourn period, they often are partially acculturated because of their limited cross-cultural contracts (Bochner,

2006). Second, Hamann (2001) suggested that student sojourners be added to the

Texas Tech University, Jiaqi Li, December, 2013 taxonomies of transnational migrants and of students. He also described student sojourners as having “vulnerability to dislocation” and having “transnational backgrounds” (Hamann, 2001, p. 32).

To date, many theoretical frameworks have been proposed and developed as significant foundations for a rounded analysis of the student sojourner and the related acculturation. In terms of offering a perspective on social support, Bochner’s functional model of friendship networks shows that student sojourners belong to three distinct social networks related to their psychology health (Bochner, McLeod, & Lin, 1977). The primary network concentrates on bonding with people from the same country or culture.

The other two networks consist of relationships with noncompatriot foreign students and people from the host culture, including students, professors, friends, counselors, and other school staff. This model mainly reflects cultural learning and social support in the international student community. The last studies are influenced more by social psychology and education. For instance, Ward, Bochner, and Furnham (2001) proposed an ABC model of acculturation to guide the research on social groups, especially for immigrants. The theoretical framework focuses on affective, behavioral, and cognitive reactions of the sojourners when they are exposed to a new culture. These theories cover various aspects of the student sojourners’ field and provide a significant theoretical foundation for researchers.

Culture Shock

Traditionally, the longitudinal studies on student sojourners have highlighted migration and mental health (Zhou, Jindal-Snape, Topping, & Todman, 2008). Influenced by the traditional perspectives, the majority of researchers agree that entering a new

Texas Tech University, Jiaqi Li, December, 2013 culture is potentially an uncomfortable and disorientating experience. In this regard, many studies emphasize negative aspects of exposure to a new environment in the mainstream literature (Zhou et al., 2008). In recent years, researchers have become more concerned about social and psychological problems of international students (Bochner,

2006; Ward, Bochner, & Furnham, 2001). Accordingly, a few new theories and models on sojourning have become well established under the direction of this research. These theories include Culture Learning Theory (Furnham & Bochner, 1986), Social Identity

Theory (Tajfel, 1981) and Acculturation Model (Ward et al., 2001), and they allow for new research to aim at a more comprehensive understanding of student sojourners.

For most international students, coming to a new environment is often considered a challenging event, and they inevitably experience some degree of culture shock (Berry,

1997). Bochner (2006) defined culture shock as the sojourners’ reactions that result from anxiety, feelings of disorientation, and confusion. These kinds of reactions vary according to the individual’s situation and ability to adapt. For instance, some student sojourners may adjust to a new environment while others may not. Moreover, the length of time they spend on the process of adaptation can vary. In the early literature, researchers assumed that student sojourners usually experience culture shock in a specific stage of adaptation. According to Oberg (1960), there are four sequential stages of adjustment: (a) Honeymoon stage of fascination: many students initially express optimism and envision a beautiful future after arriving at their new environment; (b)

Crisis stage of hostility (the culture shock stage): their positive feelings are replaced by hostility and aggression when they experience some difficulties related to adapting themselves to an unfamiliar society; (c) Recovery stage: they feel more adjusted; (d)

Texas Tech University, Jiaqi Li, December, 2013

Adjustment stage: they may cope with any difficulties by using a positive attitude. Later,

Brown (1980) further confirmed this kind of adaptation pattern and pointed out exactly when culture shock occurs in his acculturation model. His model also includes four sequential stages: exhilaration, culture shock, culture stress and adaptation. This pattern of adaptation has been called the “U-curve of adjustment” (Bochner, 2006; Brown &

Holloway, 2008). However, Bochner (2006) wrote that the “U-curve of adjustment” has been “contrasted with a linear learning curve of adjustment” (p. 190). For instance, some student sojourners might skip the honeymoon stage after arriving at a new environment and begin their transition directly with culture shock. Others might remain in the culture shock stage from the beginning and never achieve a smooth transition to the adaptation stage. In this sense, it seems to be very difficult to use “U-curve of adjustment” to classify student sojourners. As a result, some researchers who prefer a linear learning curve of adjustment would consider the adaptation period of student sojourners as a process of change. For example, individuals will feel stressed in the beginning, and then the pressure gradually decreases due to a number of variables (Ward, Bochner, &

Furnham, 2001).

As indicated, both theories have been thoroughly discussed in the literature

(Bochner, 2006; Ward et al., 2001). Nevertheless, the emergence and development of cultural learning theory, social identity theory, and acculturation theory have gradually changed the focus of research from curves to interactions between sojourning individuals and host societies (Bochner, 2006; Furnham & Bochner, 1986; Sam & Berry, 2006; Sato

& Hodge, 2009). Bochner (2006) addressed the point that the degree and quality of engagement with the host culture play a vital role in sojourner adjustment. For instance,

Texas Tech University, Jiaqi Li, December, 2013 the more acculturated student sojourners become in the process of adaptation, the better they tend to do in the new academic and social environment. If this “integration” phenomenon is explained by Berry’s acculturation theory (1974, 2006, 2011), it often includes two aspects: individual and society. As an individual unit, a student sojourner will involve the maximal learning from the dominant society and minimal forgetting of his or her heritage culture (Berry, 2011). In the process of adaptation, individuals acquire the main features of the host society including language, norms, values, and skills important to their survival (Berry, 2011). As a reward, they may obtain their goals of sojourning and even contribute to society within an inclusive cultural context. As far as integration is concerned, Berry (2011) has provided a vision of how to live in a pluralistic society. First, it includes the recognition and acceptance of cultural diversity as a valuable part of society by all of its communities. Second, the concept of an “equitable participant” is promoted by all groups within the society (Berry, 2011, p. 216). All cultural groups have an equal right to education, work, health care, and justice.

Homesickness

Many researchers have considered homesickness as a component of culture shock to be a major problem for international students (Fisher & Hood, 1987; Poyrazli & Lopez,

2007; Tognoli, 2003). Thurber and Sigman (1998) defined homesickness as “distress or impairment caused by an actual or anticipated separation from home” (p. 903). Based on the definition, it is easy for us to detect homesickness among international students who are studying abroad. They leave their families, friends, and countries in pursuit of an academic career in a new cultural environment. Therefore, it is not surprising that every subject in the entire Chinese international student sample in Lu’s study (1990) in Great

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Britain and most international college students reported feelings of homesickness in the

United States (Yi, Giseala Lin, & Kishimoto, 2003).

As a byproduct of culture shock (Poyrazli & Lopez, 2007), homesickness in college students has negative and lasting influences on their physical and psychological well being (Fisher & Hood, 1987; Van Tilburg, Vingerhoets, & Van Heck, 1996, 1997).

Ward, Bochner, and Furnham (2001) found that homesickness among international students usually occurs with feelings of alienation, anxiety, depression, rejection and loss, hopelessness, and low self-esteem. The level of homesickness is related to the student’s ability to adapt to a new environment (Fisher & Hood, 1987). In their longitudinal study,

Fisher and Hood (1987) found that college students who reported homesickness received low scores on adaptation to the college environment and higher scores on anxiety, depression, and somatic and obsessional symptoms. Moreover, According to the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR;

American Psychiatric Association, 2000), severe homesickness may be diagnosed as an adjustment disorder with mixed anxiety and depressed mood (diagnostic code 309.28)

(Thurber & Walton, 2007).

Many researchers have indicated that homesickness consists of three factors: age and gender, social support, and cultural difference (Eurelings-Bontekoe, Brouwers, &

Verschuur, 2000; Kazantzis & Flett, 1998; Poyrazli & Lopez, 2007; Stroebe, Vlier, &

Hewstone, 2002; Van Tilburg, Vingerhoets, & Van Heck, 1997). First, in the investigation of 100 first-year university students (age range 18 to 33), Kazantzis and

Flett (1998) found that demographic factors, especially age (e.g., 18-33), may contribute to the experience of homesickness. Stroebe, Vliet, and Hewstone (2002) conducted

Texas Tech University, Jiaqi Li, December, 2013 research on all new-intake college students both in the Netherlands and the UK and similarly found that female students experienced more homesickness. Second, Van

Tilburg, Vingerhoets, and Van Heck (1997) wrote that individuals who lack social support reported higher levels of homesickness than the ones who had social support.

Finally, the greater the difference between home and host cultures, the greater the degree of homesickness experienced (Eurelings-Bontekoe et al., 2000; Poyrazli & Lopez, 2007).

Yeh and Inose (2003) found that European international students in the United States reported less stress from culture shock than did Asian, African, and Latin American students, because their home culture was more similar to that of their host culture.

Acculturation

The term acculturation strategies refers to the ways immigrants prefer to live in plural societies (Berry, 1977). Immigrants work out strategies with respect to two dimensions: home cultural maintenance and host culture adoption. Berry (1970, 1977) classified acculturation strategies under four domains: assimilation, integration, separation, and marginalization. In order to have a deep understanding of acculturation strategies, the literature suggests that we begin with acculturation and its impact on people (Berry, Phinney, Sam, & Vedder, 2006; Sam & Berry, 2006).

The definitions of acculturation vary according to the time. Many scholars agree on the classic definition of acculturation which originated in anthropology (Berry et al.,

2006; Sam & Berry, 2006) and was given by Redfield, Linton, and Herskovits (1936):

Acculturation comprehends those phenomena which result when groups of

individuals having different cultures come into continuous first-hand contact, with

subsequent changes in the original culture patterns of either or both groups…

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under this definition acculturation is to be distinguished from culture change, of

which it is but one aspect, and assimilation, which is at times a phase of

acculturation. It is also to be differentiated from diffusion, which while occurring

in all instances of acculturation, it is not only a phenomenon which frequently

takes place without the occurrence of the types of contact between peoples

specified in the definition above, but also constitutes only one aspect of the

process of acculturation. (pp. 149-152)

In 1954, the concept of acculturation was further expanded and improved.

According to the Social Science Research Council (1954), acculturation was defined as:

Acculturative change may be the consequence of direct transmission; It may be

derived from noncultural causes, such as ecological or demographic modifications

induced by an impinging culture; it may be delayed, as with internal adjustments

following upon the acceptance of alien traits or patterns; or it may be a reactive

adaptation of traditional modes of life. Its dynamics can be seen as the selective

adaptation of value systems, the processes of integration and differentiation, the

generation of developmental sequences, and the operation of role determinants

and personality factors. (p. 974)

By 2004, a more formal definition was proposed by the International Organization for Migration (IOM). Their definition stated:

The progressive adoption of elements of a foreign culture (ideas, words, values,

norms, behaviors, institutions) by persons, groups or classes of a given culture.

The partial or total adaptation is caused by contacts and interactions between

different cultures through migration and trade relations. (p. 5)

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Acculturative Stress

As outlined by the above definitions, acculturation is considered a cultural contact and learning process on both group and individual levels. Berry (2006) wrote that two types of changes occur in the process of acculturation: cultural and psychological changes, and changes that generate stress for the group and individual. The concept of acculturative stress was proposed by Berry (1970), and is similar to the concept of culture shock in the literature (Berry, 2006). According to Berry, acculturative stress is “a response by people to life events that are rooted in intercultural contact (Berry, 2006, p.

43)”. Compared to culture shock, acculturative stress is considered a more positive concept, because it not only includes some psychological stressors of culture shock such as depression and anxiety, but also provides various strategies for how to cope with negative feelings and experiences (Berry, 2006).

Berry (1997) developed a theoretical framework that outlines the acculturative stress process as well as the factors affecting acculturative stress and adaptation (see

Figure 2.1). This framework represents a completed process of psychological acculturation, beginning with group and individual-level acculturation experience (e.g., participation, and problems), going through acculturative stress (e.g., problem appraisal, anxiety, and depression), and ending with adaptation (e.g., coping strategies and health).

Emphasis is placed on the impact of society of origin (e.g., political context, economic situations, and demographic factors) on the individual prior to acculturation, as well as the impact of his or her society of settlement (e.g., attitude and social support from the larger and the ethnic society). Moreover, Berry proposed that several group and individual moderating factors could affect the acculturation and adaptation process. First,

Texas Tech University, Jiaqi Li, December, 2013 factors prior to acculturation include age, gender, education, religion, health, language, social status, motivation, and cultural distance. Second, factors affecting acculturation include social support, societal attitudes, coping strategies, and discrimination. As indicated in Figure 1, these factors have a significant impact on appraisal of stressors, strategies used, and long-term outcomes in a cross-cultural process. According to Berry, the importance of factors affecting both groups and individuals in the process of acculturation is that they are defined as “risk factors and protective factors” (Berry, 2006, p. 46). The risk and protective factors include language difficulties, loss/nostalgia, and perceived discrimination (Aroian, Norris, Tran, & Schappler-Morris, 1998).

Figure 2.1.

A Framework for Acculturative Stress Research (Berry, 1997)

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Note. Graphic rendering of the framework for acculturation stress research. Adapted from

Immigration, acculturation, and adaptation, by John Berry, 1997 in Applied Psychology:

Applied Psychology. Adapted with permission.

Acculturation Theory

Based on Berry’s acculturative stress model (Berry, 1997), acculturative stress results from contact between two distinct cultural groups and can cause psychological distress. Williams and Berry (1991) defined acculturative stress as one kind of stress, “in which the stressors are identified as having their source in the process of acculturation, often resulting in a particular set of stress behaviors that include anxiety, depression, feelings of marginality and alienation, heightened psychosomatic symptoms, and identity confusion” (p. 634). If culture shock is a term for sociologists, acculturative stress can definitely be included in the field of psychology. Acculturative stress from the perspective of psychologists and counselors represents serious symptoms including anxiety, depression, suicidal ideation, lowered self-esteem, and other mental health problems (Berry, Phinney, Sam, & Vedder, 2006; Williams & Berry, 1991). In a review of the literature, researchers attempted to identify the factors that have significant influence on acculturative stress and concluded them to be acculturation patterns, immigration status, ethnic identity, gender, age, language fluency, personality and cognitive ability, and cultural pluralism in the host society (Berry, 1977; Williams &

Berry, 1991).

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In addition, acculturation strategies are another important factor affecting acculturative stress (Williams & Berry, 1991). Berry (2003) proposed a theoretical framework to illustrate the relationships between intercultural contact and cultural maintenance in immigrant groups in Figure 2.2. The sector of the circle on the left identifies four acculturation strategies: (a) integration (e.g., individuals maintain their identity with home culture, but also want to absorb some characteristics of the host culture), (b) assimilation (e.g., people abandon their identity from their home culture and accept the host culture), (c) separation (e.g., individuals separate themselves from the host culture), (d) marginalization (e.g., they neither accept the host culture nor the home culture). The sector of the circle on the right represents the social policy used by the larger society to deal with minority or outside cultures: (a) multiculturalism (e.g., cultural diversity and integration is accepted by the larger society), (b) melting pot (e.g., assimilation is preferred or sought by the dominant group within the larger society), (c) segregation (e.g., separation is enforced by the dominant group), (d) exclusion (e.g., marginalization is imposed by the dominant group). Berry, Kim, Minde, and Mok (1987) emphasized that individuals who feel marginalized or tend to remain separate tend to be highly stressed; in contrast, those who seek integration tend to be minimally stressed; while assimilation results in intermediate levels of stress.

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Figure 2.2.

Acculturation Patterns of Immigrant Groups and of the Larger Society (Berry, 2003)

Note. Acculturation Patterns of Immigrant Groups and of the Larger Society. Adapted from Conceptual approaches to acculturation, by John Berry, 2003, In K. M. Chun, P.

Balls Organista, and G. Marín (Eds.), Acculturation: Advances in theory, measurement, and applied research (pp. 17-37). Washington, DC: American Psychological Association. doi:10.1037/10472-004. Copyright © 2003 by American Psychological Association.

Adapted with permission.

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Ethnic Identity

Closely related to acculturation is ethnic identity which has been regarded as another important factor in examining an individual’s sense of self in terms of membership in a particular ethnic group (Helms, 1993; Phinney, 1992; Romero &

Roberts, 2003). Broadly speaking, it was included in the term cultural identity, and studied along with national identity as a dimension of cultural identity (Phinney, Berry,

Vedder, & Liebkind, 1996). Phinney (1990) indicated that ethnic identity may be considered a key aspect of acculturation, and to an extent may provide the evidence necessary to identify a particular ethnic group or culture of origin. In brief, ethnic identity was defined as “a sense of group or collective identity based on one’s perception that he or she shares a common heritage with a particular racial group” (Helms, 1993, p. 3).

Many researchers have indicated that ethnic identity belongs to a multifaceted construct with various dimensions (Ashmore, Deaux, & McLaughlin-Volpe, 2004;

Phinney & Ong, 2007; Romero & Roberts, 2003). The dimensions depend on how an individual identifies self. For instance, an individual may choose to identify with a single aspect of self (e.g., gender or sexual orientation or race) or multiple aspects of self (e.g., white and gay; father and solider). Based on the overview of the dimensions of ethnic identity in the literature, Phinney and Ong (2007) summarized seven significant aspects of ethnic identity. They include: (a) self-categorization and labeling (e.g., individuals may use different labels or categories to identify themselves as members of a particular ethnic group, (b) commitment and attachment (e.g., a commitment or sense of belonging to a certain ethnic group), (c) exploration (e.g., exploring information and experiences that are related to one’s ethnicity), (d) ethnic behaviors (e.g., ethnic practices and social

Texas Tech University, Jiaqi Li, December, 2013 interactions relevant to one’s ethnicity), (e) evaluation and in-group attitudes (e.g., a strong sense of belonging to an ethnic group or a positive attitude toward one’s group), (f) values and beliefs (e.g., specific to an ethnic group), and (g) importance and salience (e.g., member of the minority group attributing more importance to his or her ethnicity than attributed by members of the dominant majority). To illustrate it clearly, an example is provided. A Chinese international male student is likely to label himself as a male

Chinese, have a strong sense of belonging to Chinese, be willing to know information regarding his culture, be willing to participate in social activities that are related to

Chinese culture, have values and beliefs that are related to Chinese culture, and contribute more to his country than do members of other ethnic groups. Therefore, these component parts of an ethnic identity provide a framework by which we can categorize and assess the construct of an ethnic identity. The framework was used in the Multigroup

Ethnic Identity Measure instrument (Phinney, 1992).

In recent years, researchers have examined ethnic identity among individuals from different ethnic groups (Ashmore, Deaux, & McLaughlin-Volpe, 2004), as well as the way in which ethnic identity has been associated with different psychosocial adjustment, such as psychological well-being among Asian Americans and Asian international college students (Iwamoto & Liu, 2010), race-related stress among African

American college students (Johnson & Arbona, 2006), and body dissatisfaction and disordered eating (Wood & Petrie, 2010). In these studies reviewed, researchers measured ethnic identity by using the Multi-group Ethnic Identity Measure (e.g., MEIM;

Phinney, 1992). MEIM assesses identity along two domains, including exploration (e.g., learning and seeking information about and becoming involved in an ethnic group) and

Texas Tech University, Jiaqi Li, December, 2013 commitment (e.g., commitment to and sense of belonging to an ethnic group). Phinney

(1990) indicated that ethnic identity may be considered a two-dimensional process (see

Figure 2.3), while examining the relationship between minority and dominant cultures.

According to this view, if an individual belonging to an ethnic minority has a strong identification with the majority group, he or she will likely have two attitudes toward the acculturation process: integrated/acculturated/bicultural or assimilated. For instance, if a minority individual still maintains a strong identification with his or her own ethnic group, he or she is considered to be integrated/acculturated/bicultural. On the other hand, if such an individual maintains a weak identification with his or her own ethnic group, he or she is called assimilated.

Figure 2.3.

Terms Used for Four Orientations

Items Identification with ethnic group

Identification with majority Strong Weak group

Strong Acculturated/Integrated/Bicultural Assimilated

Weak Ethnically Marginal

identified/Separated/Dissociated

Note. Terms used for the four orientations are based on the degree of identification with both one’s own ethnic group and the majority group. Adapted from “Ethnic identity in adolescents and adults: Review of research” by Jean Phinney, 1990. Psychological

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American Psychological Association, Inc. Adapted with permission.

Language Proficiency

In addition to acculturation and ethnic identity, language proficiency can serve as another important component of studies on mental health services in the international student population. Past studies have indicated that language proficiency and use have been key factors in acculturation and multicultural counseling research (Brown, 1980;

Sue & Sue, 2007; Yeh & Inose, 2003). Many researchers found that low English proficiency among immigrants had been considered a barrier to seeking professional counseling services (Berry, 1997; Berry, Phinney, Sam, & Vedder, 2006; Furnham &

Bochner, 1986; Furnham & Trezise, 1983; Kung, 2003; Kung, 2004; Marbley, 2011; Sam

& Berry, 2006; Sentell, Shumway, & Snowden, 2007; Sue & Morishima, 2007; Sue &

Sue, 2007; Ward & Furnham, 2001; Wu, 2010; Zhang, Snowden, & Sue, 1998).

According to Sentell, Shumway, and Snowden (2007), the effect of a language barrier on clients is obvious because much of mental health diagnosis and treatment depends on direct communication instead of objective tests or medication. They also found that limited English-language proficiency among Asian clients prevented them from seeking needed mental health services (2007). In their investigation of 55,428

California households, 50% of the Asian respondents who spoke only English reported that they received needed mental health services. In contrast, only 11% of Asian respondents who did not speak English received similar services. Shi, Lebrun, and Tsai

(2009) concluded that English-language competency may also be associated with health literacy. In their analysis of 29,868 families, they found that individuals with limited

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English-language proficiency have more difficulty acquiring health information about important health care services than English-proficient ones. They also concluded that

Asians with limited English may be less acculturated to Western health care and depend more heavily on complementary and alternative help.

Furthermore, Sue and Sue (2007) considered counselors’ use of Standard English a barrier to clients from a bilingual or lower-class background using mental health services. In therapy, if a client has poor verbal skills, the likely result would be therapists misunderstanding the client’s problems or motives (Sue & Sue, 2007). Such a client will likely be seen as “uncooperative, sullen, negative, nonverbal, or repressed on the basis of language expression alone” (Sue & Sue, 2007, p. 153).

Phrase 2: Help-Seeking Behavior

According to Rogler, Malgady, and Rodriguez (1989), Phase 2, as the second stage of a hypothetical temporal sequence, concerns immigrants’ experience of mental health problems and the subsequent help-seeking behaviors. Based on the characteristics of the groups introduced in the previous research, ethnic minority clients such as Asians and Asian Americans, African Americans, Hispanics, and Native Americans (Leong &

Lau, 2001; Marbley, 2011; Rogler, Malgady, & Rodriguez, 1989), are less likely than

Caucasian Americans to seek the help of professional mental health services.

Accordingly, following the questions posted in Phase One, this section focuses on factors which explain ethnic minority utilization of mental health facilities.

In Phase 2, emphasis is placed on the factors involved in underutilization of mental health services due to cultural barriers among Chinese international students. First, underutilization of mental health services among international students in general is

Texas Tech University, Jiaqi Li, December, 2013 discussed. Following that is the introduction to cultural determinants of the help-seeking model (Saint Arnault, 2009) and its application. This mode covers four sections, including (a) misconception (e.g., corresponding to perception and labeling in the mode),

(b) loss of face (e.g., causal attributions), (c) collectivism and individualism (e.g., social significance), and (d) alternative resources (e.g., availability of resources).

Underutilization of Mental Health Services

The underutilization of mental health services by people of color is “well- documented,” and it is a “complex, multitiered, macrolevel problem” (Marbley, 2011, p.

15). Researchers have concluded that Asians and Asian Americans underutilize mental health services in comparison to most other ethnic groups such as white Americans (Kim

& Omizo, 2003; Marbley, 2011; Zhang, Snowden, & Sue, 1998). Zhang, Snowden, and

Sue (1998) posited that each Asian-American culture may have a distinct influence on help-seeking and utilization patterns of its descendants. Zhang , Snowden, and Sue (1998) also found from their samples of 161 Asian Americans and 1,332 Caucasian Americans that the low rate of utilization of mental health services among Asian Americans is due to this population’s preference for friends or relatives rather than professionals when it comes to sharing mental distress. These results are further supported by another study that examined Vietnamese Americans’ use of mental health services and expanded the theory that acculturation and cultural barriers were significantly associated with positive attitudes toward seeking psychological help (Luu, Leung, & Nash, 2009).

From the perspective of a client, Kung (2004) categorized the barriers to Asian

Americans’ use of mental health services as cultural and practical barriers. Cultural barriers include (a) clients’ perception of the relevance and credibility of mental health

Texas Tech University, Jiaqi Li, December, 2013 treatment, (b) clients’ denial of need for service, and (c) fear of stigma and loss of face.

Practical barriers are (a) knowledge of access, (b) cost of treatment and time, and (c) the language barrier.

In addition, Wu (2011) provided a shorter explanation for the underutilization of community mental health services by Chinese Americans. Based on a total sample of 152

Chinese international students, Wu (2011) identified several possible factors that impede

Chinese international students from seeking professional counseling help. They are (a) misconceptions about psychological/mental illness and treatments, (b) strong cultural stigma and shame associated with psychological problems, (c) availability of alternative resources to psychological therapies, and (d) the language barrier.

From a mental health practitioner’s point of view, Sue and Sue (2007) concluded there were three major potential barriers affecting multicultural therapy: (a) class-bound values, (c) language bias/misunderstanding, and (d) culture-bound values. First, class- bound values include three important aspects: “(a) low socioeconomic class presents stressors to people, especially those in poverty, and may seriously undermine the mental and physical health of clients, (b) financial failure of helping professionals to understand the life circumstance of clients who lack finical resources, and their unintentional class biases may affect their ability to delivery appropriate mental health services, and (c) classism and its discriminating nature can make its appearance in the assessment, diagnosis, and treatment of lower SES clients” (Sue & Sue, 2007, pp. 149-150). Secondly, language bias is that “culturally different client’s communication in English may limit the person’s ability to progress in counseling/therapy, and it may lead many therapists to impute inaccurate characteristics or motives to him/her” (Sue & Sue, 2007. pp. 152-153).

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Finally, culture-bound value means that “culture consists of all those things that people have learned to do, believe, value, and enjoy. It is the totality of the ideals, beliefs, skills, tools, customs, and institutions into which each member of society is born” (Sue & Sue,

2007, p. 140).

Help-Seeking Theory

Saint Arnault (2009) developed a theoretical framework for examining the cultural determinants of help-seeking behavior among Asian Americans and immigrants.

This model purports to explore the cultural factors of seeking help to maintain wellness and relieve distress, as well as explain the influence of individual perception and experience on help-seeking behavior and attitude. Due to the cultural focus of this theoretical framework, the model provides researchers with an in-depth perspective on the phenomenon of seeking mental health services by people of color. This model also allows for research to emphasize the individual and societal factors that have an influence on making a help-seeking decision. These significant factors include (a) perception and labeling, (b) causal attributions, (c) social significance, (d) availability of resources, and

(e) exchange rules. These factors are explained in the following paragraphs.

Perception and labeling. Perception and labeling explain how people experience, interpret, and label their internal sensations based on their cultural knowledge and experience. Saint Arnault (2009) demonstrated that people usually label their physical or emotional sensations as “signs of wellness” when these “signs” are interpreted as

“desired, valued, ideal, or optimal states” (p. 265). However, when interpreted as “an abnormal state, a disturbance, a pathology, or an illness” (p. 265), physical sensations or emotions are considered “symptoms.” According to either sign or symptom, people

Texas Tech University, Jiaqi Li, December, 2013 evaluate the level of severity of their wellness problems (Saint Arnault, 2009). Due to cultural differences, minority clients usually use different labeling for the same issue or sensation.

Causal Attributions. According to Saint Arnault (2009), causal attributions are the indicators of causes of signs or symptoms. Saint Arnault (2009) proposed that there are three significant factors affecting these interpretations. They include (a) shared conceptualizations about the body, (b) the nature of the healthy self, and (c) what symptoms signify a condition outside the range of normal. According to Saint Arnault

(2009), these factors provide “culturally specific explanations about how health and wellness are achieved as well as the causes of distress and illness” (p. 264). As a consequence, individuals make three types of interpretations for causes of their signs or symptoms. They include (a) somatic interpretation (the attribution of physical sources of wellness or distress), (b) psychological interpretation (emotional sources), and (c) environmental interpretation (social or environmental sources) (Saint Arnault, 2009).

Social Significance. Social significance focuses on the influence of a social standard or social acceptance on the individual’s evaluation of his or her signs or symptoms. Saint Arnault (2009) reported that signs of wellness may be evaluated in a positive way as socially desirable, while symptoms of distress signify that a person has failed in a social role. When people evaluate their distress as negative and socially unacceptable, they will have “emotional responses of shame, humiliation, anxiety, or fear”

(p. 264).

Availability of Resources. Saint Arnault (2009) demonstrated the impact of groups or individuals on the availability of social resources and the distribution of social

Texas Tech University, Jiaqi Li, December, 2013 resources in both a group-oriented and an individual-oriented system. As he indicated, within a group-oriented system, resources are understood to be available to group members for the benefit of the group, and family is described as “the primary vehicle of support and nurturance of the individual” (p. 265). On the contrary, resources are distributed by the group to the individual within an individual-oriented system and individuals should be responsible for their health.

Exchange Rules. Exchange rules refer to “the guidelines about the exchange of support and help within the perceived social resources” (Saint Arnault, 2009, p. 265).

Saint Arnault (2009) reported that a group-oriented system expects its members to ask for assistance “only from known, intimate, or in-group members” and repay the favor to other people within the in-group (p. 265). In an individual-oriented system, however, people are expected to seek help “only when they cannot do for themselves” and repay the favor within a short time frame (p. 265).

Barriers to Help-Seeking Behavior among Chinese International Students

Misconception

In general, counseling is described as a process of interpersonal communication and interaction, with a focus on emotional, social, health-related, and developmental concerns. Talking about psychological problems and seeking counseling services are often viewed as fairly normal in Western culture. However, mental disorders and counseling are foreign concepts to people in the Eastern cultures. Based on the literature,

Kung (2003) concluded that psychological problems in Asian countries are explained as a result of “malingering bad thoughts,” “a lack of will power,” and “personality weakness”

(p. 29). For instance, people with mental disorders in China are labeled as having

Texas Tech University, Jiaqi Li, December, 2013

“inherited weakness, spiritual unrest, bad karma, or a character weakness” (ChinaSource,

2010). Traditionally, Chinese theories of medicine have attributed mental health problems to imbalances in nature and considered the goal of achieving balance as treatment (Cook, Lei, & Chiang, 2010). Moreover, during the Cultural Revolution (1964-

1976), China’s government had declared psychology and psychiatry to be counter- revolutionary and dangerous to society (Lim, Lim, Michael, Cai, & Shock, 2010;

Thomason & Qiong, 2008). As a result, the development of psychotherapy in the universities and hospitals was interrupted, with many psychologists exiled to the countryside (Lim et al., 2010; Thomason & Qiong, 2008). After the Cultural Revolution ended, China gradually restored psychotherapy, and education and research became open to the ideas of American psychology (Jing, 1994). With such a historical and cultural background, the development of counseling services in China is far behind those of their counterparts in the West.

Loss of face

One barrier to help-seeking behavior is the perception of loss of face (or called mental health stigma) (Kramer, Ton, & Lu, 2008). Culture shapes the expression and recognition of mental illness. Researchers have found that loss of face associated with mental illness stigma is a critical factor influencing decision-making on seeking professional mental health services among Asians and Asian Americans (Kam & Bond,

2008; Leong, Kim, & Gupta, 2011; Sue & Sue, 2006). Sue and Morishima (1982) explained loss of face as a threat or loss of social integrity in interpersonal relationships among Asian Americans.

Texas Tech University, Jiaqi Li, December, 2013

Loss of face is a social phenomenon related to loss of status and stigma. It stemmed from cultural views of mental illness. For instance, an individual following the ideas of traditional Chinese culture (Confucianism, Buddhism, and Taoism) is accustomed to viewing a symptom of mental illness as personality weakness. According to Kung (2003), many Asian American clients believe that they have the ability to overcome such a weakness, and refuse to seek professional psychological help because admitting the presence of a psychological problem amounts to loss of face. Moreover, seeking counseling services and receiving psychological therapy will be viewed as bringing shame to oneself and family (Root, 1985). As indicated in the study of 134

Asian American undergraduates, Leong, Kim, and Gupta (2011) once again showed that cultural factors such as acculturation, loss of face, and misconception of mental health have a direct influence on attitudes of Asians and Asian Americans toward seeking professional counseling services.

Compared with the definition of a face that can be washed or shaved in Western culture, in Eastern cultures, especially China and Japan, the face is considered a symbol of dignity, honor, and prestige. Ho (1976) defined face as “the respectability and/or deference which a person can claim for himself from others, by virtue of the relative position he occupies in his social network and the degree to which he is judged to have functioned adequately in that position as well as acceptably in his general conduct” (p.

883). In China and Japan, face plays a vital role in maintaining the interpersonal harmony in a social network. For many Chinese and Chinese Americans, face is part of a sociocultural phenomenon deeply rooted in the popular psyche. Lin (1935) stated that people’s lives are focused on the issue of face. To that extent, the Chinese language

Texas Tech University, Jiaqi Li, December, 2013 features many ways of discussing face, including: (a) granting face (giving someone a chance to regain lost honor); (b) losing face; (c) fighting for face (seeking respect and honor); and (d) giving face (showing respect toward someone’s feelings) (Lin, 1935).

More importantly, loss of face means that an individual or group is directly or indirectly disgraced and humiliated due to criticism, ridicule and noncooperation from others in communicative interactions (Brown & Levinson, 1987). The consequences of such disgrace or humiliation vary depending on “how much” face has been lost and individual circumstances. Generally speaking, the individual usually feels shame when he or she loses face. In extreme cases, losing face can result in suicide when family honor is at stake, and on a national level, the phenomenon can lead to war when national honor is seen to be under attack.

Individualism and collectivism

According to the principles of multicultural counseling competencies (Arredondo,

Toporek, Brow, Jones, Locke, Sanchez, & Stadler, 1996), a culturally skilled counselor is one who not only has specific knowledge and understanding of his or her own values, attitudes, and biases and how they affect the counseling process, but also possesses such information about his or her clients. In the multicultural counseling literature, the individual’s needs, desires, and values are usually elucidated and studied in the dimension of individualism and collectivism (Bellon, 2010; Tata & Leong, 1994;

Williams, 2003).

The scholarly focus on the concept of individualism-collectivism (I-C) originated from the five dimensions (e.g., power distance, uncertainty avoidance, individualism- collectivism, masculinity-femininity, and long-term versus short-term orientation)

Texas Tech University, Jiaqi Li, December, 2013 proposed by Hofstede in 1980. Based on Hofstede’s study, a great number of researchers began to adopt the use of the dimension of I-C to explain cultural differences in human beliefs and behaviors (Bellon, 2010; Chiou, 2001; Darwish & Huber, 2003; Tata &

Leong, 1994; Williams, 2003). Hofstede (1980) indicated that individualism-collectivism reflects cultural values and needs between Eastern and Western cultures. Moreover, he defined individualism as a situation in which an individual centralizes his or her immediate family and personal needs (Hofstede, 1980). Collectivism, on the contrary,

“stands for a society in which people from birth onwards are integrated into strong, cohesive in-groups, which throughout people’s lifetime continue to protect them in exchange for unquestioning loyalty” (Hofstede, 1991, pp. 260-261). Generally speaking, the cultures of Western countries and white counselors are considered to favor individualism whereas the cultures of Eastern countries and Asian clients lean toward collectivism. Therefore, individualism and collectivism are usually theorized to have a critical influence on counselors’ and clients’ beliefs, views, and attitudes toward the counseling process (Tata & Leong, 1994; Williams, 2003). For example, compared with

Caucasian clients, Asian clients are more reluctant to open themselves up and prefer to exclude personal issues regarding their families during counseling. They prefer to talk to a counselor from the same or similar cultural group, because they believe that a therapist who endorses individualism is unable to understand them or provide appropriate solutions to problems stemming from a collectivist culture.

Alternative resources

Another important factor influencing help-seeking and underutilization of counseling services is that many Asians and Asian Americans have alternative resources

Texas Tech University, Jiaqi Li, December, 2013 to deal with psychological issues. Marbley (2011) described resources as indigenous support systems, which refer to “the sources of help that occur naturally within the traditions of many non-European, non-Western cultures” (p. 15). She (2011) wrote that there are contemporary and traditional indigenous systems existing as viable healing and helping networks among people of color. In Asian, Native American, African, and

Hispanic cultures, such support systems are very common (Kung, 2003; Marbley, 2011;

Rogler, Malgady, & Rodriguez, 1989).

In Chinese culture, this can mean people traditionally rely on Chinese medicine and nutritional practices (such as using herbs and creating proper nutritional balance using the concept of yin and yang) (Hessler, 1975; Sue & Morishima, 1982). Chinese people also traditionally believe that herbalists or acupuncturists are able to solve their emotional problems (Kung, 2003). For example, in Kung’s study of help-seeking behaviors among Chinese Americans (2003), 8% of the Chinese respondents with emotional problems reported that they did not seek professional help from mental health specialists. Instead, they chose herbalists, acupuncturists, ministers, or fortunetellers, which are all considered a part of traditional Chinese culture.

Summary

The research literature for each of two phases under investigation varies significantly in scope. In phase 1, many important factors related to mental health problems of Chinese international students are discussed, including culture shock (Zhou,

Jindal-Snape, Topping, & Todman, 2008), homesickness (Fisher & Hood, 1987; Poyrazli

& Lopez, 2007; Tognoli, 2003), acculturative stress (Berry, 1997), ethnic identity (Helms,

1993; Phinney, 1992; Romero & Roberts, 2003), and language proficiency (Berry, 1997;

Texas Tech University, Jiaqi Li, December, 2013

Berry, Phinney, Sam, & Vedder, 2006; Furnham & Bochner, 1986; Furnham & Trezise,

1983; Kung, 2003; Kung, 2004; Marbley, 2011; Sam & Berry, 2006; Sentell, Shumway,

& Snowden, 2007; Sue & Morishima, 2007; Sue & Sue, 2007; Ward & Furnham, 2001;

Wu, 2010; Zhang, Snowden, & Sue, 1998).

In phase 2, the help-seeking behavior literature describes the underutilization of mental health services by Chinese international students, which may be due in part to different barriers. Based on Saint Arnault's (2009) theoretical framework for examining the cultural determinants of help-seeking behavior among Asian Americans and immigrants. Several of major barriers to help-seeking behavior among Chinese international students are discussed, including misconception (Kung , 2003), loss of face

(Kam & Bond, 2008; Leong, Kim, & Gupta, 2011; Sue & Sue, 2006), individualism and collectivism (Arredondo, Toporek, Brow, Jones, Locke, Sanchez, & Stadler, 1996), and alternative resources (Kung, 2003; Marbley, 2011; Rogler, Malgady, & Rodriguez, 1989).

Texas Tech University, Jiaqi Li, December, 2013

CHAPTER III

METHODOLOGY

Introduction

Based on the literature review in Chapter 2, this present study is designed for two purposes. The primary purpose is to examine the relationship between Chinese international students’ acculturation, ethnic identity, language proficiency, and their attitudes toward seeking professional counseling services. Within the purpose, there are three subpurposes included: (a) examining the role of acculturation, ethnic identity, and

English proficiency, collectively, in understanding Chinese international students’ attitudes toward seeking professional counseling services; (b) finding among acculturation, ethnic identity, and English proficiency the most significant predictor or predictors of Chinese international students’ attitudes toward seeking professional counseling; (c) exploring how Chinese international students’ attitudes toward seeking professional counseling differ among acculturation strategies. The second purpose of the study is to help culturally skilled counselors gain the necessary knowledge and information about Chinese international students’ attitudes toward seeking counseling help. Accordingly, the research questions include: (a) Do acculturation, ethnic identity, and English proficiency of Chinese international students significantly explain their attitudes toward seeking professional counseling? (b) Among acculturation, ethnic identity, and English proficiency of Chinese international students, which variable or variables are significant predictors of their attitudes toward seeking professional counseling? (c) How are the Chinese international students’ attitudes toward seeking professional counseling services different across various acculturation strategies?

Texas Tech University, Jiaqi Li, December, 2013

This chapter outlines the methodology for answering the above research questions. It includes a description of participants, instruments, procedures, and data analysis methods. In the first section, participants are discussed. In the second section, measuring instruments and the procedures of administration are described. The third section articulates the data analysis methods employed to answer the research questions.

Participants

Prospective participants were from Chinese international students pursuing their baccalaureate or graduate degrees in a large southwestern research institution in the

United States. Participant inclusion in the current study was based on a specific set of criteria. The criteria included that all participants: (a) had valid student visas; (b) were currently enrolled in the target university; and (c) were from Mainland China.

Participants were recruited through an electronic mailing list of the local association of Chinese students. To order to protect identities of participants, the researcher requested the current president of association of Chinese students to distribute a recruitment E-mail to all members on the mailing list. Members who agreed to participate were directed to the online survey designed for this study. The recruitment E- mail template was Institutional Review Board (IRB) approved.

To estimate a minimum sample size, a software was used with an alpha value of .05, a statistical power level of .8, and a predictor of 3. The software yielded a sample size of 76 for the current study. A total sample of 135 Chinese international students participated in the study. Of the 135 participants, 26 students did not complete the survey, thus resulting in a sample of 109 participants who completed the survey.

Texas Tech University, Jiaqi Li, December, 2013

Instruments

Demographic Information Survey. The survey was designed to gather basic information on each participant (see Appendix A). Chinese international students who participated in the study were asked to provide the following information: gender, age, academic level, length of residency in the United States, marital status, religious background, and previous counseling experience. For example, the questions regarding previous counseling experience include: “have you sought professional counseling help

(e.g., social worker, counselor, & psychologist) in the United States?” This question requires respondents to provide “yes” or “no” answer. If “no” is selected, the participants will be requested to answer the following question regarding the reason why they did not seek professional counseling help. The follow-up question includes “I did not seek professional counseling help because” as well as three options: (a) “I am not aware of my problem that requires professional counseling help,” (b) sometimes I need help but I do not go, and (c) other reasons.

Measure of English Proficiency (TOEFL Scores). TOEFL (Test of English as a

Foreign Language) scores are shown as a reliable and valid measurement of English proficiency of learners learning English as a foreign language. It has been used by more than 8,500 colleges, agencies, and other institutions as a measure of international students’ ability to use and understand English at the university level (Educational Testing Service,

2012). TOEFL scores are based on participants’ performance on the questions in various areas of the test. For example, a TOEFL iBT (Internet-based Test) test includes four sections of reading, listening, speaking, and writing. In each section, scores range from 0-

30 and the total score of the test is between 0 and 120. Following is a descriptive

Texas Tech University, Jiaqi Li, December, 2013 interpretation of the TOEFL scores provided by the Educational Testing Service (ETS,

2012). For the current study, the English proficiency measure was obtained from participants’ self-reported TOEFL scores.

Figure 3.1.

TOEFL iBT Performance Rubric for Test Takers

Reading Skills

Scores Level Description

22-30 High Have a very good command of academic vocabulary and

grammatical structure; can understand and connect information,

make appropriate inferences and synthesize ideas, even when

the test is conceptually dense and the language is complex.

15-21 Intermediate Have a good command of common academic vocabulary, but

still have some difficulty with high-level vocabulary.

0-14 Low Have a command of basic academic vocabulary, but their

understanding of less common vocabulary is inconsistent; have

limited ability to understand and connect information.

Listening Skills

22-30 High Understand main ideas and important details, whether they are

stated or implied; distinguish more important ideas from less

important ones.

15-21 Intermediate Understand explicitly stated main ideas and important details,

especially if they are reinforced, but may have difficulty

understanding main ideas that must be inferred or important

Texas Tech University, Jiaqi Li, December, 2013

details that are not reinforced.

0-14 Low Understand main ideas when they are stated explicitly or marked

as important, but may have difficulty understanding main ideas

if they are not stated explicitly.

Speaking Skills

3.5-4.0 Good Indicate an ability to communicate personal experiences and

/26-30 opinions effectively in English. Overall, speech is clear and

fluent.

2.5-3.0 Fair Indicate an ability to speak in English about personal

/18-25 experiences and opinions in a mostly clear and coherent manner.

Speech is mostly clear with only occasional errors.

1.5-2.0 Limited Indicate some difficulty speaking in English about everyday

/10-17 experiences and opinions. Listeners sometimes have trouble

understanding you because of noticeable problems with

pronunciation, grammar and vocabulary.

0-1.0 Weak Have incomplete responses. Responses have contained little or

/0-9 no content and are difficult for listeners to understand.

Writing Skills

4.0-5.0 Good Lack imprecision slight in the summary of some of the main

/24-30 points, and/or use of English that is occasionally ungrammatical

or unclear.

2.5-3.5 Fair Have important idea or ideas missing, unclear or inaccurate;

/17-23 it may not be clear how the lecture and the reading passage are

Texas Tech University, Jiaqi Li, December, 2013

related; and/or grammatical mistakes or vague/incorrect uses of

words may make the writing difficult to understand.

1.0-2.0 limited Lack understanding of the lecture or reading passage;

/1-16 deficiencies in relating the lecture to the reading passage; and/or

many grammatical errors and/or very unclear expressions and

sentence structures.

Note. TOEFL iBT Performance Rubric for Test Takers. Adapted from ETS TOEFL IBT

2007 by Educational Testing Service. Adapted with permission.

Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA). The Suinn-

Lew Asian Self-Identity Acculturation Scale (SL-ASIA; see Appendix B), developed by

Suinn, Rickard-Figueroa, Lew, and Vigil (1987), is a widely used acculturation measure for people of Asian or Asian-American background. For instance, the response options for the question, “what language can you speak”, include: (1) Asian only (Chinese,

Japanese, Korean, Vietnamese, etc.); (2) Mostly Asian, some English; (3) Asian and

English about equally well (bilingual); (4) Mostly English, some Asian, and (5) Only

English. The original SL-ASIA had 21 items that examined language preference (4 questions), ethnic identity (4 questions), friendships (4 questions), behaviors (5 questions), generation-geographic history (3 questions) and attitudes (1 question). Scores could range from a low of 1.00, indicative of high Asian identity (or low acculturation) to a high of 5.00, indicative of high Western identity (or high acculturation).

Texas Tech University, Jiaqi Li, December, 2013

The original SL-ASIA scale has recently been modified and extended to 26 items, which can further measure acculturation in an orthogonal way (e.g., Asian identified,

Western identified, bicultural, & alienated). The current study used a new version of the

26-item SL-ASIA modified by Suinn, Khoo, and Ahun (1992). Items in the SL-ASIA are rated by participants on a five-point Likert scale. The response options for the new item,

“rate yourself on how much you believe in Asian values” (e.g., about marriage, families, education, work), for example, range from a low of 1.00, indicative of “do not believe,” to a high of 5.00, indicative of “strongly believe in Asian values.” Below were instructions on how to use the new items (Suinn, Khoo, & Ahun, 1992):

(a) if question 22 has 4 or 5 (high Asian values) and question 23 has either 1, 2, or 3

(low Western values), then classify this person as Asian-identified; (b) if question 23

has 4 or 5 (high Western) and question 22 has either 1, 2, or 3 (low Asian), then

classify this person as Western-identified; (c) if question 22 has 4 or 5 (high Asian)

and question 23 has 4 or 5 (high Western), then classify this person as bicultural; (d)

if the subject has checked 1, or 2 for both 22 and 23 (low Asian and low Western

values), this person is denying any identification and may be alienated from both

cultures. (p. 2)

In the current study, the orthogonal measure of acculturation, which divides participants into four strategy groups, such as separation, assimilation, integration, and marginalization from both cultures, was used as an independent variable of “acculturation strategy,” and its relationship with students’ attitude toward seeking professional counseling services was examined. Likewise, Harik-Williams (2003) indicated that the orthogonal measurement of acculturation resulting from the SL-ASIA is identified with

Texas Tech University, Jiaqi Li, December, 2013

Berry’s acculturation theory (Berry, 1997; 2003). For example, Asian identified, Western identified, bicultural, and alienated used in the SL-ASIA, are equivalent to separation, assimilation, integration, and marginalization in Berry’s acculturation theory.

Due to lack of validity and reliability information on the new items (Suinn, Khoo,

& Ahun, 1992), all the psychometric evidence pertains to the original version of the SL-

ASIA. In terms of internal consistency, Suinn, Rickard-Figueroa, Lew, and Vigil (1987) reported an internal consistency reliability of .88, using the original scale. Ponterotto,

Baluch, and Carielli (1998) reported a Cronbach’s alpha, ranging from .68 to .91 in their investigation of 16 studies that have used SL-ASIA for measuring acculturation. Recent literature seems to indicate that the original 21-item scale has demonstrated a high reliability of scores measuring acculturation among Asian-American groups such as

Chinese, Japanese, Korean, and Vietnamese Americans (Abe-Kim, Okazaki, & Goto,

2001; Mallinckrodt, Shigeoka, & Suzuki, 2005).

In addition, there is much evidence that speaks to the construct validity of the original SL-ASIA. For example, Suinn, Khoo, and Ahun (1992) in their investigation of

324 Asian-American students reported that language varied significantly between Asian- identified and Western-identified participants. Their results also indicated five factors accounting for 69.7% of the variance as well as including: (a) reading, writing, and cultural preference, (b) ethnic interaction, (c) ethnic identity and pride, (d) generation identity, and (e) food preference. Further, SL-ASIA scores were reported to correlate with acculturation, ethnic interaction, generational identity, and residency in the United

States (Suinn, Richard-Figueroa, Lew, Vigil, Yen, Robin, & Lin, 2000).

Texas Tech University, Jiaqi Li, December, 2013

Multigroup Ethnic Identity Measure. The Multigroup Ethnic Identity Measure

(MEIM; see Appendix C) is a 15-item instrument developed to measure behavioral and attitudinal aspects of ethnic identity that are common to all members of an ethnic group

(Phinney, 1992). The MEIM has been used to assess ethnic identity of participants with ethnic origins including Hispanics, African Americans, Asian Americans, Chinese,

Filipinos, American Indians, and Caucasians (Roberts, Phinney, Masse, Chen, Roberts, &

Romero, 1999). The MEIM has three subscales of exploration (items 1, 2, 4, 8), commitment (items 3, 5, 6, 7, 9, 11, 12), and categorization (items 13, 14, 15). Each subscale is rated on a four-point Likert scale, ranging from 1 (strongly disagree) to 4

(strongly agree), with a higher score representing greater exploration or commitment, as well as a lower score representing weaker exploration or commitment. A sample MEIM question for exploration includes: “I have spent time trying to find out more about my ethnic group, such as its history, traditions, and customs.” A sample item for commitment includes: “I have a clear sense of my ethnic background and what it means for me.” The response options for the sample question for categorization, “my ethnicity is” include: (a)

Asian or Asian American, including Chinese, Japanese, and others; (b) Black or African

American; (c) Hispanic or Latino, including Mexican American, Central American, and others; (d) White, Caucasian, Anglo, European American; not Hispanic; (e) American

Indian/Native American; (f) Mixed; parents are from two different groups; (g) other

(write in). For the current study, only the subscale for commitment was used for measuring ethnic identity. As Phinney (1992) suggested, the preferred scoring is to use the mean of the item scores. For example, participants whose mean item scores ranging

Texas Tech University, Jiaqi Li, December, 2013 from 3.0 to 4.0 showed strong ethnic identity. ON the other hand, the mean item scores ranging from 1.0 to 2.0 presented a weak ethnic identity.

The MEIM has consistently shown good reliability, typically with alphas above .80 across a wide range of ethnic groups and ages (Lee, Falbo, Doh, & Park, 2001;

Phinney, 1992; Worrell, Vandiver, & Cross, 2000; Yasuda & Duan, 2003). In an investigation of 63 Asian Americans and 55 Asian international students, Yasuda and

Duan (2003) found that the reliability analysis of MEIM resulted in a Cronbach’s alpha of .89 for Asian-American students and .80 for Asian international students.

Attitudes Toward Seeking Professional Psychological Help Scale Short Form.

Attitudes Toward Seeking Professional Psychological Help Scale Short Form

(ATSPPHS-SF; see Appendix D; Fischer & Farina, 1995) is a 10-item unidimensional scale, which is based on Fischer and Turner’s (1970) 29-item scale for measuring attitudes toward seeking professional psychological help. The short scale includes 10 items. The sample times are described as follows: “If I believed I was having a mental breakdown, my first inclination would be to get professional attention”; or “the idea of taking about problems with a psychologist strikes as a poor way to get rid of emotional conflicts.” According to Fishcer and Turner (1970), the total score is obtained by summing each 4-point Likert-type item scale, ranging from 0 (strongly disagree) to 3

(strongly agree). A higher score could reflect a more positive attitude toward seeking professional psychological help.

As reported by the scale’s author, this scale produced an internal consistency reliability of 0.86 and a retest reliability coefficient of 0.83 (Fishcer & Turner, 1970).

According to Fischer and Farina (1995), the short form has a correlation of 0.87 with the

Texas Tech University, Jiaqi Li, December, 2013 original one. The one-month test-retest reliability coefficient was 0.80, and the coefficient alpha was 0.84 for the short version of the instrument.

Procedure

The target population of this study was international students from Mainland

China studying in the United States with an F-1 student nonimmigrant visa. The specific sample for this study was Chinese international students enrolled in a large four-year public institution in the Southwestern United States. Prospective participants were contacted by E-mail and invited to participate in the research project. E-mails were sent out via the Chinese student associations’ listservs to all members on the E-mail list. The invitation E-mail included information on the purpose of the study and a link to an online survey hosted on www.qualtrics.com. Participation in this study was completely voluntary and no identifying information was collected. Students who were interested in participating in this study were directed to the informed consent page to proceed with the instrument. The survey consisted of demographic information survey, the Suinn-Lew

Asian Self-Identity Acculturation Scale (SL-ASIA), the Multigroup Ethnic Identity

Measure (MEIM), and Attitudes toward Seeking Professional Psychological Help Scale

(ATSPPHS).

Data Analysis

Three analyses were conducted to answer three research questions. For the first research question on whether Chinese international students’ acculturation, ethnic identity, and English proficiency were significantly related to their attitudes toward seeking professional counseling, a multiple regression analysis was conducted with acculturation, ethnic identity, and English proficiency as predictors, while attitudes

Texas Tech University, Jiaqi Li, December, 2013 toward seeking professional counseling was the criterion variable. Because the research question is about the relationship between the combination of the predictors and the criterion variable, the method of “Enter” was used for the multiple regression analysis to include all predictor variables regardless significance of individual predictors, into the final regression equation.

The second question was to determine which would be the most significant predictor for Chinese international students’ attitudes toward seeking professional counseling services among acculturation, ethnic identity, and English proficiency. To answer the question, the method of “forward” in SPSS was utilized for the multiple regression analysis with attitude toward seeking professional counseling services as the criterion variable. Only the significant predictors were selected while other predictors were statistically controlled as constants to be included in the final multiple regression equation.

For the third research question, one-way ANOVA was conducted to evaluate the relationship between Chinese international students’ acculturation strategies and their attitudes toward seeking professional counseling services. The independent variables were four dimensions (e.g., separation, assimilation, integration, and marginalization) in acculturation strategies, which were measured by SL-ASIA scale. The dependent variable was attitude toward seeking professional counseling services, which was measured by

ATSPPHS scale.

Using Liu’s format (2009), research questions, hypotheses, and their related data analysis are presented.

Texas Tech University, Jiaqi Li, December, 2013

Table 3.1

Research questions, hypotheses, and data analysis

Research Question 1

Are acculturation, ethnic identity, and the English proficiency of Chinese international students significant predictors of their attitudes toward seeking professional counseling services?

Hypothesis:

Acculturation, ethnic identity, and English proficiency will be statistically significant predictors for attitude toward seeking professional counseling services among Chinese international students.

Variables Data Analysis

Predictors: Multiple regression analysis

Acculturation; ethnic identity; English proficiency with “Enter” method

Criterion:

Attitudes toward seeking professional counseling

Research Question 2

Among the three potential predictors, is there any significant predictor of Chinese international students’ attitudes toward seeking professional counseling services?

Hypothesis:

There will be at least one significant predictor for Chinese international students’ attitudes toward seeking professional counseling services among acculturation, ethnic identity, and English proficiency.

Variables Data Analysis

Texas Tech University, Jiaqi Li, December, 2013

Predictors: Multiple regression analysis

Acculturation; ethnic identity; English proficiency with “Forward” method

Criterion:

Attitudes toward seeking professional counseling

Research Question 3

How are the Chinese international students’ attitudes toward seeking professional counseling services different across various acculturation strategies?

Hypothesis:

There will be a statistically significant difference in Chinese international students’ attitudes toward seeking professional counseling between different acculturation strategies.

Independent variables: One-way ANOVA

Acculturation strategies (i.e., integration, assimilation, separation, and marginalization)

Dependent variable: attitudes toward seeking professional counseling

Summary

The purpose of this chapter was to describe the methodology used in this study. It described the rational for a quantitative method for this study, and detailed procedures of data collection and analysis. More specifically, the independent variables under investigation in this study were (1) acculturation, (2) ethnic identity, (3) English proficiency, and (4) acculturation strategies. Participants’ attitude toward seeking

Texas Tech University, Jiaqi Li, December, 2013 professional counseling as measured by the ATSPPH was the dependent variable in this study. Three research questions were used to allow the researcher to satisfy the purpose of this study.

Texas Tech University, Jiaqi Li, December, 2013

CHAPTER IV

RESULTS

Introduction

The purpose of this chapter is to provide a detailed description of the data and analyses conducted for this study. The data were obtained from participants through online survey questionnaires, which included a demographic information survey, the

Multigroup Ethnic Identity Measure (MEIM), the Attitudes toward Seeking Professional

Psychological Help- Short Form (ATSPPH), the Test of English as a Foreign Language

(TOEFL), and the Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA).

In the current study, three research questions were presented as follows:

1. Are acculturation, ethnic identity, and English proficiency of Chinese

international students significant predictors of their attitudes toward seeking

professional counseling services?

2. Among the three potential predictors, is there any significant predictor of

Chinese international students’ attitudes toward seeking professional

counseling services?

3. How are the Chinese international students’ attitudes toward seeking

professional counseling services different across various acculturation

strategies?

Accordingly, three statistical analyses were conducted to answer these three questions. First, a multiple regression analysis was conducted to examine whether a combination of the predictor variables was able to predict the criterion variable. Second, the relative importance of the independent variables in the prediction of the criterion

Texas Tech University, Jiaqi Li, December, 2013 variable was examined in another multiple regression analysis. For both of the multiple regression analyses, the predictor variables were acculturation, ethnic identity, and

English proficiency while the criterion variable was attitude toward seeking professional counseling services. Third, differences in attitudes toward seeking professional counseling services between different acculturation strategies of Chinese international students were examined via ANOVA. The independent variables included four dimensions (separation, assimilation, integration, and marginalization) in acculturation strategies, which were measured by the Suinn-Lew Asian Self-Identity Acculturation

Scale (SL-ASIA). The dependent variable was attitude toward seeking professional counseling services, which was measured by the Attitudes toward Seeking Professional

Psychological Help- Short Form (ATSPPH).

This chapter consists of four sections describing the process of data collection and data analysis. The first section discusses data collection of the survey responses. The second section examines the demographics of the participants in this study. The third section presents a summary of analysis results. The final section provides a summary of the chapter.

Survey Response Rate

This study utilized a convenience sample that consisted of 135 participants.

Among them were 109 with completed surveys and 26 uncompleted ones. For an experimentally accessible population of 237 students, the 109 participants represented a response rate of 46%, which is appropriate for the survey research (Parker & Rea, 1997;

Phillips & Phillips, 2004). Likewise, inasmuch as the sample size calculator software

Texas Tech University, Jiaqi Li, December, 2013 yielded a minimum sample size of 76 for the regression analysis, the current sample of

109 was adequate for the planned analysis.

Sample Demographics

A total of 135 students answered surveys. Out of this sample, 26 students were missing questionnaire data for the SL-ASIA, MEIM, and ATSPPHS. The resulting sample of 109 students was first analyzed based on the age, residence time, and TOEFL scores.

Table 4.1

Descriptive Statistics for Age, Residence periods, and TOEFL

Men Women

Demographic Data M SD M SD

Age (years) 26.75 5.78 28.29 6.12

Residence Time 27.91 29.47 22.32 38.27 (Months)

TOEFL 89.77 10.53 90.22 10.60

In Table 4.1, the data for residence time (RT) in months for male and female students were reported. The mean RT of male students was 27.91 months with a standard deviation of 29.47. The mean RT of female students was 22.32 months with a standard deviation of 38.27. Male students’ RT ranged from a minimum of 2 to a maximum of 130 months at the time of testing. Female students’ RT ranged from a minimum of 1 to a maximum of 291 months.

As shown in Chapter Three, TOEFL scores were used to measure English proficiency of Chinese international student in this test of English, which served as an

Texas Tech University, Jiaqi Li, December, 2013 independent variable in the study. According to the ETS (2012), Internet-based TOEFL scores were classified into three levels such as low, intermediate, and high. The low

TOEFL scores are below 65 and indicate that a testee has poor skills in reading, speaking, listening, and writing. The intermediate TOEFL scores range from 65 to 94, and show that a testee has difficulties with high-level vocabulary and with understanding main ideas, communicates with occasional errors, and has important ideas missing, unclear, or inaccurate in writing. The high TOEFL scores range from 94 to 120, which indicate that a testee has a good command of grammar and vocabulary, understands main ideas and important details, is able to communicate personal experiences and opinion effectively in

English, and shows excellent writing skills. For participants in the current study, the mean TOEFL score of male students was 89.77 with a standard deviation of 10.53. The mean TOEFL score of female students was 90.22 with a standard deviation of 10.60.

Male students’ TOEFL scores ranged from a minimum score of 78 to a maximum score of 120 at the time of testing. Female students’ TOEFL scores ranged from a minimum of

79 to a maximum of 111 months.

Data Analysis

Data Screening

In this section, data were first screened for missing data and outliers and examined for test assumptions. Outliers were identified by calculating Mahalanobis distance in a preliminary regression procedure. According to a chi-square table, the critical value of chi-square at p < .001 with df = 4 is 18.47. No outliers were found based on the criteria.

Texas Tech University, Jiaqi Li, December, 2013

Reliability Analysis

Reliability for each scale was assessed by using the internal consistency method.

The reliability coefficients were described as follows: acculturation (.80) and ethnic identity (.89). All reliability coefficients were above the commonly acceptable reliability level of .70.

Research Question 1

Are acculturation, ethnic identity, and English proficiency of Chinese international students significant predictors for their attitudes toward seeking professional counseling services?

A standard multiple regression analysis was performed to answer the first research question, with acculturation, ethnic identity, and English proficiency as the predictors and attitudes toward seeking professional counseling services as the criterion.

Descriptive statistics of the criterion and predictors are summarized in Table 4.2

Table 4.2

Descriptive Statistics for dependent variable and independent variables used in the multiple regression analysis.

Measures M SD N

Attitudes toward 1.75 .45 109 seeking counseling

English Proficiency 90.35 10.55 109

Acculturation 1.92 .24 109

Ethnic Identity 1.82 .47 109

Texas Tech University, Jiaqi Li, December, 2013

The method of “enter” was utilized for the multiple regression analysis that forced all predictors into the multiple regression equation, regardless of the significance level of the relationship between individual predictors and the criterion. Results of the ANOVA for the multiple regression analysis are summarized in Table 4.3.

Table 4.3

ANOVA summary table

ANOVAᵃ

Model SS df Mean F p

Square

1 Regression 1.57 3 .52 3.02 .033ᵇ

Residual 18.14 105 .17

Total 19.71 108

a. Dependent Variable: Attitudes Toward Seeking Counseling Services

b. Predictors: (Constants), Ethnic Identity, English Proficiency, Acculturation

As shown in Table 4.4, the combination of the predictors, including acculturation, ethnic identity, and English proficiency significantly predicted Chinese international students’ attitudes toward seeking professional counseling services, F(3, 105) = 3.02, p

= .03. Regression results indicated that three predictors collectively explained about 8% of the variance of the variable of attitudes toward seeking professional counseling services R2 = .08, Adjusted R2 = .05. A summary of the regression analysis is presented in

Table 4.4. From the partial correlation coefficient presented in the table, it seems that only one (ethnic identity) of the three predictors significantly contributed to the prediction for attitude toward seeking professional services. The result, therefore,

Texas Tech University, Jiaqi Li, December, 2013 supported the hypothesis that acculturation, ethnic identity, and English proficiency are statistically significant predictors for attitude toward seeking professional counseling services among Chinese international students. Furthermore, the relationship between ethnic identity and attitude toward seeking counseling service was negative, which means that Chinese international students who have strong Chinese identity are less likely to seek professional counseling services.

Table 4.4

Coefficients for Predictors

Measures B β t p Bivariate Partial r

Acculturation .232 .130 1.249 .214 .035 .121

Ethnic -.254 -.279 -2.730 .007 -.226 -.257 Identity

English .004 .101 1.061 .291 .118 .103 Proficiency

Research Question 2

Among the three potential predictors, is there any significant predictor for Chinese international students’ attitudes toward seeking professional counseling services?

To answer the question, the method of “forward” in SPSS was utilized for the multiple regression analysis with attitude toward seeking professional counseling services as the criterion variable. Only the significant predictors were selected while other predictors were statistically controlled as constants to be included in the final multiple regression equation. Results of the ANOVA for the multiple regression analysis are summarized in Table 4.5.

Texas Tech University, Jiaqi Li, December, 2013

Table 4.5

ANOVA summary table

ANOVAᵇ

Model SS df Mean F p

Square

1 Regression 1.01 1 1.01 5.75 .018ᵃ

Residual 18.71 107 .18

Total 19.71 108

a. Predictor: (constant) Ethnic Identity

b. Dependent Variable: Attitudes Toward Seeking Counseling

As shown in Table 4.5, ethnic identity was the only significant predictor among independent variables to be selected to predict the criterion variable of Chinese international students’ attitudes toward seeking professional counseling, p = .02.

Regression results indicated that ethnic identity explained 5% of the variance of Chinese international students’ attitudes toward seeking professional counseling, R2 = .05,

Adjusted R2 = .04, p = .018. A summary of regression analysis is presented in Table 4.6 and suggests that Chinese students with a strong identity are less likely to seek professional counseling than those with a weak ethnic identity. Acculturation and English proficiency were not significant predictors of the criterion variable. The result, therefore, supported the hypothesis that there is at least one significant predictor for Chinese international students’ attitudes toward seeking professional counseling services among acculturation, ethnic identity, and English proficiency.

Texas Tech University, Jiaqi Li, December, 2013

Table 4.6

Coefficients for Predictor

Model B β T p

Ethnic Identity -.21 -.23 -2.40 .018

Research Question 3

How are the Chinese international students’ attitudes toward seeking professional counseling services different across various acculturation strategies?

To help understand the result of the analysis for this research question, the scoring method of the SL-ASIA scale that classifies students into different acculturation strategy groups needs to be explained. The SL-ASIA used in the current study included the original 21 items as well as new added ones. According to Suinn, Khoo, and Ahun (1992), these new items can “serve to further classify the research participants in ways that use current theorizing that acculturation is not linear, uni-dimensional but multi-dimensional and orthogonal” (p.1). Therefore, the new items were retained for measuring four dimensions (assimilation, integration, separation, and marginalization) in acculturation while the original ones were used to calculate the acculturation scores. The scoring method developed by Suinn, Khoo, and Ahun (1992) is shown in Table 4.7.

Texas Tech University, Jiaqi Li, December, 2013

Table 4.7

Scoring Table

Answers to Items 22 or 24

Items 1 2 3 4 5

23 or 25 1 N N (A) A A

2 N N (A) A A

3 (W) (W) (B) A A

4 W W W B B

5 W W W B B

A: Asian identified/Separation

B: Bicultural/Integration

W: Western/Assimilation

N: Neither/ Marginalization

Note. Scoring Table. Adapted from The Suinn-Lew Asian Self-Identity Acculturation

After applying Suinn, Khoo, and Ahun’s (1992) method to classify participants in different acculturation strategy groups, only 100 out of 109 participants were successfully classified with 34 in the separation group, 9 in the assimilation group, 51 in the integration group, and 6 in the marginalization group. A one-way analysis of variance

(ANOVA) was conducted to evaluate the relationship between Chinese international

Texas Tech University, Jiaqi Li, December, 2013 students’ acculturation strategies, as the independent variable, and their attitudes toward seeking professional counseling services as the dependent variable. Descriptive statistics for acculturation strategy groups are presented in Table 4.8.

Table 4.8

Descriptive Statistics for Acculturation Strategies

Measures M SD n

Marginalization 2.00 .39 6

Integration 1.68 .43 51

Separation 1.72 .41 34

Assimilation 2.02 .43 9

Total 1.74 .43 100

The ANOVA summary is shown in Table 4.9, which shows strategy effect that is approaching significance, F(3, 95) = 2.53, p = .06. The strength of relationship between

Chinese international students’ acculturation strategies and their attitudes toward seeking professional counseling services, as assessed by η², was weak, with acculturation strategies accounting for 7% of the variance of the dependent variable.

Texas Tech University, Jiaqi Li, December, 2013

Table 4.9

ANOVA Summary Table

Source SS df Mean F p Partial

Square Eta

Squared

Acculturation 1.32 3 .44 2.53 .06 .07 strategies

Error 16.56 95

Total 318.45 99

Dependent Variable: Attitudes toward Seeking Counseling

Following the significant strategy effect detected in the ANOVA, post-hoc comparisons between the four strategy groups were conducted. Results of the follow-up tests, using Tukey’s method for the post-hoc comparison in Table 5.0, revealed that (a) attitudes toward seeking professional counseling in the assimilation group (M = 2.02, SD

= .43) was significantly more positive than that in the integration group (M = 1.68, SD

= .43), p = .03; (b) attitudes toward seeking professional counseling in the assimilation group (M = 2.02, SD = .43) was significantly more positive than that in the separation group (M = 1.72, SD = .41), p = .05. None other comparisons were significant. The results of analysis suggest that Chinese international students who are in the assimilation group, which is the group that was assimilated to the Western culture, are more likely to seek professional counseling services than ones in the integration and separation group.

The result, therefore, supported the hypothesis that there is statistically significant

Texas Tech University, Jiaqi Li, December, 2013 difference between Chinese international students’ acculturation strategies and their attitudes toward seeking professional counseling services.

Table 5.0

Multiple Comparisons

(I) response 3 (J) response 3 Mean SE Sig. 95% Confidence

counted counted Difference Interval

LSD (I-J) Lower Upper

Bound Bound

Assimilation Marginalization .02 .22 .92 -.41 .46

Integration .34 .15 .03 .04 .64

Separation .31 .16 .05 -.00 .62

Marginalization Integration .32 .18 .08 -.04 .68

Assimilation .28 .19 .13 -.08 .65

Separation -.02 .22 .92 -.46 .41

Integration Marginalization -.32 .18 .08 -.68 .03

Separation -.03 .09 .71 -.22 .15

Assimilation -.34 .15 .03 -.64 -.04

Separation Marginalization -.28 .19 .13 -.65 .08

Integration .03 .09 .71 -.15 .22

Assimilation -.31 .16 .05 -.62 .00

Based on observed means

The error term is mean Square (Error) = .174.

Texas Tech University, Jiaqi Li, December, 2013

* The mean difference is significant at the .05 level.

Summary

In this chapter, correlational analysis identified three statistically significant relationships: (a) the combination of the predictors explained a significant portion of the variance of the dependent variable; (b) ethnic identity is the only significant predictor; and (c) the assimilation strategy group holds a more positive attitude toward seeking professional counseling services than the groups of separation and integration. These findings may provide insight to counselor educators, mental health counselors, and scholars on how to improve counseling services and education for Asian international students, especially those from Mainland China.

Texas Tech University, Jiaqi Li, December, 2013

CHAPTER V

DISCUSSION

Introduction

The following chapter is composed of four sections. In the first section, a summary of the important research findings is presented. In the second section, implications for practice are discussed. Limitations of this study and recommendations for the future research are identified in the third and fourth section separately.

Summary

The purpose of the current study was to examine the relationships between

Chinese international students’ acculturation, ethnic identity, English proficiency, and their attitudes toward seeking professional counseling services. The hypotheses of this study were analyzed by two multiple regression analyses and one analysis of variance

(ANOVA). In two multiple regression analyses, the predictor variables included: acculturation, ethnic identity, and English proficiency while the criterion variable was attitude toward seeking professional counseling services. In the ANOVA analysis, the independent variable included four dimensions (separation, assimilation, integration, and marginalization) in acculturation strategies while the dependent variable was attitude toward seeking professional counseling services. Results supported the following hypotheses: (a) acculturation, ethnic identity, and English proficiency are statistically significant predictors of attitude toward seeking professional counseling services among

Chinese international students. (b) There is at least one significant predictor of Chinese international students’ attitudes toward seeking professional counseling services among acculturation, ethnic identity, and English proficiency. (c) There is a statistically

Texas Tech University, Jiaqi Li, December, 2013 significant difference in Chinese international students’ attitudes toward seeking professional counseling between different acculturation strategies. Further investigation revealed that (a) ethnic identity is the only significant predictor for Chinese international students’ attitudes toward seeking professional counseling services among acculturation, ethnic identity, and English proficiency; and (b) the assimilation strategy group holds more positive attitudes toward seeking professional counseling services than the groups of separation and integration.

Ethnic Identity and Help-Seeking Attitudes. The results of this study helped sort out the relationship between ethnic identity and help-seeking attitudes. As is consistent with previous research findings (Price & McNeil, 1992), ethnic identity was found to be correlated with attitudes toward seeking counseling. For example, in the investigation of 80 American Indian college students, Price and McNeil (1992) found that

Indian students strongly committed to their tribal culture showed significantly less favorable overall attitudes toward seeking counseling. Further, Indian students strongly identified with tribal culture had less favorable attitudes toward their needs for counseling and less confidence in mental health professional than those committed to Western culture or to both cultures. In addition, the result was consistent with the studies regarding underutilization of mental health services and Chinese and Chinese Americans.

In the investigation of 152 Chinese international students, Wu (2011) found that a strong cultural stigma and misconceptions about mental illness to some degree discourage

Chinese international students from seeking professional counseling help. Kung (2004) indicated that cultural barriers (beliefs, ideas, & customs) are one of significant barriers to Asian Americans’ using of mental health services. Similarly, Zhang et al. (1998) found

Texas Tech University, Jiaqi Li, December, 2013 that from their sample of 161 Asian Americans and 1,332 Caucasian Americans that the low rate of utilization of mental health services among Asian Americans is due to that population’s preference for friends or relatives rather than counselors or psychologists when they need professional counseling assistance. Taken as another cultural group, the current findings indicated that ethnic identity was identified as the most significant predictor for attitudes toward seeking professional counseling among Chinese international students. This would suggest that Chinese international students with a strong identity are less likely to utilize counseling services than those weakly committed to Chinese culture.

Ethnic identity theory (Phinney & Ong, 2007) assumes that Chinese international students committed to Chinese culture would be less likely to seek professional counseling services than ones committed to Western culture because individuals’ commitment and attachment to a certain ethnic group would be closely related to ethnic behaviors that traditionally exclude professional counseling assistance. Results of this study supported this assumption. In addition, findings are consistent with Phinney’s

(1990) model of ethnic identity development. Phinney (1990) proposed that all ethnic groups must resolve two basic conflicts: (a) stereotyping and prejudicial treatment of the dominant group individuals toward nondominant ones; (b) the clash of value systems between the dominant and nondominant groups. As one representative of minority groups and Asian international students, Chinese international students’ underutilization of counseling services is due to their stereotyping of professional counseling services provided by White counselors and institutions (Kung 2004; Lim et al., 2010; Thomason

Texas Tech University, Jiaqi Li, December, 2013

& Qiong, 2008) and the cultural stigma and shame associated with psychological problems (Leong, Kim, & Gupta, 2011; Wu, 2011).

Assimilation and Help-Seeking Attitudes. As indicated in Chapter Two, cultural assimilation, or Western identified, is directly related to precounseling attitudes among

Asian international students. Berry (1970, 1984, 2003) concluded that individuals who were identified with the dominant culture were in the process of assimilation in his acculturation model. Individuals identified with the dominant culture do not maintain their own culture but seek daily interaction with the dominant culture. They adapt themselves into the dominant culture in eating, clothing, housing, living, and so on. In the present study, the results for acculturation extend the findings of Miller et al. (2011), who found that a high acculturation level is related to more positive attitudes toward seeking professional psychological help. The results of this study suggest that Chinese international students in the assimilation strategy group hold more positive attitudes toward seeking professional counseling services than ones in the groups of separation and integration. In other words, cultural assimilation in a person’s acculturation strategy is positively related to attitude toward seeking professional counseling services. To some extent help-seeking attitudes are positively related to utilizing mental health services

(Ramos-Sanchez & Atkinson, 2009).

Overall, these effects highlight the complex ways in which acculturation and ethnic identity factors relate to attitudes toward seeking professional counseling services.

It is worth noting that cultural assimilation or identification with Western culture was positively related to help-seeking attitudes. This might reflect another aspect of cross- cultural adaptation that individuals in the process of acculturation might choose different

Texas Tech University, Jiaqi Li, December, 2013 ways of adjusting to the local culture given their attitudes toward a new environment.

Finally, these results provide solid evidence for multifaceted approaches to conceptualizing the relationship of acculturation, ethnic identity, English proficiency, and attitudes toward seeking professional counseling services among Chinese international students.

In addition, the findings fulfilled the purpose of the current study that helps culturally skilled counselors gain useful knowledge and information about culturally different populations, which is required by the ACA Code of Ethics and the AMCD

Multicultural Counseling Competencies (Arredondo et al., 1996). The ACA Code of

Ethics states that “counselors recognize the need for continuing education to acquire and maintain a reasonable level of awareness of current scientific and professional information in their fields of activity. They take steps to maintain competence in the skills they use, are open to new procedures, and keep current with the diverse populations and specific population with whom they work” (C.2.f.). The AMCD Multicultural

Counseling Competencies (Arredondo et al., 1996) also states that:

1. Culturally skilled counselors possess specific knowledge and information

about the particular group with which they are working. They are aware of the

life experiences, cultural heritage, and historic background of their culturally

different clients. This particular competency is strongly linked to the

“minority identity development models” available in the literature.

2. Culturally skilled counselors understand how race, culture, ethnicity, and so

forth may affect personality formation, vocational choices, manifestation of

Texas Tech University, Jiaqi Li, December, 2013

psychological disorders, help-seeking behaviors, and the appropriateness or

inappropriateness of counseling approaches.

3. Culturally skilled counselors understand and have knowledge about

sociopolitical influences that impinge upon the life of racial and ethnic

minorities. Immigration issues, poverty, racism, stereotyping, and

powerlessness may impact self-esteem and self-concept in the counseling

process.

Limitations

There are a number of limitations to the present study. First, as in many studies focusing on Asian international students, our sample was a traditional college student sample, and the results may therefore be limited by sample characteristics. For instance, a majority of the sample was Chinese international students, which may reflect the status of international students of this college sample but certainly is not an accurate representation of the Asian international student population as a whole. In addition, although we were able to randomly select 135 Chinese international students to recruit for the present study, it is unclear how well those who actually participated in the study represent potential differences in Asian international students studying in the United States. Second, language considerations need to be taken into account with the present study. Although some scales used in the study were intentionally chosen because they were specifically designed for use with Asian international students, it is possible that the participants had difficulty in understanding questions and answers. In addition, the level of participants’ language proficiency affected the data that were collected. There exist cultural differences between the way Chinese international students understand and perceive

Texas Tech University, Jiaqi Li, December, 2013 mental problems when compared with Americans. Due to lack of the appropriate translations of technical terminology, participants might understand questions on scales in an inaccuracy way. Finally, although the present sample size met the minimal requirement (n = 76) for multiple regression analysis, the relatively small size of the students sample (N = 135) represents methodological limitation. It is possible that findings for this sample lack stability and cannot represent both Asian and Chinese international students as a whole. Meanwhile, the sample tended to be homogeneous in terms of demographics. The majority of the participants were graduate students and nearly half of them were between 25 and 29 years old.

Implications for Practice

Given the increasing number of Asian international students and the gap between

Asian international students and mental health practitioners, there are few universally appropriate guidelines for effectively counseling this group. Therefore, the present review offers tentative implications for mental health practitioners when working with this population. First, although Chinese international students encountered psychological challenges during the acculturation process and had low rate of utilizing professional counseling services to solve their disturbances, the intensity of the challenges was greatly impacted by various factors. According to the review of literature, Zhang et al. (1998) found that Asian students are inclined to seek help from friends or relatives when it comes to sharing mental distress. In addition, Chinese students traditionally believe that herbalists and acupuncturists will be able to solve their emotional problems (Kung, 2003).

Based on the results of this study, ethnic identity is a significant predictor of Chinese international students’ attitudes toward seeking professional counseling services. The

Texas Tech University, Jiaqi Li, December, 2013 higher level of ethnic identity Chinese international students show, the lower rate of professional counseling utilization they have. If we take all these pieces and put them together, we may find that cultural and racial reviews of mental health have a powerful influence on help-seeking attitudes and behaviors. Thus, understanding the roles of culture and race in help-seeking can prepare mental health practitioners to become more culturally sensitive and responsive to international student clients. It is also consistent with some of important principles articulated in the Multicultural Counseling

Competencies (Sue, Arredondo, & McDavis, 1992). For example, Multicultural

Counseling Competencies require mental health practitioners to understand “how race, culture, ethnicity, and so forth may affect personality formation, vocational choices, manifestation of psychological disorders, help seeking behavior, and the appropriateness or inappropriateness of counseling approaches,” and “sociopolitical influences that impinge upon the life of racial and ethnic minorities” (p. 486). Second, the present findings will be of value to mental health practitioners, college counseling centers, and community agencies that plan to provide psychological services for the Asian international student population in the colleges and universities. They need to be aware of acculturation levels of their clients. According to the results of this study, Chinese international students who assimilated into Anglo-American culture are more likely to seek professional counseling services than their peers who still adhered to Chinese cultural values. Thus, understanding international student clients’ exposure to both

Anglo-American and Asian cultures and values will be greatly beneficial to counselors when building therapeutic rapport. Since acculturation levels of Asian international students were in a dynamic process and difficult to measure, Counselors need to offer

Texas Tech University, Jiaqi Li, December, 2013 more opportunities for students to discuss their concerns and feelings about adjusting to a new cultural setting before carrying on a treatment plan. It is also important for conversations be conducted in a culturally appropriate manner that respects Asian international student clients’ values and belief systems. Such recognition may help Asian international student clients reduce reluctance to enter a therapeutic process.

Recommendations for Future Research

The results of this study contribute to the body of literature that addresses the relationship between acculturation, ethnic identity, English proficiency, and attitudes toward seeking professional counseling services among Asian international students. The research has supported and expanded the finding that Asian international students are reluctant to utilize available counseling services (Tung, 2011; Yasuda & Duan, 2002; Yi,

Giseala, & Kishimoto, 2003; Zhang, Snowden, & Sue, 1998). Although a few novel findings were reported, much more work is needed in this area of research to replicate the findings, and researchers need to shift to a new direction. For instance, the current study mainly investigated variables such as acculturation, ethnic identity, and English proficiency. However, there are other significantly cultural and social variables to consider when studying the underutilization of mental health services among Asian international students. These variables include: racial identity development, perceived racism and discrimination, age, social support, country difference, and economic status.

In addition, a longitudinal research design as well as a qualitative research design should help researchers gain a much better understanding of Asian international students’ dynamic change in the process of cross-cultural adaptation. Finally, further exploration of the individual and group characteristics of Asian international students might be of

Texas Tech University, Jiaqi Li, December, 2013 benefit to client dropout. Overall, answers associated with the above suggestions could provide much more powerful evidence for the underutilization of mental health services and culturally appropriate treatment for Asian international students.

Texas Tech University, Jiaqi Li, December, 2013

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Appendix A

Online Survey

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Appendix B

Demographic Information Survey

1. What is your gender? a. Male b. Female 2. How old are you? a. Your answer is ___ year old. 3. Are you? a. An undergraduate student b. A Master’s student c. A PhD student 4. How long have you been in the United States? a. Your answer is ___ months 5. Are you? a. Married b. Single 6. Do you have any religious belief? a. Yes b. NO 7. Which religious belief do you have? a. I am a Christian b. I am an atheist c. I am Buddhist d. I am a Taoist 8. Have you sought professional counseling help (e.g., social worker, counselor, psychologist, etc) in the United States? a. Yes b. No 9. I did not see professional counseling help because a. I am not aware of my problem that requires professional counseling help b. Sometimes I need help but I do not go c. Other reasons 10. How many Internet-based TOEFL scores did you obtain? a. Your answer is ().

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Appendix C

SUINN-LEW ASIAN SELF-IDENTITY ACCULTURATION SCALE (SL-ASIA)

(Has obtained written permission to use the scale)

INSTRUCTIONS: The questions which follow are for the purpose of collecting information about your historical background as well as more recent behaviors which may be related to your cultural identity. Choose the one answer which best describes you.

1. What language can you speak? a. Asian only (for example, Chinese, Japanese, Korean, Vietnamese, etc.) b. Mostly Asian, some English c. Asian and English about equally well (bilingual) d. Mostly English, some Asian e. Only English 2. What language do you prefer? a. Asian only (for example, Chinese, Japanese, Korean, Vietnamese, etc.) b. Mostly Asian, some English c. Asian and English about equally well (bilingual) d. Mostly English, some Asian e. Only English 3. How do you identify yourself? a. Oriental b. Asian c. Asian-American d. Chinese-American, Japanese-American, Korean-American, etc. e. American 4. Which identification does (did) your mother use? a. Oriental b. Asian c. Asian-American d. Chinese-American, Japanese-American, Korean-American, etc. e. American 5. Which identification does (did) your father use? a. Oriental b. Asian c. Asian-American d. Chinese-American, Japanese-American, Korean-American, etc. e. American 6. What was the ethnic origin of the friends and peers you had, as a child up to age 6? a. Almost exclusively Asians, Asian-Americans, Orientals b. Mostly Asians, Asian-Americans, Orientals c. About equally Asian groups and Anglo groups d. Mostly Anglos, Blacks, Hispanics, or other non-Asian ethnic groups

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e. Almost exclusively Anglos, Blacks, Hispanics, or other non-Asian ethnic groups 7. What was the ethnic origin of the friends and peers you had, as a child from 6 to 18? a. Almost exclusively Asians, Asian-Americans, Orientals b. Mostly Asians, Asian-Americans, Orientals c. About equally Asian groups and Anglo groups d. Mostly Anglos, Blacks, Hispanics, or other non-Asian ethnic groups e. Almost exclusively Anglos, Blacks, Hispanics, or other non-Asian ethnic groups 8. Whom do you now associate with in the community? a. Almost exclusively Asians, Asian-Americans, Orientals b. Mostly Asians, Asian-Americans, Orientals c. About equally Asian groups and Anglo groups d. Mostly Anglos, Blacks, Hispanics, or other non-Asian ethnic groups e. Almost exclusively Anglos, Blacks, Hispanics, or other non-Asian ethnic groups 9. If you could pick, whom would you prefer to associate with in the community? a. Almost exclusively Asians, Asian-Americans, Orientals b. Mostly Asians, Asian-Americans, Orientals c. About equally Asian groups and Anglo groups d. Mostly Anglos, Blacks, Hispanics, or other non-Asian ethnic groups e. Almost exclusively Anglos, Blacks, Hispanics, or other non-Asian ethnic groups 10. What is your music preference? a. Only Asian music (for example, Chinese, Japanese, Korean, Vietnamese, etc.) b. Mostly Asian c. Equally Asian and English d. Mostly English e. English only 11. What is your movie preference? a. Asian-language movies only b. Asian-language movies mostly c. Equally Asian/English-language movies d. Mostly English-language movies only e. English-language movies only 12. What generation are you? ( circle the generation that best applies to you: ) a. 1st Generation = I was born in Asia or country other than U.S. b. 2nd Generation = I was born in U.S., either parent was born in Asia or country other than U.S. c. 3rd Generation = I was born in U.S., both parents were born in U.S, and all grandparents born in Asia or country other than U.S. d. 4th Generation = I was born in U.S., both parents were born in U.S, and at least one grandparent born in Asia or country other than U.S. and one grandparent born in U.S.

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e. 5th Generation = I was born in U.S., both parents were born in U.S., and all grandparents also born in U.S. f. Don't know what generation best fits since I lack some information. 13. What contact have you had with Asia? a. Do you b. Do you c. Raised one year or more in Asia d. Lived for less than one year in Asia e. Occasional visits to Asia f. Occasional communications (letters, phone calls, etc.) with people in Asia g. No exposure or communications with people in Asia 14. Where were you raised? a. In Asia only b. Mostly in Asia, some in U.S. c. Equally in Asia and U.S. d. Mostly in U.S., some in Asia e. In U.S. only 15. What is your food preference at home? a. Exclusively Asian food b. Mostly Asian food, some American c. About equally Asian and American d. Mostly American food e. Exclusively American food 16. What is your food preference in restaurants? a. Exclusively Asian food b. Mostly Asian food, some American c. About equally Asian and American d. Mostly American food e. Exclusively American food 17. Do you a. read only an Asian language b. read an Asian language better than English c. read both Asian and English equally well d. read English better than an Asian language e. read only English 18. Do you a. write only an Asian language b. write an Asian language better than English c. write both Asian and English equally well d. write English better than an Asian language e. write only English 19. If you consider yourself a member of the Asian group (Oriental, Asian, Asian- American, Chinese-American, etc., whatever term you prefer), how much pride do you have in this group? a. Extremely proud b. Moderately proud

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c. Little pride d. No pride but do not feel negative toward group e. No pride but do feel negative toward group 20. How would you rate yourself? a. Very Asian b. Mostly Asian c. Bicultural d. Mostly Westernized e. Very Westernized 21. Do you participate in Asian occasions, holidays, traditions, etc.? a. Nearly all b. Most of them c. Some of them d. A few of them e. None at all 22. Rate yourself on how much you believe in Asian values (e.g., about marriage, families, education, work): a. Do not b. barely believe c. believe d. less strongly believe e. strongly believe 23. Rate yourself on how much you believe in American (Western) values a. Do not b. barely believe c. believe d. less strongly believe e. strongly believe 24. Rate yourself on how well you fit when with other Asians of the same ethnicity a. Do not b. barely believe c. believe d. less strongly believe e. strongly believe 25. Rate yourself on how well you fit when with other Americans who are non-Asian (Westerners) a. Do not b. barely believe c. believe d. less strongly believe e. strongly believe 26. There are many different ways in which people think of themselves. Which One of the following most closely describes how you view yourself? a. I consider myself basically an Asian person (e.g., Chinese, Japanese, Korean, Vietnamese, etc.). Even though I live and work in America, I still view myself basically as an Asian person.

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Appendix D

The Multigroup Ethnic Identity Measure (MEIM)

(No written permission is required for use of the measure)

In this country, people come from many different countries and cultures, and there are many different words to describe the different backgrounds or ethnic groups that people come from. Some examples of the names of ethnic groups are Hispanic or Latino, Black or African American, Asian American, Chinese, Filipino, American Indian, Mexican American, Caucasian or White, Italian American, and many others. These questions are about your ethnicity or your ethnic group and how you feel about it or react to it.

Please fill in: In terms of ethnic group, I consider myself to be ______

Use the numbers below to indicate how much you agree or disagree with each statement.

(4) Strongly agree (3) Agree (2) Disagree (1) Strongly disagree

1- I have spent time trying to find out more about my ethnic group, such as its history, traditions, and customs. 2- I am active in organizations or social groups that include mostly members of my own ethnic group. 3- I have a clear sense of my ethnic background and what it means for me. 4- I think a lot about how my life will be affected by my ethnic group membership. 5- I am happy that I am a member of the group I belong to. 6- I have a strong sense of belonging to my own ethnic group. 7- I understand pretty well what my ethnic group membership means to me. 8- In order to learn more about my ethnic background, I have often talked to other people about my ethnic group. 9- I have a lot of pride in my ethnic group. 10- I participate in cultural practices of my own group, such as special food, music, or customs. 11- I feel a strong attachment towards my own ethnic group. 12- I feel good about my cultural or ethnic background. 13- My ethnicity is (1) Asian or Asian American, including Chinese, Japanese, and others (2) Black or African American (3) Hispanic or Latino, including Mexican American, Central American, and others (4) White, Caucasian, Anglo, European American; not Hispanic (5) American Indian/Native American

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(6) Mixed; Parents are from two different groups (7) Other (write in): ______

14- My father's ethnicity is (use numbers above) 15- My mother's ethnicity is (use numbers above)

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Appendix E

Attitudes Toward Seeking Professional Psychological Help (Short Form)

(No written permission is required for use of the measure)

Directions: Please mark on the number that corresponds to your level of agreement with the following statements

1. If I believe I was having a mental breakdown, my first inclination would be to get professional attention. a. Strongly Disagree b. Disagree c. Agree d. Strongly Agree 2. The idea of taking about problems with a psychologist strikes as a poor way to get rid of emotional conflicts. a. Strongly Disagree b. Disagree c. Agree d. Strongly Agree 3. If I were experiencing a serious emotional crisis at this point in my life, I would be confident that I could find relief in psychotherapy. a. Strongly Disagree b. Disagree c. Agree d. Strongly Agree 4. There is something admirable in the attitude of a person who is willing to cope with his or her conflicts and fears without resorting to professional help. a. Strongly Disagree b. Disagree c. Agree d. Strongly Agree 5. I would want to get psychological help if I were worried or upset for a long period of time. a. Strongly Disagree b. Disagree c. Agree d. Strongly Agree 6. I might want to have psychological counseling in the future. a. Strongly Disagree b. Disagree c. Agree d. Strongly Agree 7. A person with an emotional problem is not likely to solve it alone; he or she is likely to solve it without professional help.

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a. Strongly Disagree b. Disagree c. Agree d. Strongly Agree 8. Considering the time and expense involved in psychotherapy, it would have doubtful value for a persona like me. a. Strongly Disagree b. Disagree c. Agree d. Strongly Agree 9. A person should work out his or her own problems; getting psychological counseling would be a last resort. a. Strongly Disagree b. Disagree c. Agree d. Strongly Agree 10. Personal and emotional troubles, like many things, tend to work out by themselves. a. Strongly Disagree b. Disagree c. Agree d. Strongly Agree

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Appendix F

Permission Request for the Suinn-Lew Asian Self-identity Acculturation Scale

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Appendix G

Permission Letter (John Berry)

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Appendix H

Permission Letter (Jean Phinney)

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Appendix I

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