A RESEARCH REPORT OF THE RESEARCH CONSORTIUM OF COUNSELING & PSYCHOLOGICAL SERVICES IN HIGHER EDUCATION Counseling Utilization by Ethnic Minority Students

While multicultural awareness in counseling has risen substantially in the last decade, little research has examined counseling utilization and outcomes for ethnic minorities on university campuses. A sample of 1,166 African American, Asian American, Caucasian, and Hispanic help-seeking university students from over 40 universities nationwide filled out the Outcome Questionnaire 45 at the first and last therapy sessions. Caucasian students attended significantly more sessions than all other groups. Further, greatest distress was found at intake in Asian American clients, followed by Hispanic, African American, and Caucasian students. All groups appeared to benefit from therapy, as noted by a decrease in symptomatology, but none of the groups met the criteria for clinically significant change. Implications for therapists working with minority clients are discussed. Counseling Utilization 4 Counseling Utilization by Ethnic Minority Students Although multicultural awareness is on the rise, there is still a remarkable dearth of research regarding the use of counseling services and outcomes for racial and ethnic minorities. This same trend is seen when examining research in university counseling centers, where studies have primarily evaluated counseling utilization and outcome by university students as a whole, not by particular racial and ethnic groups (Glen, Mcnair, & Hight, 1988; Snell, Hill, Mallinckrodt, & Lambert, 2001; Vonk & Thyer, 1999). Bernal and Scharron-Del-Rio (2001) have addressed the need for future research in identifying the efficacy of therapy for ethnic minorities. Our aim is to ameliorate this scarcity of research by examining the differences among African American, Asian American, Hispanic, and Caucasian students in therapy attendance after intake, and severity at both intake and last session. The exploration of these factors will assist therapists in becoming more culturally sensitive to the needs of their clients by increasing their understanding of how minority students currently utilize university counseling services. Further, we aim to identify whether present university counseling services are, in fact, meeting the mental health needs of these groups. Numerous factors appear to lead minority individuals to utilize counseling services less frequently than Caucasian individuals (Steward, Jackson & Jackson, 1990; Thompson, Neville, Weathers, & Poston, 1990; Watkins & Terrell, 1988). One factor suggested by Atkinson, Morton, and Sue (1998) is that minorities may perceive mental health services as unrelated to their needs and thereby do not initiate services. With little attention focused on the psychological needs of minorities in counseling centers and the common utilization of Westernoriented counseling styles, which emphasize an intrapsychic etiology model, minorities may feel that most counseling services simply do not apply to them (Austin, Carter, & Vaux, 1990; Thorn & Sarata, 1998). Unfortunately, beliefs that counselors cannot be helpful may often extend to those members of minority groups suffering from more severe forms of emotional disorders, potentially preventing them from seeking counseling (Hatch, Friedman, & Paradis, 1996). Further, counselors untrained in culturally sensitive therapy models, a dearth of bilingual counselors, few counselors with similar ethnic/racial backgrounds, and a lack of cultural sensitivity may lead minorities to feel misunderstood by therapists in counseling communities (Atkinson, et al., 1998; Atkinson, Jennings, & Liongson, 1990). Potential stigma regarding the use of mental health services, still found among African American, Asian American, and Hispanic cultures, may further diminish the likelihood of seeking counseling services (Leong, Wagner, & Tata, 1995; Neighbors, Caldwell, Thompson, & Jackson, 1994; Sue, 1994; Thorn & Sarata, 1998). For example, Asian Americans may view psychological problems as marks of weakness, which reflect negatively upon the character of individuals who seek professional mental health services (Root, 1998). Hispanic individuals may carry stigma regarding therapy for other reasons, such as the importance of seeking help from family or religious community members, rather than sharing private information with outsiders (Altarriba Counseling Utilization 5 & Bauer, 1998). A study of African American and Latino youth found that these two groups were much less likely to seek help from professionals than Caucasians and more likely to use family resources for their personal problems (McMiller & Weisz, 1996). Associated stigma, in conjunction with feelings that mental health services may be irrelevant to their needs, serve as powerful forces in keeping minority individuals from utilizing counseling services. These factors may also provide an explanation for why minorities frequently fail to return for additional appointments after an initial session. Sue, Fujino, Hu, Takeuchi, and Zane (1991) found that African Americans averaged far fewer sessions and terminated more quickly than Caucasians within the Los Angeles County Mental Health System. Barnes (1994) likewise reported that racial/ethnic minorities are far less likely to return for more appointments and report having fewer sessions than Caucasian counterparts. However, Flaskerud and Liu (1991) found a significant increase in the number of sessions when both an ethnic and language match existed between client and therapist. Hence, factors affecting counseling utilization can be changed to better meet the needs of racial/ethnic minority clients. Overall, racial/ethnic minorities appear to return less often for future sessions and average fewer sessions overall in comparison to Caucasians when such factors are not addressed. Racial/ethnic differences have been explored not only in the utilization of counseling services, but also in the types and severity of disorders seen among different populations. Race related differences have been found in rates of alcoholism, phobic disorders, general anxiety disorder, obsessive compulsive disorder, and somatization disorders (Adebimpe, 1994). For example, African Americans may report higher levels of negative symptomatology than Caucasians (Adebimpe, 1994; Jones-Webb & Snowden, 1994; Lefley, 1994). Prior research offers some suggestions as to why such differences may exist. Mays and Albee (1992) indicate that ethnic minorities experience greater social stressors in association with psychological conditions than Caucasians. Atkinson et al. (1998) further speculate that increased reporting of symptoms may be the result of elevated stress levels caused by higher poverty and unemployment rates, discrimination and racism, recent relocation, and loss of support systems. Further, if ethnic minorities perceive counselors as lacking cultural sensitivity or knowledge (Atkinson, et al., 1998; Atkinson, et al., 1990), they may postpone the seeking of services, causing an increase in their initial symptomatology at intake. However, other reports indicate that when one controls for sociodemographic differences, these differences of severity are negligible (Adebimpe, 1994; Jones-Webb & Snowden, 1994; Lefley, 1994). Problems of minority under-representation in community-based surveys of mental health service utilization may further complicate these findings (Cheung & Snowden, 1990). Counseling Utilization 6