by Alisha Mann, MPsy
This series was originally completed as a Major Research Project in partial fulfillment of Adler Graduate Professional School’s Master of Psychology degree.
Cultural Differences
Despite the debilitating experience of stigma, several people including those of the South Asian community are still willing to seek counselling. However, South Asian individuals show a heightened tendency and higher risk of terminating counselling prematurely (Chandras et al., 2013). Johnson and Nadirshaw (1993) found that the individualistic model of Westernized or European counselling was not designed for ethnic minorities, culturally different life experiences, or collectivist cultures, such as those of South Asians.
Multiple studies show that the South Asian culture, as religiously vast as it is, has many beliefs and practices in common. As family is seen as the most important social unit, the tendency is to assume that conflicts must be resolved within the family or community and sharing of personal information with an outsider can bring shame to the family (Assanand et al., 1990; Chadda & Deb, 2013; Johnson & Nadirshaw, 1993; Rehman, 2010). This collectivist culture is different from the individualistic Western culture, which makes seeking counselling an individual act. A study conducted by Beliappa (1991) showed that participants were more likely to seek support from the community than from extended members of the family or health care providers (as cited in Hussain & Cochrane, 2003, p. 25).
Research conducted by Hamid and colleagues (2009) showed that Australian Asian individuals with a higher adherence to Asian cultural values displayed lower positive attitudes towards seeking psychological help. Similarly, Constantine et al. (2004) found that international students with fewer English skills were more likely to be depressed and experience acculturative stress than those with better English skills. With this case, these individuals would be less likely to seek help but may require it the most. The level of acculturation was positively related to seeking help, with women showing greater willingness (Hamid et al., 2009, Soorkia et al., 2011). This highlights the path for specialized educational courses that build upon culturally informed individual ideas of mental health and counselling (Rehman, 2010).
However, cultural differences in themselves are also a strong component in the stigma felt by South Asian individuals. Some doctors feel that South Asian patients would want more concrete forms of advice and practical help than the idea of counselling (Bhui, 2003; Chadda & Deb, 2013). Doctors and health care providers report that South Asians typically present with physical manifestations of psychological complaints and do not consider the two to be related (Bhui, 2003). Having such a stereotype among health care providers of South Asian individuals might exaggerate cultural differences and play into the systematic stigma discussed above. This stereotyping may even lead to increased dropout rates for those from such cultures (Rehman, 2010) and increased disclaiming of perceived symptoms (Netto, 2006).
With that being said, studies have considered implementing the collectivist culture within the individualistic framework of therapy (Kuo, 2004; Rehman, 2010), thus suggesting a path for culturally sensitive therapists and health care providers. Current research points to the need for therapists who are sensitive to multiple cultures (Chandras et al., 2013; Fairchild & Mistler, 2005; Netto, 2006; Rehman, 2010; Shariff, 2009) and the importance of being innovative within their practice (Bhui, 2003), as well as being mindful of the existing resources within the community (Hussain & Cochrane, 2003), such as elders and temples with clerics. It is also important for therapists to understand the individuals’ subjective experience of their culture, as opposed to assuming that preconceived notions apply to everyone (Rehman, 2010).
A qualitative study conducted by Gilbert and colleagues (2004) found that participants in four focus groups felt a sense of distrust and fear of judgement from Asian health professionals. Participants were willing to speak with White therapists just to have someone to talk to, but felt that their cultural values and issues would not be understood (Gilbert et al., 2004). This shows not only the need for an increase in culturally sensitive therapists but also the need for awareness of nonjudgmental, culturally/religiously similar therapists. Future research may look into how culturally sensitive health care providers operate and alter the actual experience of counselling. Using this experience, researchers may be more able to understand what about the therapy setting may need to change in order to increase uptake of such services.
