Experiences with Counselling for Individuals Within the South Asian Community II: Methodology, Stories and Analysis
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.
Discussion and Conclusions
The purpose of this paper was to gather an understanding about the experience of seeking and participating actively in mental health counselling for South Asian individuals. This research involved three participants who associated themselves with the South Asian culture, were above the age of 18, and participated in a minimum of 1 hour of mental health counselling in the past 3 years. Although not part of the initial criterion, all the participants had attended university and considered themselves to be assimilated into the Western culture while upholding some traditions of their Eastern culture and associating with it. Using grounded theory for analysis, the individual stories informed the data to create and collectively answer the actual question: What change(s) allowed these individuals to seek and participate in counselling?
The data implied that changes in awareness, more specifically the awareness of symptoms, supports, and resources, were crucial in the journey towards seeking and participating in counselling. The sustained awareness of symptoms, potential supports, and the availability of financial resources were essential factors for the continuation of counselling. The awareness was trifold in that if someone did not feel supported, they were less likely to seek counselling, even though they were aware of symptoms and resources.
As such, each level of awareness informs another, and it appears that the trifold of change allows individuals to seek and participate in counselling. These findings were not surprising, as previous research has shown that awareness of services influences the uptake of services, in that a lack of awareness leads to fewer services being utilized (Johnson & Nadirshaw, 1993). Yet the data show that if the triad has not been accomplished, the services may not be utilized, such as in Sara’s case.
However, as noted previously, much of the previous research has questioned barriers to seeking help, and although this study confirmed some of that research, it also showed that awareness may have a greater influence than previously expected. Although stigma continued to be a barrier, it was not as pronounced as expected. The results seem to oppose findings by Wynaden and colleagues (2005) in indicating that people of South Asian communities do not seek help due to stigma and difference in views or beliefs.
The notions of izzat and bringing shame to their parents or themselves (Gilbert et al., 2004; Rehman, 2010) were felt more by the female participants (Amy and Sara), but not so much by Vik. Both Amy and Sara were afraid of letting others know they were seeking counselling as a result of this stigma, but they continued when they had complete support from at least one person and the complete triad of changes in awareness. This result was quite different from the Hamid et al. (2009) study, which found that male participants were more likely to conform to Eastern cultural norms than female participants. In fact, the results were similar to a study by Netto, Gaag, Thanki, Bondi, and Munro (2001) that indicated fears of a confidentiality breach by the therapist were greater than the fear of stigmatization itself. Therefore, the barrier may actually be a lack of support rather than the fear of stigmatization, but the stigmatization might fuel the lack of support. Also, as Vik did not have the same experience, it may be more a result of hegemonic cultural differences in gender than of stigmatization itself.
Since the participants were open to describing their cultural phenomenon to the therapist, they were not as concerned about seeking a therapist of the same religion.
However, their fear of not being understood or of confidentiality breaches by someone of the same religion may be overcome through educational material outlining ethical policies. Therefore, the cultural differences and the differences resulting from having a culturally sensitive therapist who has innovative responses to adjust to client needs may be a requisite for help-seeking (Bhui, 2003). Although Rehman (2010) studied Pakistani women in the US, the results were similar to those of this study. The participants were more willing to explain their cultural phenomenon than to have a therapist with preconceived notions. They all provided their support for culturally sensitive therapists, but not necessarily ethnically identical therapists. Future researchers may choose to compare the experiences of counselling for individuals with ethnically diverse therapists and those with religiously or culturally identical therapists.
The results showed that the participants were aware of their symptoms as being psychological in nature, and not necessarily somatic, as doctors and health care professionals have been shown to believe (Bhui, 2003). All participants noted that education and a degree of acculturation influenced this awareness. Rehman (2010) also indicated that creating a common language about mental health notions within the culture might help individuals become aware of their symptoms in order to influence participation in counselling. Education and culturally sensitive therapists who questioned Amy and Vik about their cultural notions before providing support for symptoms were considered helpful in the process of continuing counselling. All of the participants were hesitant in discussing personal matters with someone of the same ethnicity for fear of judgement and because of a lack of trust in their professionalism (Bhui, 2003; Rehman, 2010). Overcoming of this barrier was aided by awareness of symptoms, support, and resources. Thus, if these factors can be strengthened, individuals may be more likely to seek counselling.
Future researchers have the opportunity to further explore and attempt to understand how family awareness of symptoms, support, and resources may impact an individual’s willingness to seek counselling. A deeper look into gender differences and autonomy may also lead to new ways of providing help to those individuals. An understanding of South Asian cultural norms within the Western context, through counselling experiences, may increase the levels of awareness for individuals, family members, and even policy makers or health care providers.
An awareness of resources might also come from educating students on how to seek counselling outside of the school environment as well as from informing the general public about their options when seeking counselling. Although universities provide psychological counselling, creating an environment where counselling and help-seeking are normative and encouraged may lead to less stigmatization and an increase in utilization of services. However, as noted in this research, that is only one part of the solution. The notions of autonomy and support also play a factor.
Vik pointed out that the role of religion was a barrier to the awareness of symptoms but could possibly be a useful resource. Research conducted with South Asian males in Alcoholics Anonymous (AA) groups also shared a similar viewpoint (Morjaria & Orford, 2002).
All participants initially sought counselling in university, as many Canadian universities cover a few hours in the health plans they provide (Nunes et al., 2014). As such, group counselling within universities may be considered helpful (Thakore-Dunlap & Velsor, 2014). Implementing group counselling may allow individuals to gain further awareness of support and symptoms.