Counseling Across Cultures (1996)

I WEST CAMPUS LIBRARY
PIMA COMMUNITY COLLEGE
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4th Edition

This book is dedicated to our children Counseling
and to the futures they represent:
Across
Deborah Peterson, Karen Michaelsen, Kai Pedersen,
Jon Pedersen, Julie Draguns, George Draguns, Jay Lonner, Cultures

Alyssa Lonner, Andrea Lonner, Jennifer Susan Trimble, Paul B. Pedersen
Lee Erin Trimble, and Casey Ann Trimble. Juris G. Draguns
Walter J. Lonner
~ Joseph E. Trimble

editors

'SAGE Publications

/17/emaltollalEducaliollalalldProless1ollalP!I/Jlis/Jer
Thousand Oaks London New Delhi

Copyright © 1996 by Sage Publications, Inc.

All rights reserved. No part of this book may be reproduced or utilized in any CONTENTS
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For information address: Introduction: Priority Issues of Vll
Counseling Across Cultures
($) SAGE Publications, Inc. 1
2455 Teller Road Paul B. Pedersen 21
Thousand Oaks, California 91320 Juris G. Draguns 47
E-mail: order@sagepub.com Walter J. Lonner 73
Joseph E. Trimble 108
SAGE Publications Ltd.
6 Bonhill Street 1. Humanly Universal and Culturally Distinctive:
London EC2A 4PU Charting the Course of Cultural Counseling
United Kingdom Juris G. Draguns

SAGE Publications India Pvt. Ltd. 2. Cultural Empathy in Multicultural Counseling:
M-32 Market A Multidimensional Process Model
Greater Kailash I Charles R. Ridley
New Delhi 110 048 India Danielle W. Lingle

Printed in the United States of America 3. Ethics in Multicultural Counseling
Teresa D. Lafromboise
Library of Congress Cataloging-in-Publication Data Sandra Foster
Amy James
Main entry under title:
4. Gender Issues in Multicultural Counseling
Counseling across cultures / edited by Paul B. Pedersen, ... [et al.]. L. Sunny Hansen
Elizabeth M. P. Gama
-4th ed.
5. Nigrescence and Ego Identity Development:
p. cm. Accounting for Differential Black Identity Patterns
William E. Cross, Jr.
Includes bibliographical references and index. Peony Fhagen-Smith

ISBN 0-8039-5748-3 (acid-free paper: cloth}. -

ISBN 0-8039-5749-1 (acid-free paper: pbk.}

1. Cross-cultural counseling. 2. Cultural psychiatry.

I. Pedersen, Paul, 1936-

BF637.C6C63 1996

616.89'14-dc20 96-32491

This book is printed on acid-free paper.

96 97 98 99 10 9 8 7 6 5 4 3 2 1

Sage Production Editor: Diane S. Foster
Sage Typesetter: Janelle LeMaster

6. Continuity, Change, and Diversity: 124 I INTRODUCTION
Counseling Asian Americans 146 Priority Issues of
Harry H. L. Kitano 177 Counseling Across Cultures
Mitchell T. Maki
210 Paul B. Pedersen
7. Counseling the Hispanic: A Guiding 243 Juris G. Draguns
Framework for a Diverse Population 266
]. Manuel Casas 293 Walter J. Lonner
Melba]. T. Vasquez 323
353 Joseph E. Trimble
8. Essential Cultural and Social Strategies for 365
Counseling Native American Indians THE role played by culture has increasingly come to be recognized in all
Joseph E. Trimble aspects of counseling, from assessment to intervention. Culture has
Candace M. Fleming ceased to be an exotic and esoteric topic in the counseling literature-
Fred Beauvais perhaps fascinating to many, but alien to the practical concerns of most
Pamela Jumper-Thurman counselors. When Counseling Across Cultures (Pedersen, Lonner, &
Draguns, 1976) appeared, it broke new ground in attempting to survey
9. Counseling International Students the field of multicultural intervention. In the fourth edition of this
Frederick T. L. Leong volume, we are attempting to take stock of the many developments and
Elayne L. Chou changes that have occurred in providing counseling services to culturally
unique populations.
10. Counseling and Psychotherapy With Refugees
Fred Bemak By this time, there is general agreement that the cultures of both the
Rita Chi-Ying Chung providers and the users of counseling services influence the counseling
Thomas H. Bornemann process both pervasively and profoundly (Ponterotto, Casas, Suzuki, &
Alexander, 1995). Cross-cultural counseling has been recognized as the
11. Behavioral Approaches to Counseling Across Cultures "fourth force" in counseling, coequal in its relevance and impact to the
Junko Tanaka-Matsumi
H. Nick Higginbotham vii

12. Appraisal and Assessment in Cross-Cultural Counseling
Walter J. Lonner
Farah A. Ibrahim

13. Research and Research Hypotheses About
Effectiveness in lntercultural Counseling
David Sue
Norman D. Sundberg

Index

About the Contributors

Vlll COUNSELING ACROSS CULTURES Introduction IX

three traditional "forces" of psychoanalytic, behavior modification, and extracting from each of them one fundamental question around which
humanistic counseling (Pedersen, 1990, 1991). Moreover, culture in the chapter is organized.
some ways is not unlike the fourth "time" dimension of modern physics,
which is recognized as an indispensable addition to the three dimensions 1. What are the humanly universal and the culturally variable com-
of space. As such, cross-cultural counseling does not abrogate, or even ponents of counseling? (Draguns, "Humanly Universal and Culturally
compete with, the three established theoretical orientations. Instead, it Distinctive: Charting the Course of Cultural Counseling").
extends each of these three frameworks and makes them, optimally, more
applicable and realistic in contemporary multicultural contexts. All counseling occurs in a cultural context, and culture has been
described as the invisible and silent, yet crucial, component of the
The origin of psychoanalytic, behavioral, and humanistic movements counseling experience (Draguns, 1975). The greater the cultural differ-
is inextricably linked with the pioneering figures of Freud, Skinner, and ences between the counselor and counselee, the more noticeable and
Rogers. In the case of the multicultural fourth force in counseling, we obtrusive is the role of culture in the counseling experience. The poten-
look in vain for one specific founder. Rather, the movement can be tial is increased for a clash of expectations, misunderstandings of inten-
described as a grassroots revolution, driven simultaneously by the frus- tions and meanings, and entanglements in counseling relationships.
trations of culturally different counselees and the dissatisfaction of
counselors with the available-presumably culture-free, but actually The subjective cultures (Triandis, 1994; Vassiliou & Vassiliou, 1973)
mainstream-oriented-techniques and services. In the process, culturally of both counselor and counselee come into play, composed as they are
marginalized counselees have found their voice, and culturally encapsu- of assumptions and conclusions that appear to be self-evident in a specific
lated counselors have striven to develop and provide services for a milieu, but are rarely verbalized and even less frequently challenged. Yet
culturally distinctive clientele and to provide a sense of purpose and we also assume that counseling is not a culture-bound collection of
procedures that loses all relevance outside of its cultural milieu. What,
competence. then, about counseling is stable across time and space?
The effect of these developments has been both centripetal and
In attempting to answer that question, it is helpful to define counseling
centrifugal. Culture-centered perspectives have moved toward the center broadly rather than narrowly. On the one hand, we know that culture
of the counseling field in both visibility and relevance. Many counselors cuts deeply into the person's inner life, even shaping self-experience
now recognize that cultural issues in counseling do not just pertain to (Markus & Kitayama, 1991; Triandis, 1972). On the other hand, per-
clients from the recognized ethnic minority groups. Rather, in the ceptive observers have been able to discern commonalities in personality
multicultural settings of North America and elsewhere, cultural differ- that are helpful for intervention in vastly different cultures. The scope
ences in all counseling relationships are the rule rather than the exception of cross-cultural counseling is bounded by these two extremes as coun-
selors strive to integrate sensitivity to culture with effectiveness of
(Ponterotto et al., 1995). intervention. Empathy is accorded a central role in the process.
At the same time, the very diversity of problems, issues, techniques,
2. Is it possible to have empathy without first developing sensitivity
rationales, and objectives in cross-cultural counseling has spawned diver- to the client's culture? (Ridley and Lingle, "Cultural Empathy in Mul-
gence in approaches and concerns. This trend has resulted in a rather ticultural Counseling: A Multidimensional Process Model").
bewildering variety. In this volume, we attempt to capture both the
divergent and the convergent tendencies in contemporary counseling The only absolutely necessary but not sufficient variable that shows
across cultures. These goals would appear to be best accomplished in an up in the research literature about counseling is the relationship variable,
edited text with several contributors rather than in a book written in its presuming a high level of empathy by the counselor. It would be difficult
entirety by a single author or a small group of individuals. In planning if not impossible for a counselor to have a high level of empathy without
this volume, we have attempted to pinpoint the multiple directions in first being sensitive to the client's cultural context and background. In
which culturally oriented counseling is moving. At the same time, we the process of training counselors to increase their multicultural aware-
have tried to identify the paramount concerns of cross-cultural counsel- ness, we may at the same time be training them to achieve higher levels
ing. The remainder of this chapter is organized around these priorities. of empathy with their culturally different clients.
We have endeavored to capture the gist of the ensuing chapters by

X COUNSELING ACROSS CUL TURES r Introduction xi

Empathy is a complicated multidimensional variable and has been wrong while reasoning from different culturally learned gender-related
difficult to measure in previous research efforts. Attempts to simplify the assumptions.
empathy construct have been unsuccessful and in some cases misleading.
Rather than ignoring the complexity of empathy, it may be more con- Gender roles are changing rapidly, even though data demonstrating
structive to accept the necessary complexity of empathy by defining systematic cultural biases favoring males continue to be robust. Gender
empathy in a multicultural context. The multidimensional processes of stereotypes continue to be a powerful force even without supporting
perceptual, cognitive, affective, and communicative skills can be inte- data. More research needs to be done both to document the bias and to
grated within the client's cultural context and from the client's cultural test the stereotypes against actual events. Many assumptions about
point of view. To distinguish this more complicated but perhaps authen- gender seem to be non-rational and therefore not very responsive to more
tic definition it may be appropriate to introduce the term cultural information unless the emotional issues can be addressed at the same
empathy into the counseling literature. time.

3. Can the dichotomy of ethical relativism versus ethical absolutism be 5. What is cultural identity and how does it develop? (Cross and
transcended in separating right from wrong in multicultural counseling? Fhagen-Smith, "Nigrescence and Ego Identity Development: Accounting
(Lafromboise, Foster, and James, "Ethics in Multicultural Counseling"). for Differential Black Identity Patterns").

Ethical relativism is imbued with an aura of tolerance and broadmind- The importance of cultural ethnic identity as a construct is widely
edness. Yet it poses barriers to the formulation of ethical principles across recognized (Phinney, 1990), as is its relevance for effective counseling
cultures and even makes the discussion of ethical issues difficult. across cultures. However, the question remains open on how cultural
identity is to be measured. The several scales of this construct are being
The opposing stance, that of moral absolutism, carries the connotation developed and validated, and the assessment of identity is in flux
of rigidity. Moreover, it runs the risk of imposing culture-bound values (Trimble, 1995). There is more consensus about describing cultural
upon other ethnic groups and nations. In the counseling context, abso- identity when its degree is low than in identifying "high" degrees of
lutist judgments have the potential of penalizing the powerless and cultural identity and in specifying its implications. Erikson's stage theory
excusing the powerful. The risk of "blaming the victim" (Ryan, 1971) and reformulations of Piaget's developmental progression assign a key
must be forever kept in mind. role to culture in the development of personal identity. On this basis, the
intertwining of personal experiences and cultural influences becomes a
An alternative perspective is provided by the "ethic of caring and fundamental issue in identity development.
responsibility." This position constitutes the middle ground between the
absolutist and relativist positions in their pure form. It articulates a Theories of cultural identity are faced with the task of explaining the
dialectal and situational viewpoint with flexibility to respond to each phenomenon of "recycling" or moving up and down the developmental
context differently. However, this point of view is grounded in the scale. An adaptive personal identity acquired in a specific cultural context
universal principle that accords central value to caring for others and holds major implications for human choices and decisions. As such,
responsibility for one's own acts. This relational view is laden with identity becomes a crucial construct in counseling. If behavior is learned
ambiguity and complexity; its advantage is that it is contextual, yet in a cultural context, identity formation becomes an experience of
rooted in universal and non-negotiable principles. culture learning.

4. Can culture be defined broadly enough to include gender similarities 6. How do Asian Americans combine inherited elements of their
and differences? (Hansen and Gama, "Gender Issues in Multicultural ancestral culture with American cultural features? (Kitano and Maki,
Counseling"). "Continuity, Change, and Diversity: Counseling Asian Americans").

Given that gender may be more salient than ethnicity or nationality Asians have been prominent in the recent waves of immigration. Asian
in some circumstances, it would seem to fit the definition of a cultural traditions and values have frequently been maintained by immigrants and
perspective. However, broadening the categories of culture to include transmitted to subsequent generations. At the same time, Asian immi-
gender has been controversial. At the same time, the cultural construct grants and their descendants have placed a high emphasis on education
allows for men and women to disagree without either being "necessarily" and achievement. As a result, a unique configuration of characteristics

Xll COUNSELING ACROSS CUL TURES Introduction xiii

has come into being that is neither exclusively Asian nor American. diversity. Even the determination of who is and who is not an American
Attitudes and values derived from Asian heritage have persisted, and they Indian admits of a number of political, legal, anthropological, and
coexist with a great many American patterns of experience and behavior. psychological answers. In any individual case, these determinations may
or may not coincide. Furthermore, there is the dazzling variety of Indian
In relation to counseling, Asian and American expectations have often tribes and nations, each with its own historical memories and traditions.
been divergent. To make counseling experiences meaningful and helpful, Even attempting to articulate similarities among these diverse groupings
counselors working with Asian Americans have had to develop special becomes a controversial undertaking.
sensitivities and new skills. Counseling techniques for Asian Americans
are in a state of flux; their relevance and applicability for coming gener- However, certain general affinities can be identified. Native American
ations and future waves of Asian Americans have yet to be ascertained. Indians are the only indigenous ethnic group in the contiguous 48 states
of the United States. There are profound unresolved historical and
7. What are the counseling needs of Hispanic clients? (Casas and political conflicts between the Native American Indians and the Euro-
Vasquez, "Counseling the Hispanic: A Guiding Framework for a Diverse American majority. These conflicts cast a shadow over many counseling
Population"). experiences in which Native American Indian counselees and majority-
group counselors are involved. Counselors from the outside work at a
Hispanic Americans are a segment of the U.S. population that is both distinctive disadvantage unless they have undergone extensive prepara-
burgeoning and heterogeneous. Often described as the fastest growing tion about the expected behavior patterns and the prevailing value
minority group in the United States, Hispanics encompass persons of differences of a specific Native American community.
Mexican, Puerto Rican, and Cuban ancestry as well as immigrants and
their descendants from Spain and a host of countries in the Western Standard American counseling practices emphasize individualism,
hemisphere in which Spanish is the main language spoken. Hispanic, independence, aggressive and assertive orientation, and conventional
moreover, is an externally imposed label or "ethnic gloss" (Trimble, indicators of status and success. Some or all of these values may be
1991) on people of tremendous heterogeneity. It follows, then, that discrepant from, and even in violation of, cherished tenets within some
Hispanics defy being fitted into any stereotype or accommodated into an or many Native American Indian communities. This value clash may be
identity. To be sure, there is the heritage of speaking Spanish, which responsible for the well-documented underutilization of mainstream
many, but not all, Hispanic Americans share. American counseling services. In the extreme case, opting for counseling
may be tantamount, in Native American Indian eyes, to giving up a valued
As the Hispanic clientele is heterogeneous, so are its problems and the cultural identity-thereby becoming an outcast from one's culture-for
approaches to intervention. Certain commonalities, however, can be the illusory benefit of attaining "health," "well-being," or "adjustment,"
discerned. Importance of family and relationships is one such feature. all of them determined on the basis of the White culture's criteria.
Economic and social disadvantage are intertwined with culturally medi-
ated experience. An outsider finds it difficult to separate these various 9. How can counseling be made more appropriate for international
threads of influence. Counseling with Hispanics has in other groups also students and temporary residents or visitors? (Leong and Chou, "Coun-
taught the helping professions about the limitations of standard counsel- seling International Students").
ing practices. Recent developments have included culturally sensitive
innovations and adaptations. They hold the promise of improving the Counseling developed within the European American cultural context
effectiveness of counseling with Hispanics and of pointing the way and has been heavily beholden to Euro-American premises. In work with
toward more culturally relevant counseling with other groups as well. temporary residents or sojourners from around the globe, these assump-
tions must be searchingly examined and often modified so that coun-
8. What is the impact of similarities and differences among Native seling services can be provided in a realistic and helpful manner. A
American Indians upon the design and delivery of counseling services? prominent category of sojourners is composed of international students.
(Trimble, Fleming, Beauvais, and Jumper-Thurman, "Essential Cultural These visitors and sojourners are faced with the challenges of completing
and Social Strategies for Counseling Native American Indians"). what is often a difficult and stressful course of study and simultaneously
adapting effectively to a new and different social environment.
The aggregate of the present-day Native American Indians (including
Indians, Native Alaskans and Native Hawaiians) is remarkable for its

XlV COUNSELING ACROSS CUL TURES Introduction xv

"Culture shock" looms large in the studies of sojourners' adaptation. is relevant for culturally distinct clients in other countries. On the other
However, the intensity, generality, and predictability of this phenome- side of the ledger, the flexibility and parsimony of behavioral principles
non remain in doubt. Emphasis appears to be shifting from intrapersonal would argue for wide, perhaps universal, applicability of behavioral
to interpersonal influences upon accommodation to the host culture. intervention procedures. Let us recall that the laws of behaviorism were
There is a lopsided concentration of research effort upon the sojourners' formulated by Pavlov, Watson, Hull, and Skinner on the basis of experi-
accommodation at the site of their temporary residence. By contrast, the ments with animals and were explicitly expected to be valid for all
experience of "re-entry shock" upon return to the country of origin is organisms.
much more often invoked and discussed than it is empirically studied.
Paradoxically, overadaptation to the culture of the sojourn may harbor Against this background, behavior therapists have provisionally solved
problems; it may be a harbinger of adjustment difficulties after the the philosophical dilemma by negotiating with the client the objective
sojourner's return. and means of intervention. Within this context, the demonstrated util-
ity of behavioral procedures, including their more recently developed
10. What is the contribution of counseling services in addressing the cognitive offshoots, is extensive indeed. Provided the procedures are cul-
problems ofrefugees? (Bemak, Chung, and Bornemann, "Counseling and turally meaningful and reinforcers are culturally effective, behavior mod-
Psychotherapy With Refugees"). ification "works" across a wide range of cultural milieus and contexts.

Involuntary migrants such as refugees face unique stresses resulting This conclusion, however, does not imply that all problems of behav-
from the trauma of flight and displacement. Adjustment and accommo- ioral intervention have been left behind. Accusations of impersonal,
dation problems faced by all migrants may be tremendously magnified mechanical intervention and of the periods of external control continue
by the loss and violence that are the lot of a great many refugees. The to be leveled, within and outside the American mainstream. At its best,
very institutions and agencies called upon to assist the refugees may however, behavioral intervention accords maximal autonomy and em-
instead be viewed as an insensitive and impersonal bureaucracy, often powerment to the client, who then decides what behavior is to be
reminiscent of the power structures from which the refugee sought changed, by whom, and by what means. The advantage of behavioral
shelter. techniques, then, is that they measure progress according to the client's
own cultural baseline.
Support networks and indigenous sources of security and comfort are
often seriously disrupted and are difficult to replace with strange and 12. Do valid methods exist to assess individuals in and from widely
unfamiliar mental health services. Under the pressure of time, advice and different cultures? (Lonner and Ibrahim, "Appraisal and Assessment in
orientation are often more effective than reflection of feelings. The Cross-Cultural Counseling").
family-nuclear or extended-becomes an indispensable source of sup-
port and a necessary arena for intervention. The usual personal goals of The quest for universally applicable, culture-free measures of person-
intervention, such as enhancement of self-esteem and self-efficacy, re- ality, intelligence, and other important characteristics has so far been
cede into the background by comparison with economic self-sufficiency frustratingly unsuccessful, yet many continue to search for solutions.
and social competence in new surroundings. Instead of seeking to measure characteristics of persons in their abstract,
pure state, modern practitioners have focused their attention on trans-
11. With its roots in American culture, what has behavior modifi- actional and contextual variables. Numerical scores, where they are
cation to offer to persons of different cultural environments? (fanaka- meaningful and appropriate, are supplemented by qualitative informa-
Matsumi and Higginbotham, "Behavioral Approaches to Counseling tion. Such concepts as values and meanings, once dismissed as nebulous,
Across Cultures"). are taken seriously as objects of measurement and comparison both
within and across cultures. Cultural worldview has emerged as a major
It is commonly acknowledged that behaviorism as a theoretical frame- unifying concept. Its importance is dual, for understanding and interpret-
work originated and developed in the mainstream American culture. It ing of testees' responses and for controlling the possible cultural biases
is based on American assumptions about social behavior, especially in the testers' interpretations.
motivation, efficiency, and interpersonal influence. The question arises
whether behavior modification, rooted as it is in American experience, The key concept in cultural assessment is equivalence. Its impact is
most apparent in the continuing debate about the intelligence or compe-

...

XVl COUNSELING ACROSS CUL TURES Introduction XVll

tencies of various cultural groups. In a somewhat less strident debate, the been successful, cultural awareness has almost always been an explicit
same issues affect the separation of adaptation from disorder, as it is agenda of the skilled counselor.
attempted in different cultural environments. Instead of using context-
free instruments, contemporary experts in assessment increasingly turn By addressing these priority issues, this book seeks to articulate the
to context-dependent measures, which, however, of necessity are often positive contribution that can be made by incorporating multicultural
improvised and nonstandardized. awareness in the training of skilled counselors. Properly understood,
cultural awareness will make the counselor's job easier rather than
13. What are the gaps in research-based knowledge about counseling harder, more satisfying rather than frustrating, and more efficient rather
across cultures? (Sue and Sundberg, "Research and Research Hypotheses than cumbersome.
About Effectiveness in lntercultural Counseling").
REFERENCES
Traditional therapy research was embedded in an implicit individual-
istic worldview that has shaped and distorted its direction and nature. A Draguns, J. G. (1975). Resocialization into culture: The complexities of taking a worldwide
restricted set of assumptions has affected this research enterprise to the view of psychotherapy. In R. W. Brislin, S. Bochner, & W. J. Lonner (Eds.),
present day. As criteria of adaptive functioning and psychological health Cross-cultural perspectives on learning (pp. 273-289). Beverly Hills, CA: Sage.
become more culturally flexible and sensitive, therapy research may re-
flect more accurately the impact of interventions upon culturally distinc- Markus, H., & Kitayama, S. (1991). Culture and self. Psychological Review, 98, 224-253.
tive clients. At the same time, culturally biased and hitherto unquestioned Pedersen, P. B. (1990). The multicultural perspective as a fourth force in psychology.Journal
assumptions should be converted into hypotheses. In particular, their
applicability across cultures should be assessed. of Mental Health Counseling, 12, 93-95.
Pedersen, P. B. (1991). Multiculturalism as a generic approach to counseling. Journal of
Solid and replicated research findings should point the way, by means
of quantitative and qualitative data, toward improving the effectiveness Counseling and Development, 70, 3-14.
and efficiency of the counseling process. The very definitions of such Pedersen, P. B., Lonner, W. J., & Draguns, J. G. (Eds.). (1976). Counseling across cultures.
basic constructs as empathy, coping, growth, and health may need to be
reframed. As the pace of social change accelerates throughout the world, Honolulu: University Press of Hawaii.
something akin to counseling as we now know it may assume prominence Phinney, J. S. (1990). Ethnic identity in adolescence and adulthood: A review of research.
and urgency as one of the antidotes against the stress of modernization.
For that reason, it is vitally important that we define and develop Psychological Bulletin, 108, 499-544.
counseling in such a manner that it would be ready to meet the challenge Ponterotto, J. G., Casas, J.M., Suzuki, L.A., & Alexander, C. M. (1995). Handbook of
in all regions of the world.
multicultural counseling. Thousand Oaks, CA: Sage.
CONCLUSION Ryan, W. (1971). Blaming the victim. New York: Random House.
Triandis, H. C. (1972). The analysis of subjective culture. New York: John Wiley.
The priority issues of counseling across cultures are also the priority Triandis, H. C. (1994). Culture and social behavior. New York: McGraw-Hill.
issues for counseling generally. As the field of counseling becomes more Trimble, J.E. (1991). Ethnic specification, validation prospects, and the future of drug use
familiar with the importance of the client's cultural context, the practical
utility of multiculturalism is becoming more obvious. The infusion of research. International Journal of the Addictions, 25(A), 149-170.
multiculturalism in the theory and practice of counseling will be a long Trimble, J.E. (1995). Toward an understanding of ethnicity and ethnic identity, and their
process requiring the understanding of "new rules." The imposition of a
"one-size-fits-all" approach to counseling is no longer acceptable to relationship with drug use research. In G. J. Botvin, S. Schinke, & M. A. Orlandi
clients from their diversity of cultural contexts. When counseling has (Eds.), Drug abuse prevention with multiethnic youth (pp. 3-27). Newbury Park, CA:
Sage.
Vassiliou, G., & Vassiliou, V. G. (1973). Subjective culture and psychotherapy. American
Journal of Psychotherapy, 27, 42-51.

Counseling International Students 211

9 COUNSELING INTERNATIONAL provide some guidelines about counseling and psychotherapy with inter-
STUDENTS national students who are experiencing such psychological problems.

Frederick T. L. Leong To provide a review of the literature on counseling international
Elayne L. Chou students, we adopted the framework developed by Bergin and Garfield
(1994) in their classic Handbook ofPsychotherapy and Behavior Change,
··;pR1fv!A:ttv,qaJE~11vl= which is now in its fourth edition. The handbook identifies four compo-
nents to counseling and psychotherapy: the client, the therapist, the
To provide a review of the literature on counseling interna- process, and the outcome. Using this framework, we have divided the
tional students body of our chapter into three sections: the first exploring the client
variables with regard to counseling international students, the second
· ~iijCPNOAB'l{0B~E9JJ'IV,E: exploring the therapist variables, and the third exploring process and
outcome variables, combined into one section because they are highly
To provide guidelines for counseling international students interrelated. We identify salient variables for those four components so
To review the client, therapist, process, and outcome perspec- that the counselor can know which client and process variables are
unique in counseling international students, which therapist variables
tives influence the counseling process and outcome with international stu-
dents, and which factors to consider with regard to outcomes of coun-
ACCORDING to a recent estimate (Zikopoulos, 1992), there are more seling with international students.
than 438,000 international students attending the various colleges and
universities within the United States. As international sojourners, many CLIENT VARIABLES
of these students experience a whole range of adjustment problems,
including culture shock, language problems, isolation, and loneliness of In previous reviews of the literature on counseling international
living in a strange country for extended periods. Recent epidemiological students, client variables have been a major focus. This section on client
studies of mental disorders within the United States have found that variables, like the sections on the other sets of variables, has been divided
approximately 20% of the population have experienced some form of into two parts. The first part consists of an overview of key issues, based
psychological disorder during their lifetime (Robbins & Regier, 1991). in part on previous reviews of the literature on counseling international
Given the stress associated with these adjustment problems, and the typ- students. The second part consists of reviews of more recent studies on
ical epidemiological estimate of about 20%, many of these internationals international students related to the relevant set of variables.
(approx. 88,000) are likely to experience a range of psychiatric disorders
and psychological problems. The purpose of the current chapter is to Key Issues
provide a review of the current literature and to use that review to
In their review, Alexander, Klein, Workneh, and Miller (1976) found
210 that studies on adaptation of non-Western international students show
that warm international contacts are exceptions on large American
campuses. Those students able to bridge the barriers are unique, and
those who remain estranged from Americans are more traditional and
more inhibited socially (p. 231). Leong (1984) divided personal adjust-
ment problems of international students into three types: those common
to all students, those common to most sojourners, and those unique to
international students. Likewise, Furnham and Bochner (1982) parti-
tioned international students' problems into four areas: problems con-

212 COUNSELING ACROSS CULTURES f Counseling International Students 213

fronting anybody living in a foreign culture, difficulties facing all late I key indicators of each stage that vary with the culture of origin (p. 131).
adolescents and young adults, academic stresses, and stresses related to
the role overseas students have to play as ambassadors for their country. !
Thus international students face additional stresses to those of native
students, but not all their difficulties can be attributed to their foreignness Furnham and Bochner (1982) explained, "The limitation of the 'culture
(Furnham & Bochner, 1982, p. 125).
shock' formulation lies in its simplistic theoretical foundation, its non-
In the third edition of Counseling Across Cultures, Thomas and Althen
(1989) listed some major problems and issues of adjustment unique to specific nature and its lack of clear implications for remedial action; i.e.,
international students: culture shock; academic difficulty stemming from how to reduce culture shock" (p. 171).
the novelty of the academic system; political, religious, and social
conflicts among fellow nationals; impact of developments in their home The stage model of culture shock is related to the hypothesis of a
countries; cross-cultural male-female relationships; social isolation, de- U-curve of adjustment, in which cross-cultural sojourners are thought to
pression, or paranoia; financial difficulties; anxiety brought on by fear
of immigration authorities; stressful relationships with Americans; deal- progress through three stages: initial elation and optimism, followed by
ing with new-found freedom; dealing with disappointed expectations; frustration and depression, and finally an upswing toward confidence
dealing with the death of family or friends in the home country; deciding
where to live after graduation; and anxieties about returning home and satisfaction (Furnham & Bochner, 1982). Some studies have found
(pp. 214-217).
support for the hypothesis, while others have not. An alternative formu-
Martinez, Huang, Johnson, and Edwards (1989) used experiences
from their own clinical work in suggesting that international students lation of the hypothesis pits the three phases (initial adjustment, crisis,
who predominantly identify with either mainstream American culture or and regained adjustment) in the U-curve hypothesis against the W-curve,
their own culture of origin are less likely to experience major identity/
self-concept problems than those who feel torn between two cultures which takes into account return to the country of origin, where there is
(p. 299). Unique problems international students are thought to have are a reacculturation process in the same U shape, forming a W-curve al-
adjusting to American values and ways, English as a second language,
and reduced socioeconomic status. together (Furnham & Bochner, 1986). Both of these conceptions have

The adjustment literature has included the area of culture shock viewed adjustment problems on the basis of the medical model (Furnham
research. The term culture shock was introduced into the literature after & Bochner, 1986, p. 131).
World War II and implied that entering a new culture was a potentially
confusing and disorienting experience (Furnham & Bochner, 1982). Furnham and Bochner (1982) argued that problems of the sojourner
Paige (1990) pointed out that sojourners' responses are popularly re-
ferred to by the term culture shock, but are known in the theoretical have been conceptualized in the medical model, in which psychologists
literature as cultural adjustment and culture learning. He divided this apply traditional psychotherapeutic models and techniques to adjust-
concept into the categories of adjusting to and learning about the culture, ment problems (pp. 163-164). An alternate view is that sojourners do
adjusting to the academic environment, and psychological acculturation.
Furnham and Bochner (1986) cited Oberg (1960) as the first to describe not need to adjust to a new culture but instead need to learn its
culture shock in terms of stages and discussed Oberg's four stages of characteristics (the social skills model; Bochner, 1981). One implication
honeymoon, crisis, recovery, and adjustment. However, they also related
some of the problems others have found with the stage model of culture of this view is that failures and problems of international students should
shock (Church, 1982, cited in Furnham & Bochner, 1986): order of the not be regarded as symptoms of underlying pathology, but as due to lack
stages, skipping stages versus passing through all of them, and lack of
of necessary cultural skills and knowledge. Further, although adjusting

a person to a culture is ethnocentric, helping someone to learn a second
culture is not (p. 164).

Related to studies on culture shock is research on coping strategies.
Leong (1984) cited several different authors' conceptualizations of the

coping process and various strategies international students use toward
adjustment to the new culture. The social skills model falls under the

category of strategies for coping. Klineberg and Hull (1979, cited in

Furnham and Bochner, 1986) studied 2,536 international students from

139 nations, studying in 11 countries. The authors found no support for
the U-curve hypothesis of adjustment and they found that the two most
important factors in the coping process were social contact with local

people and prior foreign experience. In Pedersen's (1991) review, Klein

(1977) was cited as having identified four coping strategies: instrumental
adaptation, identification adaptation, withdrawal adaptation, and resis-

I214
COUNSELING ACROSS CULTURES Counseling International Students 215

tance adaptation. In addition, Taft (1977) listed four areas tied to coping: students are often perceived as being in the United States because its
size of gap between familiar and unfamiliar culture, abruptness of education system is superior, and because the United States has advanced
discontinuity, salience of changes to functioning, and encompassing technologies and a developed economy. Second, international students
can be handicapped in language ability, academic preparation, analytical
degree of new culture. reasoning and writing skills, and familiarity with our education system,
International students have been found to somaticize their emotional all of which make Americans feel superior. International students are also
perceived as competing for scarce resources. Third, they serve as cultural
problems. Alexander et al. (1976) asserted that international students are resources who can enrich American students and communities. Fourth,
a high-risk group because of the amount of stress they are under. In they are economic resources who contribute to the economy by main-
addition, stress is more likely to be experienced physically than psycho- taining enrollments and bringing in tuition revenue, and by purchasing
logically, international students are more likely to seek medical than from local stores. Finally, they occupy the role of the outsider (pp. 169-
psychological help, and there is much commonality to international 170). Pedersen (1991) commented that of all the roles confronting the
student psychosomatic and emotional problems. Leong (1984) reported international student, perhaps the most diffuse and difficult to fulfill is
that some studies show that international students suffer from more the stereotype of what international students are supposed to be. That
health problems than local students, perhaps because of somatization of is, international students are often confined to a narrow role, although
adjustment problems. Other studies he looked at reported underutiliza- there is actually great variability within the population of international
tion, with large numbers caused by a small percentage of the population students, even those from the same home country. Pedersen cautioned
skewing figures. Furnham and Bochner (1986) cited previous research that by making them into a "special case," researchers may be isolating
by Cole et al. (1980) that failed to find that international students were them, which is just as bad as not recognizing their unique problems.
more prone than native-born students to visit university health centers. Finally, he stressed that how international students perceive and define
The authors suggested that previous studies had found more health their roles and learn to cope accordingly is important. Thus the study of
problems among international students only because Western doctors international students requires an individualized perspective (pp. 13-
labeled as pathological the normal behavior of members of another 14).
culture. Ward (1967, cited in Furnham & Bochner, 1986) presented a
"foreign-student syndrome" that had the symptoms of nonspecific physi- Recent Studies
cal complaints, withdrawn and passive interaction style, and an unkempt
appearance. He proposed that international students somaticized their In a descriptive study on frequency and types of use of a university
problems because they were less likely to lose face by seeking medical health center, Ebbin and Blankenship (1986) suggested that international
help than by seeking psychological help. Furnham and Bochner (1986) students bring multiple complaints that do not readily fit into any
cautioned that "studies purporting to show differences in the mental syndrome complex. In addition, emotions may be attributed to body
health of native and overseas students by using medical consultation rates parts, or language barriers may contribute to problems in making diag-
must be interpreted with caution. Overseas students may have no other noses. They compared the frequency of health center use of international
source of help, and their beliefs about illness may differ from those and domestic students and examined differences in diagnoses, isolating
prevalent in the host country" (p. 123). Further, an above-average utili- those associated with stress. Although international students constituted
zation rate for a group can result from frequent visits of a small subgroup 13% of the student population, they made up 18% of the visits to the
of its members if corrective statistics are not used. Thus the question of health center and 210/o of the individuals who visited the center. Of the
whether international students over- or underutilize health centers needs various diseases seen more often in international students than domestic
to take into account repeat users, as well as somatization of psychological students, psychiatric or counseling problems was one category. This
problems. The issue of the nature and extent of somatization among included such diagnoses as anxiety/stress reaction, depression, insomnia,
and sexual dysfunction/concerns. Findings are suggestive of somatization
international students also remains controversial. of emotional problems in international students.
Finally, the roles international students take on have also been re-

searched and reviewed. Paige (1990) described the roles of international
students in terms of perceptions of international students. International

216 COUNSELING ACROSS CUL TURES I Counseling International Students 217

Studies Focusing on Stress in in the types of social support that were most helpful: Relations with
Relation to the Sojourner Experience faculty members were particularly beneficial for men, whereas tangible
support, relations with other students, and curriculum flexibility seemed
Oropeza, Fitzgibbon, and Bar6n (1991) described stressors they felt most beneficial for women. Likewise, all types of family support seemed
were central to mental health crises among international students. The beneficial for men, whereas quality of child care was negatively corre-
first is culture shock, which usually is manifested as anxiety and depres- lated with stressful life events for women, and problems in living condi-
sion-related symptoms. Second, changes in both social and economic tions and inadequate financial resources were related to depression for
status can create feelings of loss, grief, or resentment. Third, expectations women. Thus models of stress and buffering effects of social support for
about academic performance are another stress for international students American students also applied to this sample of international students.
who have a high need for achievement. Such stress is exacerbated by the The authors suggested that female international students were possibly
stereotypic view of international students as a homogeneous group of in "double jeopardy" for experiencing stress.
highly talented individuals. A fourth stressor is isolation, alienation, and
discrimination. It is a mistake to think that all international students will Studies Focusing on Adaptation to New Cultures
gravitate toward persons of their own nationality; students of one
nationality may well be divided by political, religious, and social con- In the adjustment literature, some recent studies focused on specific
flicts. Finally, family-related pressures can include different rates of aspects of coping or adaptation to the new culture. Because different
acculturation for different family members. This stressor can exacerbate countries are likely to subscribe to different beliefs and value orienta-
all other stressors. tions, international students from the same country (e.g., the United
States) are likely to experience a somewhat different set of adjustment
In a similar vein, Aubrey (1991) identified common sources of stress issues in different countries. Due to this cultural variation in adjustment
for international students. These include their academic situation and issues for international students, a series of studies have been conducted
nonacademic stresses such as unfamiliar living arrangements or culture to identify these culture-specific factors. For example, Barker, Child,
shock from experiencing dissimilar values. Students may repress stress Gallois, Jones, and Callan (1991) conducted two studies examining
because they are unwilling to admit they are unhappy in a country when difficulties of international students compared with host national stu-
that would entail loss of face. They may also somaticize stress. One diffi- dents in dealing with social and academic situations. The first study
.culty in treating mental problems related to stress is that they are usually focused on social situations and coping strategies. Three groups of
very stigmatized in the culture of the international student. Also, "talking students at the University of Queensland-Australian urban, Australian
therapy" may not be as familiar to international students as it is to local rural, and Asian-were matched for sex, age, and amount of time as a
students, and therefore may be difficult to explain. Finally, international resident of Brisbane and completed a questionnaire. Overall, Asian
students may be accustomed to receiving medication for psychological students had the most difficulty in a list of social situations given (i.e.,
problems. going to pubs, dances, small private parties, dating, being with a group
of the opposite sex, being intimate with a member of the opposite sex,
The effects of stress on international students may be mitigated by and dealing with someone who was angry or aggressive). In addition,
social support, according to Mallinckrodt and Leong (1992). Current Asian students did more information seeking and problem solving to
models of social support for American students deem social support resolve difficult social situations than Australians. Many social difficul-
necessary for positive adjustment and well-being-a direct effect. In ties were shared by international and host national students in that
addition, it is a coping resource for students adjusting to a new and adjustment to a new environment was difficult for rural Australians as
unfamiliar environment in that it provides a buffering effect against the well as Asian students. However, these students also differed in percep-
impact of stress. This study examined level of stress symptoms and tions of social situations, pointing to cultural differences.
sources of social support in male and female international graduate
students. Results supported the direct effects of social support in that In their second study, the authors looked at academic situations and
social support correlated negatively with stress symptoms. Hypotheses attributions made to explain actions. This sample consisted of equal num-
about the buffering effect were supported for academic program support bers of Chinese students and Australian students. Rural/urban differences
but not family environment support. There were also gender differences

218 COUNSELING ACROSS CUL TURES T Counseling International Students 219

were not examined because students came from a variety of different situation was reversed when job performance was assessed. This may
campuses. A questionnaire was administered in which four vignettes have been because family life is very different and not easy in China.
describing behavior in academic situations were presented (addressing a Thus these people may have had an extra adjustment to make. Third,
lecturer by his or her first name, actively participating in discussions or professions such as marketing, trading, and advertising made adjustment
seminars and expressing personal opinions, asking a lecturer or supervi- more challenging because these jobs required more direct and frequent
sor for help with subject or lecture material, and asking a lecturer for an interaction with people of the host culture, suggesting that these people
explanation about a low grade on an assignment). They portrayed needed more preparation than those in other professions before going
contexts in which Asian students were believed to use inappropriate overseas (Cui & Awa, 1992). Although this study did not look at inter-
styles of communication. The students rated each situation on a scale of national students, the findings that effective job performance and cultural
likelihood that they would behave in the depicted way. Attributional style adjustment are two different tasks can be expanded to studies on inter-
was assessed via ability to speak English, strategies for doing things, traits, national students so that studies look separately at academic adjustment
and efforts. In addition, attributions about culture were assessed by and cultural adjustment. For instance, it is intriguing to think of possible
norms in home culture and norms in Australian culture. Overall, par- differences in students' adaptation depending on what field they are
ticipation in tutorials was the only situation in which Asian students studying. On the other hand, these two tasks may not be as easily sepa-
differed significantly from Australians in likelihood of behavior. Asian rable for students as they are for business people.
students were more aware of Australian norms than Australian students.
Lack of English skills was the explanation given by Asian students to Ying and Liese (1990) wanted to know what differentiated interna-
explain behaviors in all four situations. They were aware of how they tional students who benefited and grew from the experience of studying
were expected to act but were unsure about their English language abroad from those who were overburdened and unable to cope with the
capabilities. Implications of the findings provide support for the social experience. The authors used a longitudinal perspective in examining the
skills model in that the authors suggested linking newly arrived interna- process of adaptation of a group of Taiwanese international students and
tional students with local families or students to provide friendship and studied the impact of prearrival preparation and resources on initial
skills training. Also, they suggested that there may be overattribution of postarrival emotional well-being and adjustment to the United States.
problems to difficulties with English when problems actually result from Adaptation was conceptualized as a subjective sense of adjustment (result
unfamiliarity with cultural norms or with the new environment (Barker oriented, cognitive appraisal of one's life), as well as emotional well-
being (process oriented, level of distress experienced while engaged in
et al., 1991). the process of making the adjustment). Culture shock theory suggests
Cui and Awa (1992) argued that too much attention has been paid to that initial euphoria is a result of traveling to a host culture vastly
different from the home culture. But because Taiwan is not extremely
identifying predictors of ability to adapt and not enough to conceptual- different from the United States socially, politically, or economically,
izing the process of cross-cultural adaptation. Their study examined the there was no expectation, and no finding, of postarrival euphoria.
importance of dimensions of intercultural effectiveness to two aspects of Instead, groups appeared quite emotionally distraught after arrival, but
cross-cultural adaptation (adjustment and job performance) and assessed reported adequate adjustment. Results showed that superior adjustment
the impact of background and situational variables on cross-cultural after arrival was significantly correlated with postarrival emotional well-
adaptation. In this study, language and interpersonal skills, social inter- being. Postarrival CES-D level was predicted by baseline prearrival
action, cultural empathy, personality traits, and managerial ability were CES-D, poorer self-assessment of English ability, anticipation of more
the underlying dimensions of intercultural effectiveness. Subjects were interpersonal problems, a higher Test of English as a Foreign Language
sojourner Chinese business people. (TOEFL) score, and a higher score on the feminine tendency scale. These
findings suggest that it may be possible to predict adaptation to the new
Results indicated that to be interculturally effective, a person had to culture because it is largely a self- fulfilling prophecy. Thus predeparture
be effective in both cross-cultural adjustment and job performance. Thus programs that build confidence are a possible measure for adaptation.
intercultural effectiveness should be studied as two related processes-
adjustment to the cultural environment and to the workplace-that have A methodological problem with adjustment studies of international
different requirements and priorities and should not be confounded. students is that they fail to distinguish between mental health of the
Second, married sojourners adjusted better than single persons, but the

220 COUNSELING ACROSS CULTURES Counseling International Students 221

student prior to the overseas sojourn and during the sojourn (Sam & vocational-educational problems, Chinese students indicated a friend as
Eide, 1991). If it is the case that international students tend to exhibit their first choice, but American students chose an academic adviser. For
the "foreign student syndrome" (Ward, 1967) of somatization of psy- psychological pathology, Chinese favored no one, whereas American
chosocial problems into physical symptoms, then it is necessary to find students favored a psychiatrist. Chinese students chose a broader range
out which physical symptoms were present prior to departure. Sam and of preferred helpers for psychopathology problems than did Americans.
Eide assessed general health of foreign students prior to and during the The top three problems for which American students sought help were
sojourn, symptoms indicating mental health, psychosocial factors that health, academic, and financial, whereas those for the Chinese were
predict mental health, and students most vulnerable to poor health. academic, vocational-educational, and health (Mau & Jepsen, 1990).
International students at the University of Bergen, Norway, representing The authors concluded that results could be due to the view, in Chinese
50 different nationalities, were asked to evaluate both their current culture, that personal problems indicate a lack of resolve by the individ-
general health and their health prior to their overseas studies. Results ual. Alternative explanations are that Chinese students found it difficult
indicated that health was evaluated as better before the sojourn and that to admit to having a problem, gave academic goals higher priority than
there was general impairment of health of international students during social concerns, or were less open in expressing needs. However, findings
their sojourn. Prevalence of anxiety, depression, paranoia, and somatic suggested that Chinese students do not differ from American students in
complaints was predicted by psychosocial factors. preference for helpers {p. 101). Thus this study lends support to the idea
that international students face some problems faced by all college
The predominance of academic issues suggested that international students, but also place different emphases on these problems and may
students gave higher priority to education than to social matters. The seek different sources of help for problems.
sociocultural issues suggested that poor mental health of international
students resulted not just from being a student or being a foreigner, but Schram and Lauver (1988) showed that alienation of international
from a combination of the two. Single students, married students living students from university life can be predicted on the basis of social
away from their spouses, young students, women, undergraduates, contact, graduate status, and geographic home region. They used the
Asians, and Arabic-speaking students were found to be most vulnerable definition of alienation provided by Burbach (1972), which includes
to poor mental health. Also, the period between the second and the third feelings of (a) powerlessness (feeling that it is impossible to achieve
years of overseas stay was the most critical period in the development of desired outcomes, based on a subjective personal interpretation of the
poor mental health. The authors found their sample of international situation rather than objective societal conditions), (b) meaninglessness
students to have higher rates of mental health problems than the general (inability to make sense of what is happening and uncertainty as to what
student population, as well as higher rates of mental problems prior to to believe or do), and (c) social estrangement (loneliness). In their study,
overseas studies (Sam & Eide, 1991). they investigated nine independent variables as possible predictors of
alienation: social contact, age, sex, presence of a spouse, geographic
Mau and Jepsen (1990) looked at differences between international home region, length of time in the United States, length of time in the
students and American students in perceptions of problems and prefer- university town, urban or suburban versus rural background, and gradu-
ences for helpers. Chinese and American graduate students from the ate versus undergraduate academic status. With a sample of 266 interna-
fields of engineering, mathematical science, business, and education tional students, social contact, graduate status, and Europe as home
filled out a questionnaire and checklist of problems, identifying ideal region were negatively correlated with alienation and accounted for 10%
of the variance in alienation scores. Students from Asia, followed by those
helpers for various problem areas. from Africa, had slightly higher alienation scores than students from the
American students were significantly more likely than international Middle or Near East and Latin America. International students most
likely to be at risk were non-European undergraduates who spent little
students to regard hypothetical health problems, personal-psychological time with others.
problems, financial difficulties, courtship/sex/marriage problems, home/
family problems, and psychological pathology as serious. All students felt The implications that the authors drew from this study were that
that the ideal helper for health problems was a doctor; for financial dif- programs designed to help international students adjust to the United
ficulties, one's parents; for social-psychological, personal-psychological, States could be tailored to particular groups so that particular approaches
courtship/sex/marriage, and family problems, a friend; for moral/
religious problems, no one; and for academic problems, an adviser. For

222 COUNSELING ACROSS CUL TURES Counseling International Students 223

could be matched to specific needs. Second, orientation programs could In an addition to the extensive literature on the U-curve of adjustment,
encourage international students to become acquainted with Americans Nash (1991) cited several possible explanations for the lack of empirical
by helping them understand why this is important. Also, these programs support for the U-curve hypothesis of sojourner adjustment. The U-curve
could help students practice skills involved in getting to know others, as does not take into consideration those sojourners who fail to adapt
well as providing opportunities for doing so in the university setting. and/or return home. Also, it does not apply to those who do not involve
Interventions could also be designed that specifically address the three themselves deeply in a foreign culture, such as tourists. Nash also
aspects of alienation (powerlessness, meaninglessness, and social es- questioned how adaptation or adjustment was to be measured. A final
trangement) (Schram & Lauver, 1988). query was whether the U-curve was unique to sojourners or whether it
also applied to people engaged in other endeavors (e.g., achieving
Students' concerns were the focus of a study by Parr, Bradley, and mastery of any significant problem). Methodological problems of pre-
Bingi (1992). Specifically, the authors asked: (a) What are the concerns vious U-curve studies also abounded in Nash's review of the literature.
of international students, and how might these be best classified? (b) Are Cross-sectional studies of sojourners will not detect a U-curve; longitu-
students' concerns related to their feelings? and (c) Does the magnitude dinal studies are needed. But even then, a control group is needed so that
of students' concerns and feelings vary significantly across demographic outcomes can be attributed to the sojourn itself. In addition, retrospective
differences such as sex and race? The authors drew a random sample of data can be subjectively distorted, so on-the-spot assessments of subjects'
100 institutions and mailed five questionnaires to each student personnel conditions in both experimental and control groups are necessary.
office. Office directors were asked to give the questionnaires to the first
five international students who came into their offices. The total sample In this study, Nash (1991) compared a group of American students in
was 163 students. The questionnaire had items on demographics, con- France with a group at their home University of Connecticut in the
cerns, and feelings. International students' concerns were moderate in United States during an academic year. The questionnaire was adminis-
intensity and depicted feelings that were more positive than negative. tered to both groups immediately before departure, once after the
International students were most concerned about their extended family, overseas group was in Paris, and twice more during the year. Taylor
cultural differences, finances, and school. Findings did not confirm the Manifest Anxiety Scale (Taylor, 1953) scores indicated no significant
belief that depression is a common reaction to homesickness. Concerns difference between the two groups' changes between the administration
regarding cultural differences focused on the competitiveness, individu- at the very beginning and the one at the very end of the year.
alism, and assertiveness of American culture. Concerns about finances
targeted work opportunities rather than living expenses. Students were Thus, when compared with the control (home) group, the overseas
also concerned about finding adequate time with an adviser and in (experimental) group did not show any differences in the course of
understanding lectures. They expressed little concern about meeting well-being. Because of his findings with more stringent methodology,
their essential needs of housing and food. They showed almost no con- Nash questioned whether there is any value in the U-curve hypothesis
cern about finding a place of worship, or about using American tele- for science. He advised continued careful use of it as a heuristic device,
phones or cars. Scores on the feelings items depicted international but warned that it tells nothing about how the foreign situation is
students as determined, thankful, happy, confident, cheerful, and cau- experienced by the sbjourner. Rather, this notion is more fully accounted
tious. They saw themselves as coping well. Positive feelings ran highest for by studies of culture shock.
during their first year in the United States, with the second year being
less positive, followed by another positive upswing, a finding similar to Studies Focusing on Acculturation
the U-curve hypothesis (Lysgaard, 1955). However, there could have ofInternational Students
been overrepresentation of assertive, resourceful international students
in this study due to the method of selection. On the other hand, the Acculturation has been identified as one of the major moderator
authors suggested that students who frequently visit their student per- variables in understanding ethnic minorities for several decades now
sonnel offices may be effective peer helpers or could serve as role models (e.g., Leong, 1986; Sue & Morishima, 1982; Sue & Sue, 1990). More
for helping others understand how to meet basic needs. recently, the acculturation process has also been applied to international
students' adjustment process. The most commonly used model of accul-

T

224 COUNSELING ACROSS CULTURES Counseling International Students 225

turation within cross-cultural psychology has been the one proposed by ability to carry on; the eventual outcome for any particular individual is
Berry (1980). Acculturation is often defined as the amount of change that affected by other variables that govern the relationship between accul-
occurs when two cultural groups come into contact with each other over turation and stress" (p. 453). These other variables are nature of the
an extended time period. According to Berry's model, ethnic or cultural larger society, type of acculturating group, modes of acculturation,
minorities, in undergoing the acculturation process, have to answer two demographic and social characteristics of the individual, and psychologi-
basic questions: (a) What is their basic orientation toward their own cal characteristics of the individual (Berry & Kim, 1988). Subjects were
culture {positive or negative)? and (b) What is their basic orientation administered questionnaire materials and divided into five groups. These
toward their host culture {positive or negative)? were local Chinese students and faculty (LC) at a university in China,
sojourner group 1 (Sl; visiting Chinese scholars in Canada), sojourner
These two questions can be the basis of a 2 x 2 matrix in which group 2 (S2; visiting scholars and visa students in Canada), Chinese-Ca-
individuals are classified into four distinct groups. The first group are nadian (CC) students, and non-Chinese Canadian (NCC) students.
individuals who answer "yes" to maintaining a positive orientation
toward their own culture and "yes" to learning and adopting host Results showed significant between-group differences across the five
culture's values, practices, and behaviors. These individuals are what samples in total English fluency, reported ease of making friends, physi-
Berry has called Integrationists. They are trying to adopt and integrate cal health concept, and three items of health causation (one's fate or luck,
the best of both worlds-what they have brought to the country and what innate qualities, and health behaviors). Problem areas such as work,
they can take from the country. The second group, who are positive family and children, language and communication, discrimination, and
toward their host culture but negative toward their own culture, are homesickness were reported to be the greatest difficulties by S1 and S2
labeled Assimilationists. In the case of international students in the and the least by CC and NCC. However, in scholastic problems, and love
United States, these individuals tend to become very Americanized and and marriage, the least difficulties were reported by S1 and S2 and the
give up much of their traditional cultural values, practices, and behaviors. greatest by CC and NCC. There were significant differences between
The third group, the Separationists, are those who maintain a very strong groups in ways of coping such as problem solving, wishful thinking,
positive orientation toward their traditional culture and values and tend self-blame, tension reduction, and seeking informational support. On
to reject the host cultural values. The fourth and final group would be acculturation attitudes, Integration scores were uniformly high. Groups
the Marginalists-individuals who have given up their own traditional Sl and S2 were significantly higher on Separation, but lower on Assimi-
cultural values but at the same time have not adopted the host culture. lation than CC. No significant differences between groups were found
They include alienated youth and marginal people in U.S. communities for Integration and Marginalization. There were significant differences
who tend to be gang members. Berry's two-dimensional model of accul- on adaptation to life, study, and work in Canada. The longitudinal
turation has provided an important framework for research into inter- analysis of S1 adaptation showed significant differences on number of
national students' adjustment process. problems between predeparture scores (on the questionnaire given dur-
ing the past month before departure from China) and after-arrival scores
Zheng and Berry (1991) examined the acculturation process among (on the questionnaire given during the second and fourth months after
sojourners-specifically, Chinese sojourners in Canada. They investi- arrival in Canada). Their total scores increased, as did specific problems
gated the psychological adaptation of Chinese sojourners and the rela- of finance, school, language, recreation, social relations, homesickness,
tionships of health beliefs and behaviors, acculturative experiences and and loneliness (Zheng & Berry, 1991).
attitudes, acculturative stress, and subjective adaptation. Previous work
on acculturative stress (e.g., the U-curve of adaptation) was carried out When scores of adaptational outcome for Sl (predeparture to 3-4
cross-sectionally rather than longitudinally, limiting understanding of months) were combined with scores of S2 (5 months and over), an
the acculturation process, so the authors addressed this restriction by inverted U-curve was found. Overall, the longitudinal analysis done in
including a longitudinal readministration of the questionnaire on adap- this study found that lower health status was a frequent outcome for
tational outcomes for one group of subjects. The authors' study was individuals undergoing acculturation. However, decreasing health status
based on the idea that acculturation stress is affected by many variables. appeared mainly as lower psychological health. Acculturation did not
As Zheng and Berry explained, "Acculturation sometimes enhances one's always lead to a negative outcome or lower health status. The authors
life chances and mental health, and sometimes virtually destroys one's suggested a link from health concept to health causation to health beliefs

226 COUNSELING ACROSS CULTURES r Counseling International Students 227

to health behaviors, and finally to adaptational outcomes. They indicated tations of the native culture. The authors asserted that the best model to
that some steps should be taken to improve sojourners' health status and account for previous findings is Mendoza and Martinez's model of
adaptation to study abroad: predeparture screening; predeparture acculturation (1981). This model is two-dimensional and includes (a) a
courses and training; and after-arrival counseling, programs, and services modalities dimension (cognitive, affective, and behavioral components)
(Zheng & Berry, 1991). and (b) a types dimension (cultural assimilation, native cultural extinc-
tion, cultural resistance, cultural shift, cultural incorporation, cultural
In a different study, Sodowsky and Plake (1992) examined the effects transmutation). The primary hypothesis was that behavioral, affective,
of culture and sociocultural variables on acculturation by asking, "Are cognitive, and socioeconomic variables affect overall cultural adjust-
people from different continents such as Africa, Asia, South America, and ment. The second hypothesis was that most of the variance in personal
Europe different in their acculturation?" and "Do variables such as and social adjustment could be accounted for by five acculturation levels
permanent ... versus nonpermanent ... residence status, length of resi- of cultural assimilation, cultural resistance, cultural shift, cultural incor-
dence in the United States, religion, and gender affect acculturation?" poration, and cultural transmutation. A third hypothesis was that various
(p. 54). They mailed 925 questionnaires to international students, post- levels of acculturation would predict low or high cultural adjustment. An
doctoral researchers, and permanent U.S. residents and naturalized international student group and an American student control group were
citizens, and received 606 in return. Africans, Asians, and South Ameri- administered questionnaires. The primary hypothesis was supported in
cans perceived prejudice significantly more than did Europeans; in fact, that cultural adjustment was affected by marital status, employment level,
Europeans disagreed that there was prejudice. Europeans seemed bicul- language spoken at home, having close American friends, having native
tural in acculturation, whereas Africans, Asians, and South Americans friends, internal decision making, work value, and happiness value.
preferred the values and practices of their own nationality groups. A
relationship between perception of prejudice and acculturation is possi- Overall cultural adjustment (acculturation) was characterized by cul-
ble. International students perceived prejudice significantly more, were tural resistance, cultural shift, and cultural assimilation. International
more affiliated with their own nationality groups, and used English students who scored high on cultural resistance tended to be married,
significantly less than did permanent residents and visiting international non-English speaking at home, and without close American friends. They
scholars. These findings point to important within-group differences that did not make decisions based on internal values and did not value work
warn against overgeneralization of adjustment issues to all sojourners. and happiness. Those with high cultural shift scores were single, English-
The authors hypothesize that permanent U.S. residents and naturalized speaking at home, and had close American friends. They made decisions
citizens may have chosen acculturation to White U.S. society, whereas based on internal values and highly valued work and happiness. In regard
international students may have rejected acculturation. Muslims per- to the second hypothesis, cultural incorporation and cultural transmuta-
ceived the greatest amount of prejudice, then Buddhists, Hindus, those tion were the only two acculturation levels accounting for a significant
who did not belong to any organized religion, and finally Protestants and portion of the variance in international students' personal and social
Catholics. There were no significant gender differences. Significant adjustment. In regard to the third hypothesis, international students who
aspects of identity for international students were different from what adjusted well to the United States generally scored low on external
has been shown for African Americans. Subjects in this study based racial decision making, society values, and cultural incorporation. In addition,
identity not so much on race issues as on religion, values, need to depend they scored high on cultural transmutation, spoke English at home, and
on or seek freedom from symbols of their nationality group, physical subscribed to newspapers and magazines of their native country. Inter-
appearance, and language/accent. national students who did not adjust well to the United States were
characterized by the opposite. Speaking English at home was the single
Cultural adjustment involves both acculturation and assimilation, but factor that contributed to both cultural adjustment and personal and
there are no standard definitions of these terms in the ethnicity literature social adjustment. The implications are that international students who
(Kagan & Cohen, 1990). The terms adjustment, acculturation, and are predicted to adjust well to the host culture should be encouraged to
assimilation have been used interchangeably to denote behavior, value, immerse themselves in the host culture, especially by making friends and
and attitude changes associated with feelings of mental health and social using the host language at home. But they also should be encouraged to
integration. Kagan and Cohen stated that cultural adjustment is a process preserve their ties with native friends (Kagan & Cohen, 1990).
that incorporates levels of association with the host culture and expec-

228 COUNSELING ACROSS CUL TURES r 229
Counseling International Students
THERAPIST VARIABLES
problem. There are major differences between how persons from indi-
Key Issues vidualistic cultures and those from collectivistic cultures experience and
perceive their worlds. Triandis, Brislin, and Hui (1988) provided an
In discussing the therapist variables that may affect counseling with excellent discussion of this important value dimension. They contrasted
international students, it seems appropriate to begin with the compre- the individualism typical of American counselors with the collectivism
hensive model developed by Sue et al. (1982) in their position paper on of many international students, and provided an excellent set of recom-
cross-cultural counseling competencies. According to this model, there mendations on how an individualist needs to interact and deal effectively
are three dimensions to cross-cultural counseling competencies: aware- with someone from a collectivistic culture.
ness, knowledge, and skills. First, in counseling international students,
the counselor needs to be aware of potential cultural differences that can Besides personal biases such as an individualistic orientation, the
be barriers to effective counseling both in the process and in the goals training provided to the therapist in particular approaches to counseling
and outcomes chosen by the client or the counselor. Second, the coun- and psychotherapy may have inherent biases. Leong (1986) discussed the
selor needs certain culture-specific knowledge: Counseling a Nigerian notion of training bias as it affects the cross-cultural counseling relation-
student is not exactly the same as counseling a Chinese student from ship. Many counselors and therapists in the United States are trained in
mainland China. Third, the counselor needs to develop skills in the Western-oriented models of mental health, adjustment, and psychother-
application of this knowledge with international students. If we accept apy. The mindless application of these models without taking into
the dictionary definition of skill as "the ability to do something well," account cultural variables for international students will be doomed to
then culture-specific knowledge is a prerequisite for the development of failure with, and perhaps cause harm to, international student clients.
special skills in counseling international students. This knowledge is of Counselors should not underestimate the power of the professional
three kinds: (a) knowledge about one's cultural background, training socialization to which they have been subjected in their training.
biases, and blind spots; (b) knowledge about the client's cultural back-
ground; and (c) knowledge about the cross-cultural counseling process. Another therapist variable is that of the contact hypothesis, as pro-
The second and third kinds of knowledge have been addressed elsewhere posed by Amir (1969). Exchange programs in the United States are based
in this chapter. The present section is concerned with the first kind of on the principle that increased contacts with other cultures increase both
knowledge. one's culture knowledge and one's cultural sensitivity. Hence an impor-
tant therapist variable with regard to counseling international students
As mentioned above, an important therapist variable is the therapist's is the amount of contact that the therapist has had with culturally dif-
examination of his or her own value orientations and their impact on the ferent individuals. Whether the contact is with racial/ethnic minorities
counseling process with international students. Leong (1986) and others in the United States or with international students outside of the United
have written about the importance of therapist bias as a major barrier in States, greater contact should produce a higher level of cultural sophis-
cross-cultural counseling. As a human being embedded within a cultural tication. The cultural contact hypothesis maintains that counselors with
framework with a specific set of values, the therapist is likely to bring limited contact and experience with culturally different individuals will
those values into the counseling relationship. Hence the therapist, in be less effective with culturally different clients. Counselors who find
evaluating the mental health adjustment and prognosis for international themselves in these situations would do well to arrange supervision or
students, may be exhibiting some bias. Ethnocentrism is a significant consultation with other counselors who have more experience with such
problem because many American counselors may assume that the goal clients. Future research should empirically examine the extent to which
of counseling is to make international students adapt and adjust to the the contact hypothesis holds true for improving cross-cultural counseling
American way of life. However, that would be to impose an "etic" effectiveness and competencies.
framework that might not be truly helpful to the client. One example of
an American counselor's imposition of an etic framework on an interna- Another important therapist variable related to therapist bias and
tional student client would be the counselor's attempt to encourage the training bias is that of the therapist's expectations of the clients. The
client to think and behave more like an individualist in solving his or her training bias as manifested in Western-oriented approaches to counseling
and psychotherapy includes a certain set of expectations about what a
good client should be or should be doing in the counseling relationship.
If these expectations are carried into a counseling encounter with an

230 COUNSELING ACROSS CULTURES I Counseling International Students 231

international student, they will lead to problems in both the estab- and maintammg family harmony) were respected and supported,
lishment of a therapeutic alliance and the effective resolution of the whereas the latter approach was a Western approach in which the client
client's problems. Such expectations, when imposed upon the client by was encouraged to be more individualistic and self-assertive. As hypothe-
the therapist, will be a culturally dystonic experience for the former. sized by Sadowsky (1991), Asian Indian subjects perceived the counselor
They are likely to be perceived by international students as ethnocentric using the non-Western, culturally consistent approach as higher on
at best and alienating and offensive at worst. expertness and trustworthiness as measured by the Counselor Rating
Form (CRF). Conversely, the White American subjects perceived the
Another important therapist variable is that of counselor's skill in counselor using the Western approach as higher on the expertness and
intercultural communication. The work of the anthropologist Edward trustworthiness dimension of the CRF. Interestingly, the Korean subjects
Hall (1976) on high-context and low-context cultures is important here. in the study found neither approach to have been appropriate for them.
The United States is a low-context culture in which a high proportion of Sadowsky (1991) concluded from these results that the use of a culturally
the communication is carried in the words and a small proportion of the consistent approach by counselors of international students was highly
communication is carried by the context. Thus many therapists are likely important. She went on to observe that the differential results for the
to approach interpersonal communication as a low-context endeavor Asian Indian and the Korean subjects called for more culture-specific
without realizing it. On the other hand, cultures such as those of China, formulations about what constituted culturally appropriate approaches
Japan, and other countries are very high-context cultures in which much for international students. A generic approach formulated for all inter-
of the communication is carried by the context and the nonverbal aspects national students may work for one group (in this case Asian Indians) but
of the communication and hence much less communication needs to be not for another group (Koreans).
carried by the words. When individuals from high- and low-context
cultures interact with each other, much misunderstanding usually occurs In a related study, Merta, Ponterotto, and Brown (1992) compared
because of these different styles of communication. Counselors working Asian international students' ratings of two academic counseling ap-
with international students need to know about the dynamics of high proaches. Using the Counselor Effectiveness Rating Scale as the outcome
versus low-context intercultural communication and when to modulate measure, they found that the high-acculturated Asian students rated
their preferred approach in light of the client's preference. authoritative peer counselors in an orientation program as higher on
overall effectiveness, whereas the low-acculturated Asian students rated
Recent Studies collaborative peer counselors as more effective. These results seem to be
contrary to previous findings about acculturation, which predict that the
In general, there has been a scarcity of empirical studies investigating high-acculturation Asian students would rate the collaborative peer
the role of therapist variables in counseling with international students. counselors as more effective than the authoritative counselors. Unfortu-
Similar to studies of counseling process and outcomes with international nately, this study seems to have been confounded by an unvalidated
students, studies on therapist variables, unlike studies with client vari- measure of acculturation that precluded any comparison of the relative
ables, are simply very costly to conduct in terms of time, resources, and acculturation levels of their sample to those of previous studies. What
samples. It is not surprising, then, that there are many more studies and the results do indicate is that the acculturation level of the Asian
articles devoted to client variables than to therapist variables. Yet there international students did interact with their perceptions of the effective-
is no reason to assume that knowledge about therapist variables is any ness of different counseling approaches adopted by the counselor.
less important than knowledge about client variables in the provision of
effective and culturally relevant counseling services to international In the third study of therapist variables, Yau, Sue, and Hayden (1992)
students. also used an analogue design to examine the counseling style preferences
of international students. They sought to compare the international
Using an analogue design, Sadowsky (1991) examined international students' preferences for either a client-centered/nondirective approach
students' perceptions of counselor's credibility as a function of the or a problem-solving/directive approach. The students listened to audio-
counselor's use of a "culturally consistent" approach or "culturally dis- tapes illustrating both approaches and were assigned to counseling
crepant" approach. The former approach was a non-Western approach sessions consisting of both approaches in a within-group design. Con-
in which the cultural values of the client (meeting parents' expectations trary to the existing literature, the investigators found no differences in

232 COUNSELING ACROSS CULTURES r Counseling International Students 233

the students' preferences for directive over nondirective counseling students avoided seeking treatment until a crisis occurred or as a last
approaches. Like Sadowsky (1991), Yau et al. concluded from their study resort when handling problems on their own had not worked. In addi-
that global recommendations such as "international students will prefer tion, underutilization may be explained by the fact that international
more directive counseling approaches" may not be warranted. However, students may be attending to other dimensions of their problem, which
it should be emphasized that all three studies used an analogue design as do not make counseling centers seem the obvious place to get help.
well as a very small sample of subjects who volunteered for the study. Assessment may be difficult because of communication problems, as well
Analogue designs have a host of problems associated with them, and as the complexity of international students' problems. Communication
generalizability of the findings from small self-selected samples is also issues can include difficulties expressing feelings in English, different
problematic. norms about asking and transmitting information, attention to nonverbal
behavior, semantic difficulties, and difficulties of expressing problems in
Although it is clear that these studies are very costly and difficult to a second language.
conduct and that their yields are often quite limited (due to the use of
small samples and analogue designs), they are nonetheless very important Thomas and Althen (1989) focused on four primary issues in counsel-
in increasing our understanding of cross-cultural counseling with inter- ing international students: cultural stereotyping, the plethora of factors
national students. Studies of therapist variables as well as counseling affecting international students' situations, difficulty in identifying sources
process variables are very crucial to teasing out the key ingredients of of problems, and doubts about the appropriateness of conventional
effective counseling approaches with international students. Western approaches to counseling. They suggested several strategies for
effective counseling with international students: modifying communica-
COUNSELING PROCESS tive style, modifying counseling strategies, modifying counseling styles
AND OUTCOME VARIABLES and client expectations, explaining the adjustment process, dealing with
adjustment-related depression, addressing presenting concerns first, and
There has been much less work done in the area of counseling process acknowledging cultural differences.
and outcome for international students than in describing, explaining,
and predicting client variables of international students. Pedersen (1991) In their review, Furnham and Bochner (1982) detailed how the social
suggested that research on international students has been inhibited by skills model can be used to identify specific situations that trouble
lack of theory in the field; there is more focus on identifying problems individual sojourners and provide specific training in those skills that are
and outcomes than on process research. He found that most studies used lacking. Seven social skills capable of being developed in individuals are
a sample of convenience and that there has consequently been little perceptive, expressive, conversational, assertiveness, emotional expres-
synthesis of research to test theories in the field. Much of the work in sion, anxiety management, and affiliative skills.
this area is also based in the student personnel literature rather than the
psychological literature. As in the client variables section, we first looked Alexander et al. (1976) pointed out reasons why international stu-
to previous reviews of the literature on counseling international students, dents seeking help with emotional problems are likely to be in greater
then sought more recent articles. need of help than an American counterpart. First, international students
from non-Western cultures may not be familiar with professional help
Key Issues for emotional problems. Second, need for professional help constitutes
a loss of status and thus may have been avoided for a longer period of
In their review, Martinez et al. (1989) addressed international stu- time. Third, problems are at a more serious stage because other sources
dents' utilization of counseling services. Underutilization could result for dealing with psychological stress will have been sought first. Finally,
from students' preference to seek help from individuals they know. Also, international students may be reluctant to attract the attention of authori-
students may feel more comfortable with a therapist from a similar ties for fear of damaging their status and national image. It has also been
background. International students tended to enter counseling in a less found that group therapy has little or no therapeutic impact on interna-
formalized way, by making casual overtures. Frequently, international tional students. Medication is one form of treatment that is sometimes
prescribed to international students because it is easier than overcom-
ing various cultural, language, and interpersonal difficulties of therapy.
It is prescribed more frequently for international students than for

234 COUNSELING ACROSS CULTURES Counseling International Students 235

Americans, but taken less regularly by international students. On the A suggested approach to take when counseling Southeast Asian clients
other hand, medication can be very eagerly and responsibly taken by is a system approach, because of the holistic perspective Asians have of
international students if a sense of trust and understanding is developed themselves, or a behavioral approach that reinforces appropriate social
first because this approach is more familiar to them and less demanding skills behavior, modifies existing skills, and teaches new ones. Finally,
than interpersonal contact. the author emphasized that some elements of counseling are common
across cultures, such as tolerance for anxiety in the client, flexibility in
Recent Studies response to the client, confidence in one's belief system, and interest in
the client as a person (p. 165). We feel that most of these recommenda-
Hanassab (1991) administered a questionnaire to young Iranian tions and observations apply not only to Southeast Asians but to most
women who had immigrated to the United States to provide counselors Asians in general (Fernandez, 1988).
with a background for counseling Iranian immigrant women. Although
not all the subjects in this study were students, implications given for Oropeza et al. (1991) presented some of the challenges that face
counseling are nonetheless applicable. Hanassab reiterated Ibrahim's anyone who works with international students in managing mental dis-
(1985) idea that cross-cultural counseling is enhanced by an under- orders. The first issue is learning to recognize and diagnose serious
standing of one's own and the client's worldview and philosophy of life. mental disorders that may manifest or be communicated differently
Because Iranians come from a family-oriented culture, mental health because of cultural differences. There may be cultural differences in what
practitioners should be aware that different rates of transition between is considered "abnormal" as well as many culture-bound psychiatric
generations or genders in a family that has come to the United States can syndromes. Another issue is that of confidentiality and privileged com-
be underlying problems. A second recommendation is that issues of munication. Several factors make confidentiality particularly difficult to
identity be addressed at the personal, social, and cultural levels (p. 18). maintain in the case of international students. First, Immigration and
Naturalization Service (INS) regulations require documentation in a
In a study on factors contributing to culture shock for Southeast student's file if the student needs to interrupt or reduce course load due
Asians, Fernandez (1988) described several factors that influence culture to illness. Second, financial sponsorship rules can sometimes call for
shock in Southeast Asians: time orientation differences, role of the family obtaining permission before making decisions about personal issues.
and its individual members, value systems, social behavior, expectations Third, communicating with support systems can become problematic if
of international students, and acculturation. Because of these differences confidentiality laws prohibit notification of a son's or daughter's hospi-
between Asian and American culture, many counseling assumptions are talization. Fourth, non-native speakers of English can find language
inappropriate for counseling international students from Southeast Asia. barriers extremely stressful when they are struggling to express thoughts
For example, Western counseling theories are based on an emphasis on and feelings in a foreign language at a time when they are mentally
personal growth via self-exploration. Openness, genuineness, and hon- unstable, but using an interpreter can breach confidentiality laws as well.
esty may all be construed as negative invasions of privacy or affronts to Yet another issue is arranging mental health services in the home country
dignity by Southeast Asians, who are more reserved and modest (p. 163). if the student is sent home; mental health services may not be available
It is also suggested that Southeast Asian clients prefer counselors to be in the home country of the student.
active and directive, giving explicit recommendations on how to solve
problems immediately. There may also be gender-role stereotyping of Aubrey (1991) discussed several issues that counselors should bear in
counselors, such that female counselors are expected to be empathetic mind when working with international students. First, students must be
and understanding, whereas male counselors have the right to be aggres- approached in a manner that takes their worldview into consideration.
sive and confrontational. Finally, it is recommended that counselors keep Presenting symptoms that may not fit our diagnostic frameworks (DSM-
in mind that the Western expectation that clients be verbal and direct III-R or ICD-9) should still be accepted as valid. It is suggested that
may cause conflict because Asian culture encourages modesty, not admit- American physicians may benefit from consultation with native healers.
ting to problems, and holding counselors in high esteem because of their This recommendation may be more relevant for some international stu-
authority. dents (e.g., Southeast Asian students) than others (e.g., Australian stu-
dents). A second suggestion is that there may be difficulties in developing

236 COUNSELING ACROSS CULTURES f Counseling International Students 237

a treatment relationship. Non-Westerners rarely focus on abstract con- minority clients. The second type is from questionnaires tapping expec-
cepts, and it is often inappropriate to speak of personal matters with tations of the counseling process and the perceived role of the counselor.
anyone outside the extended family. Sessions predicated on the student's The third type is from analogue studies. Yau et al.'s study compared
talking and the clinician's listening may be in violation of accustomed preferences stated in response to an audiotape presentation of two styles
deference to authority. However, the flip side is that if a relationship is of counseling with preferences that were manifested during actual coun-
not established quickly, students are likely to drop out. A third issue is seling sessions. The authors also determined the counseling style prefer-
that countertransference issues need to be considered. The eagerness of ence of international students during actual counseling sessions. Finally,
international students to adapt and their deference to the authority of they decided whether preferences changed across counseling sessions.
the clinician may evoke compassion and make them seem like good They used single-case studies of six clients from an International Students
patients, whereas their focus on somatic symptoms, psychological Club recruited as part of the university counseling center's outreach pro-
nai'vete, neediness, and demands for advice may be annoying. Interna- gram. The counseling styles used were the nondirective/client-centered
tional students need a sense of real relationship outside of transference (CC) approach and the directive/problem-solving (PS) approach. CC
to trust the unfamiliar process of therapy. style was defined as use of open-ended questions, reflective and affective
responses, and paraphrases and summaries. The PS approach was defined
Brief therapy and/or crisis intervention seem to be the treatments of as use of suggestions, advice giving, problem solving, closed questions,
choice for international students. Unlike other authors, Aubrey (1991) and client guidance. A counseling style preference form was developed
suggested that group therapy can also be helpful if cultural inhibitions for evaluating client's preference for counseling styles in this study. A
block confrontation of certain issues in one-on-one treatment. Commu- personal data form used to collect demographic information also con-
nication can be limited by students' command of English, especially tained a measure of cultural identity, in which participants indicated
under stress. Use of an interpreter can lead to complications. The concept degree of identity with values of their own ethnic group. This study failed
of time varies from culture to culture. Students may arrive for appoint- to support conclusions drawn from the questionnaire and analogue
ments late, early, or even on the wrong day and still expect the counselor studies that indicated that international students prefer a directive style
to see them, just as a trusted family member would always be available of counseling. Clients appeared to find both styles of counseling helpful.
to them. Cultural learning by clinicians is the last recommendation. By Many clients felt that the approaches complemented one another. Results
enlisting students as teachers, several things are accomplished: Students indicate that a blanket statement that the directive approach should be
overcome their passive deference to counselors, are enlisted as equal used with counseling international students may not be correct.
partners in the helping process, and have some self-esteem restored.
DISCUSSION
Hammer (1992) stated that not only counselors but also advisers
need to be trained in cross-cultural counseling because often the inter- Our review of the literature and knowledge base on counseling
national student first seeks the adviser rather than a formal psychological international students shows that we have considerably more informa-
counseling service on campus for emotional or adjustment counseling tion on client variables than on therapist variables or counseling process
assistance. Advisers need to be able to provide culturally appropriate variables. It should not be assumed that we now know everything we
counseling or referrals. Counseling skills should be in both interpersonal need to know about client variables. However, it is time we shifted some
and small-group interaction formats because small groups of interna- of our collective energies, in both empirical research and theory devel-
tional students can focus on particular concerns, be divided by gender, opment, to therapist and counseling process variables. Only when we
or be for spouses. In these group settings, advisers have increased oppor- have developed a viable and relevant set of therapist variables can we
tunities for recognizing and taking action, based on developing trust then proceed to the next step in improving our knowledge base on
within the group, to suggest specific counseling for students experiencing counseling international students; namely, the matching of client and
more severe cultural stress. therapist variables to study differential processes and outcomes. This is
how mainstream psychotherapy research has proceeded, and there is no
Yau et al. (1992) cited previous research with three types of data
implying that more directive and structured counseling is appropriate for
international students because it fits the worldview of minority clients.
The first type of data is from impressions of counselors working with

238 COUNSELING ACROSS CULTURES Counseling International Students 239

reason to believe that scientific knowledge about psychotherapy with Another important innovation is to use and adapt pretherapy orien-
international students would proceed in a drastically different direction. tations so that international students can be prepared to receive maxi-
There are, however, some unique elements to counseling international mum benefit from counseling encounters, given their lack of exposure
students. to traditional Western approaches to counseling and psychotherapy. At
the same time, we need to develop creative ways of reducing help-seeking
The first element is concerned with a controversy within the cross- thresholds, perhaps through outreach programs, educational programs,
cultural counseling field. From its very inception, the cross-cultural and training of paraprofessionals (e.g., dorm residence hall advisers). We
counseling approach has been struggling between adopting a universalist also need to develop prevention activities.
or a culture-specific approach to counseling culturally different indi-
viduals. As illustrated in a recent debate between Fukuyama (1990) and There are so many unique problems in counseling international stu-
Locke (1990), the universalist approach maintains that there are so many dents that it would not be possible to address all of them in a single
culture subgroups that it would be impossible to acquire the necessary chapter. There is an old Chinese proverb that if you give someone a fish,
knowledge to work with each subgroup as clients come in. What is he will eat for a day, but that if you teach him to fish, he will eat for a
needed is a universalist approach to cross-cultural counseling focusing lifetime. Our final recommendations are offered in the spirit of having
on some common themes and parallels that run across all groups that a counselors of international students "fish for themselves." The use of
cross-cultural counselor would need to know. Hence the field of cross- critical incidents as opportunities to learn about cultures has a long
cultural counseling and psychotherapy needs to identify these universal- tradition, and some authors (e.g., Leong & Kim, 1991) have recently
ist principles and apply them sensitively with culturally different clients. recommended using them in cross-cultural counseling training. Our
The alternative approach is that culture-specific information and knowl- recommendation to counselors working with international students is
edge are needed if we are to work effectively with culturally different that they be aware of critical incidents that can teach them about
clients. Thus, if we are to help the Nigerian or Korean client, we need important cultural differences. Published incidents by Brislin, Cushner,
to acquire and appreciate the culture-specific differences between these Cherrie, and Yong (1986) in their book lntercultural Interactions may
different types of students. This controversy is particularly salient in prove very helpful. At the same time, counselors in a particular university
counseling with international students because on any one campus there or counseling service may wish to collect local incidents and compile
may be students from more than 100 countries, not to mention cultural sub- these for case conferences so that they can be used as additional teaching
groups. It should be noted that Leong (1995) recently offered an inte- tools. In addition, organizations such as the National Association for
grative model for cross-cultural counseling and psychotherapy that seeks Foreign Student Advisors (NAFSA) may begin collecting and disseminat-
to combine creatively the universalist and culture-specific approaches. ing such critical incidents as training resources.

Given the sheer number of countries and cultures involved, it seems REFERENCES
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pp. 205-241). Honolulu: University of Hawaii Press.

242 COUNSELING ACROSS CUL TURES r

Triandis, H. C., Brislin, R., & Hui, C. H. (1988). Cross-cultural training across the 10I
individualism-collectivism divide. InternationalJournal oflntercultural Relations, 12, COUNSELING AND
269-289. PSYCHOTHERAPY WITH REFUGEES

Ward, L. (1967). Some observations on the underlying dynamics of conflict in a foreign Fred Bemak
student. Journal of the American College Health Association, 10, 430-440. Rita Chi~ing Chung
Thomas H. Bornemann
Yau, T. Y., Sue, D., & Hayden, D. (1992). Counseling style preference of international
students. Journal of Counseling Psychology, 39, 100-104.

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exchange. New York: Institute of International Education.

PAIMARY OBJECTIVE:

To assist the counselor/psychotherapist in understand-
ing and providing effective mental health counseling
for refugees

SECONDARY OBJECTIVES:

To develop and present the multilevel model (MLM) for
counseling refugees

To incorporate an intervention approach that integrates
Western with indigenous methods

To present a holistic framework as an integrated strategy
to meet the complex needs of refugees

THE interrelationship of mental health problems and refugees has been
well documented during the past decade (e.g., Beiser, 1987; Bottinelli,
1990; Cervantes, Salgado, & Padilla, 1988; Chung & Kagawa-Singer,
1993; Farias, 1991; Jenkins, 1991; Kinzie, Frederickson, Ben, Fleck,
& Karls, 1984; Lin & Masuda, 1983; Mollica & Lavelle, 1988;
Westermeyer, 1986). Refugee migrations in the latter part of the 20th

243

'' COUNSELING ACROSS CULTURES

322

Suinn, R. M., Rickard-Figueroa, K., Lew, S., & Vigil, P. (1987). The Suinn-Lew Asian 13 RESEARCH AND RESEARCH
HYPOTHESES ABOUT
Self-Identity Acculturation Scale. Psychological Measurement, 4 7, 401-407. EFFECTIVENESS IN
Tamase, K., & Ivey, A. E. (1991). Tamase's introspective-developmental counseling ques- INTERCULTURAL COUNSELING

tions. In A. E. Ivey (Ed.), Developmental strategies for helpers (pp. 313-415). Pacific David Sue
Norman D. Sundberg
Grove, CA: Brooks/Cole.
PRIMARY OBJECTIVE:
Torrey, E. F. (1986). Witch doctors and psychiatrists: The common roots of psychotherapy.
New York: Harper & Row. To describe the difficulties in designing and implement-
ing cross-cultural research and to present 15 hy-
Triandis, H. C. (1994 ). Culture and social behavior. New York: McGraw-Hill. potheses for future research

Trickett, E. J., Watts, R. J., & Birman, D. (1994). Human diversity: Perspectives on people SECONDARY OBJECTIVES:
in context. San Francisco: Jossey-Bass.
To demonstrate the Euro-American bias in research
Trimble, J. E. (1995). Toward an understanding of ethnicity and ethnic identity and their To point out the need to define the research constructs

relationship with drug research. In G. Botvin, S. Schinke, & M. Orlandi (Eds.), Drug in cross-cultural counseling more carefully
To emphasize the importance of both universal and
use prevention with multiethnic youth (pp. 3-27). Newbury Park, CA: Sage.
unique aspects in cross-cultural counseling
Trimble, J.E., Lonner, W. J., & Boucher, J. (1983). Stalking the wily emic: Alternatives to
cross-cultural assessment. In S. Irvine & J. W. Berry (Eds.), Human assessment and • A research article (Mischel, 1958) seemed to indicate that poor Black children
were unable to "delay gratification." They were more likely than comparison
cultural factors (pp. 259-274). New York: Plenum. children to select an immediate, smaller reward than a delayed, larger reward.
Van der Kolk, B. (1987). Psychological trauma. Washington, DC: American Psychiatric The inability to delay gratification was hypothesized to contribute to the cycle
of poverty.
Association Press.
Weiss, M. G., & Kleinman, A. (1988). Depression in cross-cultural perspective: Developing • A Chinese international student was discouraged from going into counsel-
ing.... "My advisor thought I was not qualified as a counselor because I
a culturally informed model. In P.R. Dasen, J. W. Berry, & N. Sartorius (Eds.), Health always 'held' something to myself. He did not understand that we seldom
'confess' our 'personal stuff' to someone else.... I tried to clarify these mis-
and cross-cultural psychology: Toward applications (pp. 179-206). Newbury Park, understandings" (Chin, 1993, p. 2).

CA: Sage. 323

Westermeyer, J. (1988). Cross-cultural care for PTSD: Research, training, and service needs

for the future. Journal of Traumatic Stress, 2, 515-536.
Williams, R. (1975). The BITCH-100: A culture-specific test. Journal of Afro-American

Issues, 3, 103-116.
World Health Organization. (1983). Depressive disorders in different cultures. Geneva:

Author.
Zung, W. W. K. (1969). A cross-cultural survey of symptoms of depression. American

Journal of Psychiatry, 126, 116-121.

J

324 COUNSELING ACROSS CULTURES Research About Effectiveness 325

• Chinese American and Caucasian psychiatrists rated videotapes of interviews Hoare (1991) found that the number of "self" prefixes in the Psychology
with Chinese and Caucasian clients. The Caucasian clinicians used adjectives Abstracts increased from 8 in 1969 to 33 in 1989. U.S. residents are
such as anxious, awkward, confused, nervous, and quiet to describe the becoming increasingly interested in the independent self and in giving
Chinese clients. Chinese clinicians used terms such as adaptable, alert, children more of a voice in arriving at decisions. Other cultures are more
dependable, and friendly to describe the same clients. In describing Caucasian likely to have a collectivistic orientation and a hierarchical communica-
clients, Caucasian clinicians included terms such as affectionate, adventurous, tion pattern. African American families have extended family relation-
and capable, whereas Chinese clinicians described them as active, aggressive, ships that often include individuals who are not biologically related.
and rebellious (Li-Repac, 1980). Among the Japanese, the "self" refers to an interdependent pattern of
obligations and affections. The Japanese term for myself, uchi, encom-
The above examples illustrate the difficulty in doing research in passes relationships in which there is emotional linkage, such as "my
cross-cultural counseling. Our observations and interpretations are based home," "my school," or "my workplace" (Minatoya & Higa, 1988). The
on our own cultural perspectives and worldview. Biases often color our unit is more important than individual desires. The American stress on
perceptions. In the study on Black children, Mischel (1958) was testing individuality would be seen negatively as a threat to family and societal
the "anthropological" observation that "Negroes are impulsive, indulge cohesiveness. Egalitarian relationships in which individuals get to have
themselves, settle for next to nothing if they can get it right away, do not an input are seen as disruptive to the order of a society.
work or wait for bigger things in the future but, instead, prefer smaller
gains immediately" (p. 57). The investigator did not consider the possi- Let us consider another study. Bollin (1989) reported that African
bility that the behaviors displayed might be a result of conditions found American mothers had a more authoritarian child-rearing pattern (more
among poor families. For the African American children, taking an controlling, more punitive, and involving less discussion with children),
immediate reward might have been adaptive in an environment that was whereas White mothers were more authoritative (more egalitarian, so-
always changing (Jones, 1986; Mio & Iwamasa, 1993). Misinterpreta- liciting input from the child, and using reason rather than punishment).
tions of research involving different cultural groups are common. This The authoritative pattern was seen as positive, whereas the authoritarian
problem also occurs in the field of cross-cultural counseling. Although pattern was defined negatively. The danger is that an individual may use
the major focus of this chapter is on the evaluation of 15 hypotheses his or her beliefs about the best child-rearing patterns to judge other
concerning intercultural counseling, we thought it would be helpful first groups. Other cultures might use the term permissive rather than authori-
to identify cultural biases that exist within much of our current research. tative in describing the pattern of child rearing in the United States. As
This chapter emphasizes research since the last edition; for earlier Shweder and Sullivan (1993) pointed out, it is important to realize that
references, refer to Sundberg and Sue (1989). "there is no single population for research in the United States that can
be treated as the normative base line for social and psychological func-
IMPACT OF WORLDVIEWS ON RESEARCH tioning or for health and human development" (p. 503). Interestingly,
Baumrind (1972) reported that among African American families "the
Our worldviews are so deeply ingrained that we rarely question our most authoritarian of these families produced the most self-assertive and
standards, and may not be consciously aware of the impact of our values independent girls" (p. 261). We might also remember that standards on
on research. Consider the United States as an example. The values of appropriate child-parent relationships in the United States are continuing
U.S. citizens generally differ from those of other cultures. For example, to change. At one time, the notion of "spare the rod and spoil the child"
Hofstede (1986) indicated that the United States scores the highest on was seen as the correct philosophy for raising children.
individualism and is more egalitarian than many of the 50 countries
studied. People in the United States believe in independence and individ- On personality measures, Asians are often characterized as "passive,"
ual decision making. These are considered to be signs of maturity and "introverted," and "dependent" (Sue & Sue, 1990). These qualities are
mental health. If adults in counseling indicate the need to talk to their often seen as deficits when compared with the qualities of independence
parents in making decisions, they may be viewed as "dependent." This and assertiveness that are admired in the United States. But from an Asian
trend toward individualism in the United States appears to be increasing. viewpoint, Asians may be showing the positive cultural characteristics of
modesty, respect for authority, and filial piety. Mio and lwamasa (1993)
related the story of a foreign student living in Uganda who noticed that

r 326 COUNSELING ACROSS CULTURES Research About Effectiveness 327

the Ugandans would immediately spend the money that they received. constructed the rules of procedure and evidence" (p. 8). He stated that
Because of her concern that they were spending money without regard interpreting ethnic data from a Euro-American framework may be prob-
for the future, she suggested that they save some of it. Her Ugandan lematic and asked whether the subjective world of people of color can
friends informed her that the rate of inflation was 3,000% and that be understood by a Euro-American.
"saving" money would lead to a loss. Unless individuals are able to
recognize their cultural framework and acknowledge environmental Although there remains a great deal of controversy regarding cross-
differences, misinterpretations will continue to occur. cultural research in counseling, the number of experimental and empiri-
cal studies has increased dramatically in recent years. However, as Casas
We will never know if the Chinese international student (presented and Miguel (1993) observed, much of the research is in special-focus
earlier) who wanted to be a counselor would have made a good one. issues in journals rather than "mainstream" counseling articles. Dana
Openness and the revealing of inner emotions thought to be indicative (1994) characterized cross-cultural psychology as occupying a "state of
of good counselor qualities reflect a Western framework. Other cultures limbo" in that it is still considered to be outside mainstream psychology.
may not value these characteristics as highly (Sue & Sue, 1990), and In addition, Sedlacek (1994) characterized much of the research in
successful multicultural counseling may require a different set of skills. counseling and other applied areas as "throw-ins": That is, the attitude
We often judge our clients, ourselves, and our trainees in counseling reflected is one of "we are doing the study anyway, so let's add some
according to cultural standards to which we have been exposed. These (e.g., Blacks, women, Hispanics) to it and see how they look" (p. 551).
can lead to interpersonal difficulties. Helms (1982) found that White Research designs and measures were not developed for use with diverse
supervisors perceived Black, Hispanic, and Asian supervisees as less open populations. These types of studies can lead to erroneous conclusions.
to self- examination and less able to accept constructive criticisms than Although some of the research is designed to take ethnic factors into
White supervisees. White supervisors report the greatest difficulties in consideration, cross-cultural studies are still at the beginning stage. As
working with Native American or Black supervisees (Cook & Helms, Ridley, Mendoza, Kanitz, Angermeier, and Zenk (1994) observed, "Re-
1988). These communication problems may be the result of differing search on multicultural training and counseling is still in its infancy,
values and worldviews. Cultural bias can work both ways, as illustrated providing little empirical data" (p. 228). One of the problems that they
in the ratings of the Chinese and Caucasian psychiatrists discussed ear- noted is the lack of agreement on many of the operational definitions of
lier. Although the same sets of clients were rated by both groups, cultural constructs used in cross-cultural research. If we predict a relationship
values seemed to have influenced the observations of the clinicians. between "cultural sensitivity" and counseling outcome, the construct
needs to be operationally defined. Unfortunately, a number of different
PROBLEMS WITH CURRENT RESEARCH definitions have been used, and this leads to difficulty in interpreting the
results.
Ethnic researchers have often mistrusted the results and interpreta-
tions of "objective" research. The resurrection of the controversy about Most of the studies discussed in this chapter have limited generalizabil-
race and IQ (Herrnstein & Murray, 1994) has deepened this concern. ity. The majority are analogue studies based on college student popula-
Again, environmental and cultural considerations are not acknowledged, tions rather than work with actual clients and patients. For instance,
and minority members are blamed for their condition. Cross-cultural studies reporting that ethnic minorities prefer structured, directive forms
research has been shaped primarily by the Euro-American standard, with of counseling have been based on student ratings of preference in
little input from ethnic minorities. According to Helms (1993, p. 242), response to audio-or videotaped role-play situations. As a result, the
White researchers in the area of counseling are the "primary gatekeepers findings can be considered to be only suggestive. With actual clients, Yau,
of cross-cultural research": That is, they are journal editors and disser- Sue, and Hayden (1992) found that preferences for specific counseling
tation advisors who control the definition of research. She argued that styles during an analogue phase were not predictive of preferences during
this has resulted in a "constricted" study of cultural diversity issues actual counseling sessions. The preference for a particular counseling
because of the "restricted" worldview of White researchers. Stanfield style also varied from session to session. We need more research with
(1993) concurred with Helms and concluded that "Euro-Americans have actual clients in cross-cultural counseling sessions. Parham (1993) also
stated that we need to include research designs that involve qualitative
and not just quantitative analysis. A positive move in cross-cultural

r 328 COUNSELING ACROSS CULTURES Research About Effectiveness 329

Ii research is the increasing examination of both within- and between- to make in counseling to make it appropriate for ethnic minorities? And
I group differences. Sasao and Sue (1993) presented a culturally anchored what special problems may arise or what special opportunities exist in
ecological framework for ethnic community research. In counseling the process of cross-cultural counseling research? It would seem that
I research, some investigators are also examining within-group differences the greatest value of doing research under intercultural conditions lies in
not only in ethnic minorities but among counselors. Helms (1990) found the possibility for studying the effects of similarity-diversity and for
:11 the White Racial Identity Scale to be useful in predicting reactions of determining how universally applicable our counseling theories and
Whites to ethnic minorities. Although much of the current research has techniques are. The variations in expectations, frames of reference,
its shortcomings, specific areas in cross-cultural counseling are being adaptation processes, and communication style offer excellent natural
investigated. We have formulated a number of hypotheses that have been opportunities for experiments if we can record and analyze our observa-
or need to be tested in cross-cultural counseling studies. tions effectively.

HYPOTHESES FOR RESEARCH The specific hypotheses are listed and described below.

As we mentioned earlier, a principal purpose of this chapter is to 1. Entry into the counseling system will be affected by cultural concep-
propose hypotheses leading toward research in cross-cultural counseling. tualization of mental disorders and socialization toward seeking help.
Although we call them hypotheses, it might be better to think of some as
"protohypotheses," as they are far from having good operational defini- What the prospective client brings to the counseling setting in atti-
tions. We propose these hypotheses with the hope that they will be tudes and beliefs is particularly important in cross-cultural work. In
formulated better and subjected to testing to obtain reliable and valid addition to individual motives for contacting the counseling service, the
information concerning cross-cultural encounters. A basic assumption counselor should be aware of the socialization of the person seeking help.
underlying all these hypotheses is that each person involved in a mul- It is likely that individual members of different cultural groups will vary
ticultural counseling dyad has three kinds of components: universal in their willingness to come to strangers for help and in their sense of
human components shared with all human beings, culture-related com- comfort with a bureaucratic array of services. Attitudes toward seeking
ponents shared with certain other human beings, and unique components help are also a factor in whether an individual will seek counseling.
particular to each individual (Kluckhohn & Murray, 1953; Speight, Minority members coming into counseling may unconsciously see them-
Myers, Cox, & Highlen, 1991). Much of the cross-cultural research has selves as threatened in a one-down power relationship; for instance, the
focused primarily on cultural aspects and has ignored the universal and African American client may be ambivalent about the White counselor
unique aspects. Studies that consider within-group differences are in- because Whites may symbolize oppression. Nickerson, Helms, and Terrell
creasing in number. Another assumption is that there is an optimum (1994) found that higher levels of cultural mistrust in African American
number of shared components important for the effectiveness of the students were related to negative help-seeking attitudes. Higher levels of
counseling interaction. Such components may be shared communication mistrust were associated with negative views in seeking help from a clinic
patterns, both verbal and nonverbal, attitudes and worldviews, cognitive staffed primarily by White counselors and less positive expectations as
styles, and problem-solving approaches. At this time, we do not have to the result of counseling.
enough information to determine the optimal mix of cross-cultural
counseling qualities for effective counseling. Vietnamese refugees have fewer positive attitudes toward seeking
professional psychological help, are less likely to recognize the need for
The hypotheses in this chapter will focus on those aspects of one-to- help and more concerned with the stigma attached to counseling, and
one counseling that are most relevant to cross-cultural and interethnic are less confident in being helped by mental health professionals than
work. The crucial questions are these: Does the fact that the client and Anglo-Americans (Atkinson, Ponterotto, & Sanchez, 1984). Hispanics
counselor differ in cultural background make for differences in the prefer family, relatives, or community resources for assistance with
effectiveness of counseling? How do differences in expectations and emotional problems (Juarez, 1985). Idowu (1985) reported that few
worldviews affect receptivity to counseling? What alterations do we have Nigerian students in the United States seek counseling because they are
suspicious of the counseling process and question its usefulness. South-
east Asian refugees, who are at very high risk for psychiatric problems,
often do not seek mental health services because of their perception that

' 330 COUNSELING ACROSS CUL TURES Research About Effectiveness 331

their disorder is physical in nature (Mollica, Wyshak, de Marneffe, population (Sue, Fujino, Hu, & Takeuchi, 1991). However, African
Khuon, & LaVelle, 1987). In non-Western countries, emotional conflicts American clients showed the least positive changes and terminated more
are discussed in terms of bodily or somatic complaints (Fabrega, 1990), quickly than did Whites, Mexican Americans, and Asian Americans.
and help is sought in terms of physical treatment. Japanese American and Differences in utilization rates and differential outcomes as they relate
White American subjects differ in terms of perceived causes of mental to expectations and conceptualization of mental disorders need to be
illness and help-seeking preferences. The former rated the admonition further studied.
to "endure and adjust to the situation" as more helpful than did White
Americans, which suggests a greater tendency among Japanese to resolve 2. The more similar the expectations of the intercultural client and
problems on their own. This is consistent with the perspective of many counselor in regard to the goals and process of counseling, the more
Asian groups that mental illness is a result of a lack of will power, and effective the counseling will be.
may result in the low rate of utilization of mental health services. Such
attitudes decrease the probability that these groups will enter into the Cultural differences in expectations are likely to create incongruence,
counseling system. In many non-Western countries, the family, extended and the greater the incongruence, the more difficult it will be to establish
family networks, and community are the primary sources for promoting trust, confidence, and a working alliance. In regard not only to goals but
mental health. Because of the emphasis on interdependency, individual also to techniques, process, and relationship, the client and the counselor
counseling is not well understood. Problems are viewed as involving the have expectations that are implicit and explicit before their first meeting
entire family (Lee, Oh, & Mountcastle, 1992). There is little support for and that develop further as the counseling sessions progress (Sue & Sue,
seeking help outside the family system. It is highly possible that counsel- 1990). Expectations relating to socialization for dependency, customs of
ing theories developed from a Eurocentric perspective may conflict with restricting personal communication to the family circle, and attitudes
cultural values and beliefs of other cultural or ethnic groups. In India, toward social hierarchy are relevant. Another important variable is the
counseling is described primarily as advice giving without mutual com- symbolic nature of the counselor (as priest, healer, parental figure,
munication. Scorzelli and Reinke-Scorzelli (1994) wanted to determine scientist, or outcast) in the culture of origin or the culture of residence.
if cognitive-behavioral approaches were considered to be acceptable in In cultures in which counselors may be seen as authority figures and be
that country. Graduate students in India participated in a workshop on expected to give advice, clients may show a preference for action-
cognitive therapy that followed the Ellis and Beck models. Later they oriented styles (Narikiyo & Kameoka, 1992).
filled out a survey to determine if the theories were considered to be
consistent with their religious beliefs and cultural values. More than 87% Counseling approaches that "fit" the expectations of ethnic minorities
indicated that cognitive approaches conflicted with their values and may be perceived with greater credibility. In general, the research is
beliefs. Many expressed the view that destiny is fixed and based on supportive of this view. Atkinson, Maruyama, and Matsui (1978) found
previous good or bad deeds, in line with Hindu beliefs in reincarnation that Asian Americans rated directive styles as more credible than nondi-
and karma. The existence of free will was questioned because they rective ones. Similar preferences for directive counseling approaches
believed in control by a higher power. Appropriate behavior for women were found in American Indians (Dauphinais, Dauphinais, & Rowe,
1981), foreign students (Alexander, Klein, Workneh, & Miller, 1981),
:, and low-income minorities (De La Cancela, 1985). In a study of interna-
tional students (39 Chinese from Hong Kong, 35 from Africa, and 36
I! was also an area of conflict with cognitive approaches. More than a from Iran), it was found that the students expected the counselor to be
quarter of the Indian students believed that females will always need an authority figure and to offer structure and direction in counseling
support of a stronger person. Qualities most admired in women in India (Yuen & Tinsley, 1981). In contrast, a study involving White and Asian
were modesty of manner, shyness, and self-effacement, not indepen- American social workers found that both groups believed a nondirective
dence or assertiveness. style was more effective than directive counseling with Asian clients
A study of the utilization by ethnic minorities of facilities in the Los (Mokuau, 1987). Folensbee, Draguns, and Danish (1986) found that
Angeles County Mental Health System found that Mexican Americans African American and Puerto Rican females responded more favorably
and Asian Americans were greatly underrepresented, whereas African to an affective approach over one that involved closed questions. These
Americans overutilized services in relation to their proportion of the

332 COUNSELING ACROSS CULTURES Research About Effectiveness 333

two studies seem to cast doubts on the view that minorities respond more found that the students with a "mechanistic" worldview did prefer the
positively to a directive rather than a nondirective or affective counseling behavioral and rationalist approaches over the constructivist style. How-
approach. The results, however, may be a result more of the research ever, those with an organismic worldview showed similar ratings for the
designs and operational definitions than of actual preferences on the part three approaches. Lyddon and Adamson (1992) asserted that those with
of minority clients. Szapocznik, Scopetta, Kurtines, and Aranalde (1978) an "organismic" worldview are more flexible and therefore see potential
indicated that among Cubans in Miami, a greater value was placed on benefits from all approaches. This study is one of the few that attempts
hierarchical relations than among Anglos; consequently, therapists were to relate worldview with counseling preference. It would be interesting
expected to be more effective if they brought the families into the to see more research of this nature that would use different measures of
treatment center and in general exerted strong control. Expectations worldview and involve actual clients. Client-counselor congruence on
about counseling and appropriate approaches appear to affect preference values and attitudes may be more important than client-counselor match
for certain counseling styles. Gender differences may also have an impact on ethnicity.
on counseling expectations and the process of counseling.
Common understanding of purposes is more important in some
3. Of special importance in intercultural counseling effectiveness is the instances than in others. A counselor could help someone from another
degree of congruence between the counselor and client in their orienta- culture with a minor problem more easily than he or she could help
tions in philosophical values and views toward dependency, authority, someone from his or her own culture with a serious problem. Minor
power, openness ofcommunication, and other special relationships inher- problems are more likely to be alleviated by the simple provision of
ent in counseling. information, or they may just "go away." The clarity of communication
is likely to relate to the effectiveness of the contact. The more the
Counseling approaches reflect specific philosophical values or world- "problem" can be identified clearly and targeted, the more likely it is that
views. The degree of fit between the counselor's and the client's frames both parties will be satisfied with the results.
of reference is important because it will govern the way psychological
phenomena or "reality" is perceived. It would seem that the greater the 4. The more the aims and desires of the client can be appropriately
congruence of philosophical values, the more effective cross-cultural simplified and formulated as objective behavior or information (such as
counseling will be. Lyddon and Adamson (1992) hypothesized that university course requirements or specific tasks), the more effective the
preference for a counseling approach would be related to the worldview intercultural counseling will be.
of individuals. Students filled out a questionnaire indicating their degree
of adherence to a "mechanistic" worldview ("understanding of the world This hypothesis suggests that the intercultural counselor should be
as composed of discrete elements that interact and influence one another prepared to use multiple channels for communication. Brochures,
-each with a specific location and function and all within a specifiable printed explanations, graphic portrayals, and films of procedures for
antecedent-consequence sequence") or to an "organismic" worldview handling problems may be of much more value in intercultural counsel-
{"phenomena are perceived as in a dynamic process of development and ing than in ordinary counseling. The counselor may also need to teach
transformation"). The "mechanistic" worldview is concerned with no- the other-culture client specific skills for handling specific situations. It
tions of cause and effect, whereas the "organismic" worldview stresses should be noted, however, that the simplification and use of supplemen-
i1 the importance of development to higher stages or outcomes. They were tary material should be used only when relevant to the client's needs and
then asked to evaluate three types of counseling approaches: (a) rationalist not as an escape from facing crucial emotional issues.
-"My approach to counseling focuses on the way people think about
certain life events and situations" (p. 43), (b) constructivist-"My ap- Montijo (1985) emphasized the importance of a problem-solving
proach to counseling is based on the idea that we all experience a unique approach and indicated that the counselor should deal with specific and
history of development which leads us to view the world in a very concrete treatment of goals before dealing with more complex issues.
personal way" {p. 43), and (c) behavioral-"Fundamental to my view of The usefulness of formulating specific objectives and tasks was a reason
counseling is the idea that all behavior is lawful and can be explained that Asian American mental health professionals felt that behavioral
through systematic observation and study" (p. 43). The researchers approaches were useful in working with an immigrant population
(Stumphauzer & Davis, 1983).

334 COUNSELING ACROSS CUL TURES Research About Effectiveness 335

5. Culture-sensitive empathy and rapport are important in establishing know more than they do, and the result is a less individualized approach.
a working alliance between the counselor and the culturally different Sue and Zane (1987) pointed out mental health professionals often apply
client. cultural knowledge in a stereotypic fashion without considering within-
group differences. A report of a California survey (Landers, 1987)
It makes sense that demonstrating an understanding of the client's indicated that counselors taking a client's cultural background into
problem and establishing a relationship would be important factors in account tend to minimize significant problems. Of course, there are many
the effectiveness of counseling. However, traditional means of estab- advising and guidance situations in which a large amount of cultural
lishing empathy may not be appropriate for certain ethnic minority information is not necessary; for example, if the focus is on a sharply
groups. Ibrahim (1991) spoke of the need to "convey empathy in a defined financial or academic information problem, detailed examina-
culturally consistent and meaningful manner" (p. 18) when working with tion may confuse the issue or alienate the client.
diverse populations. Cultural empathy may be a necessary part of cross-
cultural training, although its attributes and characteristics have yet to In some situations, with non-English-speaking clients, an interpreter
be operationally defined. In a preliminary research study, Sue, Yau, and may be necessary. Anyone who has used an interpreter has questioned
Mao (1995) attempted to determine if empathy was understood and the adequacy of translation. The one-to-one interview is changed into a
accepted as important among Asian international students. Qualities of three-dyad conversation. A short question by the counselor may be
acceptance of and respect for value differences were seen as essential followed by a mystifying long interpretation. When relatives are the
parts of empathy. Demonstration of understanding the client's world- interpreters, they often answer the question directed to the client before
view and acknowledgment of cultural differences increased the credibil- asking the question. As Tung (1985) noted, "Generally, their motives are
ity of the counselor. The Asian students felt that the counselor displayed generous, and the 'little' changes and embellishments that they bring into
greater empathy when considering family or societal influences than the translation are made with the most laudable intent" (p. 8). Unfortu-
when focusing on the individual's personal emotions or individual ex- nately, the information obtained from interpreters may not be the most
ploration. Even though empathy is said to be an important factor in valid. Interpreters are also influenced by cultural norms and values and
successful counseling, its precise role in cross-cultural counseling is still may be reluctant to ask about material considered disrespectful, related
not clear. Different definitions and concepts of cultural empathy need to to sex, or related to suicidal or homicidal thoughts (Ishisaka, Nguyen, &
be developed and tested with different ethnic groups. Whether there are Okimoto, 1985). Interpreters in counseling sessions serve not only as
aspects of empathy that are universally accepted is still an open question. translators but also as informants to explain a client's cultural associa-
tions and meanings. Errors in translation can be reduced by the proper
6. Effectiveness will be enhanced by the counselor's general sensitivity to training of interpreters and by making certain that they are knowledge-
communications, both verbal and nonverbal. The more personal and able about mental health issues.
emotionally laden the counseling becomes, the more the client will rely
' on words and concepts learned early in life, and the more helpful it will In cross-cultural work, the counselor must be sensitive to the meanings
be for the counselor to be knowledgeable about socialization and com- and connotations of language, both in the client's culture and in the
munication styles in the client's culture. contextual culture surrounding the interaction. Words carry different
emotional charges and bring different images to persons of different
Differences between early and late periods in a client's life history may cultures. Likewise, nonverbal aspects of communication enter into the
be important. Emotionality relates to many life events and also to understanding of feedback and reinforcement patterns. Americans often
language used to express emotions (whether in English or another misinterpret as "no" the slight twist of the head that in India signifies
language). What is taboo for self-disclosure in one culture and language "yes" or "agreed." In bazaars, naive Americans have been known to walk
may be less so in another (Goodwin & Lee, 1994). The counselor's away, thinking a haggling proposal has been rejected until the shop-
learning could come about before or during the counseling sessions. keeper calls them back. Within the counseling session itself, the study of
Counselors who are open and able to relate to their client's host culture nonverbal aspects of movement and use of space could be an interesting
are better equipped to function in an effective manner (Pedersen, 1985). contribution.
Sometimes prior knowledge is an impediment; counselors may think they

336 COUNSELING ACROSS CULTURES Research About Effectiveness 337

7. The less familiar the client is with the counseling process, the more the Another less elaborate illustration of a culture-specific approach was
counselor or the counseling program will need to instruct the client in Cuento therapy for Puerto Rican children (Costantino, Malgady, &
what counseling is and in the role of the client. Rogler, 1986). Using folk tales (which fit cultural patterns) as models of
adaptive behaviors, the researchers found a reduction of anxiety and
The client may need to be prepared so that he or she may participate aggression in high-risk Puerto Rican children. Similarly, Sadowsky
effectively in the counseling interaction. Brochures, printed explana- (1991) exposed White American, Asian Indian, and South Korean inter-
tions, graphic portrayals, and films of procedures for handling problems national students to a tape of an Asian Indian client receiving either a
may be especially useful. The counselor must give consideration to culture-consistent approach or "mainstream" counseling. Asian Indian
explaining the role of the counselor and client and teaching specific skills students were the most positive about the culture-specific approach,
to clients. With some clients, it may be necessary to explain the counsel- whereas White students rated both approaches about the same. The
ing process carefully, with frequent use of such techniques as paraphras- Korean students did not like either approach. Although the latter study
ing and perception checks. Lambert and Lambert (1984) found that was very limited in scope, it does seem to indicate that the different ethnic
immigrants who were given information about the course of psychother- groups may be responsive to different aspects of the counseling inter-
apy, appropriate client and therapist behaviors, and an explanation of action. It appears that mental health programs successful in the United
typical problems encountered in therapy attended and completed more States cannot be transferred to developing countries without consid-
sessions than a control group who was not given a role induction. In erable attention to specific cultural needs and conditions (Sundberg,
addition, the experimental group saw the therapist as significantly more Hadiyono, Latkin, & Padilla, 1995).
interested and accepting, and they perceived themselves as more satisfied
with therapy and as changing more. Pretreatment preparations for The culture-specific model has the advantage of conceptualizing and
therapy with clients from less educated social classes were also favorable developing treatment strategies for emotional problems within a specific
(Lorion, 1978). Although preparing any client for counseling is impor- culture, thereby decreasing the possibility of cultural bias. However, this
tant, it may be crucial in work with ethnically different populations. model has come under criticism. Speight et al. (1991) stated that culture-
However, client preparation is not meant to be a replacement for having specific models could lead to the continued separation of cross-cultural
the counselor develop cross-cultural strategies and techniques. counseling from "regular" counseling and result in the need to memorize
the cultural variables involved among the different ethnic groups. Would
8. Culture-specific modes of counseling will be found that work more we have to develop different counseling approaches for each different
effectively with certain cultural and ethnic groups than others. cultural group? Sue and Zane (1987) asserted that the development of
culture-specific techniques may fail to address the problem of within-
Counseling may have to be altered to work effectively with specific group differences. The tension between researchers who argue for the
ethnic groups and individuals of different social classes. Some believe need to develop culture-specific approaches and those that favor the
that we must examine indigenous approaches. Culture-specific modes of identification of universal aspects in cross-cultural counseling will con-
counseling may have to be developed for different ethnic groups. tinue. It would be interesting to determine commonalities among the
Nwachuku and Ivey (1991) suggested that this process would involve different culture-specific approaches.
three steps. First, researchers must identify the types of behaviors labeled
as problems within the culture-how and what types of behaviors are 9. Ethnic similarity between counselor and client increases the prob-
considered to be "deviant." Second, researchers must learn about tradi- ability of a positive outcome.
tional helping styles and problem-solving methods-when a culturally
defined problem occurs, who treats it and what is done. Third, re- Several reviews of client-counselor differences present a mixed pic-
searchers must develop a theory of counseling based on the analysis of ture. Sue (1988), Atkinson (1983), and Atkinson and Schein (1986)
the culture and the culture's conceptualization of mental health and found support for preference among Blacks for a Black counselor, but
treatment. Nwachuku and Ivey reported that this approach was effective little support for an ethnically similar counselor among American Indi-
in constructing a counselor training module in working with the African ans, Asian Americans, and Hispanic Americans. A recent study (Gim,
lgbo. Individuals receiving training were rated high in "expertness." Atkinson, & Kim, 1991) reported that Asian Americans perceived an

338 COUNSELING ACROSS CUL TURES Research About Effectiveness 339

ethnically similar counselor as more credible. However, even more acculturated Chinese American children value self-actualization more
important than an ethnic match was the display of cultural sensitivity or than less acculturated children (Leong & Tata, 1990). Gomez and
attitude of the counselor. Preference for a Black counselor by Black Fassinger (1994) also found acculturation related to achievement styles
individuals has been found to be a function of the stage of racial iden- among Latinas. The more bicultural the individual, the wider her reper-
tity (Morten & Atkinson, 1983; Parham & Helms, 1981; Ponterotto, toire of achieving style.
Anderson, & Grieger, 1986). Ethnic similarity may be less important
than similarity on other dimensions. Atkinson, Furlong, and Williams Cultural identification may also affect counselor ethnic preference
(1986) found that the five most preferred counselor characteristics were, among ethnic minorities. Similar ethnicity appeared to be more impor-
in order, more education, similar attitudes and values, higher age, similar tant to American Indian than to White students, particularly those with
personality, and the same ethnicity. Studies on ethnic matching were a stronger sense of involvement with American Indian culture (Bennett
based on responses by students during analogue or hypothetical situ- & Bigfoot-Sipes, 1991). Low-acculturated Asian subjects gave their
ations and not on the responses of actual clients. lowest credibility ratings to culture-blind Caucasian counselors (Gim
et al., 1991). Sanchez and Atkinson (1983) found that Mexican American
One study involving actual clients was reported. Sue et al. (1991) college students who indicated a strong commitment to Mexican Ameri-
examined the records of Asian American, African American, Mexican can culture and a weak commitment to Anglo-American culture ex-
American, and White clients utilizing outpatient treatment in the Los pressed a preference for ethnically similar counselors. However, several
Angeles County mental health system during a 5-year period. Ethnic studies found no relationship between acculturation and ethnic prefer-
match failed to be a significant predictor of outcome except for Mexican ence. In a study involving Mexican American high school students (Hess
Americans, although it approached significance for Asian Americans. For & Street, 1991), acculturation levels were not related to preference for
all groups except African Americans, ethnic match was related to lower counselor ethnicity. Atkinson, Casas, and Abreu (1992) also identified
dropout rates and greater number of sessions. Ethnic match is a very Mexican American students as low, medium, or high in acculturation.
important consideration for Asian American, Mexican American, and They were randomly assigned to one of four stimulus conditions (Mexi-
White clients in predicting premature termination. So it would seem to can American or Caucasian American counselor and culturally responsive
be more important for length of treatment than outcome. Ethnic match or culturally unresponsive approach). Acculturation was not related to
was important for Asian and Mexican Americans who did not speak ethnic preference. The most important variable appeared to be the
English as the primary language in terms of premature termination, cultural responsiveness of the counselor. Degree of acculturation may be
number of sessions, and treatment outcome. African Americans showed related to preference for a counseling style. Kunkel (1990) found that
the lowest rate of positive treatment changes. Lin (1994) also found that low-acculturated Mexican Americans had greater expectations for coun-
ethnic and language match was important for a group of Chinese selor directiveness than high-acculturated Mexican Americans. The rela-
immigrants. The importance of ethnic match appears to be related to a tionship between acculturation and variables such as preference for a
number of counseling variables and appears to be especially important specific counseling style or counselor ethnicity may be relatively weak
among immigrant populations. and only one of the many factors influencing the outcome of cross-
cultural counseling. Similar attitudes and values between the counselor
10. Within-group differences on variables such as acculturation and stage and client may be more important than ethnicity. However, most of the
of racial identity may influence receptivity to counseling. research involves college students in analogue situations. We cannot be
certain that actual clients would respond in a similar fashion.
It is clear that ethnic minority members differ in degree of accultura-
tion or acceptance in their cultural values. Within-group differences have The stage of racial identity may also influence receptivity to counsel-
to be considered in any cross-cultural research. On personality measures, ing. It is hypothesized that many ethnic minorities go through different
foreign-born Asian Americans were significantly more other directed, stages of development as they struggle to understand their relationship
and less extroverted, than were native-born Whites. However, Ameri- with the dominant culture. The stages are Conformity (Pre-Encounter)-
can-born Asians fell between both groups on levels of other-directedness preferring Western values over one's own; Dissonance (Encounter)-
and extroversion (Abe & Zane, 1990). The results are thought to be due encountering information contrary to currently held beliefs and values;
to the increased acculturation of the American-born Asians. Highly Resistance-Immersion-completely immersing self in minority-held val-

340 COUNSELING ACROSS CULTURES Research About Effectiveness 341

ues and rejecting dominant societal values; Introspection-questioning greater satisfaction with counseling than did clients assigned to experi-
uncritical acceptance of all values and beginning to sort out self-identity; enced counselors who had not received culture-sensitive training. Inter-
and Integrative Awareness-developing inner sense of security and ap- estingly, Black counselors were also rated higher when they used the
preciating aspects of different sets of values (Sue & Sue, 1990). Predic- culture-sensitive approach. Although same-race counseling dyads re-
tions can be developed from the identity model in terms of the types of sulted in less client attrition, this factor did not influence client percep-
conflicts faced by ethnic minorities at the different stages. Some research tions of counselors and the counseling process.
support exists. Carter (1991) found that stage of racial identity was re-
lated to psychological functioning in African Americans. Pre-Encounter Several other studies support the importance of cultural orientations.
attitudes (passively accepting the dominant values and not acknowl- Pomales, Claiborn, and Lafromboise (1986) found that White counsel-
edging own cultural group values) were significantly related to self- ors who made culture-relevant statements to Black students were per-
reported anxiety, alcohol concerns, and global psychological distress. ceived to be more expert, trustworthy, and attractive than counselors
Carter suggested that the stage of racial development is related to the who did not acknowledge the importance of race or culture. Asian
types of problems that the individual presents and his or her reaction to American college students rated culture-sensitive counselors as more
the counselor. As with research on the impact of acculturation, the credible and culturally competent than culture-blind counselors (Gim
support for the view that stages of development are related to specific et al., 1991). The importance of the culture-sensitive approach was also
problems or reactions to a counselor is mixed. found with Mexican American students. Higher ratings of counselor
competence were given to counselors (Anglo- or Mexican American) who
11. Credibility can be enhanced through acknowledgment of cultural displayed cultural responsiveness than to those who were culturally
factors in cross-cultural encounters. unresponsive (Atkinson et al., 1992). Acknowledging cultural factors in
counseling is also important in work with Asian Americans, especially
When one is working with culturally different clients, the exploration those who are less acculturated (Gim et al., 1991). Counselors who
of the influence of culture and acculturation conflicts becomes impor- acknowledge the importance of culture in client problems are perceived
tant. This helps the client feel that the counselor has an understanding as more culturally competent by ethnic minorities than are counselors
of the issues and increases his or her credibility. Cultural sensitivity has who ignore cultural variables.
been demonstrated by expressing knowledge of and willingness to discuss
cultural issues with an ethnic minority client. Thompson, Worthington, 12. In general, women respond more positively than men to Western-
and Atkinson (1994) explored the reaction of Black women exposed to style counseling.
Black or White female counselors who used verbal statements reflective
of either a cultural content orientation ("Tell me how your feelings of Several studies have found that Asian American women (Tata &
loneliness reflect your experiences as a Black student on this campus") Leong, 1994) and Mexican American women have more positive atti-
or a universal content orientation ("As a student here, you've encoun- tudes than men in seeking professional psychological help. This may be
tered some difficulties in your efforts to make friends"). The use of due to different socialization patterns among ethnic minority women.
cultural statements was related significantly to depth of disclosure, with Few studies have been directed to determine whether women differ from
participants revealing more intimate information and reporting a greater men in responding to traditional counseling. In research with Asian
willingness to return to counselors who had a cultural orientation. Even international students, Sue et al. (1995) found that Asian women were
Black counselors were responded to more positively when they made more open to emotional exploration and Western-style techniques than
cultural rather than universal statements. Similar findings were reported were the men. Ethnic minority women may be more receptive to mi-
by Wade and Bernstein (1991). Black female clients assigned to expe- croskills such as the reflection of feeling and paraphrasing than men. The
rienced counselors (same or different race) who displayed a culture- differential responses of ethnic males and females to counseling are an
sensitive approach (exploration of cultural issues, acknowledged race or area that needs to be explored.
class differences, and discussed ways in which being Black affected the
counseling process) rated the counselors higher on credibility and rela- 13. "The person who acts with intentionality has a sense of capability.
tionship measures, returned for more follow-up sessions, and expressed She or he can generate alternative behaviors in a given situation and
'approach' a problem from different vantage points. The intentional, fully

342 COUNSELING ACROSS CULTURES Research About Effectiveness 343

functioning individual is not bound to one course of action but can 2. Disintegration-The individual becomes conflicted as he or she becomes
respond in the moment to changing life situations and look forward to aware of membership in White society.
longer-term goals" (Ivey, Ivey, & Simek-Morgan, 1993, p. 8).
3. Reintegration-The individual resolves the conflict by viewing Whites as
There has always been some controversy over what constitutes a superior and other ethnic minorities as inferior.
"well-functioning" individual. Carl Rogers and Abraham Maslow believe
that self-actualization is the healthy standard. However, in most collec- 4. Pseudoindependence-The individual is dissatisfied with reintegration and
tivistic societies, the self is less important than the welfare of the family attempts to help other Whites understand racial minorities.
or the group. Ivey et al. (1993, pp. 9-10) defined "intentional living"
within a specific culture as consisting of three components. The first is 5. Immersion/Emersion-The individual makes efforts to develop personally
the ability to "generate a maximum number of thoughts, words and by understanding what it is to be White.
behaviors" in communicating with oneself and others. The second is the
ability to communicate with a number of individuals both within and 6. Autonomy-The individual has internalized a nonracist White identity that
outside of one's own culture. The third involves the ability "to formulate is based on the realistic analysis of the strengths and weaknesses of the
plans, act on many possibilities existing in a culture, and reflect on these White culture.
actions." The intentional individual is one who can bring different
responses to bear on a specific situation or can show a variety of re- There has been limited support for the view that the specific stage of
sponses to different situations. Whether these goals apply across cultures development of a White individual affects counseling. Ottavi, Pope-
or are a reflection of Western values is yet to be determined. In our Davis, and Dings (1994) reported moderate correlations between White
research with Asian international students (Sue et al., 1995), there was counseling graduate students' scores on a White Racial Identity Scale and
some support for the view that a goal of counseling should be to expand self-reported multicultural competencies. Tokar and Swanson (1991)
the response repertoire or response possibilities of clients. Most of them administered the White Racial Identity Scale to 308 White college stu-
agreed that developing different views of the problem helped, as well as dents and found that the higher stages were related to self-actualization
considering different options in dealing with their problems. It would be tendencies as measured by the Personal Orientation Inventory. Rowe,
useful to determine if other ethnic groups also accept the goal of Bennett, and Atkinson (1994) have criticized current White Racial Iden-
"intentional living" as defined by Ivey et al. tity Scales as based on models of ethnic minority racial development and
being developmental in nature. Although the focus on the response of
14. Identity-related characteristics of White counselors can influence majority-culture counselors to their own identity development and the
their reaction to ethnic minority clients. acknowledgment that they are also subject to prevailing racial attitudes
are useful, more needs to be done in determining the validity of the
Part of self-knowledge is awareness of one's own background and current measures.
predispositions. Recently, an argument has been advanced that White
individuals are also exposed to the societal impact of racism and preju- 15. Despite great differences in cultural contexts, in language, and in the
dice and that they also have to come to terms with their own racial implicit theory of counseling process, a majority of the important ele-
identity. Helms (1993) stated that attempts to resolve White identity ments ofintercultural counseling are common across cultures and clients.
have an impact on research and counseling activities. For example, a
White counselor's reaction to an African American client may depend on Current research on ethnic minority and cross-cultural counseling has
the White counselor's resolution of his or her own issues regarding racial been helpful in supporting the commonsense notion that Western styles
identity. This model parallels the racial identity model of ethnic minori- of helping may not be appropriate for all groups. However, it is difficult
ties. Helms has posited a six-stage identity process of White people: to develop counseling strategies for each individual group, and attention
is increasingly being placed on the "universal" aspects of counseling. As
1. Contact-The individual is oblivious to his or her own Whiteness and is mentioned earlier, a multicultural counseling dyad has three compo-
unaware of the implications of racial group difference. nents: universal human aspects, culture-specific factors, and unique com-
ponents particular to an individual. Most of our research involves the
investigation of between-group differences (culture-specific aspects) and
the examination of variables such as acculturation or racial identity
(individual aspects). There has been little systematic research on the uni-

344 COUNSELING ACROSS CULTURES 1 Research About Effectiveness 345

versal aspects involved in cross-cultural counseling. Tyler and Sundberg I proaches. As was mentioned earlier, these hypotheses would be more
(1991) pointed to commonalities in values and aspirations among Indian properly called protohypotheses, in that the constructs and propositions
and American adolescents. I have yet to be sharpened and assessment methods identified or developed
to measure the variables. We hope, however, that they will stimulate
Torrey (1986) found common elements between helping procedures research on bringing cultural considerations into counseling theory
in modern and premodern societies. His four pancultural commonalities building and research. In developing research from hypotheses, questions
are {a) shared worldview leading to the labeling of the disorder, {b) be- arise in terms of how one measures similarities and which similarities
nevolent personal qualities of the therapist or healer, {c) the patient's between counselor and client should be studied. Are we selecting the
expectations for being helped, and {d) an emerging sense of mastery. most influential factors for consideration? Ethnic match is important for
Certain specific techniques of counseling and therapy, such as catharsis some dyads; however, similar attitudes may be of greater value in
and interpretation, are also held in common over wide variations in producing positive outcomes. We would expect that as the amount of
culture. According to Torrey, counseling and similar processes serve as shared client and counselor expectations, knowledge, and interests in-
a refuge from society. In previous interaction with the surrounding creases, the probable success of counseling also increases. Thousands of
system, the client has lost out in the judgment of self {regarding sociocul- pages have been written about the measurement of outcomes in dyadic
tural expectations) or in the judgment of society. He or she is out of step. or small-group counseling and psychotherapy. However, are these mea-
The counselor typically provides a socially approved antithesis to main- sures appropriate for use with ethnically different populations? Probably
stream society, offering a confidential, noncritical environment in which the best kinds of criteria for intercultural counseling would involve both
the client can talk about weaknesses and dependence and about taboo objective measures {e.g., symptom reduction, school grades, and sessions
topics such as hate, sex, and egotism. attended) and subjective measures {ratings by the client and family
members). Research involving actual clients is also necessary if we are to
The attempt to find universal aspects of cross-cultural counseling or determine the applicability of findings based on college students in ana-
to create new theories applicable across cultures is important if we are to logue studies. It remains to be seen whether some or all of these hy-
keep from having to develop approaches for each possible culture or group potheses are in themselves culture bound. A number of researchers {Casas
within a diverse population. It is necessary if multicultural counseling is & Miguel, 1993; Helms, 1994; Parham, 1993; Sue, 1991) believe that
to be considered the "fourth force" in psychology. Cross-cultural and majority-group researchers need to understand themselves as racial/
"regular" counseling have to become integrated. Means of accomplishing cultural beings, and to ensure that the design and interpretation of studies
this task are still not available. Some theorists have attempted to develop do not reflect a cultural bias.
theoretical orientations that can apply across cultures. Vontress (1988)
stated that the existential framework has universal application, and There seem to be three directions for realistic cross-cultural counseling
Speight et al. (1991) asserted that self-knowledge is the "primary human research. One is to retain the goal of obtaining a large sample but to
force." However, problems exist with the observations by Torrey and broaden the notion of intercultural status to include the category of
the theories utilized by Vontress and Speight et al. First, the "universal" marginal clients compared with mainstream clients. Marginal clients
components are so general {person has a problem, seeks solution from might include all those with characteristics and backgrounds that are
another, etc.) that they are virtually useless for counseling. Second, the different from the dominant, majority society, such as minority members,
"universal" counseling approaches seem to stem from a Western perspec- gays and lesbians, handicapped students, lower-income citizens, and
tive and are very individualistic. The theories of both Vontress and Speight people who do not speak the main language of the society very well. In
et al. have to be tested with culturally diverse populations. Research in such a sampling, foreign students {in the United States and other coun-
determining the universal aspects in cross-cultural counseling is vital. tries) might occupy positions on continua based on such factors as
communication ability, knowledge of mainstream social customs, and
CONCLUSION ability to cope with problem situations. The continua might then be
related to the larger problems of counseling effectiveness and process.
We have identified 15 hypotheses that need further study and would
be important in the development of cross-cultural counseling ap- The opposite direction would involve the study of individuals, one at
a time. Historically, Allport, Skinner, and other psychologists have found

346 COUNSELING ACROSS CUL TURES 1 Research About Effectiveness

347

conducting intensive studies of personal documents, performances, and cross-cultural psychology such as the forthcoming three-volume Hand-
reports of experience to be productive. Discussions of the single-case book of Cross-Cultural Psychology (Berry et al., in press). Like cross-
designs can be found in Garfield and Bergin (1986). The object of the cultural psychology, intercultural counseling is an exciting and promising
controlled study is to demonstrate that changes in behavior and self- area of study. It not only offers promise for improved services to people
report co-vary with changes in counseling. A single-subject design was but also brings to psychology and other social sciences opportunities for
used in the study of counseling preferences of international students (Yau important learning-how different people might understand each other
et al., 1992). The application need not be limited to the usual behavioral better, how one culture is viewed by another, and new ways of observing
approaches. Similar research programs can be used with free associations our basic human commonalities, similarities, and uniqueness.
and other verbal behavior. Such intensive study, one by one, of persons
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AAMFT. See American Association for Alexander, A., 211,214,233
Marriage and Family Therapy Al-Issa, L., 272
Alper, T., 88
Abeles, N., 62 Althen, G., 212,233,282
Amaro, H., 80
Aber, J., 118 American Association for Marriage and
Abreu, J., 339
Family Therapy (AAMFT), 52
Abu-Lughod, ]., 83 American Counseling Association (ACA),
ACA. See American Counseling Associa-
48,52,66n1
tion American Psychiatric Association (APA),
Acculturation:
268-269, 294-295
and culture shock, 3, 212-213, 216, American Psychological Association (APA):
234, 282-284
Accreditation Criterion II, 61
assessment of, 298-299
of Asian Americans, xi-xii, 140-141, Committee on International Relations
in Psychology, 53
338-339
of Hispanics, 162-164, 339 counseling psychology, 57
of international students, 217-227 ethical principles of, 48, 50-53
of Native American Indians, 196-205 guidelines for providers of psychologi-
of refugees, 245, 248-254
Adair, R., 134-135 cal services to ethnic, linguistic,
Adamson, L., 332-333 and culturally diverse popula-
African Americans: tions, 48, 52, 54
and behaviorism, 272, 281 Amir, Y., 229
and counseling bias, 323, 324, 325, Angermeier, L., 36-37, 327
Angyal, A., 87
326,329, 340-341 Anxiety, 309-310
and counseling ethics, 48-49, 53, 56, APA. See American Psychiatric Associa-
tion; American Psychological
57 Association
and homosexuality, 115-116, 117 Aranalde, M., 332
and Nigrescence theory, 111-117, Arbona, C., 162
Arce, A., 257
118-121 Aristotle, 83
identity development of, xi, 108-111, Arredondo, P., 77-78, 79, 80, 90, 91
Ashby, M., 194
117, 121-122 Asian Americans:
See also Gender
Agosta, L., 23
Ajdukovic, D., 254
Ajdukovic, M., 254

353

T

354 COUNSELING ACROSS CULTURES Index 355

acculturation of, xi-xii, 140-141, Awa, N., 218 Black identity development. See African Chodorow, N., 87-88
338-339 Americans Chung, R., 13 0
Axelson, J., 301
and behaviorism, 271, 273-274, 276, Blankenship, E., 215 Chunn, J., 59
279, 280-281 Ayres, M., 183 Block, J., 87
Bloom, J., 195 CICL. See Cultural Identity Check List
and counseling bias, 135-137, 323-324, Bakan, D., 87 Bloombaum, M., 159 Claiborn, C., 341
325,326, 329-330 Bandura, A., 276 Blue, A., 188 Clarkson, F., 83
Barker, M., 217 Blue, M., 188 Clements, C., 61
and counseling ethics, 48-49, 56 Bar6n, A., 216 Blumenthal, R., 8
and counselor role, 131-132 Barter, E., 182 Boas, F., 178 Cohen, J., 226-227
and empathy, 29-30, 37 Barter, J., 182 Bochner, S., 211-213, 214,233
and ethnicity, 127-129, 140-141 Baumrind, D., 325 Bollin, G., 325 Cohen, R., 259
and psychopharmacology, 131 Beauvais, F., 54-55, 162, 205 Boothby, N., 254
as refugees, 129-130, 250,251,252, Behaviorism: Borgers, S., 62 Cole, J., 160
Borodovsky, L., 29, 40
260 acceptance of, 275-276 Boulette, R., 166 Coleman, V., 194, 195
as students, 217-218, 219, 220-221, and African Americans, 272, 281 Collectivism:
and Asian Americans, 271, 273-274, Bowlby, J., 87
224-226,231,234-235,283 and behaviorism, 276
counseling utilization of, 132-135 276,279, 280-281 Bradley, L., 222 and counseling, 13-15
defined, 125 and culture shock, 282-284 and gender, 86-89
immigration of, 125-126 and Hispanics, 166-167, 271,274, Bransford, J., 185 and international students, 228-229
interracial marriages of, 137-140 and refugees, 248-249
literature on, 129-141 280,281 Breakwell, G., 85 See also Individualism
population of, 125 and individualism/collectivism, 276 Brislin, R., 229,239,283,314 Comas-Diaz, L., 80, 94-95, 96, 100,257,
values of, 126-127 and international students, 282-284 Bronfenbrenner, U., 118
See also Gender and Native American Indians, 272 Braverman, D., 83 274
Assessment, xv-xvi, 293-294, 316-317 application of, xiv-xv, 280-284 Braverman, I., 83, 85 Communication. See Language
and constructivism, 312-313 as single-subject model, 277 Brown, L., 80, 99 Constructivism, 312-313
and equivalence, 301-303 cognitive, 274-275 Brown, R., 231
ethics in, 313-314 counselors for, 276-277 Carbine, J., 195
of acculturation, 298-299 development of, 267-268 Bryde, J., 188, 189
of anxiety, 309-310 efficacy of, 277-279 Costantino, G., 8
of counseling process, 314-315 ethics in, 279-280 Burbach, H., 221 Counseling, multicultural, vii-ix
of depression, 310-312 functional analysis in, 267, 270-275, Burton, L., 189, 193
of individual development, 297-298 and constructivism, 312-313
of intelligence, 304-306 284 Butcher, J., 307 and counseling defined, 3-4
of personality, 306-313 in cultural context, 275-280 and culture accommodation, 8
of refugees, 315-316 psychiatric diagnosis in, 268-270 California Psychological Inventory (CPI), and culture defined, 2-3
of worldview, 295-297 See also Assessment; Research 308-309 and culture shock, 3, 212-213, 216,
qualitative, 294-299 Beiser, M., 257, 310
quantitative, 299-303 Bemak, F., 244, 249, 258, 259 Callan, V., 217 234, 282-284
with California Psychological Inven- Bennett, J., 311 Calnek, M., 137 and individualism/collectivism, 13-15,
Bennett, S., 186, 187, 343 Campbell, D., 53
tory (CPI), 308-309 Ben-Porath, Y., 249 Cannibals and Kings (Harris), 82 86-89, 157, 228-229, 248-249,
with Minnesota Multiphasic Personal- Bergin, A., 211, 346 Carney, C., 57 276, 324-325
Bernstein, B., 340 and positivism, 101-102
ity Inventory (MMPI), 306-308 Berreman, G., 189 Carr, J., 310 and power distance, 13-15
with State-Trait Anxiety Inventory Berry, J., 6, 76, 163, 180, 223-225, 248, and psychotherapy, 4
Carter, R., 80, 340 and self, 3-4, 11-12, 13, 25-26, 38
(STAI), 309-310 298,311,314, 316-317, 347 and subjective culture, 2-3
See also Behaviorism; Counseling, Best, D., 84-85 Casas, A., 163,339 and uncertainty avoidance, 13-15
Betancourt, H., 55 approaches to, 6-11
multicultural; Empathy; Ethics; Bigfoot-Sipes, D., 186, 187 Casas, J., 51, 60, 152, 160, 162, 163, clientele for, 9-11
Research Bingi, R., 222 dimensions of, 12-15
Atkinson, D., 55, 79, 134, 160, 169, 280, Birman, D., 314 166,271,294,327 education for, 58-63
301,331,337,338,339,340,343 Cella, K., 77-78 generalizations in, 15-17
Attneave, C., 54, 194 Chalice and the Blade, The (Eisler), 81, 82 interface of, 4-5
Aubrey, R., 216, 235, 236 Chan, S., 129 justification for, 1-2
Chance, N., 189 language barriers in, 247-248, 251-252,
Charles, C., 257-258, 259 334-335
Cherrie, C., 239 stereotyping in, 16, 81, 84-86, 99-
Child, C., 217 100, 159-160, 215,216

356 COUNSELING ACROSS CUL TURES 1 357

Index

worldview in, 295-297, 324-326, Ebbin, A., 215 and culture defined, 48-49 and counseling strategies, 89, 96,
332-333 Echemendia, R., 147 and ethnicity defined, 48 97-102
Education: and gender, 49, 88, 96-97, 99
See also Assessment; Behaviorism; Em- and Hispanics, 48-49, 56 and culture interaction, 89-97
pathy; Ethics; Research and counselor ethics, 5 8-63 and Larry P. v. Riles (California), 57 and ethnicity, 75-76, 77-78, 79-81,
of refugees, 253-254 and minority defined, 49
Counseling Across Cultures Edwards, E., 183, 189, 194 and Native American Indians, 48-49, 9~93-100, 130,150-15~341
(Thomas/Althen), vii, 212 Edwards, M., 183, 189, 194 and feminist therapy, 92-93, 95-96
Edwards, S., 212 53,54 and heterogeneity, 94-95
Cox, G., 56 Eide, R., 220 and race defined, 48 and individualism/collectivism, 86-89
CPI. See California Psychological Inventory Eisenberg, N., 22, 26 future directions in, 63-66 and inequality, 83-84
Crosbie-Burnett, M., 50 Eisler, R., 81, 82 in assessment, 313-314 and international students, 216-217
Cross, W., 79, 111-113, 116-117, 118 Empathy, ix-x, 16, 21-22, 334 in behaviorism, 279-280 and multicultural counseling defined,
Cui, G., 27, 218 active, 29 in counseling, 55-58
Cultural empathy. See Empathy affective, 23, 29, 34(figure), 38-40 in counselor education, 58-63 91-92
Cultural Identity Check List (CICL), 297 and Asian Americans, 29-30, 37 in research, 53-55 and oppression, 95-96
Cultural sensitivity. See Empathy and cultural sensitivity, 33, 34(figure), professional regulation of, 48, 49-53, and research, 93-94, 100-102, 341
Culture shock, 3 and socialization, 76-77, 85-86, 87-89
36-37 66n1 and stereotyping, 81, 84-86, 99-100
and behaviorism, 282-284 and Hispanics, 166 and systems intervention, 100
and international students, 212-213, and personal differences, 25, 28-29, 32 Fassinger, R., 339 as cultural dimension, 74-81
and perspective, 34(figure), 37-38 Feminism. See Gender conceptions of, 81-89
216,234, 282-284 and responsiveness, 34(figure), 35-36, Fernandez, M., 234-235 historical perspectives on, 81-83
See also Acculturation Fitzgibbon, M., 216 ideology, 81
Cushner, K., 239 39, 40-42 in global context, 80-81, 90
and self-other differentiation, 25-26, Fitzpatrick, J., 163-164 in literature, 77-81
Dabul, A., 93-94 Flaskerud, J., 133 Gergen, K., 101
Dadfar, A., 254 34(figure), 38
Dana, R., 295,301,309,311,316,327 and understanding, 34(figure), 35, Foa, D., 258 Gilchrist, L., 194
Daniels, R., 125 Folensbee, R., 331
Danish, S., 331 40-42 Forsyth, D., 8, 271 Gilligan, C., 63, 64, 87, 88, 89
Darou, W., 189 cognitive, 23, 29, 37 Foster, S., 59-60 Gim, R., 134
Dasen, P., 76 communication of, 24, 34(figure), 40 France, W., 185 Gimbutas, M., 82
Dauphinais, L., 185 model of, 33-40 Frenkel-Brunswik, E., 13 Giordano, G., 10
Dauphinais, P., 185, 186, 193 multicultural literature on, 26-3 0 Freud, S., 22, 25, 83
David, A., 26-27 multidimensionality of, 23, 32 Friedman, M., 244, 258-259 Giordano, J., 10
David, K., 283 operationalization of, 26, 30-32 Fugita, S., 129
Davis, J., 257 purpose of, 23-24 Fujihara, T., 283 Glazer, N., 128
DeBlassie, R., 185 traditional literature on, 22-26 Fujino, D., 56 Goddesses and Gods of Old Europe, The
Delgado-Gaitan, C., 148 value neutrality of, 24-25, 32 Fukuyama, M., 75, 79, 238
Depression, 310-312 Engels, F., 82 Furlong, M., 338 (Gimbutas), 82
De Silva, P., 257, 275 Erickson, C., 26-27 Furnham, A., 211-213, 214,233 Goldstein, A., 32, 36, 278
Diagnostic and Statistical Manual of Erikson, E., 109-110, 297 Goldstein, G., 194,272
Espin, 0., 80, 95-96 Galante, R., 258 Gomez, M, 339
Mental Disorders (American Eth, S., 257 Gallimore, R., 276 Good, B., 310
Psychiatric Association), 268-269, Ethics, x, 47-49 Gallois, C., 217 Gough, H., 308-309
294-295 and African Americans, 48-49, 53, 56, Gama, E., 88, 101-102
Dinges, N., 185, 193 Garcia, J., 59 Graham, J., 307
Dings, J., 60, 343 57 Garfield, S., 211,346
Dixon, D., 184 and American Association for Gender, x-xi, 13-15, 73-74 Grant, S., 169
Gray, L., 195
Draguns, J., 331 Marriage and Family Therapy and counseling ethics, 49, 88, 96-97, Green, L., 281
(AAMFT), 52 99
Drum, D., 170, 171 and American Counseling Association Greenberg, B., 244
Dube, K., 245 (ACA), 48, 52, 66n1 Greene, B., 80, 94-95
Dufrene, P., 194, 195 and American Psychological Associa- Guthrie, G., 273-274
Dunston, P., 59 tion (APA), 48, 50-53, 54, 57, 61 Gynther, M., 308
Dynneson, V., 185 and Asian Americans, 48-49, 56
Hackett, G., 301
Hall, E., 230

358 COUNSELING ACROSS CUL TURES Index 359

Ham, M., 29-30, 31 Holtzman, W., 312-313 Kagan, H., 226-227 Lazarus, P., 189, 193, 194
Hammer, M., 236 Homosexuality, 49 Kagawa-Singer, M., 130 Lee, C., 301
Hanassab, S., 234 Kagehiro, D., 59 Lee, D., 185
Handbook of Cross-Cultural Psychology and African Americans, 115-116, 117 Kahn, H., 80 Lee, E., 259
Honigmann, J., 189-190 Kahn, K., 57 Leong, F., 211,213,214,216,228,229,
(Berry), 316-317, 346-347 Horswill, R., 185 Kahn, P., 96, 97
Handbook of Psychotherapy and Behavior Hsu, F., 11 Kamenchenko, P., 315 238
Hu, L., 56 Kanitz, B., 31, 36-37, 38,327 Lerner, G., 81
Change (Bergin/Garfield), 211 Huang, K., 212 Kaplan, G., 57 Levine, E., 50, 167-168
Hansen, L., 87 Hui, C., 229 Katz, J., 159 Lewis, E., 50
Hanson, W., 194 Katz, R., 22-23 Lewis, J., 305
Hare-Mustin, R., 57, 88-89 Ibrahim, F., 80,166,234, 295-296, 315, Keefe, T., 23 Liese, L., 219
Harris, M., 82 334 Keith-Spiegel, P., 62 Lin,J., 338
Harris, S., 301 Kelly, E., 80, 90 Lindzey, G., 312
Haviland, M., 185 Idowu, A., 329 Kelly, G., 312 Lipps, T., 22
Hayden, D., 231-232, 327 Impara, J., 316 Kelly, T., 38 Lipsitz, N., 61, 62
Hayes, S., 183, 185, 193, 270 Indexical self, 11-12, 13 Kim Berg, I., 132 Li-Repac, D., 280-281
Healers, indigenous: Indigenous healers: Kinzie, J., 257,258 Liss-Levinson, N., 57
Kirkeby, J., 56 Littrell, J., 185
and refugees, 246, 247, 256, 260 and refugees, 246,247,256, 260 Kitano, H., 125, 129, 133, 137 Littrell, M., 185
of Native American Indians, 195, of Native American Indians, 195, Kitayama, S., 11, 37 Locke, D., 75, 238
Klein, M., 211 Lonner, W., 314
200-202, 203, 214 200-202, 203, 214 Kleinman, A., 246,271,310 Loo, C., 55-56, 132
Heinrich, R., 195 Individualism: Kluckhohn, F., 80, 188 Lopez, S., 16, 55, 61
Helms, J., 78, 79, 80, 98, 326, 328, 329, Knefelkamp, L., 171 Lowrey, L., 185
and behaviorism, 276 Kohut, H., 23, 24-25, 26 Lyddon, W., 332-333
342 and counseling, 13-15 Koocher, G., 62 Lyerly, R., 182
Herring, R., 189 and gender, 86-89 Koverola, C., 185
Herskovits, M., 2 and Hispanics, 157 Krasner, L., 267 Malgady, R., 8
Hiegel, A., 260 and international students, 228-229 Krasnienski, A., 315 Malinowski, B., 178
Higginbotham, H., 8, 271, 274, 278 and refugees, 248-249 Kraus, R., 315 Mallinckrodt, B., 216
in United States, 324-325 Krystal, H., 316 Malpass, R., 314
Hillerbrand, E., 63 Intelligence, 304-306 Kunkel, M., 339 Manson, S., 182, 185,195,311
and Larry P. v. Riles (California), 57 Kurtines, W., 163, 332 Mao,J., 334
Hispanics: Intercultural Interactions (Brislin et al.), Maracek, J., 57, 88-89
acculturation of, 162-164, 339 Lafromboise, T., 59-60, 184, 186, 193, Marcia, J., 24
and behaviorism, 166-167, 271,274, 239 195,341 Marin, G., 13
Markus, H., 11, 37
280,281 Irving, J., 59 Lambert, M., 336 Marsella, A., 49,244,310
and counseling ethics, 48-49, 56 Lambert, R., 336 Martinez, A., 212,232
and counseling process, 154-155 Ivey, A., 6, 27, 28, 50, 63, 166,297, 336, Landis, D., 283 Martinez, J., 227
342 Landrine, H., 11 Maruyama, M., 331
(table), 165-173 Lang-Takac, E., 88 Maslow, A., 4, 342
and counselor variables, 154-155 Ivey, M., 27,297 Language: Matsui, S., 331
Iwamasa, G., 280, 281, 325-326 Matsumoto, D., 314
(table), 156-160, 165-173 and refugees, 247-248, 251-252 Matsushita, Y., 134
Jacobsen, F., 294, 315 and research, 334-335 Mau, W., 220-221
and empathy, 166 Jalbert, R., 250 Larry P. v. Riles (California), 57 Maultsby, M., 281
and individualism, 157 James, Q., 159 Lashley, K., 186 McGoldrick, M., 10,315
as clients, 154-155(table), 160-173 Jaranson, J., 258-259 Lauver, P., 221 McWhirter, E., 99-100
demographics of, 146-153, 173 Jepsen, D., 220-221 Lawler, A., 170, 171
diversity of, xii, 149-153, 162, 164-165 Jewell, D., 177-178
intervention for, 170-172
stereotyping of, 15 9-160 Johnson, J., 115-116, 117
See also Gender
Ho, D., 35 Johnson, M., 186
Ho, M., 126, 127, 128, 129 Johnson, S., 212
Hoare, C., 325 Jones, E., 217
Hoffman, L., 88 Josephy, A., 180
Hofstede, G., 12-15, 324
Hollenbeck, A., 193

360 COUNSELING ACROSS CULTURES r 361
I
Index

Mead, G., 22 and indigenous healers, 195, 200-202, Pollitt, K., 89 on communication, 334-335
Meichenbaum, D., 274 203,214 on counseling commonalities, 343-344,
MEIM. See Multigroup Ethnic Identity Pomales, J., 341
as clients, xii-xiii, 186-188 346-347
Measure communities of, 183-184 Ponterotto,J., 152,167,231,294 on counseling expectations, 331-332
Mejia, J., 59 counseling for, 192-196 Poortinga, Y., 76 on counseling familiarity, 336
Mendoza, D., 31, 36-37, 38,327 defined, 178-180 Pope-Davis, D., 60, 343 on counseling objectives, 333
Mendoza, R., 227 demographics of, 180-181 Portes, A., 315 on counselor empathy, 334
Mercer, J., 305 mental health issues of, 181-183 Positivism, 101-102 on counselor identity, 342-343
Merta, R., 231 values of, 188-192 Power distance, 13-15 on cultural acknowledgment, 340-341
Michaels, G., 32, 36 See also Gender Prejudice. See Gender; specific ethnic on culture-specific counseling, 336-337
Miguel, S., 327 Nicholls, W., 194 on gender, 93-94, 100-102, 341
Mikulas, W., 257,275 Nickerson, K., 329 groups; Stereotyping on within-group differences, 338-340
Miller, M., 211 Nigrescence theory. See African Americans Prince, R., 4 on worldview, 324-326, 332-333
Miller, N., 196 Noddings, N., 63-64 Psalti, A., 77-78 See also Assessment; Counseling,
Miller, S., 132, 182 Nwachuku, U., 6, 336 Psychotherapy, 4
Miller, T., 315 Pynoos, R., 257 multicultural
Minnesota Multiphasic Personality O'Brien, R., 129 Residents, temporary, 10. See also Students,
Quintana, D., 248
Inventory (MMPI), 306-308 O'Connell, J., 185 international
Minority Children and Adolescents in Ramirez, M., 298-299 Reynolds, A., 60
Odegaard, 0., 248 Referential self, 11-12, 13 Richardson, E., 192-193
Therapy (Ho), 129 Oetting, E., 162,205 Refugees, xiv, 10 Rickard, H., 61
Olmedo, E., 180 Ridley, C., 31, 35, 36-37, 38, 42, 60,327
Mio, J., 325-326 acculturation of, 245, 248-254 Riegel, K., 50
O'Neil, J., 86 adjustment of, 249-254 Rigazio-DiGilio, S., 297
Miramontez, A., 194 and indigenous healers, 246,247, Rogers, C., 4, 23, 24, 26, 32, 35, 39, 40,
Miranda, M., 133 Oropeza, B., 216, 235
Mischel, W., 324 Osterweil, Z., 88 256,260 342
Mitchum, M., 194 O'Sullivan, M., 56 and individualism/collectivism, 248-249 Rogler, L., 8
Miyamoto, S., 126 Ottavi, T., 60, 343 Asian Americans as, 129-130, 250, Roland, A., 11
MMPI. See Minnesota Multiphasic Root, M., 95
Padilla, A., 167-168 251,252,260 Rosenkrantz, P., 83
Personality Inventory Paige, R., 212, 214-215 assessment of, 315-316 Ross-Sheriff, R., 59
Mollica, R., 248,250 Paniagua, F., 298,301,316 belief systems of, 245-246 Rowe, W., 185,186,343
Parham, T., 118, 120-121, 327 characteristics of, 243-245 Ruiz, R., 166, 271
Montijo, J., 333 Parker, C., 171 counseling model for, 255-261 Rumbaut, R., 315
Parr, G., 222 counseling utilization of, 246-248 Russo, N., 58, 80, 93-94
Morten, G., 79 Pasquale, I., 185 education of, 253-254
Moynihan, P., 128 Patterson, C., 3 employment of, 252,254 Saadawi, N., 97
Multicultural empathy. See Empathy family dynamics of, 252-253 Sadongei, M., 192
Multigroup Ethnic Identity Measure Pearce, J., 10 language barriers of, 247-248, 251-252 Sakano, Y., 279
resettlement for, 254 Sam, D., 220, 298
(MEIM), 111 Pedersen, P., 3, 10-11, 21-22, 49, 50, 62, Reid, P., 80, 90, 100 Sanchez, A., 339
Murphy, H., 2440 75,80, 156,158,213,215,232 Reik, W., 22-23, 26
Murphy, S., 185 Reinke-Scorzelli, M., 330 Sanchez-Hudes, J., 80
Myers, H., 147 Pelsmas, D., 62 Research:
Perl, H., 59 cultural bias in, 323-328 Sasao, T., 328
NAFSA. See National Association for Peterson, P., 56 directions for, xvi, 345-346 SAVW. See Scale to Assess W orldview
Foreign Student Advisors Phares, E., 311 ethics in, 53-55 Scale to Assess Worldview (SAVW),
hypotheses for, 328-345
Nash, D., 223 Phinney, J., 110-111, 118 on client belief system, 329-331 295-297
Nathan, T., 7, 11 Piaget, J., 305 on client/counselor similarities, Schein, S., 337
National Association for Foreign Student Schoenfeld, L., 182
Pilisuk, M., 160 337-338
Advisors (NAFSA), 239 Pinderhughes, H., 78 on client personality, 341-342 Schram, J., 221
Native American Indians: Plake, B., 226
Plotch, W., 163 Scopetta, M., 332
acculturation of, 196-205 Pok, T., 249
and behaviorism, 272 Scorzelli, J., 330
and counseling ethics, 48-49, 53, 54
and counselor characteristics, 184-186

362 COUNSELING ACROSS CULTURES r 363

Index

Scott, N., 29, 40 and gender, 216-217 Topper, M., 184 White, R., 190
Sedlacek, W., 327 and individualism/collectivism, 228-229 Torres-Matrullo, C., 257 WHO. See World Health Organization
Segall, M., 76 as clients, 211-227, 237-239 Torrey, E., 6-7, 184,300,344 Widick, C., 171
Self, 3-4 Asian, 217-218, 219, 220-221, 224- Training. See Education Wiggins, F., 113
Triandis, H., 2, 11, 12, 13, 229, 248, Williams, C., 307
and empathy, 25-26, 38 226, 231, 234-235, 283
indexical, 11-12, 13 Australian, 217-218 314 Williams, J., 84-85
referential, 11-12, 13 coping strategies of, 213-214 Trickett, E., 59, 314
culture shock of, 212-213, 216,234, Williams, R., 304-305
Seligman, M., 274 Tiimb~~/;'i~~\~~o, 182, 183, 185, Williams, W., 338
Serpell, R., 306 282-284 Wispe, L., 23
roles of, 214-215 True, R., 132 Wolf, M., 277
Shore, J., 194, 195 stereotyping of, 215, 216 Tumin, M., 163 Women. See Gender
stress of, 214, 215-217, 282 Tung, T., 335 Women of Color: Integrating Ethnic and
Shweder, R., 325
Simek-Downing, L., 27 Stumphauser, J., 257 Uba, L., 130 Gender Identities in Psychotherapy
Simek-Morgan, L., 27 Uchiyama, K., 279 (Comas-Dia7)Greene), 94-95
Skinner, B., 270,279, 282 Sue, D., 41, 79, 228, 231-232, 315, 324, Uhlemann, M., 185 Wong-Reiger, D., 248
327,334,341 Ullmann, L., 267 Workneh, F., 211
Skovholt, T., 86 Uncertainty avoidance, 13-15 World Health Organization (WHO), 245,
Smith, E., 80, 166, 168 Sue, D. W., 41, 79, 80,315 Unger, R., 80 259
Su~~,56,129,257,281,328,335,337, Worldview:
Sobel, S., 58 Van Den Berg, S., 27 and research, 324-326, 332-333
Sodowski, G., 316 338 van der Kolk, B., 254, 316 assessment of, 295-297
Sodowsky, G., 226, 230-231, 232,337 Suinn, R., 166-167 van der Veer, G., 130 Scale to Assess Worldview (SAVW),
Sojourners. See Students, international Sullivan, M., 325 Vasquez, M., 166
SOMPA. See System of Multicultural Sumner, W., 178 Vitaliano, P., 310 295-297
Sundberg, N., 324 Vogel, S., 83 Worthington, R., 340
Pluralistic Assessment Svensson, F., 179 Vogt, E., 190
Vontress, C., 344 Yalom, I., 258
Spain, D., 312 Swanson, J., 343 Yamamoto,]., 29, 159
Spain, H., 244 Wade, P., 340 Yang, K., 276
Spang, A., 189, 193 System of Multicultural Pluralistic Walden Two (Skinner), 279 Yau, T., 231-232, 236-237, 327, 334
Speck, R., 194 Assessment (SOMPA), 305 Wampold, B., 160 Ying, Y., 219
Speight, S., 337, 344 Ward, L., 214 Yong, M., 239
Spencer, M., 118, 121 Szapocznik, J., 163, 259, 332 Watts, R., 59, 153, 314 Youngman, G., 192
Spielberger, C., 309 Welfel, E., 61, 62 Yu, A., 276
Stabb, S., 301 Taft, R., 214 West, S., 8, 271
STAI. See State-Trait Anxiety Inventory Takaki, R., 129 Zane, N., 56,257,335,337
Takeuchi, D., 56, 134-135 Westermeyer, J., 315 Zenk, R., 36-37, 327
Stanfield, J., 326-327 Zheng, X., 224-225
Talley, J., 301 Wetzel, R., 276-277 Zintz, M., 188, 189
State-Trait Anxiety Inventory (STAI), Zuniga, R., 54
Tanaka, T., 283
309-310 Tayabas, T., 249
Stereotyping:
Taylor, J., 223
and gender, 81, 84-86, 99-100
in counseling, 16 Tefft, S., 189
of Hispanics, 159-160 Teich, N., 23, 24
of international students, 215, 216 Temporary residents, 10. See also Students,

Stewart, E., 22, 28-29, 35, 39 international
Terrell, K., 329
Strayer, J., 22, 26 Tharp, R., 276-277
Thomas, K., 195,212,233,282
Streiner, D., 274 Thomason, T., 195
Stress, 214, 215-217, 282 Thompson, C., 169,340
Strodtbeck, F., 80, 188 Thornstrom, S., 10
Students, international, xiii-xiv, 10, Tichener, E., 22

210-211 Timm, J., 258
acculturation of, 217-227
and behaviorism, 282-284 Toarmino, D., 270
and counseling process, 232-239 Tokar, D., 343
and counselor variables, 228-232, Tong, B., 132

237-239

i

ABOUT THE CONTRIBUTORS

Fred Beauvais (Ph.D., Colorado State University) is a Senior Research
Scientist with the Tri-Ethnic Center for Prevention Research at Colorado
State University. He is Principal Investigator on a project funded by the
National Institute on Drug Abuse that examines the trends and patterns
of drug abuse among American Indian adolescents. This project has been
ongoing since 1974. He also participates in a number of other research
projects that are concerned with social and psychological problems con-
fronting ethnic minority populations. In addition to his interests in drug
abuse, he has done extensive research and writing on cultural identifica-
tion and its implications for both deviant and prosocial behavior.

Fred Bemak is an Associate Professor and Chair in the Department of
Counseling and Human Services at Johns Hopkins University. He has
given seminars and lectures and conducted research in Latin America,
Asia, and the Caribbean on cross-cultural counseling and at-risk youth
and families. He is a former Fulbright Scholar, a Kellogg International
Fellow, and a recipient of the International Exchange of Experts Fellow-
ship through the World Rehabilitation Fund. He has been working
nationally with refugees for the past 13 years as a researcher, clinician,
and clinical consultant and is currently working on a book with Rita
Chi-Ying Chung, Paul Pedersen, and Thomas Bornemann entitled Mul-
ticultural Counseling With Refugees: A Case Study Approach to Innova-
tive Interventions.

Thomas H. Bornemann, Ed.D., is the Deputy Director of the Federal
Center for Mental Health Services (CMHS), a component of the Sub-
stance Abuse and Mental Health Services Administration in the U.S.
Department of Health and Human Services (DHHS). He also holds
appointments at Johns Hopkins University in the Schools of Hygiene and
Public Health and Continuing Studies. One of DHHS's leading experts

365

366 COUNSELING ACROSS CULTURES r 367

in refugee mental health, he formerly served as Chief of Refugee Pro- I
grams in the Office on International and Refugee Health, and from 1988
to 1993, he served as Director of the Federal Refugee Mental Health About the Contributors
Program-first at the National Institute of Mental Health and then at
CMHS. He has lectured and published extensively in the areas of refugee the Federal University of Rio Grande do Sul in Brazil and a consultant
mental health policy and practice. His most recent collaboration was the for the World Bank. She has written extensively on Asian and refugee
edited volume Amidst Peril and Pain for the American Psychological mental health and has worked in the Pacific Rim, Asia, Europe, and Latin
Association Press. America. Currently she is an Adjunct Associate Professor at George
Washington University and also holds an adjunct appointment at The
J. Manuel Casas received his Ph.D. from Stanford University with a Johns Hopkins University.

specialization in the areas of counseling and cross-cultural psychology. William E. Cross, Jr., received a doctorate in psychology from Princeton
Currently he is a professor in the Counseling, Clinical, and School University in 1976. From June 1973 through the summer of 1994, he
Psychology Program at the University of California, Santa Barbara. He was an Associate Professor of African-American Studies and Psychology
has published widely in professional journals (more than 60 articles) in at the Africana Studies and Research Center, Cornell University, Ithaca,
the area of cross-cultural counseling and education. His most recent New York. Currently, he is a Professor of Psychology and African
research and publication endeavors have focused on Hispanic families American Studies at Pennsylvania State University at University Park. He
and children who are at risk for experiencing educational and psychoso- is considered one of the leading experts on the study of African American
cial problems, including drug and alcohol abuse. His research in this area identity, and his long-awaited scholarly text on this topic, Shades of
gives special attention to resiliency factors that can help Hispanic families Black: Diversity in African-American Identity, was published in 1991. His
avoid and/or overcome such problems. As president of JMC & Associ- model of African American identity development has been the focus of
ates, one of the few Hispanic-owned consulting and research companies, countless essays and numerous empirical studies, and the distinction he
he serves as a consultant to various governmental agencies, organiza- makes between personal identity and group identity in the dynamics of
tions, and corporations that are interested in working more effectively African American identity is the focus of a great deal of scholarly debate
with persons from diverse racial/ethnic and cultural backgrounds. As a within the fields of psychology and African American studies.
consultant, he is devoting much of his time to identifying specific
sociocultural variables and institutional interventions that contribute Juris G. Draguns holds a Ph.D. in clinical psychology from the University
significantly to the success and/or failure of ethnic minorities in social, of Rochester. Since 1967, he has been on the faculty of Pennsylvania
educational, and corporate settings. State University, where he is currently Professor of Psychology. He was
born in Riga, Latvia, where he completed his primary schooling. Dis-
Elayne L. Chou is a doctoral student in the Counseling Psychology placed during Wodd War II, he graduated from high school in Augsburg,
Program at Ohio State University. She recently coauthored a paper with Germany. In the United States, he completed his undergraduate studies
Frederick Leong on the role of ethnic identity and acculturation in the at the Utica College of Syracuse University and his predoctoral internship
vocational behavior of Asian Americans, which appeared in the Journal at the University of Rochester Medical Center. He held clinical and
of Vocational Behavior (1994). Her major research interests are in research positions at the Rochester (NY) and Worcester (MA} State
cross-cultural counseling and Asian American mental health. Hospitals and lectured at the University of Rochester, Clark University,
and Leisester Junior College. He held visiting appointments at the
Rita Chi-Ying Chung received her Ph.D. in psychology in New Zealand Johannes Gutenberg University in Mainz, Germany; the Flinders Univer-
and was awarded a Medical Research Council (MRC) Fellowship for sity of South Australia in Bedford Park; the National Taiwan University
postdoctoral work in the United States. She was the former Project in Taipei; the East-West Center in Honolulu, Hawaii; and the Florida
Director for the National Research Center on Asian American Mental Institute of Technology in Melbourne, Florida. He is also a member of
Health at the University of California at Los Angeles and recently a the Advisory Board of the Multicultural Research Center in Daugavpils,
Visiting Professor in the Departments of Psychology and Psychiatry at Latvia. He is interested in the interplay of cultural influences and com-
plex behavior and has published in psychological, psychiatric, and inter-
disciplinary journals on psychopathology, counseling, psychotherapy,
and personality in relation to culturally mediated experiences.

r

368 COUNSELING ACROSS CULTURES About the Contributors 369

Peony Fhagen-Smith is currently a graduate student in child clinical of Minnesota, Minneapolis, where she received her Ph.D. degree. She
psychology at the Pennsylvania State University. She earned her BA in teaches courses and advises students in career development and counsel-
psychology from Wellesley College, Massachusetts. Her research inter- ing and multicultural counseling and has taught a Multicultural Issues
ests include racial identity development among African Americans, par- and Specific Populations course since 1974. In 1976, she created the
ticularly as it relates to behavioral and emotional problems among collaborative BORN FREE Program, a continuing multimedia training
children and adolescents. and development project to expand options and reduce stereotypes of
both boys and girls, women and men, from kindergarten through adult-
Candace M. Fleming (Ph.D., University of North Carolina) joined the hood. Her research interests are in gender-role stereotypes across cul-
staff of the National Center for American Indian and Alaska Native Men- tures, career patterns of women, educational-vocational guidance, and
tal Health Research in 1987, serving principally as an Alcohol Research school climate for girls and young women of all backgrounds. An APA
Scholar. For a brief time she was chief of the Indian Health Service's Fellow (Divisions 17 and 35), she has written and lectured widely and
mental health/service programs for 10 tribes in the Puget Sound area of conducted workshops in most of the United States and 16 countries.
Washington State. Her interests are in the areas of individual, family,
and community resiliency. As of August 1992, she and her colleague H. Nick Higginbotham received his Ph.D. from the University of Hawaii
Spero Manson have served as codirectors for the Healthy Nations Pro- clinical psychology program. He is the author of The Third World
gram, an initiative funded by the Robert Wood Johnson Foundation to Challenge to Psychiatry: Culture Accommodation and Mental Health
reduce the negative impact of substance abuse in Indian communities. Care. His subsequent work extended the theme into Hawaiian and
Aboriginal cultures. He is a Senior Lecturer at the Center for Clinical
Sandra Foster received her doctorate from Stanford University and later Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences,
returned to Stanford's Counseling Psychology Program as Acting Assis- the University of Newcastle, Australia, where he coordinates a master's
tant Professor. Her research interest in performance anxiety led to her program in health and social science. In recent years, he has helped to
development of strategies for overcoming it. In 1993, she co-founded develop the social science component of the International Epidemiology
Performance Enhancement Unlimited, a consulting group dedicated to Network (INCLEN) involving medical schools in Asia, Africa, and Latin
assisting people in business, performing arts, and sports in attaining America. He is a founding member of the International Forum of Social
optimal performance. She is currently exploring ways in which young Sciences in Health.
athletes can identify and address sexism and homophobia in sports.
Farah A. Ibrahim is a Professor of Counseling Psychology and a licensed
Elizabeth M. P. Gama is Professor Emeritus of the Universidade Federal psychologist (CT) at the University of Connecticut at Storrs. She is an
do Espirito Santo, Brazil, where she was Vice President of Research and immigrant from South Asia. She currently serves on the editorial boards
Graduate Studies and Professor of Counseling and Human Development. of APA's Division 17 and Division 29 journals The Counseling Psycholo-
She earned her Ph.D. in educational psychology-counseling at the Uni- gist and Psychotherapy. She has taught and done research on cross-cultural
versity of Minnesota. Currently she is conducting research that compares counseling, training and education, assessment, ethics, and the psychol-
the effects of social class and gender on the achievement of low-incoI)1e ogy of women (including Asian American women). She has recently
students in Brazil. She has published many articles on the psychology of brought the two lines of research together in her teaching and research
women and achievement and social class and has conducted several in a variety of settings. She has served as Chair of the American Coun-
studies for the Brazilian government. As a postdoctoral Fulbright Scholar seling Association's Human Rights and International Relations Committees
at the University of Minnesota in 1990-1992, she studied qualitative as well as other committees relevant to cross-cultural counseling.
research, with applications to counseling. She currently lives in Bloom-
ington, Minnesota. Amy James, M.A., is a doctoral student in the Department of Counseling
Psychology at the University of Wisconsin, Madison. She has served as a
L. Sunny Hansen is Professor of Counseling and Student Personnel clinical supervisor for master's-level school counselors and worked in a
Psychology in the Educational Psychology Department of the University variety of settings, including schools, a university counseling center, and
a prison.

370 COUNSELING ACROSS CULTURES About the Contributors 371

Pamela Jumper-Thurman (Ph.D., Oklahoma State University) is a Clini- the Psychological and Behavioral Literature, 1967-1991 (1992). His
cal Psychologist and Research Associat~ with the Tri-Ethnic Center for latest book is an edited volume, Career Development and Vocational B _
Prevention Research at Colorado State University. She has provided havior of Racial and Ethnic Minorities (1995). In 1993, he received t:e
clinical services and program direction for drug abuse problems among Early Career Scientist/Practitioner Award from the Division of Counsel-
American Indian populations. In her current position, she participates in ing Psychology of the American Psychological Association. He is also a
several research projects concerned with drug abuse among American F~llow of the American Psychol~gical As~ociation (Divisions 17 and 45).
Indian youth. Her recent interests have focused on community develop- His major research interests are m vocational psychology, cross-cultural
ment and mobilization as a drug abuse prevention strategy, the special psychology (particularly culture and mental health and cross-cultural
needs of Indian women, and the problem of solvent abuse among youth, psychotherapy), and organizational behavior.
especially American Indian youth.
Danielle W. Lingle is a doctoral candidate in counseling psychology at
Harry H. L. Kitano is currently a Research Professor at the Department Indiana University. At the time of completing her coauthored chapter,
of Social Welfare in the School of Public Policy at the University of she was on a predoctoral internship at the Psychological and Counseling
California, Los Angeles. He was the first holder of the Endowed Chair Services, University of California at San Diego. Her research interests
in Japanese American Studies. His major books include Race Relations include multicultural counseling and training, the life span development
and Generations and Identity, Asian Americans (with Roger Daniels), and adjustment of biracial individuals, organizational consultation, and
Japanese Americans, and American Racism (with Roger Daniels). He is community outreach intervention.
currently working on a book with Mitchell Maki entitled The Impossible
Dream: Japanese Americans and Redress. Walter J. Lonner is a Professor of Psychology and Director of the Center
for Cross-Cultural Research at Western Washington University, Belling-
Teresa D. Lafromboise, an Associate Professor of Education at Stanford ham, Washington. He has been involved with many books in cross-
University, received her Ph.D. degree from the University of Oklahoma. cultural psychology as author, editor, and contributor. He is Founding
She is author of the American Indian Life Skills Development Curricu- Editor of the Journal ofCross-Cultural Psychology and continues to serve
lum, an intervention for the development of high school students' life as its Senior Editor. A former Fulbright Scholar (West Germany, 1984-
skills, including knowledge, beliefs, and ability to intervene in suicidal 1985), he has served as president of the International Association for
situations. Her publications also include "Psychological Impact of Bi- Cross-Cultural Psychology, and in 1994 the Association made him an
culturalism: Evidence and Theory" in Psychological Bulletin (1993), Honorary Fellow.
"Development and Factor Structure of the Cross-Cultural Counseling
Inventory-Revised" in Professional Psychology: Research and Practice Mitchell T. Maki is an Assistant Professor in the Department of Social
(1991), and "American Indian Women" in L. Comas-Diaz and B. Greene Welfare at the University of California at Los Angeles. His current
(Eds.), Psychotherapy With Women of Color (1994). An APA Fellow research areas include the influence of race, culture, and ethnicity on
(Divisions 17 and 45), she was formerly President of the Society of Indian social work practice and public policy issues.
Psychologists and APA Division 45.
Paul B. Pedersen is Professor in the Departments of Counseling and
Frederick T. L. Leong is an Associate Professor of Psychology at Ohio Human Services and the Department of International Relations, Syracuse
State University. He obtained his Ph.D. from the University of Maryland University. He has taught and done research for 6 years in Asia and taught
with a double specialty in counseling and industrial/organizational psy- at the University of Minnesota and the University of Hawaii. A Fellow
chology. He has authored and coauthored over 50 publications in various in APA Divisions 9, 17, and 45, he has authored and edited 20 books and
counseling and psychology journals and 14 book chapters. He was the over 100 articles and chapters on multicultural issues dealing with
coeditor, with Uma Sekaran, of Womanpower: Managing in Times of multicultural counseling, mediating multicultural conflict, international
Demographic Turbulence (Sage, 1992) and coeditor, with James Whitfield, students, and culture-centered training skills.
of the APA bibliography entitled Asians in the United States: Abstracts of

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