Counseling and Chinese Culture

WASHINGTON -- One of the lesser-known factors in why East Asian students have trouble seeking counseling lies not in the Chinese or Taiwanese culture, nor in the upbringing of these students, nor in one of the numerous myths and stereotypes that follow them around campus.

It's simply a matter of language: Mandarin has no single word for "counseling." So in a session here Saturday at the annual meeting of the American Psychological Association, Huan-Chung Scott Liu explained how the concept combines four Mandarin words: those for ask, discuss, support, and guide/teach.

"That's how we describe counseling," Liu, a staff psychologist at the University of Iowa's counseling center, said. "Maybe a lot of Western counselors, we're all wondering why they're so asking for a directive approach. That's probably why."

The session, "Mandarin-Speaking Students at University Counseling Centers," explored the enrollment trends and cultural characteristics of this population, and whether and how these students seek help. Liu and two other staff psychologists, Bai-Yin Chen of the University of California at Davis and Chun-Chung Choi of the University of Florida, explained that with more Chinese, Taiwanese and other East Asian students enrolling than in years past -- and with many becoming more receptive to counseling -- it's important that counselors understand their complex needs. (The Asian and Pacific Islander American Association of Colleges and Universities, a new group launched in June, aims to foster that understanding in all corners of higher education.)

The number of Chinese students, in particular, at U.S. colleges has surged in recent years, especially at the undergraduate level, thanks to China's economic success. In 2009, China sent to the U.S. 57,451 graduate and 26,275 undergraduate students, up from 50,976 and 8,034, respectively, in 2004. Almost one-fourth of all international students speak Mandarin, and foreign students are starting to develop English-speaking skills at younger ages, Chen said. "We need to do more outreach work to Mandarin-speaking students because there are a significant number of them on our campuses," she said. "There are still stigmas toward [the subject of] mental health, but at the same time ... acceptance of counseling is increasing."

Experts widely acknowledge that the stigma many Americans associate with mental health services such as counseling tends to be even worse among Asian American and Pacific Islander students, who come from cultures where this stigma is particularly intense.

And Mandarin-speaking students must deal with major culture clashes that can interfere with their education: while Western society revolves around individualism and independence, Chinese and Taiwanese students are accustomed to intensely interdependent group support and close relationships with and reliance on family members, whose approval and perception of the student can be more coveted than self-acceptance, speakers here said. All these traditions can make it difficult for Mandarin-speaking students who fear making mistakes to cope with the isolation and frustration college often brings -- and to seek help. In the most extreme cases, some of these students who don't develop sufficient coping strategies to compensate for the lack of mentoring and support simply stop going to classes. "They don't have good help-seeking ideas or mentoring or support, so they kind of hide," Liu said.

But, Chen said, she's seeing more students coming in with previous counseling experience, perhaps because improved Taiwanese insurance policies are making counseling and medications for anxiety or depression more widely available -- and improving general awareness of these services -- and because more Chinese students are able to afford them.

While these students do face very real, unique challenges, it's important to remember that not all of them struggle because of them. Recent studies show that only about 25 percent of Mandarin-speaking students encounter adjustment issues. "We don't want to stereotype every international Mandarin speaker," Choi said. "I'm advocating for an open mind about maybe just one informal consultation for international Mandarin-speaking students, so it's not necessarily counseling but also a form of building relationships and planting a seed, because they can come back later for the real counseling."

Such consultations can be born from outreach projects such as support groups, coffee hours, liaison programs with the international center or professional schools, or workshop series on what counseling is and what psychologists and psychiatrists do. It's critical to establish trust, speakers said, so these students -- 90 percent of whom are seeking to deal with motivation issues, not treatment for major psychological problems -- can understand that counseling is a support system, not a last resort that's there only for people with severe disorders they can't handle on their own. "You want to validate their experience of hardship in a strange land," Choi said. "Whether they are very adaptable or not, they will have some difficulties."

But to encourage Mandarin-speaking students to take the most important step -- getting their foot in the counseling center door -- counselors have to reach out and be proactive, Choi said. "The traditional role is counselors sit in an office and wait for clients to come," he said. "Well, that's not going to work for this population."