Group Counseling with South Asian Immigrant High School Girls: Reflections and Commentary of a Group Facilitator

Dec 2, 2014 | Article, Volume 4 - Issue 5

Ulash Thakore-Dunlap, Patricia Van Velsor

The diversity of the U.S. school population speaks to a need to provide support for youth from various backgrounds. As a school-based mental health counselor, the first author observed that the South Asian immigrant students at her school did not utilize any of the counseling services provided. Because South Asians are typically collectivistic, the counselor chose group counseling as a potential intervention and hoped to provide a place for the students to address issues related to orienting to a new school in a new country. In this article, the authors weave information about the South Asian population into the first author’s reflections and commentary on initiating and conducting a group with South Asian high school girls. Recommendations for group counseling in schools with South Asian immigrants are provided.

Keywords: South Asian, immigrant, youth, schools, group counseling

The United States has seen a marked increase in the number of children who have at least one parent born outside the United States (Capps et al., 2005). Between 1995 and 2012, the population of first- and second-generation immigrant children in the United States increased by 66% (Child Trends Data Bank, 2013). This sharp rise is important for American cities because 95% of all children of immigrants attend urban schools (Fix & Capps, 2005). Furthermore, according to a recent update from the Asian American Federation and South Asian Americans Leading Together (2012), the South Asian American population was the fastest growing major ethnic group in the United States from 2000–2010. Relationship building is part of acclimatizing to a new country for immigrant youth, and it is in the schools that these youth build new friendships and create social networks (Suárez-Orozco, Suárez-Orozco, & Todorova, 2008). For South Asian youth in American schools, group counseling can provide a setting for students to connect to others who share similar stories and experiences. Groups can offer a safe place for them to discuss their cultural norms, exchange stories of challenges and hope, and enhance their social development in a new country as they form emerging adult identities.

As a school-based mental health counselor in a public urban high school on the northern California coast, the first author’s responsibility is to provide overall behavioral health support through assessments, counseling (short- and long-term, individual, group, crisis), staff and teacher consultations, and presentations on mental health issues to students, parents and teachers. When two South Asian students were referred for individual counseling, the first author wondered if other South Asian students might be experiencing challenges associated with adjusting to a new school in a new country. She also was personally aware of difficulties associated with identity development for adolescents negotiating different home and school cultures. She decided that counseling focused on prevention of problems related to acculturation and identity could be helpful to the South Asian students in her school. Because the South Asian collectivistic orientation is consistent with the goals of group counseling (Sharma, 2001), she chose this approach. As a South Asian herself, the first author believed that her understanding of South Asian culture could contribute to her effectiveness as facilitator of a group with this population. Thus, the first author developed a simple strategy for recruitment and set out to create a group for South Asian immigrant high school students.

Although in many cases the first author’s expectations about the group were met, she also confronted surprises and challenges. This article is the result of discussions with the second author in which the first author shared her reflections and commentary on the facilitation of students’ exploration of issues in the group. The goal is to impart the first author’s personal knowledge and perceptions, so that counselors working with South Asian youth may consider how her experience might inform their group work with this population. A secondary goal is to inspire other counselors to find ways to meet the needs of immigrant youth in their own schools and clinics through group counseling. A very brief overview of South Asian culture will provide a context for understanding these reflections.

South Asian Culture

This section provides information about South Asian culture as it relates to the first author’s personal experience facilitating a group with South Asian immigrant girls; the authors do not intend stereotypical representation of South Asian adolescents or their families. The girls with whom the first author worked had both similarities and differences based on their cultural backgrounds, level of acculturation and individual personalities.

The term South Asian is used to describe people of various religions and nationalities who trace their cultural origins to the Indian subcontinent (Assanand, Dias, Richardson, & Waxler-Morrison, 1990; Ibrahim, Ohnishi, & Sandhu, 1997). Countries of South Asia include Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka (The World Bank, 2011). According to 2010 estimates (Pew Research Center, 2012), the majority of South Asians practice Hinduism or Islam, but there also are South Asians who practice Buddhism (the majority religion in Bhutan and Sri Lanka), Christianity or other religions. Overall, there is great diversity within this population with regard to religious affiliation, language, immigration history, socioeconomic status and education (Inman & Tewari, 2003). Despite their differences, South Asians generally share some common characteristics including customs, values, family expectations and beliefs that relate to mental health (Maker, Mittal, & Rastogi, 2005). Specific values include formality in interpersonal relationships, inhibition of strong feelings, respect of elders, primary allegiance to the family and deep respect for religion (Kim, Atkinson, & Yang, 1999).

Unlike other Asian American groups, South Asian immigrants have not been studied by social scientists to any appreciable degree (Maker et al., 2005). Existing research on South Asian individuals and counseling suggests that South Asian Americans have neutral or positive perceptions of mental health care, but infrequently use mental health services (Panganamala & Plummer; 1998; Sue & Sue, 2008). This reality may be due to South Asians’ lack of awareness of available services, cultural and language barriers, or fear of confidentiality breaches. Another reason for this infrequent use of mental health services may relate to the South Asian belief that disclosing mental problems or mental illness brings shame and stigma to the entire family (Atkinson, 2004). Moreover, research suggests that South Asians are likely to make external attributions and spiritualize emotional problems while emphasizing somatic complaints and academic or career concerns (Sandhu & Madathil, 2007). The first author used her personal understanding of South Asian culture to help inform recruitment and facilitation of the group.

Recruiting Participants for the Group

Recruiting immigrant and minority populations for counseling services involves providing an accessible service delivery location (Yuen, 1999). Recommended approaches for attracting group members include advertisements (e.g., hallways posters), referral networks (e.g., teachers) and announcements (e.g., classroom presentations; Gladding, 2008; Kline, 2003). The first author decided to take a straightforward approach by putting up posters and flyers around the school—in hallways and homerooms, and on bulletin boards. Because it was important to use language that lacked stigmatization, she carefully planned the posters. She used a term familiar to South Asians, Desi, which describes individuals who identify themselves as South Asian or with South Asian culture (e.g., music, traditions, films, food). The flyers read, “Come and meet other Desi’s in the school! Want to learn more? Come to room 200.” That approach, however, proved ineffective; after two months not a single student had inquired about the group. Next she asked teachers for referrals, approached the identified students during their homeroom period and described the group. Again, she used terms such as support group, sharing, confidential place and time to meet others in lieu of the more stigmatized language of mental health counseling. Although most students showed interest, they communicated skepticism about joining a group.

Refusing to give up, she pondered Yuen and Nakano-Matsumoto’s (1998) suggestion highlighting the importance of finding an appropriate point of entry for recruiting immigrant populations. She walked around campus targeting the places where South Asians congregated during passing hall periods and lunchtimes. She introduced herself, discussed her role at the school, disclosed her own ethnic identity as a South Asian and invited students to drop by her office at lunchtime. After an entire semester of drop-in encounters, a group of girls agreed to participate and the idea of a group for South Asian students became a reality.

Background of the Group Facilitator and Participants

When contemplating recruitment for the group, the first author believed that her background would be advantageous. Born in London, England, she was raised in an Asian Indian family; she speaks Hindi and Gujerati (Asian Indian languages) in addition to English. It seemed intuitive that her commonalities of background and language with the students would facilitate initial recruitment as well as rapport building. (As she learned, however, this was only partially true).

The group participants were first-generation immigrants, born outside the United States, or second-generation immigrants, born in the United States. All group members identified culturally as South Asian, but came from different countries in South Asia. They shared similar customs, food, clothing and popular culture (film and music). However, because the students’ home countries were different, the students spoke various languages. Moreover, as the group progressed, distinct cultural traditions (e.g., age of marriage) and values (e.g., definitions of beauty) emerged, along with differences in the girls’ perspectives on those beliefs and values. As the authors describe the first author’s reflections of the group, they carefully maintain the anonymity of the girls’ disclosures and share only overall themes and activities in the context of South Asian culture in general.

Reflections on Facilitating the Group

When the first author chose group work for the South Asian girls, she identified the counseling group as the most appropriate type of group. The counseling group utilizes members’ interactive feedback and support to help address problems of living, which may be related to transitions or development (Corey, Corey, & Corey, 2010). For adolescent immigrant students, these everyday problems often involve the challenges of adjusting to a new culture and developing a cultural identity (Ahmad-Stout & Nath, 2013; Shariff, 2009). The first author sought to provide a safe place for the South Asian girls to explore these issues of acculturation and identity. She presented topics at each session designed to encourage this exploration.

The first author’s approach to counseling this group was integrative; she borrowed concepts from relational-cultural theory as well as multicultural counseling. Relational-cultural theory is based on the idea that psychological growth takes place in the context of relationships characterized by empathy, mutuality and empowerment (Comstock et al., 2008; Jordan, 2000). Multicultural counselors also promote empowerment by helping clients develop strategies for exercising control in their lives (Crethar, Rivera, & Nash, 2008; Toporek, Lewis, & Crethar, 2009). Based on these concepts, the first author’s goal was to provide a safe space in which the South Asian girls could build mutually supportive relationships and where she could help promote the girls’ self-confidence as South Asian females.

Consistent with the beginning stage of a group, the members were initially reluctant to disclose information (Corey et al., 2010). Despite the first author’s similarity in background to the South Asian girls in her school, it still took time for them to perceive her as a safe person with whom they could share. She allowed time to build rapport and trust to aid the girls in overcoming their reluctance about help seeking. Openly discussing the expectations and goals of the group was helpful in creating safety and served to ease student anxieties about committing to a weekly group. The first author clearly laid out group expectations in the first session, invited input from all group members and highlighted confidentiality. Although members initially avoided sharing personal experiences about family, boyfriends and sexuality, two girls were very vocal about less intimate issues. After approximately 12 sessions (halfway through the group), there was a noticeable shift as all members began to disclose their experiences. At this point, the level of trust in the group allowed the girls to explore issues at a deeper level, which is one characteristic of a working stage (Corey et al., 2010). Two outcomes of the group suggested movement toward the relational-cultural theory and multicultural counseling goals of relationship building and empowerment. About midway through the group, the girls began socializing at school; and later, toward the end of the group, they continued to build relationships by spending time at each other’s homes. Additionally, the girls’ confidence showed at termination when they asked to form their own South Asian group, which the first author helped them create.

The topics presented for discussion in the group involved asking the girls to answer a list of questions that the first author formulated: “What does it mean to be a South Asian female in our school?,” “What is it like to navigate dissimilar home and school cultures?,” “What gender messages do you receive as a South Asian girl?” and “How do media messages shape your identity as a South Asian female?” The following discussion provides additional information about South Asian culture as a backdrop for the first author’s reflections on the girls’ exploration of these topics.

South Asian Lifestyle in a U.S. School

Asian Indian immigrants in Western cultures often continue to base their lifestyle on traditional values, beliefs and expectations (Farver, Bhadha, & Narang, 2002). This includes unwritten rules, such as respecting adults, so adults do not tolerate rude or disrespectful speech from children. South Asian girls must heed strict family rules regarding girls’ roles (which may include caring for younger siblings), respect for elders and male members of the family, and choices related to school and college. For example, family rules often prohibit dating, having male friends and being out after school. In group sessions, these topics permeated the discussion, as expected.

Also guiding South Asian lifestyle is collectivism. South Asian girls are taught to respect the importance of community as part of what it means to be South Asian. In the context of the group and their collectivistic orientation, it was especially important for the girls to feel connected and understood by the other girls. Sharing enjoyment of similar foods (e.g., roti, samosas), conversing in English and Hindi, and exploring what it is like to be a South Asian girl in the United States created a sense of group cohesion. This cohesion established an environment in which the girls could feel emotionally supported and empowered in an unfamiliar school environment.

Despite the apparent safety of the group environment, however, the first author noticed that the girls were sensitive to feedback and needed to consult with each other on decisions (e.g., what school clubs to join). The power of group decision making became significant in the group. When the first author initially asked for individual opinions (i.e., “What do you think?”), the girls were reticent. This restraint reminded the first author of her own upbringing, in which older members of the family made decisions jointly, and the message she internalized was that she was not supposed to offer a viewpoint. The first author felt an urge to overcome any sensitivity a girl might have to rejection or shame due to expressing ideas different from those of other group members. She found herself helping the girls to express their own thoughts and opinions, even if they differed from those of the other girls. When the first author explained that the group was a place to express thoughts and feelings that they were unable to express at home, many of the girls began to open up.

South Asian Girls’ Challenges in Negotiating Dissimilar Cultures

The dialogue around navigating home and school cultures was not surprising. The first author expected identity development to be a major issue, along with struggles to integrate South Asian cultural identity with mainstream American norms, expectations and culture. Facilitating the group brought up memories of negotiating home and school cultures in the first author’s own adolescence in London. As an Indian/South Asian in an urban high school that was over 90% Caucasian, she often felt different from others not only in terms of physical appearance (e.g., skin and hair color), but also because of family cultural activities. She felt embarrassed explaining her Indian/South Asian cultural beliefs and values to peers. Her role as a teenager was to follow family rules, respect elders and play a traditional female role (e.g., learning to cook, taking care of siblings). Her non-Asian school friends could not understand this cultural dilemma or the cultural restrictions placed on her behaviors (e.g., not going out after school). She was forced to adopt a dual identity—at home, the traditional Indian/South Asian girl, and at school, a more stereotypically British teenager. The girls’ dilemmas mirrored the first author’s experience as a teenager and she was able to understand their disclosures in a personal way. She was sometimes viewed as didi (“sister” in Hindi). It seemed advantageous to be perceived as a family member, yet this was only partially true (and explained later).

Within the context of navigating two cultures, the theme of academics came up frequently. Because a primary motivation for the immigration of South Asian parents is educational opportunity, high aspirations for their children are common (Ghuman, 2003). It did not surprise the first author that the girls had internalized messages from parents and put pressure on themselves to succeed in school. However, South Asian immigrant youth have an added pressure that stems from the fact that they must contend with schools that differ from those in their native countries. Immigrant students may come from South Asian schools that have very strict rules with rigid guidelines regarding teacher–student interaction, but they must adapt to the less formal educational approach in U.S. high schools. U.S. teachers often encourage students to express their thoughts and feelings, while South Asian parents instill in their children that openly expressing their opinions to adults shows disrespect. The first author supported the education of the girls in their U.S. school by helping them build self-confidence in expressing their viewpoints. She initiated discussion about ways for the girls to voice their opinions in the classroom to help them succeed in U.S. schools and provided an opportunity for them to practice these strategies.

In addition to these internal struggles, attempting to fit into a mainstream American school often comes with other costs for a South Asian girl. Because of the differences between Western and South Asian traditional value systems, adolescence can be a difficult time for South Asian immigrant families (Ranganath & Ranganath, 1997). An exacerbating factor borne out in research is that “children of immigrants adapt more quickly to the new culture than do their parents” (Farver et al., 2002, p. 13). These circumstances can create conflicts with parents around issues such as choice of friendships, dating and education. South Asian immigrant girls may observe their mainstream American peers having different adolescent experiences (e.g., spending time with boys) and may want to have the same experiences. In doing so, or even considering doing so, they may deal with anxiety and helplessness as well as fears of parents finding out. Although the girls’ dilemmas were similar to those in the first author’s experience as an adolescent, she was nonplussed at times by the depth of the struggles of the first-generation girls in negotiating the two cultures. As a second-generation South Asian, the first author was born and raised in London. In contrast, many of these girls were born in their home countries and immigrated to the United States, some of them as teenagers. Thus, the first author was sometimes challenged to grasp their difficulties in comprehending American culture, and she had to work assiduously to facilitate their understanding of foreign ideas and practices. She was sometimes unnerved by the intensity of the girls’ internal struggles to process the conflicts between the values and beliefs of their home and school cultures. Therefore, she realized the critical importance of giving careful attention to providing a nonjudgmental space for the expression of the girls’ frustrations related to these differences.

Gender Messages Received by South Asian Girls

Within traditional societies such as India, there are different expectations for male and female behavior (Farver et al., 2002). In traditional South Asian families, males are permitted greater independence, personal autonomy and educational opportunities, whereas females are restrained (Dasgupta, 1998; Ghuman, 1997). For example, females are expected to perform household chores and take care of younger siblings, while boys are allowed more freedom (e.g., going out after school). According to Ghuman (2003), South Asian families in the West also tend to be more lenient with boys, even overlooking breaking of social and family rules, precipitating distress for many South Asian girls. In particular, exposure to mainstream American culture may further increase girls’ distress in response to South Asian culture’s seemingly unfair expectations of girls and boys. Girls may feel overprotected by their parents, inferior to their male counterparts and envious of American-born South Asian girls who follow less traditional roles. It is important to remember, however, that there is variation in the messages that South Asian youth receive depending on a number of factors including socioeconomic status. In her middle-class family, the first author was socialized on how to behave (e.g., what to say, how to dress) as a female in order to obtain a husband. Coming from a high Hindu caste family, however, afforded more privileges such as access to education and social connections, which can result in opportunities outside the home.

Media Messages and South Asian Girls’ Identity Development

Youth often look to role models in identity development, and there are few South Asian public figures and role models in the media to whom South Asian youth can relate. Research in which Asian American children reported admiring Black figures first and White figures next (entirely overlooking Asian and Latino figures) supports this idea (Cortés as cited in Aoki & Mio, 2009). In the group, the first author helped the girls examine how South Asians are viewed in American media and discussed Bollywood (i.e., Indian film industry) movies, which present current Hindi film stars. In the film Om Shanti Om (Khan & Khan, 2007) the heroine, Shanti, is a beautiful, tall, slender Indian woman who has an unfulfilled relationship with a man because of her parents’ disapproval. Role models such as Shanti represent beauty in South Asian culture, and exposure to standards of beauty that differ from Western beauty ideals is helpful for young South Asian females’ self-image. Additionally, however, South Asian girls need exposure to a broader range of role models to enhance their development. Currently, there are many successful South Asian American individuals who integrate South Asian and American identities in the worlds of academia, business, entertainment, politics, media and the sciences, and the first author deemed it important to expose the girls to the accomplishments of these people. An array of examples includes Sri Srinivasan (judge of the U.S. Court of Appeals for the District of Columbia circuit), Anita Desai (novelist), Sanjay Gupta (neurosurgeon & CNN chief medical correspondent) and Norah Jones (singer). The author’s hope was that exposure to this diverse range of role models might motivate the girls to explore different careers and inspire them to consider nontraditional career tracks. Moreover, a future goal was to bring in local South Asian role models from the surrounding community.

South Asian youth also draw from traditional Hindi music to shape their identity and represent a sort of new ethnicity (Dawson, 2005). In the group, listening to traditional South Asian music supported the South Asian girls’ roots, and listening to music such as Indian music with hip-hop and rap fusion represented a blending of the girls’ American and South Asian cultural identities. Sharing music provided a sense of group connectedness, while analyzing lyrics led to fruitful discussions about characteristic gender themes related to being South Asian.

 Common Adolescent Issues Among South Asian Immigrants

In addition to the previous topics, the group discussed other issues that are typically important to adolescents. Though South Asian girls tend not to date and often struggle to follow rigid and unyielding norms around relationships (Ayyub, 2000; Durham, 2004), immigrant girls in American schools may want to explore the topic of dating and relationships. In the first author’s experience, some South Asian girls may never date, while others may simply refrain from informing their parents that they are involved in relationships. Fear of being caught by parents, family members and friends may precipitate girls’ avoidance of dating or permeate the experiences of girls who date.

Related to dating is the topic of ideal partners for relationships. South Asian girls from traditional families are expected to marry a person from the same cultural background (Bhatia & Ram, 2004). For example, families would not accept a union between a Pakistani girl and an Indian boy, even though both individuals are South Asian. For some girls, even thoughts of relationships with boys from different cultural backgrounds may result in sentiments about conflict as well as feelings of shame and guilt about disrespecting the family. Having a space in a school group to discuss these feelings was particularly important because South Asian girls often cannot discuss these topics with family members; and even girls who have no desire to be in a relationship in high school may be curious about such topics. The first author presented the topic of what relationships might look like for the girls in a South Asian community as well as what relationships might look like for their non-South Asian peers. She wondered about the value of disclosing that her spouse was non-South Asian, and decided to do so to address the girls’ curiosity about her non-South Asian last name. This information provided a space for the girls to process fantasies they might have about marrying a non-South Asian or someone outside their identified community.

Recommendations for Counseling Practice

From reflections and discussion of the group experience, the authors have developed recommendations for counselors serving South Asian girls in their schools. A primary component in this group counseling experience is the provision of a safe space within which South Asian students can discuss salient issues with other South Asian youth. Equally important, as authors (e.g., Shariff, 2009; Sue & Sue, 2008) have explained, is the counselor’s ability to employ culturally appropriate helping skills and interventions. Counselors must pair these skills and interventions with knowledge of topics that are relevant to the particular youth they are serving. Because identity development is a significant issue for adolescents in general and a more challenging task for South Asian girls who must straddle two cultures, it is critical to focus on this issue.

Creating A Safe Space at School

A primary goal of a group for South Asian girls is to provide a space for them to interact with students from similar backgrounds. Due to size of the student population and variety of schedules in urban schools, it may prove difficult for South Asian adolescents to connect with each other in classes. Moreover, cultural mores may make it prohibitive to meet other students after school, excluding another avenue for interaction. Therefore, group counseling offers a social sphere for interaction, but must of course be a safe space. Moreover, as Chung (2004) explains, a focus on confidentiality is critical in working with any Asian American group because disclosing family matters to outsiders is frowned upon.

Providing a safe psychological space depends not only on sensitive recruitment and open communication, but also on the counselor’s ability to analyze personal racial/ethnic beliefs and values in relation to those of South Asians. As part of this self-examination, non-South Asian counselors must explore any preconceived notions based on the portrayal of South Asians in the American media. Additionally, White European-American counselors who seek to develop groups with South Asian youth must carefully and continually explore their willingness to confront their level of privilege. In a study of graduate students in clinical psychology and social work, findings showed a correlation between White privilege attitudes and multicultural counseling competencies (Mindrup, Spray, & Lamberghini-West, 2011). Counselors committed to working with South Asian immigrants should be ready to accept responsibility for change at not only the personal level to better meet the needs of South Asian students in group counseling, but also at the institutional (i.e., school) level to enhance the experience of South Asian students in the school.

Counselors can broaden their knowledge of the South Asian culture by reading as well as watching films about South Asian life. Some recommended films for counselors include The Namesake (Pilcher & Nair, 2006) and Monsoon Wedding (Baron & Nair, 2001). Suggested books are Brick Lane: A Novel (Ali, 2004), Fasting, Feasting (Desai, 1999) and Indivisible (Banerjee, Kaipa, & Sundaralingam, 2010), an anthology of South Asian American poets who trace their roots to Bangladesh, India, Nepal, Pakistan and Sri Lanka. Another way to learn is by going to a South Asian neighborhood and immersing oneself. The counselor might observe the interactions between parents and their children, as well as how teens interact among their peer groups. Familiarity with the latest fashion trends in clothes, food, music and films can further help counselors to understand the commonalities and differences within the South Asian population, and in particular with South Asian adolescents. Moreover, community leaders can serve as valuable resources in understanding Asian American populations (Chung, 2004). For example, counselors can build relationships with persons who run community centers and organizations that serve South Asians or with faith-based leaders in the South Asian community.

Counselors who are South Asian may have an easier experience initiating a South Asian group. However, it seems important for the first author to share an observation she has made in her 13 years of working with South Asian students: First-generation students have been more likely to seek her out than to approach her non-South Asian colleagues. However, as students have become more acculturated to mainstream American schools, they seem to be more wary of this student–counselor shared ethnic background. Some students have disclosed concerns about possible connections with the South Asian community in which they live (e.g.,“Will you tell my auntie about my activities?”). In those instances, the students seem to seek out counselors who are not South Asian. (Although this cannot be generalized to all South Asian populations, it suggests an interesting area for exploration).

Creating Culturally Appropriate Counseling Interventions

The importance of knowing the backgrounds of the particular members of a group in order to design culturally appropriate interventions cannot be overstated. As many authors have asserted, not all Asians are alike (e.g., DeLucia-Waack & Donigian, 2004; Sue & Sue, 2008), and within-group differences among Asian groups is often overlooked (Sandhu, 2004). This idea holds true for South Asians who may come from a variety of different countries such as India, Pakistan, Sri Lanka or Bangladesh. In addition to within-group differences, counselors must consider each adolescent’s level of acculturation when identifying counseling strategies.

When designing interventions for group counseling, counselors may look to focus on individual disclosure, individuation and autonomy, and direct types of communication (e.g., confrontation; Corey et al., 2010)—ideals based firmly in Western culture. These goals, however, might not apply to Asians who value humility and modesty (rather than open sharing) as well as group harmony (instead of individual goals), and who might be uncomfortable with direct communication (Chung, 2004; Sue & Sue, 2008). In light of this situation, there are several issues that the counselor must keep in mind when designing interventions.

     Personal disclosure. Even within a safe environment, South Asian students may still exhibit a disinclination to share personal information. Counselors can model disclosure by sharing their own family experiences, which can prove beneficial in getting youth comfortable and involved in a group (Sandhu, 2004). However, it is still important that counselors are sensitive to any member’s reluctance (communicated either verbally or nonverbally) to disclose, especially because of the cultural value of respect for authority figures (i.e., the counselor), which could precipitate member disclosure and subsequent shame over exposing family information.

     Goal setting. Individual goal setting is consistent with Western culture and is often encouraged in group counseling literature (Corey et al., 2010; Gladding, 2008). Because of their collective orientation, South Asians may be reluctant to set individual goals and may want to focus on group goals. Potential goals may involve achieving academic success, exploring family pressures, examining gender roles and discussing taboo topics such as sexuality. The counselor must not, however, overlook a member’s desire to set individual goals. (Over time, certain members in this South Asian girls’ group did set personal goals.)

     Direct leadership. Asians’ values related to respect for adults/elders and authority figures (DeLucia-Waack & Donigian, 2004) suggest that a direct leadership role within a structured group format might work best. Initially, the first author provided a structure for the group sessions using expressive art media through which the girls could explore. For example, having the girls create individual collages from magazine cuttings helped them to share about their lives (e.g., favorite foods, clothing, places), and using South Asian and non-South Asian films and books offered metaphors that helped the girls explore their identity. After a few months of leader direction, the first author was surprised to find that the girls felt comfortable setting the group’s agenda and openly suggesting session activities. Therefore, counselors should be aware of any indication on the part of the group members that they want to self-direct.

Topics for Exploration

Through group counseling, the first author was able to identify topics that were particularly important to these high school South Asian girls; these areas could serve as a starting point for other counselors working with South Asian immigrant girls. Although the topics were often consistent with salient adolescent issues (e.g., dating, relationships), they were shaped by the girls’ South Asian backgrounds. The girls discussed the often contradictory values and beliefs of home and school culture. They explored dual identities related to being South Asian and American as well as multiple identities related to culture and gender.

  Examining values and beliefs. Family and culture are important topics for South Asians, but telling stories of family and culture in mainstream American culture may raise challenges. Especially significant is the discomfort adolescents may experience when sharing their cultural stressors with non-Asian peers. A group with peers from similar backgrounds can facilitate open sharing of cultural stories that would be difficult to disclose to those who could not identify with their experiences. In this group, the first author followed Sue and Sue’s (2008) recommendation and facilitated discussions about values, beliefs and behaviors characteristic of both the home culture and host culture, so the girls could discover those that fit for them, those with which they identified and those about which they were ambivalent. These discussions pervaded the group sessions, and counselors are advised to explore these topics in depth.

When examining values and beliefs, South Asian girls may broach topics that are unacceptable for discussion with their own families and community members. Because they are often expected to adhere strictly to the role of the “perfect” South Asian girl (e.g., attaining good grades and following family rules), girls may feel judged by family and community members when expressing curiosity about issues such as love, sexuality and relationships. A counselor can help girls examine their roles within their families and explore unique circumstances of developing peer relationships as a South Asian female growing up in mainstream American culture.

An issue that may arise with South Asian girls as they explore behaviors related to values and beliefs involves being under the watchful eyes of other South Asian immigrants. Girls might dwell in a neighborhood where they are in close proximity to local mosques, temples and community centers as well as businesses owned by South Asians. In addition to close and extended family members, they may interact frequently with South Asian peers and neighbors. This can present challenges related to the different values and beliefs of the two cultures the girls are negotiating. For example, some girls may want to talk to boys in the neighborhoods, but fear that South Asian community members might tell their parents. This anxiety underscores the girls’ need for support from trusted adults and peers both at school and in their communities as they grapple with these issues.

     Coping with dual identities. Because immigrant students are straddling home and school cultures, it is important to explore ways to cope and deal with multiple identities. One goal of a discussion of values and beliefs involves supporting girls’ positive connections to their home and community culture. According to Farver et al. (2002), several studies of adolescents from a variety of ethnic backgrounds showed a positive connection between commitment to/identification with ethnic group and self-esteem. A counselor must encourage discussion around cultural topics, emphasize the importance of family traditions and help foster pride in South Asian identity. For example, it is important to recognize religious holidays and explore the meaning of the holidays and their significance in girls’ lives.

The group setting can provide a safe environment for girls to explore challenges and voice frustrations related to dual identity. A counselor can help girls deal with the conflict of self versus collective identity through using culturally appropriate self-empowerment and self-esteem exercises. For example, the first author offered the girls an activity in which they made a collective collage (using magazine cutouts, drawings and words) of what it means to be a South Asian female. After the activity, they processed the meanings of the images on the paper, the role of women in South Asian society and school, and the similarities and differences between group members. The activity highlighted the girls’ cultural commonalities and differences as well as their shared challenges of dual identities.

An important discussion may involve decision making around behaviors that diverge from home cultural norms, because South Asian youth may choose to deviate from parental and cultural expectations in spite of the consequences. The counselor’s responsibility is to help girls explore the pros and cons of pursuing their personal happiness at the expense of their parents’ wishes or demands (Segal, 1991). For example, if the topic of dating (an area of conflict between home and school culture) arises, the counselor must help girls explore what it means to them to date, their reasons for wanting to date, and if they are dating, issues related to dating without family permission.

     Addressing racism. Racism is an important topic for South Asian immigrants, especially due to the impact of the World Trade Center attacks on September 11, 2001 (9/11). In the aftermath of 9/11, a climate of racial profiling emerged in the United States, and South Asians have been subjected to prejudicial attitudes affecting both personal autonomy and group identity (Inman, Yeh, Madan-Bahel, & Nath, 2007). In the first author’s experience, as well as that of many of her South Asian colleagues, racial profiling is not uncommon when traveling, even for professional women. It also is not atypical for South Asians to experience microaggressions, such as being stared at or asked personal questions about ethnicity by strangers. Racism has psychological impacts (Astell-Burt, Maynard, Lenguerrand, & Harding, 2012) and also can create fear. South Asians wearing traditional dress may be subjected to name calling, racial slurs and even physical violence. Adolescents with whom the first author has worked report experiencing teasing or bullying at school as well as other forms of racism when walking with a family member wearing traditional dress (e.g., headscarves, turbans). In a study of South Asian women in Canada, Beharry and Crozier (2008) found that racism in youth had a more marked effect on self-esteem and self-efficacy than that in adulthood. Moreover, social support networks were critical in helping women address negative experiences. A counseling group offers a space for South Asian girls to share their experiences, express their fears and devise ways of coping with racism in a supportive environment.

Reaching Beyond the Girls’ Counseling Group

The one challenge that eluded the first author during her recruitment of South Asian adolescents was how to meet the needs of boys. Although it made sense because of gender roles to have an all-girl group, she also recognized the need to address issues for South Asian boys. When the girls’ group terminated, she helped them form a South Asian student club within the school. All the girls from the group were members of the wider South Asian club, but in addition to girls, a number of South Asian boys joined. The cosponsor of the South Asian club is a male teacher who, although not South Asian, is Latino and well-liked and respected by students, including South Asians. In addition to finding ways to unite the group, the cosponsor and the first author have supported the boys and girls in working together to explore issues that South Asian students encounter in the school and to develop strategies to help the wider school community understand what it means to be South Asian.

An additional way for counselors to reach beyond the group is to identify any needs of the South Asian families in the school community. One way that the first author has supported parents of South Asian students is by helping them understand the school system (e.g., how grades are interpreted). Parental support is significant in light of findings that suggest parental difficulties in adjustment to a new culture may result in adolescents with more psychological problems (Farver et al., 2002). Thus, support and advocacy for families may in turn reap benefits for adolescents. A significant way to identify needs and issues of families is to connect with community leaders, who can “act as a cultural bridge” to developing relationships with parents and other community members (Chung, 2004, p. 206).

Conclusion

There is a need for research focusing on South Asian American families and a further need for research focused specifically on the issues of South Asian immigrant youth. As the population of South Asian immigrant youth in U.S. communities and schools increases, it is critical to understand the unique needs of these youth who are learning to forge an identity based on their home cultures and mainstream American culture. Because there are differences in the U.S. communities in which South Asians live, researchers also must explore the differences in identity development of South Asian immigrant youth living close to a South Asian community versus those who live in a heterogeneous (non-South Asian) environment. Understanding the South Asian experience in the United States will pave the way for developing culturally appropriate interventions for working with South Asian immigrant youth.

Growing diversity in American schools demands that counselors develop culturally appropriate strategies for working with youth from a wide variety of cultures, including those individuals who come from immigrant families. Today’s immigrant families struggle with cultural differences, racism and oppression of earlier generations, but do so in the context of easier access to transatlantic travel and global communication technology (Bhatia & Ram, 2004). Practically speaking, these closer family connections with the home country may create more challenges for adolescents forging an identity while balancing the demands of home and school. The responsibility of helping to enhance the development of these youth falls to counselors along with other school and community personnel, and group counseling is one useful strategy for meeting student needs. Before initiating a group, counselors must explore their own cultural background and biases, understand the culture of the students in the group and, from this knowledge, develop culturally appropriate interventions that highlight culturally relevant and adolescent-specific topics. Through the group described here, the first author attempted to promote the positive development of South Asian girls in her school. The authors’ hope is that these efforts will challenge other counselors to find ways to do the same with the immigrant youth in their schools and clinics.

Conflict of Interest and Funding Disclosure

The authors reported no conflict of

interest or funding contributions for

the development of this manuscript.

References

Ahmad-Stout, D. J., & Nath, S. R. (2013). South Asians in college counseling. Journal of College Student Psychotherapy, 27, 43–61. doi:10.1080/87568225.2013.739028

Ali, M. (2004). Brick lane: A novel. New York, NY: Scribner.

Aoki, G., & Mio, J. S. (2009). Stereotypes and media images. In N. Tewari & A. N. Alvarez (Eds.), Asian American psychology: Current perspectives (pp. 421–439). New York, NY: Erlbaum.

Asian American Federation/South Asian Americans Leading Together. (2012). A demographic snapshot of South Asians in the United States: July 2012 update. Retrieved from http://saalt.org/wp-content/uploads/2012/09/Demographic-Snapshot-Asian-American-Foundation-2012.pdf

Assanand, S., Dias, M., Richardson, E., & Waxler-Morrison, N. (1990). The South Asians. In N. Waxler-Morrison, J. M. Anderson, & E. Richardson (Eds.), Cross-cultural caring: A handbook for health professionals (pp. 141–180). Vancouver, Canada: University of British Columbia.

Astell-Burt, T., Maynard, M. J., Lenguerrand, E., & Harding, S. (2012). Racism, ethnic density and psychological well-being through adolescence: Evidence from the determinants of adolescent social well-being and health longitudinal study. Ethnicity & Health, 17, 71–87. doi:10.1080/13557858.2011.645153

Atkinson, D. R. (2004). Counseling American minorities (6th ed.). Boston, MA: McGraw-Hill.

Ayyub, R. (2000). Domestic violence in the South Asian immigrant population in the United States. Journal of Social Distress and the Homeless, 9, 237–248. doi:10.1023/A:1009412119016

Banerjee, N., Kaipa, S., & Sundaralingam, P. (Eds.). (2010). Indivisible: An anthology of contemporary South Asian American poetry. Fayetteville, AR: University of Arkansas Press.

Baron, C., & Nair, M. (Producers), & Nair, M. (Director). (2001). Monsoon wedding [Motion picture]. India: IFC Productions.

Beharry, P., & Crozier, S. (2008). Using phenomenology to understand experiences of racism for second-generation South Asian women. Canadian Journal of Counselling, 42, 262–277.

Bhatia, S., & Ram, A. (2004). Culture, hybridity, and the dialogical self: Cases from the South Asian diaspora. Mind,  Culture and Activity, 11, 224–240. doi:10.1207/s15327884mca1103_4

Capps, R., Fix, M. E., Murray, J., Ost, J., Passel, J. S., & Hernandez, S. H. (2005). The new demography of America’s schools: Immigration and the No Child Left Behind Act. Washington, DC: The Urban Institute. Retrieved from http://www.urban.org/publications/311230.html

Child Trends Data Bank. (2013). Immigrant children. Retrieved from http://www.childtrends.org/?indicators=immigrant-children.

Chung, R. C. Y. (2004). Group counseling with Asians. In J. L. DeLucia-Waack, D. A. Gerrity, C. R. Kalodner, & M. T. Riva (Eds.), Handbook of group counseling and psychotherapy (pp. 200–212). Thousand Oaks, CA: Sage.

Comstock, D. L., Hammer, T. R., Strentzsch, J., Cannon, K., Parsons, J., & Salazar, G., II. (2008). Relational-cultural theory: A framework for bridging relational, multicultural, and social justice competencies. Journal of Counseling & Development. 86, 279–287. doi:10.1002/j.1556-6678.2008.tb00510.x

Corey, M. S., Corey, G., & Corey, C. (2010). Groups: Process and practice (8th ed.). Belmont, CA: Brooks/Cole.

Crethar, H. C., Rivera, E. T., & Nash, S. (2008). In search of common threads: Linking multicultural, feminist, and social justice counseling paradigms. Journal of Counseling & Development, 86, 269–278. doi:10.1002/j.1556-6678.2008.tb00509.x

Dasgupta, S. D. (1998). Gender roles and cultural continuity in the Asian Indian immigrant community in the U.S. Sex Roles, 38, 953–974. doi:10.1023/A:1018822525427

Dawson, A. (2005). ‘Bollywood Flashback:’ Hindi film music and the negotiation of identity among British Asian youth. South Asian Popular Culture, 3, 161–176. doi:10.1080/14746680500234462

DeLucia-Waack, J. L., & Donigian, J. (2004). The practice of multicultural group work: Visions and perspectives from the field. Belmont, CA: Brooks/Cole.

Desai, A. (1999). Fasting, feasting. New York, NY: Houghton Mifflin.

Durham, M. G. (2004). Constructing the “new ethnicities”: Media, sexuality, and diaspora identity in the lives of South Asian immigrant girls. Critical Studies in Media Communication, 21, 140–161. doi:10.1080/07393180410001688047

Farver, J. A. M., Bhadha, B. R., & Narang, S. K. (2002). Acculturation and psychological functioning in Asian Indian adolescents. Social Development, 11(1), 11–29. doi:10.1111/1467-9507.00184

Fix, M., & Capps, R. (2005). Immigrant children, urban schools, and the No Child Left Behind Act. Washington, DC: Migration Policy Institute. Retrieved from http://www.migrationinformation.org/usfocus/display.cfm?ID=347

Ghuman, P. A. S. (1997). Assimilation or integration? A study of Asian adolescents. Educational Research, 39, 23–35.                doi:10.1080/0013188970390102

Ghuman, P. A. S. (2003). Double loyalties: South Asian adolescents in the west. Cardiff, Wales: University of Wales Press.

Gladding, S. T. (2008). Groups: A counseling specialty (5th ed.). Upper Saddle River, NJ: Pearson.

Ibrahim, F., Ohnishi, H., & Sandhu, D. S. (1997). Asian American identity development: A culture specific model for South Asian Americans. Journal of Multicultural Counseling and Development, 25, 34–50. doi:10.1002/j.2161-1912.1997.tb00314.x

Inman, A. G., & Tewari, N. (2003). The power of context: Counseling South Asians within a family context. In G. Roysircar, D. S. Sandhu, & V. E. Bibbins, Sr. (Eds.), Counseling within a family context: A guidebook of practices (pp. 97–107). Alexandria, VA: American Counseling Association.

Inman, A. G., Yeh, C. J., Madan-Behel, A., & Nath, S. (2007). Bereavement and coping of South Asian families post 9/11. Journal of Multicultural Counseling and Development, 35, 101–115. doi:10.1002/j.2161-1912.2007.tb00053.x

Jordan, J. V. (2000). The role of mutual empathy in relational/cultural therapy. Journal of Clinical Psychology, 56, 1005–1016. doi:10.1002/1097-4679(200008)56:8<1005::AID-JCLP2>3.0.CO;2-L

Khan, G. (Producer), & Khan, F. (Director). (2007). Om shanti om [Motion picture]. India: Red Chillies Entertainment.

Kim, B. S. K., Atkinson, D. R., & Yang, P. H. (1999). The Asian values scale: Development, factor analysis, validation, and reliability. Journal of Counseling Psychology, 46, 342–352. doi:10.1037/0022-0167.46.3.342

Kline, W. B. (2003). Interactive group counseling and therapy. Upper Saddle River, NJ: Pearson.

Maker, A. H., Mittal, M., & Rastogi, M. (2005). South Asians in the United States: Developing a systemic and empirically based mental health assessment model. In M. Rastogi & E. Wieling (Eds.), Voices of color: First person accounts of ethnic minority therapists (pp. 233–254). Thousand Oaks, CA: Sage.

Mindrup, R. M., Spray, B. J., & Lamberghini-West, A. (2011). White privilege and multicultural counseling competence: The influence of field of study, sex, and racial/ethnic exposure. Journal of Ethnic & Cultural Diversity in Social Work: Innovation in Theory, Research & Practice, 20, 20–38. doi:10.1080/15313204.2011.545942

Panganamala, N. R., & Plummer, D. L. (1998). Attitudes toward counseling among Asian Indians in the United States. Cultural Diversity and Mental Health, 4, 55–63. doi:10.1037/1099-9809.4.1.55

Pew Research Center. (2012). Religions and public life project: Religious composition by country. Retrieved from http://www.pewforum.org/2012/12/18/table-religious-composition-by-country-in-numbers/

Pilcher, L. D., & Nair, M. (Producers), & Nair, M. (Director). (2006). The namesake [Motion picture]. Los Angeles, CA: Fox Searchlight.

Ranganath, V. M., & Ranganath, V. K. (1997). Asian Indian children. In G. Johnson-Powell, J. Yamamoto, G. Wyatt, & W. Arroyo (Eds.), Transcultural child development: Psychological assessment and treatment (pp. 103–125). Hoboken, NJ: Wiley & Sons.

Sandhu, D. S. (2004). Daya Sandhu’s reaction as a leader of this psychoeducational group. In J. L. DeLucia-Waack & J. Donigian, The practice of multicultural group work: Visions and perspectives from the field (pp. 175–178). Belmont, CA: Brooks/Cole.

Sandhu, D. S., & Madathil, J. (2007). South Asian Americans. In G. J. McAuliffe (Ed.) Culturally alert counseling: A comprehensive introduction (pp. 353–387). Thousand Oaks, CA: Sage.

Segal, U. A. (1991). Cultural variables in Asian Indian families. Families in Society, 72, 233–242.

Shariff, A. (2009). Ethnic identity and parenting stress in South Asian families: Implications for culturally sensitive counselling. Canadian Journal of Counselling, 43, 35–46.

Sharma, A. (2001). Healing the wounds of domestic abuse: Improving the effectiveness of feminist therapeutic interventions with immigrant and racially visible women who have been abused. Violence Against Women, 7, 1405–1428. doi:10.1177/10778010122183928

Suárez-Orozco, C., Suárez-Orozco, M., & Todorova, I. (2008). Learning a new land: Immigrant students in American society. Cambridge, MA: Harvard University Press.

Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice (5th ed.) New York, NY: Wiley & Sons.

The World Bank. (2011). South Asia: Countries. Retrieved from http://go.worldbank.org/GBUHVXX420

Toporek, R. L., Lewis, J. A., & Crethar, H. C. (2009). Promoting systemic change through the ACA Advocacy Competencies. Journal of Counseling & Development, 87, 260–268.

Yuen, F. K. O. (1999). Family health and cultural diversity. In J. T. Pardeck & F. K. O. Yuen (Eds.), Family health: A holistic approach to social work practice (pp. 101–114). Westport, CT: Auburn House.

Yuen, F. K. O., & Nakano-Matsumoto, N. (1998). Effective substance abuse treatment for Asian American adolescents. Early Child Development and Care, 147, 43–54. doi:10.1080/0300443981470106

 Ulash Thakore-Dunlap is a licensed marriage and family therapist at Richmond Area Multi-Services, San Francisco. Patricia Van Velsor, NCC, is an associate professor at San Francisco State University. Correspondence can be addressed to Patricia Van Velsor, Department of Counseling, BH 524, 1600 Holloway Avenue, San Francisco, CA 94132, pvanvels@sfsu.edu.

Students’ Perceptions of School Counselors: An Investigation of Two High Schools in Beijing, China

Dec 2, 2014 | Article, Volume 4 - Issue 5

Qi Shi, Xi Liu, Wade Leuwerke

This study sought to examine students’ perceptions of their school counselors in two high schools in Beijing, China. Independent t tests found that female students rated school counselors’ availability significantly higher than male students did. Also, students who had received prior counseling services rated counselors significantly higher in the following areas than did students who had never received counseling services: knowledge of achievement tests, friendliness and approachability, understanding students’ point of view, advocating for students, promptness in responding to requests, ability to explain things clearly, reliability to keep promises, availability, and overall effectiveness. A 2 × 2 between-subjects ANOVA found an interaction effect between gender and use or nonuse of counseling services. In general, students gave positive evaluations of school counselors and were satisfied with counseling services.

Keywords: school counselors; counseling services; students’ perceptions; high schools; Beijing, China

China has been experiencing dramatic economic and social changes in the past 3 decades (Guthrie, 2012). During this time there has been increased attention to both mental health problems and student development (Cyranoski, 2010; Lim, Lim, Michael, Cai, & Schock, 2010; Xin & Zhang, 2009). It has been estimated that at least 17.5% of the Chinese population has some form of mental illness, one of the highest rates in the world (Phillips et al., 2009), accounting for about 20% of hospitalizations in the country (Fei, 2006). Facing significant mental health challenges, several authors have noted the need for more counseling professionals and mental health service providers (Cook, Lei, & Chiang, 2010; Davey & Zhao, 2012). In rural areas with fewer resources, the demand for mental health care is even greater (Ji, 2000).

Given such great needs for mental health services, China has been making tremendous efforts in reforming its mental health service system (Tse, Ran, Huang, & Zhu, 2013). In 2004, China launched the 686 Project, a mental health reform initiative modeled on the World Health Organization’s recommended framework for integrating hospital-based services with a community mental health service system (Ma, 2012). By the end of 2011, 1.83 million Chinese people with severe mental illness had been treated as a result of the project.

While China has witnessed growth in the counseling profession, at the same time it has struggled to build national certification and licensing standards, and create comprehensive counselor training (Chang & Kleinman, 2002; Cook et al., 2010; Davey & Zhao, 2012; Ding, Kuo, & Van Dyke, 2008; Hou & Zhang, 2007). In 2002, China’s National Counseling Licensing Board was formed, and there is currently a three-tier national licensing program. More than 30 locations throughout China offer the qualification exams for counselors, and recently a national exam to license school counselors was instituted (Lim et al., 2010). Results from a nationwide survey of professional training of mental health practitioners in China showed that quality of training and supervision were among common concerns (Gao et al., 2010). Also, more accredited professional training programs at the university or college level must be designed and established. Beijing Normal University, in collaboration with Rowan University in the United States, was reported to be the first university in China to offer a school counseling training program (Lim et al., 2010).

Mental Health of Students in China

Increased attention to student well-being has shown high prevalence of mental health problems among Chinese students (Cook et al., 2010; Wang & Miao, 2001). Common psychological problems among students included test anxiety, academic pressure, loneliness, social discomfort, video game addiction (Thomason & Qiong, 2008), Internet addiction, child obesity, self-centeredness and reclusion (Worrell, 2008). A study from a metropolitan area in southeastern China showed that 10.8% of high school students had mental health concerns including hostility, compulsions, depression and interpersonal relationship sensitivity (Hu, 1994). A more recent survey conducted by Wu et al. (2012) among 1,891 high school students in a southern city in China showed that 25% of the adolescents reported a perceived need for mental health services, while only 5% of the sample had used school-based mental health services, and 4% had used non-school-based services.

Researchers are starting to identify factors that contribute to Chinese students’ mental health problems, including the pressure to achieve academic success (Corbin Dwyer & McNaughton, 2004; Thomason & Qiong, 2008; Worrell, 2008), being an only child (Liu, Munakata, & Onuoha, 2005; Thomason & Qiong, 2008; Worrell, 2008), prevalence of physical abuse (Wong, Chen, Goggins, Tang, & Leung, 2009), inability to cope with multiple expectations and requirements (Tang, 2006), increased attention to personal and social development (Corbin Dwyer & McNaughton, 2004), and the generation gap between children and their parents (Thomason & Qiong, 2008). Zheng, Zhang, Li, and Zhang (1997) suggested that parents and teachers who did not attend to students’ psychological problems contributed to the high rates of mental health problems among students. Because they have the most direct interaction with students, homeroom teachers and subject teachers in China are well-positioned to help students address their mental health concerns. In fact, Chinese homeroom teachers perform a wide variety of counseling tasks (Shi & Leuwerke, 2010). However, teachers do not receive sufficient training in providing counseling services.

School Counseling in China

     School counselors are uniquely positioned to impact the mental health and academic success of students in China. As would be expected with developing professions, there are numerous challenges to school counseling in China: (a) a tremendous shortage of qualified school counselors (Cook et al., 2010; Shi & Leuwerke, 2010; Thomason & Qiong, 2008; Yan, 2003; Zheng et al., 1997), (b) an urgent need for more accredited training programs (Gao et al., 2010; Leuwerke & Shi, 2010; Lim et al., 2010) and (c) a lack of support and respect from teachers and other school staff (Jiang, 2005; Leuwerke & Shi, 2010). Although many schools in China, especially in urban areas, have begun to establish counseling offices and hire school counselors, this profession is still in its primitive developmental stage (Leuwerke & Shi, 2010). Moreover, school counselors themselves have expressed great need for more training and standard education to better serve their students (Leuwerke & Shi, 2010). A standardized training system is imperative to provide training, assessment, issuance of licenses and continued education (Cook et al., 2010; Davey & Zhao, 2012; Yan, 2003; Zheng et al., 1997).
Facing the serious situation of Chinese students’ mental health concerns and school counseling challenges, the Chinese government has turned greater attention to advanced mental health education in K–12 schools. Government policies on education reform have put more emphasis on students’ mental health and the availability of psychological services (Ding et al., 2008). The Ministry of Education in China has published two important government guidelines in the past 2 decades. “Several Suggestions on Improving Mental Health Education in Elementary & Secondary Schools” (Zhong guo jiao yu bu, 1999) identified moral and politics teachers, homeroom teachers, Communist Youth League cadres, and school counselors as the personnel in schools responsible for the mental health needs of students. K–12 schools with available resources and funding were required to establish counseling offices, and school counselors were identified as the leaders of this system (Ministry of Education of the People’s Republic of China, 1999). In 2012, the Ministry of Education released the updated version of “Guideline of Mental Health Education in Elementary & Secondary Schools.” This guideline described the goals, content and methods of mental health education as well as the personnel responsible for delivery. The report specifically called for educating students about basic knowledge and skills regarding interpersonal relationships, career development, and living and socialization (Zhong guo jiao yu bu, 2012).

As required by the Chinese government, schools in large cities have begun to hire school counselors to provide counseling for their students (Jiang, 2005). In K–12 schools in China, school counseling is called school guidance or mental health education, which is actually a part of political and moral education (Jiang, 2005). School guidance in K–12 school settings has been taught as a subject course like math or science (Hou & Zhang, 2007). In addition to school counselors, homeroom teachers also play an important role in mental health services for students by performing a large range of counseling tasks (Shi & Leuwerke, 2010; Wang, 1997). Chinese students access psychological services in schools through a variety of channels: individual counseling, group activities, lectures on common psychological concerns, parent and teacher consultation, and classroom guidance (Leuwerke & Shi, 2010).

The expansion of services in the Chinese school system has made counseling more accessible than ever to students (Thomason & Qiong, 2008). However, empirically based literature examining the role, function and scope of school counseling in China is virtually nonexistent (Jiang, 2005; Leuwerke & Shi, 2010; Shi & Leuwerke, 2010; Thomason & Qiong, 2008). Very little is known about the amount of counseling that students actually receive at school, let alone how students perceive school counselors and the school counseling services they receive (Leuwerke & Shi, 2010). The present study sought to examine some of these questions. Through surveys of students at two high schools in Beijing, the authors explored students’ use of counseling in school as well as their perceptions of the school counselors. The authors also examined possible differences among students who sought services or not, as well as any differences across gender. Correspondingly, the research questions in this study were as follows: (a) How many students seek counseling services and how often do they meet their school counselors in these two high schools in Beijing? (b) Do students’ perceptions of the school counselors differ across gender? (c) Do students’ perceptions of the school counselors differ depending on whether or not they seek counseling services? (d) Do male and female students’ perceptions differ depending on whether or not they seek counseling services?

Methods

Participants

A total of 137 (47 male, 90 female) students from two high schools in Beijing completed questionnaires; 293 surveys were distributed, resulting in a return rate of 46.76%. The sample was recruited through the first author’s contacts in Beijing. Among the students who completed the survey, 126 were from a high school affiliated with Beijing Normal University and 11 were from a high school affiliated with Beijing Renmin University. The sample consisted of 12.4% (n = 17) senior 1 students (equivalent to 10thgraders in the United States), 78.8% (n = 108) senior 2 students (equivalent to 11th graders in the United States) and 8.8% (n = 12) senior 3 students (equivalent to 12th graders in the United States). The two high schools recruited for the study are among the top ranked high schools in Beijing. The school counselors being evaluated in these two high schools had an average of 8 years of experience working as professional school counselors. Students from these schools typically perform very well in academics and gain admission to universities after high school. As for plans after high school, 97.8% (n = 134) of the students surveyed stated that the plan was a 4-year college, with only three students indicating “other plans.” No student indicated planning to attend a 2-year college or vocational training school or get a job right after graduating from high school.

Instrument

Participants completed a brief demographic questionnaire as well as the Chinese High School Students’ Perceptions of School Counselors Survey. All information students provided in the survey was anonymous. The demographic questionnaire included items such as students’ grade level, gender and postsecondary plans. The Chinese High School Students’ Perceptions of School Counselors Survey used in this study was adapted from McCullough’s (1973) survey that was originally designed to determine high school students’ perceptions of school counselors’ services in the United States. Some changes were made to adapt to Chinese students’ cultural background, including adding two questions about the number of times that students had tried to see the school counselor and the actual number of times that they had met with the school counselor. After indicating the number of times they had tried and actually met with a school counselor, participants rated their counselor’s ability and effectiveness on a four-point Likert scale (4 = excellent, 3 = good, 2 = fair, 1 = poor) in the following 11 areas: knowledge of college admission, knowledge of vocational information, knowledge of achievement tests, friendliness and approachability, understanding students’ point of view, advocate for students, promptness in responding to requests, ability to explain things clearly, reliability to keep promises, availability to students, and overall effectiveness.

Translation

The authors created all materials utilized in this study in English, and the first author then translated the documents into Mandarin Chinese. To examine translation quality, a bilingual, native Chinese speaker who was not part of the research team subsequently translated all documents back into English. The authors evaluated and considered these translated documents equivalent. This approach is consistent with common practice in research requiring translation of documents (Larkin, de Casterlé, & Schotsmans, 2007; Liu et al., 2005).

Design

Data analyses were conducted based on the four research questions in this study. First, descriptive statistical analysis was conducted to learn the number of students who had sought counseling services and the frequency of their meetings with a counselor. Second, an independent t test was conducted to determine the differences between male and female students’ perceptions of their school counselors’ services. Third, another independent t test was performed to examine the differences between students’ perceptions of their school counselors’ services depending on whether or not the students had sought prior counseling services. Finally, a 2 × 2 between-subjects ANOVA was done to determine whether there was a statistically significant interaction effect between gender and whether or not students sought prior counseling services.

The data from students who had never had individual meetings with counselors were included in these analyses. These data were included because these students had had contact with school counselors in other circumstances (e.g., lectures, classroom guidance, school-wide gathering), even though they had not met with school counselors individually (Leuwerke & Shi, 2010).

Procedure

Five teachers at the two high schools assisted with data collection. Since research participation and the protocol were new to most of the teachers, explanation of the confidential and voluntary nature of the project was provided through teleconference. Questions from the teachers were answered via e-mail. One of the teachers in Beijing was in charge of the informed consent forms and data storage. Parents of the students in the classrooms of all five teachers received one copy of the informed consent and all granted consent for their child to participate in the research. Students then received e-mails. An online survey tool (http://www.surveymonkey.com) was used to administer the questionnaire.

Results

The first goal of this study was to examine how many students had sought services from school counselors and the number of meetings they had had with their school counselors since they entered high school. Descriptive statistics were obtained in order to achieve this goal. Nearly half of the participants (48.9%, n = 67) reported having seen counselors at least once. Among these 67 students, the majority (n = 41) had met once individually with a school counselor, 22 had seen a school counselor individually two to three times, and four students had talked with school counselors four to five times. No student reported having met with a school counselor more than five times. Information on the length of these individual counseling sessions was not obtained in the survey.

The second goal of this study was to examine the students’ perceptions of their school counselors. Fifty-three students provided a complete evaluation of their school counselors in the survey. Among these 53 students, 36 had used counseling services before, whereas 17 reported no individual meetings with a counselor. As shown in Table 1, students’ most positive ratings of their school counselors were for friendliness and approachability (M = 3.20, SD = 1.25) and ability to explain things clearly (M = 2.99, SD = 1.33). The lowest rated attributes were knowledge of college admission (M = 1.30, SD = 1.42) and knowledge of vocational information (M = 1.10, SD = 1.30).

Table 1

Descriptive Statistics on Students’ Evaluations of School Counseling Services

Furthermore, independent t tests were conducted to determine whether students’ ratings of counseling services differed significantly between genders and between students who had or had not sought counseling services. A statistically significant result was found in students’ ratings of school counselors’ availability in the independent t test based on gender. Female students rated school counselors’ availability significantly higher than male students did (F = 4.196, p < .05). Statistically significant results also were found based on whether or not the students had sought counseling services. As shown in Table 2, students who had received prior counseling services rated counselors significantly higher in the following areas than did students who had never received counseling services: knowledge of achievement tests, friendliness and approachability, understanding students’ point of view, advocate for students, promptness in responding to requests, ability to explain things clearly, reliability to keep promises, availability, and overall effectiveness.

Table 2

Students’ Evaluations of School Counselors Depending on Whether or Not They Seek Services

 ^aLevene’s test for equality of variances. ^bt test for equality of means.

A 2 × 2 between-subjects ANOVA was conducted to evaluate the effects that gender and students’ experiences with counseling services had on students’ perceptions of counseling services. Levene’s test and Fmax indicated that the homogeneity of variances assumption was met. A statistically significant interaction effect was found between gender and whether or not the students had received counseling services, F(1, 133) = 5.923, p = .016. As shown in Figure 1, the relationship between whether or not students had received counseling services and their perceptions of school counselors differed depending on gender. Among students who had had individual meetings with their counselors, males rated the counselors higher than females did, while females rated the counselors higher than males did if they had never received counseling services.

Figure 1. Mean differences on gender and whether or not students received counseling services.

Discussion

     In this study, almost half of the participants reported seeking help from a school counselor at least once. Interestingly, over 60% of the students who had met with a counselor had not returned for a subsequent meeting. Although China has seen the presence of school counselors increase in urban schools, it is still not common for students to seek counseling services (Thomason & Qiong, 2008). While the specific reasons why the students discontinued meeting with school counselors in this study are not clear, the following factors might help explain this phenomenon: (a) students have been found to be most concerned with physical health and to have failed to consider other aspects of health such as mental/psychological, behavioral and social (Wang, Zou, Gifford, & Dalal, 2014); (b) stigma toward mental illness exists among Chinese students (Thomason & Qiong, 2008; Wang, Huang, Jackson, Chen, & Laks, 2012); (3) Chinese cultural beliefs promote solving family-related issues inside one’s own family (Cook et al., 2010); and (4) students spend the majority of their time preparing for the National College Entrance Exam (NCEE), which Chinese school counselors perceived as an impediment to students’ utilization of school counseling services and future school counseling development in China (Leuwerke & Shi, 2010).

As for the modal number of counseling sessions that school counselors hold in secondary schools in China and the United States, little is presented in the current literature. More research has been conducted on college students’ attendance of counseling sessions offered by university counseling centers. For example, Draper, Jennings, Baron, Erdur, and Shankar (2002) found that, on average, college students met with counselors only three times. A number of studies have confirmed that most college students attend only a few sessions and that 50% terminate counseling prematurely (Ledsky et al., 2000; Renk, Dinger, & Bjugstad, 2000; Whipple et al., 2003). The number of counseling sessions that school counselors have with high school students could be likewise related. Students who visit school counselors by referral normally do not return for a second session, even though more sessions are indicated (E. Zhang, personal communication, June 5, 2007).

In China’s current school system, homeroom teachers have close, day-to-day interaction with students in their own homerooms; these teachers are responsible for students’ behavior, academic performance, mental health and all-around development (Lim et al., 2010; Shi & Leuwerke, 2010). Homeroom teachers may refer students to school counselors if they feel that students’ problems are beyond the teachers’ ability to solve (E. Zhang, personal communication, June 5, 2007). Future research could help explain why students tend to meet with their counselor only one time, and could explore the factors associated with students’ premature termination. It might be that Chinese counselors are giving an intentional or unintentional message that only one session is appropriate. Additional research is necessary to explore how school counselors could reach out to more students and reduce the stigma attached to mental problems, which might encourage more students to utilize individual counseling in school settings.

The descriptive results of this study provide some preliminary information about the level of students’ satisfaction with particular areas. Based on the students’ perceptions in two high schools in Beijing, it appears that school counselors are doing quite well in many different areas, such as friendliness and approachability to students, ability to explain things clearly, and availability. However, there are some areas in which school counselors must improve their knowledge and skills (e.g., college admission, vocational information and opportunities, achievement tests). When interpreting the results of this study, it is important to keep in mind that participants in this study are all from top-ranking high schools in Beijing, where students have a general college-going mindset and therefore place significant emphasis on academic achievement; in addition, these students have a higher expectation and interest in seeking counseling services related to applying for college. Also, in the current school systems in China, homeroom teachers are normally in charge of handling students’ academic testing, disseminating college-related information and helping students prepare for college (Shi & Leuwerke, 2010). Therefore, school counselors might not be as prepared as homeroom teachers to provide information regarding college admission and achievement tests.

As for the low ratings in the area of vocational information and opportunities, it is critical to consider the fact that the practice and profession of career counseling is still in the developmental stage in China (Leuwerke & Shi, 2010; Zhang, Hu, & Pope, 2002). Unfortunately, a thorough literature search revealed no information on the current conditions of school counselors’ training in China. However, a few studies have briefly mentioned the training or education that school counselors receive. For example, Gao et al. (2010) conducted a national survey on professional training experience among mental health practitioners in China, with only half of their sample working in educational settings such as high schools and universities. The researchers found that mental health practitioners reported receiving only short-term training and continuing education that focused on theories; a majority reported receiving no supervision or case consultation (Gao et al., 2010). Although there is a lack of literature on school counselors’ training in particular, several authors have indicated an urgent need for a more regulated, comprehensive and standardized training and qualification system for school counselors in China (Cook et al., 2010; Leuwerke & Shi, 2010; Lim et al., 2010; Thomason & Qiong, 2008).

It was expected that students who had had individual meetings with school counselors would rate counseling services differently than the students who had never seen school counselors individually. Students who had received counseling services before rated school counselors at a significantly higher level than students who had never had counseling services in many different areas, including the school counselors’ test skills, approachability, understanding, advocacy, promptness, ability, reliability, availability and overall effectiveness in providing counseling services. This finding is not surprising, considering that students who have had personal contact with the school counselors might have a better understanding of the role of school counselors and the services they provide, and therefore are more likely to give a higher rating of school counseling services. In a study conducted in Turkey, Yüksel-Şahin (2008) also found that the factor of whether students had met with school counselors was a significant predictor of students’ evaluations of counseling guidance service.

Similarly, gender differences were expected in students’ rating of school counselors. The results show significantly higher ratings from female students than male students of school counselors’ availability. From the descriptive results of this study, one can see that female students reported more contact with school counselors than male students did; this finding might help explain female students’ higher rating of school counselors’ availability.

Finally, an interaction effect was found in students’ ratings of the effectiveness of their counselors in the 2 × 2 between-subjects ANOVA based on gender and whether or not students seek counseling services. In a 2009 study, Hou, Zhou, and Ma examined high school and university students’ expectations of counseling in China. Results of their study showed that female students had significantly higher scores than males in terms of their own openness and counselors’ acceptance. Meanwhile, the researchers also found that students who did not have counseling experience had significantly lower scores on their motivation compared to their counterparts. These trends continued in the current study, which further supports the idea that students’ previous counseling experiences and gender relate closely to their expectations and perceptions of counselors and counseling services in general.

As a developing profession facing a huge student population, school counselors in China are doing a more than adequate job with limited resources. In the current study, most high school students reported seeking counseling services from their school counselors more than once, and they reported having generally positive experiences in counseling. Meanwhile, these students also had positive perceptions of their school counselors’ services; however, they reported the need for more vocational guidance or more knowledge of achievement tests from their counselors. An interaction effect was found in students’ perceptions of school counseling services based on students’ gender and whether they had met with school counselors before.

Implications

This study contributes to the literature by filling a research gap in Chinese students’ utilization and perceptions of school counseling. This line of inquiry is very important for the future development of the school counseling profession in China in that it provides implications for researchers and school counseling practitioners, as well as counselor educators. Future researchers could further investigate factors that might predict students’ utilization of school counseling services and what students need the most from counseling. More efforts need to be made in both conducting empirical research in the school counseling field and in exploring ways to improve the profession that will suit China’s cultural and social situations (Jiang, 2005; Thomason & Qiong, 2008). Moreover, the findings from this research are informative for school counseling practitioners in China. Chinese school counselors may want to self-evaluate their services and seek further training and education to improve their services in the areas that students rated lower. School counselors also could explore ways to make their services more accessible for students. Finally, the results of this research can be beneficial for counselor educators, who could contribute to improving the quality of school counselors’ training and education by providing opportunities for supervision, practice and professional development courses targeting the knowledge and skills that school counselors need most.

Limitations

     There were a number of limitations in this study that limit generalization and call for additional research. First, the sample in this study was a convenience sample; the majority of the participants were from one high school, also limiting the generalizability of the results. Second, the two high schools are similar to each other in that they are top-ranking high schools in Beijing, and their students have similar future plans. Therefore, the results of this study may not apply to other geographic areas in China, especially rural areas, because a difference exists in educational conditions between economically developed areas (e.g., Beijing, Shanghai, Guangzhou) and underdeveloped areas (e.g., rural areas in West China). Students from different geographical areas in China may encounter different mental health problems, and the development of school counseling in urban and rural China may be different (Yan, 2003). The position of school counselor may not even exist in some areas in China. Third, the sample lacks diversity in terms of gender and grade level. Most of the participants in this study were female students and senior 2 students. Gender may be a variable that influences how students perceive counseling and school counselors. Future research utilizing more diverse and larger samples from across the country will be able to provide a more detailed and general picture of school counseling in high schools across China. Lastly, the instrument used in this study was adapted from an instrument that was developed several decades ago. Although some modifications were made, the validity and reliability of the scale used for Chinese students are not clear at this time. Future studies may investigate the validity and reliability of this instrument and also develop new instruments that are specially designed to measure students’ perceptions of Chinese school counselors’ effectiveness, competence, expertise and contributions.

Conflict of Interest and Funding Disclosure

The authors reported no conflict of

interest or funding contributions for

the development of this manuscript.

References         

Chang, D. F., & Kleinman, A. (2002). Growing pains: Mental health care in developing China. Yale-China Health Studies Journal, 1, 85–98.

Cook, A. L., Lei, A., & Chiang, D. (2010). Counseling in China: Implications for counselor education preparation and distance learning instruction. Journal for International Counselor Education, 2, 60–73.

Corbin Dwyer, S., & McNaughton, K. (2004). Perceived needs of educational administrators for student services offices in a Chinese context: School counselling programs addressing the needs of children and teachers. School Psychology International, 25, 373–382. doi:10.1177/0143034304046908

Cyranoski, D. (2010). China tackles surge in mental illness. Nature, 468, 145. doi:10.1038/468145a

Davey, G., & Zhao, X. (2012, November). Counseling in China. Therapy Today, 23(9), 12–17.

Ding, Y., Kuo, Y.-L., & Van Dyke, D. C. (2008). School psychology in China (PRC), Hong Kong, and Taiwan: A cross-regional perspective. School Psychology International, 29, 529–548. doi:10.1177/0143034308099200

Draper, M. R., Jennings, J., Baron, A., Erdur, O., & Shankar, L. (2002). Time-limited counseling outcome in a nationwide college counseling center sample. Journal of College Counseling, 5, 26–38. doi:10.1002/j.2161-1882.2002.tb00204.x

Fei, X. (2006, October 16). The cause of and solution for mental diseases in China. The Epoch Times. Retrieved from http://www.theepochtimes.com/news/6-10-16/47113.html

Gao, X., Jackson, T., Chen, H., Liu, Y., Wang, R., Qian, M., & Huang, X. (2010). There is a long way to go: A nationwide survey of professional training for mental health practitioners in China. Health Policy, 95, 74–81. doi:10.1016/j.healthpol.2009.11.004

Guthrie, D. (2012). China and globalization: The social, economic and political transformation of Chinese society (3rd ed.). New York, NY: Routledge.

Hou, Z.-J., & Zhang, N. (2007). Counseling psychology in China. Applied Psychology, 56, 33–50. doi:10.1111/j.1464-0597.2007.00274.x

Hou, Z.-J., Zhou, S.-L., & Ma, C. (2009). Preliminary research on high school and university students’ expectation about counseling. Chinese Journal of Clinical Psychology, 17, 503, 515–517.

Hu, S. (1994). Gao zhong sheng xin li jian kang shui ping ji qi ying xiang yin su de yan jiu [A study of the mental health level and its influencing factors of senior middle school students]. Acta Psychologica Sinica, 26, 153–160.

Ji, J. (2000). Suicide rates and mental health services in modern China. Crisis, 21, 118–121.

Jiang, G. (2005). Zhong guo da lu zhong xiao xue xin li fu dao fa zhan ping su [The development of school counseling in the Chinese mainland: A review]. Journal of Basic Education, 14, 65–82.

Larkin, P. J., de Casterlé, B. D., & Schotsmans, P. (2007). Multilingual translation issues in qualitative research: Reflection on a metaphorical process. Qualitative Health Research, 17, 468–476. doi:10.1177/1049732307299258

Ledsky, K. M., Reynolds, E. V., III, Weissman, M. S., Ball, J. D., Rabinowitz, M., Collins, C., . . . Mansheim, P. (2000). Practice patterns for the outpatient treatment of depression in a case-managed delivery system: A utilization study. Professional Psychology: Research and Practice, 31, 543–546.

Leuwerke, W., & Shi, Q. (2010). The practice and perceptions of school counsellors: A view from urban China. International Journal for the Advancement of Counselling, 32, 75–89. doi:10.1007/s10447-009-9091-3

Lim, S.-L., Lim, B. K. H., Michael, R., Cai, R., & Schock, C. K. (2010). The trajectory of counseling in China: Past, present and future trends. Journal of Counseling and Development, 88, 4–8.

Liu, C., Munakata, T., & Onuoha, F. N. (2005). Mental health condition of the only-child: A study of urban and rural high school students in China. Adolescence, 40, 831–845.

Ma, H. (2012). Integration of hospital and community services—the “686 Project”—is a crucial component in the reform of China’s mental health services. Shanghai Archives of Psychiatry, 24, 172–174.

McCullough, C. W. (1973). Student perceptions of counselor services in junior and senior public high schools of Montgomery County, Maryland. Dissertation Abstracts International, 34(5A), 2308.

Phillips, M. R., Zhang, J., Shi, Q., Song, Z., Ding, Z., Pang, S., . . . Wang, Z. (2009). Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: An epidemiological survey. The Lancet, 373, 2041–2053. doi:10.1016/S0140-6736(09)60660-7

Renk, K., Dinger, T. M., & Bjugstad, K. (2000). Predicting therapy duration from therapist experience and client psychopathology. Journal of Clinical Psychology, 56, 1609–1614.

Shi, Q., & Leuwerke, W. C. (2010). Examination of Chinese homeroom teachers’ performance of professional school counselors’ activities. Asia Pacific Education Review, 11, 515–523. doi:10.1007/s12564-010-9099-8

Tang, Y. (2006, June 8). Children at risk. Beijing Review, 49(23), 25–27.

Thomason, T. C., & Qiong, X. (2008). School counseling in China today. Journal of School Counseling, 6.

Tse, S., Ran, M. S., Huang, Y., & Zhu, S. (2013). The urgency of now: Building a recovery-oriented, community mental health service in China. Psychiatric Services, 64, 613–616.

Wang, G. (1997). The homeroom teacher’s role in psychological counseling at school. Proceedings of the International Conference on Counseling in the 21^st Century. China, 6, 87–92. (ERIC Document Reproduction Service No. ED439325)

Wang, S. M., Zou, J. L., Gifford, M., & Dalal, K. (2014). Young students’ knowledge and perception of health and fitness: A study in Shanghai, China. Health Education Journal, 73, 20–27. doi:10.1177/0017896912469565

Wang, W., & Miao, X. (2001). Chinese students’ concept of mental health. Western Journal of Nursing Research, 23, 255–268.

Wang, X., Huang, X., Jackson, T., Chen, R., & Laks, J. (2012). Components of implicit stigma against mental illness among Chinese students. PLoS ONE, 7, e46016.

Whipple, J. L., Lambert, M. J., Vermeersch, D. A., Smart, D. W., Nielsen, S. L., & Hawkins, E. J. (2003). Improving the effects of psychotherapy: The use of early identification of treatment and problem-solving strategies in routine practice. Journal of Counseling Psychology, 50, 59–68. doi:10.1037/0022-0167.50.1.59

Wong, W. C., Chen, W. Q., Goggins, W. B., Tang, C. S., & Leung, P. W. (2009). Individual, familial and community determinants of child physical abuse among high-school students in China. Social Science & Medicine, 68, 1819–1825. doi:10.1016/j.socscimed.2009.03.001.

Worrell, B. J. (2008, February 15). Mental health master plan. China Daily. Retrieved from http://www.chinadaily.com.cn/opinion/2008-02/15/content_6458887.htm

Wu, P., Li, L. P., Jin, J., Yuan, X. H., Liu, X., Fan, B., . . . Hoven, C. W. (2012). Need for mental health services and service use among high school students in China. Psychiatric Services, 63, 1026–1031.

Xin, Z., & Zhang, M. (2009). Changes in Chinese middle school students’ mental health, 1992–2005: A cross-temporal meta-analysis. Acta Psychologica Sinica, 41, 69–78.

Yan, H. (2003). Wo guo zhong xiao xue xin li jian kan jiao yu jiao shi de xian zhuang ji qi dui ce [Current status and strategies of elementary and secondary mental health education teachers in our country]. Jianghan Da Xue Xue Bao-Ren Wen Ke Xue Ban, 22(5), 77–80.

Yüksel-Şahin, F. (2008). Evaluation of school counseling and guidance services based on views of high school students. International Journal of Human Sciences, 5(2), 1–26.

Zhang, W., Hu, X., & Pope, M. (2002). The evolution of career guidance and counseling in the People’s Republic of China. The Career Development Quarterly, 50, 226–236. doi:10.1002/j.2161-0045.2002.tb00898.x

Zheng, R., Zhang, W., Li, T., & Zhang, S. (1997, May). The development of counseling and psychotherapy in China. In The International Conference on Counseling in the 21st Century. Retrieved from http://files.eric.ed.gov/fulltext/ED439312.pdf

Zhong guo jiao yu bu (1999). Guan yu gai shan zhong xiao xue xin li jian kang jiao yu de ji dian yi jian [Several suggestions on improving mental health education in elementary & secondary schools]. Retrieved from http://www.jylw.org/jiankangjylw/20847.html

Zhong guo jiao yu bu . (2012). Zhong xiao xue xin li jiang kang jiao yu zhi dao gang yao (2012 xiu ding) [The guideline of mental health education in elementary & secondary schools (2012 Ed)]. Retrieved from http://www.moe.gov.cn/publicfiles/business/htmlfiles/moe/s3325/201212/145679.html

Qi Shi is an assistant professor at Loyola University Maryland. Xi Liu is a doctoral student at George Washington University. Wade Leuwerke is an associate professor at Drake University. Correspondence can be addressed to Qi Shi, 2034 Greenspring Drive, Timonium, Maryland 21093, qshi@loyola.edu.

Identifying Gender Differences in Male and Female Anger Among an Adolescent Population

Dec 2, 2014 | Article, Volume 4 - Issue 5

Isaac Burt

This pilot study explored differences between the levels of anger expression and anger control by adolescent males and females. Eighteen participants (9 males and 9 females) completed a strength-based anger management group promoting wellness. Anger management group counseling consisted of a 10-week continuous intervention emphasizing anger reduction, anger control and appropriate anger expression. Results indicated gender differences in that females exhibited more anger expression, as well as less anger control. However, females had higher levels of overall improvement. The article concludes with limitations and implications for mental health counseling with adolescent populations.

Keywords: mental health counseling, group counseling, anger management, adolescent, gender differences

The profession of mental health counseling serves a diverse population with a variety of needs, including substance abuse and anger management issues (Gutierrez & Hagedorn, 2013). In order to provide services to clients, mental health counselors use a number of modalities, such as individual and group counseling. Research indicates that group counseling in particular can be useful with certain populations, such as excessively angry clients (Burt, Patel, Butler, & Gonzalez, 2013; Fleckenstein & Horne, 2004). Traditionally, anger management groups have focused on dealing with anger after it occurs. Recent developments in the field of counseling, however, suggest that a number of new trends are developing with mental health and anger management groups (Burt & Butler, 2011).

One of these trends focuses on early prevention with mental health counselors either providing facilitation or training others to facilitate anger management groups in schools (Curtis, Van Horne, Robertson, & Karvonen, 2010). The targeted clients of most of the early prevention interventions are middle and high school populations (Parker & Bickmore, 2012). Burt and Butler (2011) contended, however, that many early prevention and anger management groups are gender biased and focus excessively on adolescent males. The researchers suggested that while adolescent females experience anger as well, they often do not receive counseling services (Burt & Butler, 2011). As a result, a growing population with similar needs is potentially neglected. While numerous differences do exist between genders, anger is a common emotion experienced by both (Karreman & Bekker, 2012).

Research indicates that differences exist between adolescent males and females with regard to behavioral decision-making processes and expression of emotions (Brandts & Garofalo, 2012). Although research depicts females as more emotionally expressive, males have a reputation of being more predisposed to anger. According to Sadeh, Javdani, Finy, and Verona (2011), females experience anger, but may express it differently than males. For example, instead of expressing anger by striking objects, adolescent females may talk to friends or peers (Fischer & Evers, 2011). Conversely, other studies purport that females express anger similarly to males, but experience difficulty recognizing and admitting the emotion due to social expectations and constraints (Karreman & Bekker, 2012). Males, on the other hand, tend to display anger more commonly and comfortably (Fischer & Evers, 2011). One of the many reasons that adolescent males may feel comfortable expressing anger is because it is socially acceptable (Burt et al., 2013).

An extensive number of studies have investigated anger; however, there appears to be a lack of studies exploring anger differences between genders. Karreman and Bekker (2012) conducted a study on gender differences, investigating autonomy-connectedness between genders. Their study indicated differences related to anger and sensitivity between genders. However, the study did not attempt to determine whether males and females were equal in anger at the beginning or end of the study. Similarly, Burt, Patel, and Lewis (2012) reported that incorporating social and relational competencies into anger management groups reduced anger, but there was no discussion of anger differences between genders. Sadeh et al. (2011) indicated that women expressed more self-anger (i.e., anger directed internally toward themselves) than males, but did not investigate whether differences existed between genders before the study.

Although limited, a small number of studies have attempted to examine anger differences between genders. Similar to Sadeh et al. (2011), Fischer & Evers (2011) found that females expressed subjective anger, or self-anger, more often than males. Buntaine and Costenbader (1997) found that both genders’ self-reports (assessments) indicated no significant differences. Upon further examination of their data, however, they concluded that although self-reports specified no differences, males verbally reported higher responses of anger. In contrast, Zimprich and Mascherek (2012) determined that no anger differences existed between males and females. They declared that although genders may express anger and respond to situations differently, they generally experience similar levels of anger. As can be seen from the preceding studies, inconsistences exist in the literature. Contradicting studies indicate that researchers are unclear as to whether differences in anger exist between genders. As such, a research gap has emerged that needs to be filled (Zimprich & Mascherek, 2012). In order to understand how this research gap developed, it is necessary to examine cultural influences.

Cultural Influences and Misconceptions in Society

According to Carney, Buttell, and Dutton (2007), a misconception exists in Western society that women are less aggressive than men and do not express excessive anger. This fallacy persisted in Western culture until a report from the U.S. National Family Violence Survey of 1975 (as cited in Carney et al., 2007) found a disturbing trend: Females were just as angry as males and expressed excessive anger the same amount that men did. At the time, feminist theory and the feminist movement were developing and stood in stark contrast to these findings. Carney et al. (2007) stated that as such, the National Family Violence Survey findings were largely unreported, and in extreme situations, people reinterpreted or repudiated the survey’s findings. In either case, more misconceptions began to develop in Western culture (Carney et al., 2007), such as the idea that when females experience anger, it is always appropriate to the situation (i.e., anger is permissible). A second mistaken belief is that anger from females is less serious and not as negative. For example, the expression “you look so cute when you’re angry” portrays this biased and potentially chauvinistic thought. A third misconception is that females are more credible in reporting their emotions and, as such, females are more reliable when they state that they are not angry.

Western society has acted upon these cultural misconceptions. For example, certain myths in society (and mental health counseling) persist, declaring the following: (a) only males have angry feelings, (b) all male-comprised counseling groups are anger management groups, (c) males have a limited repertoire of emotions to express, (d) males are too angry and competitive to support one another in groups, and (e) males are not interested in meeting with other males (Andronico & Horne, 2004). Myths about female groups are that they are high functioning, conflicts are resolved faster, and a fair amount of reflection and processing exists (Gladding, 2012). According to researchers, these misconceptions can bias the truth regarding people’s beliefs. For example, Winstok (2011) stated that rates of excessive anger and intimate partner physical abuse among females equal or surpass those of males.

Clearly, cultural misconceptions of gender differences in excessive anger can lead mental health counselors to do a disservice to males and females alike. For example, culture can influence mental health and group counseling by causing a type to develop. This type is defined as best suited to be in anger management groups. As a result, mental health counselors may unconsciously choose more males than females to be members of anger management groups. Thus, a population that desperately needs services can go without an intervention (Carney et al., 2007). Mental health counselors need to reevaluate their thinking in order to avoid overlooking a population needing services due to implicit social misconceptions.

Bandura (2008a) believed that excessive anger was not sudden, but gradually manifested over time. His studies with youth corroborated this idea, as he observed modeling and negative behavioral patterns leads to excessive anger (Bandura, Ross, & Ross, 1963). Supporting Bandura’s work, Burt and Butler (2011) asserted that excessive anger begins in childhood and adolescence. They reinforced the notion that mental health counselors must be aware that both genders have common needs and issues. For females, not receiving services or having services denied, and being told that the emotion they feel is inappropriate, could cause personal damage (Gottfredson, 2002). For instance, society and mental health counselors often depict males as more in need of anger management (Burt & Butler, 2011). Conversely, mental health counselors sometimes neglect and ignore what females need (West-Olatunji et al., 2010). Stated succinctly, a gap exists between what clients need and the options mental health counseling interventions offer to both genders. It is the author’s contention that this gap is an unfair practice, as both genders have similar needs. Research has shown that males and females experience anger equally; as a result, both need anger management groups.

To determine whether both genders expressed anger similarly, the author implemented a pilot study with adolescents to explore the topic before proceeding with a full investigation. As Bandura (2008b) pointed out, anger begins early in life and timely prevention is critical. Provision of early services for children and adolescents can help to prevent issues later in life.

Method

Participants

Participants in this study were male and female middle school students in the sixth, seventh and eighth grades. Thirty potential participants (15 males and 15 females) received invitations for participation, and 20 returned signed parental informed consent forms (10 males and 10 females). Ages of participants ranged from 11–14 years and consisted of 75% Latino/Hispanic (15), 15% Black (3), and 10% White (2). Two participants did not complete the study.

Instrumentation

This pilot study used the State-Trait Anger Expression Inventory-2 Child and Adolescent (STAXI-2 C/A). A well-known and highly used instrument, the STAXI-2 C/A is a self-report assessment that indicates youths’ (ages 9–18) control and expression of their anger (Spielberger, 1999). The STAXI-2 C/A has provided reliable and consistent results across diverse cultures and settings (Chirichella-Besemer & Motta, 2008). The STAXI-2 C/A contains four scales assessing excessive anger in youths. The four scales are as follows: Anger State (S-Ang), Anger Trait (T-Ang), Anger Control (AC) and Anger Expression (AX). Each of the four scales measures a different indicator of anger, in order to provide counselors with a multifaceted perspective of the client’s anger behavior.

Past studies that utilized the STAXI-2 C/A focused on AC and AX because of the strong validity these scales have with other anger assessments (Freeman, 2004); thus, the AC and AX scales were used in this pilot study. Cronbach’s alphas were .92 and .67 for AC and AX respectively (Freeman, 2004). Barrio, Aluja, and Spielberger (2004) stated that Cronbach’s alphas demonstrated by the STAXI-2 C/A indicated a high degree of reliability. Additionally, Barrio et al. (2004) also exhibited high construct validity by correlating the STAXI-2 C/A with the Verbal and Physical Aggressiveness Scale (AFV; Caprara & Pastorelli, 1993). A significant correlation of .43 existed between the two assessments. According to Gladding (2012), numerous counselors fail to measure the successfulness of their groups accurately because of errors in measurement and evaluation. In groups, a large number of therapeutic factors are occurring, which affect members in varying ways (Corey, 2011). Focusing on too many factors can overwhelm counselors and undermine evaluation, which is critically important (Gladding, 2012). In order to avoid this potential problem, this pilot study focused on a limited number of factors.

Procedures

A large, urban public middle school in a metropolitan area provided the setting and participants for this pilot study. Serving 2,000 students in grades 6–8, the school has a standardized documentation system that keeps track of behavioral disruptions. The documentation system records in-school suspensions (ISS), out-of-school suspensions (OSS) and behavioral infractions for students (Burt, 2010). Each student has a personal identification number; the administration connects student infractions to these numbers in order to identify any student. The documentation system also contains a small description of what caused the issue. For instance, some students have behavioral outbursts of anger, while others have infractions for tardiness. Since the focus of this pilot was to determine anger differences between genders, it was imperative for the study to have participants who displayed excessive anger. To increase validity and correctly identify participants, the author used school administration recommendations.

The author conducted interviews with school staff to gather information as suggested by Bryan, Day-Vines, Griffin, and Moore-Thomas (2012). For example, the author asked school deans, teachers and professional school counselors (PSC) for recommendations about students. Many students had a high overall number of OSS and ISS, including a large number of behavioral infractions. However, some infractions were due to nonexcessive anger problems (e.g., tardiness). School staff could provide a safeguard against the author inappropriately recruiting a student who did not truly require services. The author asked school staff if a student’s number of OSS, ISS and infractions corresponded with actual behavior (i.e., excessive anger). Thus, the goal was to eliminate as much bias as possible to ensure the most appropriate candidates.

After interviewing school staff, a pool of candidates emerged, consisting of individuals with documentation of excessive anger, fights and legal procedures in the court system (Burt, 2010). School staff considered these candidates to be at high risk for excessive anger, and candidates’ records of OSS, ISS and behavioral infractions corroborated this belief. According to Burt et al. (2013), more than eight occurrences in a 12-week period constitute a high number of anger issues; thus, this study held the same parameters advocated by Burt et al. (2013). Once a list of eligible candidates emerged, the author interviewed school staff a second time. This second short interview was a safeguard measure before actually contacting candidates. The author wanted to meet with school staff again to reduce potential staff bias and ensure that candidates were still having anger issues. After the last interview, school staff explained the study to candidates in detail.

In order to increase client buy-in, school staff introduced the author of this article (who was also the group facilitator) to candidates. The author met with candidates and explained the study in more detail, in addition to answering any questions. If the candidates were interested in participating, the author gave them informed consent forms to have their parents sign. To increase the likelihood of the candidates returning the informed consent forms, candidates received tokens from the school, which allowed them to buy goods in the school store. If candidates returned signed informed consent forms, they received five tokens, comparable to five U.S. dollars. Out of 30 candidates, 20 returned signed informed consent forms. Although this is a small number, this quantity is permissible for pilot studies (Heppner, Wampold, & Kivlighan, 2008). The author split the participants in half based on gender (10 males and 10 females). One participant dropped out of each group, leaving 18 who completed the study. Each group met at a different time and was not aware of the existence of the other group (Burt, 2010). This pilot study assessed participants’ behavior via the STAXI-2 C/A, given pre- and post-intervention.

     Structure of the intervention/anger management group used in the pilot study. The anger management group consisted of eight counseling sessions and two assessment sessions (pretest and posttest assessment; Burt, 2010). Program duration was 10 weeks, and the author of this article conducted each session weekly. Corresponding with Blanton, Christensen, and Shakir (2006), each counseling session contained the following four essential components: an opening question (such as an icebreaker or introductory segment), a behavioral lesson (information gathering and learning), a behavioral activity (an experiential segment in which learned information is applied), and an appreciations and closings segment ending the group (a bonding piece for group members). Counseling sessions concluded after 60 minutes, with opening questions lasting approximately 5–10 minutes. Behavioral lessons took between 10 and 25 minutes and behavioral activities lasted 15–30 minutes. Appreciations and closing concluded after 5–10 minutes. Pre- and post-group paperwork sessions took approximately 15–30 minutes (Burt, 2010). As Burt et al. (2012) suggested, groups must be strength-based (i.e., accentuating members’ strong points), and incorporate collaboration and teamwork. The group was prosocial in nature, emphasized clients’ strengths and developed social bonding. Topics for the eight sessions included the following: improving communication skills, recognizing personal emotions, identifying emotions within others, improving observational skills, advanced detection of emotions in others, noticing anger cues in others, understanding personal anger cues, strategies for calming down, and problem-solving.

     Mental health counselor for the intervention. The mental health counselor for both groups was this author, who has experience as a group facilitator and counselor educator. Additionally, the author worked as a training liaison for anger management groups in the school system, teaching conflict resolution and peer mediation. He also has experience working with groups for adults and children with oppositional defiance disorder and anger management issues. The group facilitator used an integrative orientation, utilizing social cognitive theory (SCT) and cognitive-behavioral therapy (CBT; Burt, 2010).

Results

The focus of the study was to determine whether differences existed between male and female levels of excessive aggression. Table 1 displays descriptive statistics and indicates results from the one-way repeated measures ANOVA for AC and AX. Results for youths’ overall AC levels pre- and post-intervention indicated the following, F1, 8 = 6.36, p = .003, ES = .44. Thus, the pilot study showed preliminary findings that a significant difference existed between genders on AC. For the scale of AX, results indicated a statistically significant difference between genders pre- and post-intervention (F1, 8 = 4.06, p = .018, ES = .34). Although repeated measures indicated a statistically significant difference between genders, pair-wise comparisons allowed examination of exactly where differences lay between genders on AC and AX. Thus, a significant difference existed between gender on AC (p = .04), and on AX (.03; Table 1). At the beginning of the pilot study, males had less AC, but females had more AX. However, females had the larger increase in AC post-intervention, as well as the greatest reduction in AX between genders. Hence, females had the greater overall gains and improvement pre- and post-intervention as opposed to males.

Table 1

Outcome results for Anger Control and Anger Expression

Note. ^a N = 9 ^b N = 18

Discussion

Females had more AX than males, a finding which corresponds with Cross and Campbell (2011). Males appeared to have less AC and were somewhat less angry than females. A number of studies support the preceding findings, most notably Winstok (2011) and Carney et al. (2007). Further, this pilot’s findings corroborate the idea that both genders have equal problems with excessive anger (Carney et al., 2007). The results from this study also suggest that both genders can improve with interventions designed to address anger. According to Winstok (2011), a common misconception is that males have greater need for excessive anger interventions than females. However, in this pilot study, females responded better to the treatment than males did. This responsiveness to treatment is interesting in that few studies have directly compared sensitivity to interventions by gender. While sensitivity to treatment was not a focal point of this pilot, it is interesting to note and direct attention to this unexpected outcome.

The author believes that the primary underlying reason females responded better to the treatment is that they are an underserved population (West-Olatunji et al., 2010). This is not to say that other explanations are not contributing factors, but because the females in this study possibly represent an underserved population, the aforementioned factor likely has more influence. According to West-Olatunji (2010), an underserved population is one that needs services, but does not have access to help. In addition, a number of the females in this pilot qualify as an underserved population as defined by Burt and Butler (2011). For instance, background information provided by the school indicated that approximately 85% of males in this pilot study received prior services (e.g., counseling) before participating. Conversely, 40% of females in this pilot study received prior services. Although the purpose of this study was not to detail what causes an underserved population to develop, research indicates that it can be due to institutional, social or cultural constraints (West-Olatunji et al., 2010).

While this study did not use qualitative measures as advocated by McCarthy (2012), females verbally disclosed that the school rarely offers them anger management services. Female participants further stated that if those services were more readily available, they would use them. Conversely, males indicated being overwhelmed with staff attempting to persuade them to participate in anger management services. This dichotomy in access to treatment clearly marks the identification of an underserved population. Thus, the females’ higher responsiveness to the intervention is potentially due to the following: Perhaps this study was a first intervention for many of the female participants. For females who did receive prior services, it may have been the first intervention directly dealing with anger.

Day (2008) indicated three characteristics that clients need to increase the likelihood of a successful outcome: the client must be in distress, must actively seek help and must have high expectations for counseling. The female participants (as opposed to the majority of the males) in this study met the preceding three criteria. Members of both genders were in a state of distress (as evidenced by the school’s documentation system). However, females verbally admitted to wanting help and had higher expectations. Consequently, females in the pilot had larger, more consistent gains. As evidenced by West-Olatunji et al. (2010), when underserved populations receive desired treatments, the change is normally larger than average. Thus, the findings in this pilot study connect to previous research and provide a plausible reason for the differences between genders.

Limitations

This pilot study had limitations stemming from research methods. First, the groups were limited to one school, as well as to selection from a standardized school documentation system (Burt, 2010). The documentation system compiled an objective list of behavior issues in school, but did not differentiate between excessively angry and nonexcessively angry behaviors. For example, documented behaviors could range from threatening school staff to not returning school forms promptly. To account for this issue, this study included school staff and administration’s professional suggestions for possible candidates. However, school staff may have had subtle biases for or against certain students. There are limitations to each method of selection, including both the standardized documentation system and the school staff. An additional limitation is that the same mental health counselor (the author of this article) conducted the groups. Due to this limitation, some participants’ changes may be due to the facilitator’s style or personality. More importantly, this study lacked a control group and had a small number of participants. The lack of a control group makes generalizations difficult in that it is uncertain whether other extraneous variables influenced the results. Having a small number of participants decreases the power of the pilot study and makes it difficult to generalize results. However, the fact that a significant finding occurred with a small sample size indicates the strong influence of the intervention (Gay & Airasian, 2003). In schools, it is difficult to conduct full-scale studies due to a number of preexisting conditions, such as high-stakes testing (Burt et al., 2013). Therefore, having a study without a control group and with a small number of participants may be the most appropriate method if investigators are to conduct research in schools (Heppner et al., 2008).

Implications and Future Directions for Research

Implications for mental health counselors stemming from this pilot study are numerous. First, mental health counselors must be aware that both genders need services for excessive anger. Mental health counselors should not allow personal biases and media influences to sway professional opinion (Gladding, 2012). In addition, mental health counselors must advocate for fairness and oppose stereotyped biases and ideologies pushed by society (Burt et al., 2012). According to Gray and Rose (2012), discrimination and internalized oppression begin by ignoring discriminatory societal practices. Only by remaining reflective and cognizant of personal biases can mental health counselors reduce problematic issues and model appropriate behaviors (Young, 2012).

A second implication for mental health counselors is to understand that a strength-based model promoting wellness is critically important for clients (Hagedorn & Hirshhorn, 2009). Specific populations, such as youth, respond better to models incorporating empowerment, which can lead to increased behavioral self-efficacy (Bandura, 2008a). Furthermore, positive modeling by mental health counselors also increases growth and behavioral self-efficacy (Bandura, 2008a). A combination of strength-based approaches, empowerment and modeling improve groups’ interpersonal, intrapersonal and extrapersonal functioning (Gladding, 2012). Third, mental health counselors should seek to improve delivery of services and outcomes by evaluating the group process (Steen, 2011). For instance, Gladding (2012) and McCarthy (2012) reinforced the notion of improving counseling services through research and evaluation. This study provided a formal assessment of a group that could have otherwise gone unreported.

Future researchers may want to improve the overall research design. For example, researchers could include a larger number of participants, groups and multiple facilitators. Moreover, future studies must have a true experimental design, such as a control group with random assignment. Including participants’ personal perspectives and phenomenological views not only increases the validity of research, it improves mental health counselors’ skill levels as well (Gladding, 2012). Qualitative measures improve skill level by giving mental health counselors a clear idea of what actually worked and what did not (Burt & Butler, 2011). Lastly, future researchers may want to pay more attention to gender responsiveness (sensitivity) to treatments, to determine if males or females respond better to specific treatments.

Conclusion

The purpose of this pilot study was to determine whether gender differences existed among adolescents for excessive anger. Preliminary results indicate that differences existed, but that there also were distinctions between genders regarding the intervention itself. Females had better AC, but also had more AX compared to their male counterparts. However, females seemed to respond better to the intervention, as shown by their larger gains and improvement. Males improved as well, but did not have the substantial progress observed in females. While past research may not have lent strong support for gender differences, this author hoped to reinvigorate interest in gender discrepancies. Females are an underserved population with regard to anger management; research has indicated that they experience anger sometimes at a rate paralleling or surpassing males (Cross & Campbell, 2011). However, due to societal stigma and cultural biases, many females do not receive anger management services. Therefore, only rigorous research can determine whether these problems truly exist by improving group research and outcomes (McCarthy, 2012).

Conflict of Interest and Funding Disclosure

The author reported no conflict of

interest or funding contributions for

the development of this manuscript.

References

Andronico, M. P., & Horne, A. M. (2004). Counseling men in groups: The role of myths, therapeutic factors, leadership, and rituals. In J. L. Delucia-Waack, D. A. Gerrity, C. R. Kalodner, & M. T. Riva (Eds.), Handbook of group counseling and psychotherapy (pp. 456–468). Thousand Oaks, CA: Sage.

Bandura, A. (2008a). Reconstrual of “free will” from the agentic perspective of social cognitive theory. In J. Baer, J. C. Kaufman, & R. F. Baumeister (Eds.), Are we free? Psychology and free will (pp. 86–127). New York, NY: Oxford University Press.

Bandura, A. (2008b). Toward an agentic theory of the self. In H. W. Marsh, R. G. Craven, & D. M. McInerney (Eds.), Self-processes, learning, and enabling human potential: Dynamic new approaches (pp. 15–49). Charlotte, NC: Information Age.

Bandura, A., Ross, D., & Ross, S. A. (1963). Imitation of film-mediated aggressive models. Journal of Abnormal and Social Psychology, 66, 3–11.

Barrio, V. D., Aluja, A., & Spielberger, C. (2004). Anger assessment with the STAXI-CA: Psychometric properties of a new instrument for children and adolescents. Personality and Individual Differences, 37, 227–244. doi:10.1016/j.paid.2003.08.014

Blanton, E., Christensen, C., & Shakir, J. (2006). Empowering the angry child for positive leadership. Louisville, KY: Peace Education Program.

Brandts, J., & Garofalo, O. (2012). Gender pairings and accountability effects. Journal of Economic Behavior & Organization, 83, 31–41. doi:10.1016/j.jebo.2011.06.023

Bryan, J., Day-Vines, N. L., Griffin, D., & Moore-Thomas, C. (2012). The disproportionality dilemma: Patterns of teacher referrals to school counselors for disruptive behavior. Journal of Counseling & Development, 90, 177–­190. doi:10.1111/j.1556-6676.2012.00023.x

Buntaine, R. L., & Costenbader, V. K. (1997). Self-reported differences in the experience and expression of anger between girls and boys. Sex Roles, 36, 625–637. doi:10.1023/A:1025670008765

Burt, I. (2010). Addressing anger management in a middle school setting: Initiating a leadership driven anger management group (Doctoral dissertation, University of Central Florida). Retrieved from http://etd.fcla.edu/CF/CFE0003375/Burt_Isaac_201008_PhD.pdf

Burt, I., & Butler, S. K. (2011). Capoeira as a clinical intervention: Addressing adolescent aggression with Brazilian martial arts. Journal of Multicultural Counseling and Development, 39, 48–57. doi:10.1002/j.2161-1912.2011.tb00139.x

Burt, I., Patel, S. H., Butler, S. K., & Gonzalez, T. (2013). Integrating leadership skills into anger management groups to reduce aggressive behaviors: The LIT model. Journal of Mental Health Counseling, 35,124–141.

Burt, I., Patel, S. H., & Lewis, S. V. (2012). Anger management leadership groups: A creative intervention for increasing relational and social competencies with aggressive youth. Journal of Creativity in Mental Health, 7, 249–261.

Caprara, G. V., & Pastorelli, C. (1993). Early emotional instability, prosocial behaviour, and aggression: Some methodological aspects. European Journal of Personality, 7, 19–36. doi:10.1002/per.2410070103

Carney, M., Buttell, F., & Dutton, D. (2007). Women who perpetrate intimate partner violence: A review of the literature with recommendations for treatment. Aggression and Violent Behavior, 12, 108–115. doi:10.1016/j.avb.2006.05.002

Chirichella-Besemer, D., & Motta, R. W. (2008). Psychological maltreatment and its relationship with negative affect in men and women. Journal of Emotional Abuse, 8, 423–445. doi:10.1080/10926790802480380

Corey, G. (2011). Theory and practice of group counseling (8th ed.). Pacific Grove, CA: Brooks/Cole.

Cross, C. P., & Campbell, A. (2011). Women’s aggression. Aggression and Violent Behavior, 16, 390–398. doi:10.1016/j.avb.2011.02.012

Curtis, R., Van Horne, J. W., Robertson, P., & Karvonen, M. (2010). Outcomes of a school-wide positive behavioral support program. Professional School Counseling, 13, 159–164.

Day, S. X. (2008). Theory and design in counseling and psychotherapy (2nd ed.). Boston, MA: Houghton Mifflin.

Fischer, A. H., & Evers, C. (2011). The social costs and benefits of anger as a function of gender and relationship context. Sex Roles, 65, 23–34. doi:10.1007/s11199-011-9956-x

Fleckenstein, L., & Horne, A. M. (2004). Anger management groups. In J. L. Delucia-Waack, D. A. Gerrity, C. R. Kalodner, & M. T. Riva (Eds.), Handbook of group counseling and psychotherapy (pp. 547–562). Thousand Oaks, CA: Sage.

Freeman, S. J. (2004). Review of the State-Trait Anger Expression Inventory-2. In B. S. Plake, J. C. Impara, & R. A. Spies (Eds.), The fifteenth mental measurements yearbook (pp. 1182–1183). Lincoln, NE: Buros Center for Testing.

Gay, L. R., & Airasian, P. (2003). Educational research: Competencies for analysis and applications (7th ed.). Upper Saddle River, NJ: Merrill/Prentice Hall.

Gladding, S. T. (2012). Groups: A counseling specialty (6th ed.). Upper Saddle River, NJ: Pearson.

Gottfredson, L. S. (2002). Gottfredson’s theory of circumscription, compromise, and self-creation. In D. Brown, & Associates (Eds.), Career choice and development (4th ed., pp. 85–148). San Francisco, CA: Jossey-Bass.

Gray, J. S., & Rose, W. J. (2012). Cultural adaptation for therapy with American Indians and Alaska Natives. Journal of Multicultural Counseling and Development, 40, 82–92. doi:10.1002/j.2161-1912.2012.00008.x

Gutierrez, D., & Hagedorn, W. B. (2013). The toxicity of shame: Applications for acceptance and commitment therapy. Journal of Mental Health Counseling, 35, 43–59.

Hagedorn, W. B., & Hirshhorn, M. A. (2009). When talking won’t work: Implementing experiential group activities with addicted clients. The Journal for Specialists in Group Work, 34, 43–67. doi:10.1080/01933920802600832

Heppner, P. P., Wampold, B. E., & Kivlighan, D. M. (2008). Research design in counseling (3rd ed.). Belmont, CA: Thomson Brooks/Cole.

Karreman, A., & Bekker, M. H. J. (2012). Feeling angry and acting angry: Different effects of autonomy-connectedness in boys and girls. Journal of Adolescence, 35, 407–415. doi:10.1016/j.adolescence.2011.07.016

McCarthy, C. J. (2012). Developing best practices for researching group work. The Journal for Specialists in Group Work, 37, 93–94. doi:10.1080/01933922.2012.666445

Parker, C. A., & Bickmore, K. (2012). Conflict management and dialogue with diverse students: Novice teachers’ approaches and concerns. Journal of Teaching and Learning, 8(2), 47–64.

Sadeh, N., Javdani, S., Finy, M. S., & Verona, E. (2011). Gender differences in emotional risk for self- and other-directed violence among externalizing adults. Journal of Consulting and Clinical Psychology, 79, 106–117. doi:10.1037/a0022197

Spielberger, C. D. (1999). State-Trait Anger Expression Inventory-2 (STAXI-2). Odessa, FL: Psychological Assessment Resources.

Steen, S. (2011). Academic and personal development through group work: An exploratory study. The Journal for Specialists in Group Work, 36, 129–143. doi:10.1080/01933922.2011.562747

West-Olatunji, C., Shure, L., Pringle, R., Adams, T., Lewis, D., & Cholewa, B. (2010). Exploring how school counselors position low-income African American girls as mathematics and science learners. Professional School Counseling, 13, 184–195.

Winstok, Z. (2011). The paradigmatic cleavage on gender differences in partner violence perpetration and victimization. Aggression and Violent Behavior, 16, 303–311. doi:10.1016/j.avb.2011.04.004

Young, M. E. (2012). Learning the art of helping: Building blocks and techniques (5th ed.). Upper Saddle River, NJ: Pearson.

Zimprich, D., & Mascherek, A. (2012). Anger expression in Swiss adolescents: Establishing measurement invariance across gender in the AX scales. Journal of Adolescence, 35, 1013–1022. doi:10.1016/j.adolescence.2012.02.008

Isaac Burt is an assistant professor at Florida International University. Correspondence can be addressed to College of Education, 11200 SW 8th Street, ZEB Building Room 236, Miami, FL 33199, iburt@fiu.edu.