Help-Seeking Behavior

Help-seeking behavior can be understood as the steps an individual, a couple, or a family takes to enter into a relationship with a counseling professional. There seems to be a gap between those who need counseling services and those who utilize them, which can be attributed to multiple factors across several dimensions. The understanding of help-seeking behavior needs to include an exploration of clients’ race, ethnicity, social class, gender, and geographic origin, among other variables. Additionally, it is important to examine the availability, cost, and access to services, previous utilization experience in counseling, clients’ level of belief in the helpfulness of the counseling process, and whether counseling is sought voluntarily or is imposed. Help seeking by the client cannot be viewed apart from the relationship between the clients and the counselors offering the help, or apart from the organization with which the provider is affiliated. In the process of examining the variables that affect help-seeking behavior, it is important to consider that no variable can be understood alone, independent from other variables, or isolated from contextual dimensions. Understanding the complexity and variety of help-seeking behavior of clients has implications for the successful or unsuccessful outcome of the counseling process.

Historical Background

Healing practices across cultures to relieve emotional or relational distress are not new. The act of engaging in a relationship, however, whereby one person, a couple, or a family relate to another person in a professional setting for behavioral or cognitive change and emotional or relational relief, is a relatively new, 20th-century, Western phenomenon. This development is due, in part, to sociopolitical changes the century brought to individuals and families in the West as a result of the Industrial Revolution, including the decline of extended family proximity in urban centers, the decline of authority over the life of the family, and the adjustments needed as a result of shifts in gender roles. In the first five decades of the 20th century, clients sought relief from emotional or psychological distress with the only professionals available at the time, that is, psychoanalysts or psychiatrists. Mentally ill patients were often hospitalized, sometimes for the rest of their lives, without their consent. Outpatient treatments existed but were limited to individuals who could afford the private practice fees of psychoanalysts and psychiatrists.

Increases in client demand for counseling professionals started to occur in the United States in the 1960s and 1970s as a result of important legislative initiatives. The Community Mental Health Act of 1963, for example, funded the establishment of mental health centers across the country. This law and others that followed, including the deinstitutionalization of state mental hospital patients that took place in 1975, initiated an increase in demand for outpatient services, substance abuse services, family counseling, and other clinical services.

In the latter half of the 20th century, three historical shifts affected help-seeking behavior. The feminist movement spearheaded feminist counseling in the 1970s and resulted in women’s demand for counseling that would help them to challenge assumptions related to the nature of their mental health, their suffering, and their position in the family. Systemic ideas influenced the development of couple and family counseling, in responding to couples or families seeking help on a variety of clinical issues. Changing immigration patterns in the last three decades of the 20th century resulted in an increased demand for counseling on the part of immigrant communities.

Race and Ethnicity

The expansion of the traditional provision of counseling services to low-income ethnic minorities and immigrants has not been met without challenges. Dropout rates are high for ethnic and racial minorities and immigrants, particularly if they are in lower socioeconomic strata.

There is an important relationship between an individual’s racial or ethnic background and his or her social class, level of education, minority or majority status, level of identity development, exposure to racism and discrimination, or religious affiliation in terms of how they affect help-seeking behavior. African Americans, Latinos/as, Asian Americans, and other ethnic minority groups tend to underutilize counseling services and are less likely than Caucasians to access outpatient mental health services. African Americans drop out after the first counseling encounter at much higher rates than do other minority and nonminority groups. Exposure to racism and discrimination may make a prospective African American client distrustful of providers of a different race or ethnicity. Asian Americans may underutilize counseling services because they may lack knowledge regarding services, either because of continued stigma associated with formal help seeking or because of cultural prescriptions against self-focus. Latinos/as’ help-seeking behavior may reflect cultural prescriptions that include an unwillingness to seek help for psychological, nonmedical reasons and a degree of fatalism that precludes perceptions of self-agency. Once racial and ethnic minority clients seek the help of a counseling professional, the encounter is likely to involve a provider rooted in the cultural middle-class values of individuality, self-disclosure, self-awareness, self-improvement, rationalism, and future planning. A growing body of literature suggests that conventional services do not seem to respond adequately to the values, needs, and cultural characteristics and preferences of racial and ethnic minorities.

The religious affiliation of racial and ethnic minorities may impact the help-seeking behavior. Individuals, couples, or families who rely on clergy and a religious community for their spiritual needs may find it difficult to seek the help of secular social services, that is, services not affiliated with a religious group.

Low-income racial and ethnic minority clients can often be other-referred (as opposed to self-referred) to receive counseling by legal, medical, or school systems. Frequently, counseling is mandated as a means of social control of racial and ethnic minority clients of low socioeconomic status as an alternative to jail or termination of parental rights. Other-referred and mandated clients drop out of services at higher rates than self-referred or voluntary clients because of lack of knowledge about, lack of preparation for, or distrust regarding the counseling process.

Immigration Status

Help-seeking behavior also varies according to immigrant status (i.e., first or second generation) and acculturative processes. For immigrant groups who belong to racial, ethnic, or language minorities, lower levels of acculturation are associated with lower levels of utilization of counseling services, higher dropout rates, and higher rates of mandated referrals or referrals from other sources. For example, cultural or language incongruence is strongly related to utilization of services, as when the collectivistic orientation of certain groups clashes with the individualistic worldview of the service providers or when linguistic barriers between providers and clients affect utilization rates and outcomes.

Social Class

Help-seeking behavior varies across social class in terms of access to resources, continuity with services, and whether or not individuals with emotional, psychological, or relational distress choose the help of a counselor for their problems. Social class cannot be understood in isolation but in context with other variables, for example, immigration status and race or ethnicity. As counseling is an activity that involves the belief that speaking to a stranger about intimate matters is helpful, the outcome of counseling needs to be understood in terms of the relationship to a client of any social class background who seeks help within a middle-class, Western counseling cultural system.

Gender

There are gender differences in help-seeking behavior. As with social class, race, and ethnicity, gender cannot be viewed in isolation from other variables. Research data show that a large percentage of counseling relationships are initiated at the request of women, and women constitute by far the largest percentage of clients in counseling. This is due to a variety of reasons, including different cultural patterns of expression of psychological distress in men and women, roles traditionally held by women as family caretakers, and women’s tendency to view themselves as needing to take more responsibility for the relational needs of the family, among others. From this point of view, counseling can be considered a female cultural behavior, in addition to a middle-class cultural value, because it involves the acceptance of the free expression of emotional content and openness to vulnerability. Some men, particularly in patriarchal or hierarchical family structures, might consider talking to a stranger about intimate family matters a sign of weakness, incompetence, or lack of control.

Implications

Once clients seek help, it appears that a major factor that contributes to positive outcomes is a perceived congruence between the values of the provider of counseling services and of the client seeking help. How providers of counseling services react to the different variables involved in help-seeking behaviors, attitudes, and expectations can greatly affect the outcome of the counseling relationship. Providers who accept the differences rather than fight against them, who prepare their clients for the services they are about to engage in, and who provide culturally and linguistically relevant services have a better chance of retaining the clients who seek their help.

References:

Evans, K. M., Kincade, E. A., Marbley, A. F., & Seem, S. R. (2005). Feminism and feminist therapy: Lessons from the past and hopes for the future. Journal of Counseling & Development, 83(3), 269-277.
Falicov, C. J. (1998). Latinos and family therapy. New York: W. W. Norton.
Hays, P. (2001). Addressing cultural complexities in practice. Washington, DC: American Psychological Association.
Kliman, J. (1998). Social class as a relationship: Implications for family therapy. In M. McGoldrick (Ed.), Re-visioning family therapy: Race, culture, and gender in clinical practice (pp. 50-61). New York: Guilford Press.
McCarthy, J., & Holliday, E. I. (2004). Help seeking and counseling within a traditional male gender role: An examination from a multicultural perspective. Journal of Counseling & Development, 82(1), 25-30.
Sanchez-Hucles, J. (2000). The first session with African Americans: A step-by-step guide. San Francisco: Jossey-Bass.