Quantitative Data

Quantitative Data

Counseling Experiences and Attitudes toward Counseling- Quantitative Data

Quantitative Research Questions:

The researcher using R, an open source statistical package.Descriptive statistics to be used are frequency distribution, mean (or proportion), standard deviation, Pearson correlation and Chi-Square test statistics. Inferential statistics in this research will be Analysis of Variance (ANOVA), Multiple Regression, and Factor Analysis to answer the three quantitative questions.

What is the relationship of the psychological attitudes of International Saudi students toward mental health services as related to gender, age, education, marital status, and counselor type?
Do gender, educational level and therapy experiences predict the psychological attitudes international Saudi students have toward mental health services?
Are the factors of the psychological attitude scales confirmed with International Saudi students?

Data Analysis: 378 responses to the survey request were received. Their responses were first evaluated for meeting the survey criteria. 26 records that looked suspicious (because there were multiple entries from the same IP address at the same time of day) were investigated and excluded because the IP addresses were based in Saudi Arabia or countries other than the United States. Another 84 records were excluded because the individual stated they currently lived in a country other than the United States or the latitude and longitude of the IP address was from a country other than the U.S., and 29 records were excluded either because the individual failed to give consent, or were younger than 18 years old. Of the remaining records, 70 had no answers to the BAPS questions, so they were removed. Three records that were complete had exactly the same demographics as a complete response from an earlier day or time of day, and were dropped as duplicate entries from the same person. Finally, four surveys were eliminated because the answers to the BAPS questions were all 1’s or all 6’s (which indicates the individual was not making a serious effort because some of the BAPS questions are purposefully worded with a negative context). This left 162 records that met all the criteria and answered the questions that revealed psychological attitudes.

The 18 BAPS questions were sorted into the three factors identified by their originator: Intent (questions 1, 2, 3, 4, 6, and 12), Stigma Tolerance (questions 5, 8, 10, 11, 13, 15, 17, and 18), and Expertness (questions 7, 9, 14, and 16). Each respondent rated each question from a value of 1 (Strongly Disagree) to 6 (Strongly Agree). The rating for each question was added together for the Intent and Expertness factors, while the rating for the first seven questions in the Stigma Tolerance factor were reverse scored (6 becoming 1, 2 becoming 5, and so on) before being added together. The minimum possible score for the Intent factor was 6 and the maximum was 36; for Stigma Tolerance the minimum and maximum were 8 and 48 respectively; and for Expertness the scores could range from 4 to 24.

Table 1 shows the demographic breakdown of the eligible participants in the study, which matches the expectations of a typical Saudi Arabian student in the United States. Note that about a fourth of the participants reported receiving therapist services at some point in their life. Table 1 also lists responses to questions about future use of counseling services, and the BAPS factor scores. The BAPS scores show that the participants ranged over the entire spectrum of possible scores on each of the factors, but the mean score in each category indicated that the typical participant was more likely than not to be in agreement with each of the factors.

Table 1. Participant Demographics

Characteristic	Statistic
Age	Mean: 28.8, Range: 19 to 45
Gender	55.6% Male, 44.4% Female
Marital Status	58.6% Married, 41.4% Not currently married
Education Status (Highest Level achieved)	16.7% less than Bachelor’s degree 35.2% Bachelor’s degree 48.1% Master’s degree or Doctorate
Received Therapist Services?	24.7% Yes, 75.3% No
Likely to Seek Psych Services in the Future if experienced difficult emotional issues?	64.2% Somewhat likely to very likely 35.8% Somewhat unlikely to very unlikely
What would prevent you from receiving services?	45.7% Nothing 16.7% Lack of availability of suitable counselors 16.0% Shame reasons 21.6% Financial, Family, or Other reasons
BAPS Factor 1: Intent	Mean of Total: 25.0, Range: 6 to 36 Mean of the Mean: 4.2
BAPS Factor 2: Stigma Tolerance	Mean of Total: 33.4, Range: 13 to 48 Mean of the Mean: 4.2
BAPS Factor 3: Expertness	Mean of Total: 18.3, Range: 5 to 24 Mean of the Mean: 4.6

Research Question 1: The first research question sought to determine the relationship between psychological attitudes and certain demographic features of the participant population. As with each of the first three research questions, analysis was done using R, an open source statistical package. Pearson’s correlation test was used to check the relationship between Age and each of the three BAPS factors. Age was determined to be unrelated to all three factors, with correlation coefficients of 0.12 (p-value= 0.13) for Intent, 0.08 (p-value= 0.31) for Stigma Tolerance, and 0.06 (p-value= 0.45) for Expertness.

The Analysis of Variance (ANOVA) F-test was used to check the relationship between the categorical variables of Gender, Marital Status, Education Status, and the type of counselor used (for example, either a Psychologist was consulted or one was not used by the participant). For the Intent factor, gender had a statistically significant relationship, with a p-value of 0.03, with females being more likely to achieve a higher Intent score. Those who had seen a Psychologist, and those who had used services from a Licensed Professional Counselor (LPC) also had statistically significant relationships with Intent, with p-values of 0.004 and 0.00001, with the users of these services more likely to achieve a higher Intent score. Education status, marital status, and the use of Psychiatrists or other types of therapists had no relationship with the Intent score. For the Stigma Tolerance factor, only gender had a statistically significant relationship with the score, with a p-value of 0.0004, with females achieving a higher Tolerance score on average. For the Expertness factor, the variables with a statistically significant relationship were the use of Psychologists and the use of LPCs, each with p-values of 0.046, again with the Expertness score more likely to be larger for those who had used services from a Psychologist or an LPC in the past.

Research Question 2: The second research question was interested in using multiple linear regression to determine if gender, education status, and therapy experience could predict the psychological attitude scores of international Saudi students living in the U.S. For each factor, a statistical model was established in the following manner, for example with Intent:

Intent score_i = b₀ + b₁*Gender_i + b₂*Education Level_i + b₃*Services Received_i + Σb_j* interactions_i + error_i

where the subscript i refers to each individual participant, b₀ is a mean value of the factor score after taking into account variations caused by the variables of interest (gender, etc.), b_j are coefficients to multiply by the variables of interest, interactions are possible effects in which the factor score depends on specific levels of two or three variables, and error means random variations in the data caused because humans are unique. Once the model was established and the data applied to the model, tests were done of the hypothesis that the model was better than just using the mean alone, and of the hypotheses that one or more of the coefficients were effectively zero (i.e., unimportant). If the statistical evidence indicated that the interactions coefficients were zero, the model was re-run without them. If any variables of interest were determined to have coefficients equal to zero, they also were removed from the model one at a time until the remaining variables had evidence of non-zero coefficients. This statistical method for multiple linear regression is called backward elimination.

For the Intent factor, the ANOVA table 2for the regression equation with interactions is given below:

Table 2.

The Intent factor, the ANOVAfor the regression equation with interactions.

Variable of Interest	Degrees of Freedom	Sum of Squares	Mean Square	F-value	p-value
Gender	1	190	190	5.29	0.023
Education Level	2	16	8	0.22	0.804
Services Received?	1	606	606	16.89	<0.001
Gender*Educ	2	12	6	0.17	0.848
Gender*Services	1	4	4	0.11	0.738
Educ*Services	2	78	39	1.09	0.340
GenderEducServ	2	36	18	0.51	0.603
Error	150	5381	35.9	—	—

From this table, it can be seen that the hypothesis that the coefficients for the interaction terms are zero is supported, because the p-values are all large (from 0.340 to 0.848). The interaction terms were removed from the model and regression was re-run, resulting in the following ANOVA table 3.

Table 3.

Variable of Interest	Degrees of Freedom	Sum of Squares	Mean Square	F-value	p-value
Gender	1	190	190	5.40	0.021
Education Level	2	16	8	0.22	0.801
Services Received?	1	606	606	17.26	<0.001
Error	157	5511	35.1	—	—

From this table, it is quickly seen that the hypothesis of values of zero for the coefficients is rejected for gender (p-value = 0.021) and services (p-value < 0.001), but there is enough evidence to support that the coefficient for education level is zero. After dropping education level as a variable, the final ANOVA table4 was:

Table 4.

Variable of Interest	Degrees of Freedom	Sum of Squares	Mean Square	F-value	p-value
Gender	1	190	190	5.47	0.021
Services Received?	1	616	616	17.74	<0.001
Error	96	5517	34.7	—	—

The final model, with coefficients included, is:

Intent score = 24.9 – 1.9 (if male) + 4.5 (if previously used services).

This indicates that for a female Saudi student living in the U.S. who has never used psychological services, the expected Intent score is about 25. For a male Saudi student who has never used psychological services, the expected Intent score is 23, and for anyone who has used psychological services, their Intent score is expected to rise by 4.5 points.

Multiple linear regression with backward elimination was also used to model the Stigma Tolerance and Expertness scores. It was found that only gender had a statistically significant effect on Stigma Tolerance. The ANOVA table 5 for the full model for Stigma Tolerance is shown below (the reduced tables are not shown because they reveal nothing new):

Table 5.The ANOVA for the full model for Stigma Tolerance.

Variable of Interest	Degrees of Freedom	Sum of Squares	Mean Square	F-value	p-value
Gender	1	511	511	12.83	<0.001
Education Level	2	53	26.5	0.66	0.518
Services Received?	1	1	0.5	0.01	0.907
Gender*Educ	2	15	7.5	0.19	0.824
Gender*Services	1	7	7	0.17	0.681
Educ*Services	2	39	19.5	0.50	0.610
GenderEducServ	2	74	37	0.92	0.400
Error	150	5976	39.8	—	—

The final model is:

Tolerance score = 35.4 – 3.6 (if male).

This indicates that female Saudi students living in the U.S. would average a Stigma Tolerance score of just over 35, while male Saudi students would average a score of just less than 32 points.

For the Expertness factor, only past use of psychological services was determined to have a coefficient statistically different from zero. Again, the ANOVA table 6 for the full model is shown only because the reduced tables reveal nothing new.

Table 6.

Variable of Interest	Degrees of Freedom	Sum of Squares	Mean Square	F-value	p-value
Gender	1	40.9	40.9	3.14	0.078
Education Level	2	5.0	2.5	0.19	0.826
Services Received?	1	93.4	93.4	7.18	0.008
Gender*Educ	2	1.2	0.6	0.05	0.956
Gender*Services	1	7.2	7.2	0.56	0.457
Educ*Services	2	7.8	3.9	0.30	0.743
GenderEducServ	2	48.6	24.3	1.87	0.158
Error	150	1951.5	13.0	—	—

The final model for Expertness is:

Expertness score = 17.9 + 1.9 (if previously used services).

This indicates that the expected score for a Saudi student who has never used psychological services, regardless of gender or educational level, is about 18. For anyone who has used psychological services, their Expertness score is expected to be greater by about 2 points.

Research Question 3: The third research question asked if the factors were confirmed for International Saudi students living in the U.S. In other words, should the 18 questions included in the BAPS survey be combined in the same manner to arrive at the Intent, Stigma Tolerance, and Expertness factors that have been determined for U.S. students, and other groups in other countries. This test is called Confirmatory Factor Analysis (CFA). Within the R environment, CFA for this project was conducted using the statistical package called LAVAAN, which stands for Latent Variable Analysis, and was created by Yves Rosseel. The hypothesis was that, for the set of data coming from Saudi students, the BAPS questions 1, 2, 3, 4, 6, and 12 would adequately combine together into one factor, that questions 5, 8, 10, 11, 13, 15, 17, and 18 would satisfactorily group together into a second factor, and that the remaining questions (7, 9, 14, and 16) would be a third factor. Diagnostic values that have been shown to be effective for this test are the Root Mean Squared Error of Approximation (RMSEA), which is expected to be 0.07 or less if the factors are confirmed; the Tucker-Lewis Index (TLI), which is expected to be 0.9 or above if the factors are confirmed; and the Comparative Fit Index (CFI), which is expected to be 0.95 or above if the factors are confirmed. All three of these diagnostic tests will always return a value between 0 and 1.

When confirmatory factor analysis was conducted on the data from 162 Saudi students in this project, the RMSEA was 0.086, TLI was 0.804, and CFI was 0.831. This indicates that the combination of questions established for U.S. students and other groups has relevance for the Saudi student population, but does not adequately account for all the nuances of this group. The latent variable parameter estimates were reviewed for each proposed factor, to try to determine which specific latent variables don’t fit with the rest of the model. Those estimates and their p-values are given in the table 7 below:

Table 7.

Factor grouping

– Latent variables

Parameter Estimate

p-value

(Intent) BAPS1

BAPS2

BAPS3

BAPS4

BAPS6

BAPS12

1.00 (fixed)

0.90

0.89

0.75

0.56

—

0.000

(Stigma) BAPS5

BAPS8

BAPS10

BAPS11

BAPS13

BAPS15

BAPS17

BAPS18

1.00 (fixed)

1.66

0.87

2.23

2.07

1.45

1.97

-1.13

—

0.003

0.024

0.003

0.002

0.005

0.003

0.010

(Expert) BAPS7

BAPS9

BAPS14

BAPS16

1.00 (fixed)

0.80

0.98

0.89

—

0.000

A good fit of the data to the factors would result in the absolute value of all parameter estimates to be between 0.7 and 1.3, as compared to the fixed variable (the arbitrarily chosen first variable within each group), and p-values less than 0.05. A review of the parameters indicates that Stigma Tolerance is the least well fitted factor for Saudi students. Five of the eight questions have parameter estimates larger than 1.3, which indicates that they have substantial dissimilarities from the other three questions, arguing for a possible separation of these questions into two or more factors. (Note that the parameter estimate for BAPS18 is negative because it is the only question in this factor which is not meant to be reverse scored). On the other hand, the factors associated with Expertness all fit together nicely, as do the factors associated with Intent, except question 12 (with a parameter estimate of 0.56).

Because CFA could not confirm the grouping of questions into the established factors, Exploratory Factor Analysis was conducted to look at other possible ways to group the questions for Saudi students living in the U.S. Within the R statistical package, the princomp function was used to perform Principal Component Analysis to search for the optimum number of factors involved, and the factanal function was used to perform Exploratory Factor Analysis. The table 8 below shows the variance results for the first eight components from Principal Component Analysis.

Table 8. The variance results for the first eight components from Principal Component Analysis.

Component:	1	2	3	4	5	6	7	8
Proportion of Variance	0.285	0.149	0.078	0.070	0.065	0.046	0.043	0.040
Cumulative Proportion	0.285	0.434	0.512	0.582	0.647	0.693	0.736	0.776

There is no single agreed-upon measure for how to select the best number of factors. Some sources say the cumulative proportion of variance should be at least 0.7, and others say 0.8 or more. Other sources state that the number of factors should be chosen based on a steep drop in the proportion of variance from one component to the next, and most agree that it is best to limit the number of factors to no more than 6 or 7, for simplicity of interpretation. In this case, the results of principal component analysis are mixed. There is a steep drop in proportion between two and three components, but two components account for only 43.4% of the variance. There is a moderate drop in proportion between five and six components, but five components account only for 64.7% of the variance. It takes six components to achieve a cumulative proportion of almost 0.7, and more than eight components to achieve 0.8. Based on the results of the Confirmatory Factor Analysis, it was decided to try five factors for Exploratory Factor Analysis because of the moderate drop-off in proportion of variance at that point, and it would keep the analysis simple, while still accounting for almost 65% of the variance.

Results of Exploratory Factor Analysis with five factors is shown in the tables below. One value that can be calculated by this method is Uniqueness. It is an indicator of whether or not the question acts uniquely as a factor on its own. The first table gives the largest eight values for the BAPS questions. With Uniqueness values close to or greater than 0.7, questions 5, 15, and 18, and 10 might be uniquely different from the five factors attempted with this method. In the second table, the loadings for the four potential factors are shown on a scale between 0 and 1 (a value of — is equivalent to 0). Loadings with an absolute value between 0 and 0.3 can be ignored. Usually, each question is associated just with the factor with the largest loading. Those loadings are shown in bold in the table. A test of the hypothesis that five factors is sufficient was done, achieving a Chi-Square statistic of 79.1 with 73 degrees of freedom, and a p-value of 0.293, which indicates five factors is a good enough way to separate the questions.

Table 9.

Question:	5	15	18	10	9	12	8	6
Uniqueness:	0.811	0.696	0.689	0.682	0.658	0.618	0.597	0.561

Loadings:	Factor 1	Factor 2	Factor 3	Factor 4	Factor 5
Question 1	0.774	0.161	—	-0.171	—
Question 2	0.764	0.200	—	-0.202	0.230
Question 3	0.637	0.454	—	—	—
Question 4	0.722	0.225	—	—	—
Question 5	0.122	—	0.373	—	0.167
Question 6	0.538	0.305	—	—	-0.206
Question 7	0.357	0.692	-0.157	—	—
Question 8	—	-0.185	0.591	0.131	—
Question 9	0.173	0.532	—	-0.145	—
Question 10	—	0.215	0.516	—	—
Question 11	-0.160	—	0.360	0.604	-0.311
Question 12	0.287	0.531	—	—	-0.118
Question 13	-0.191	-0.461	0.498	0.273	0.128
Question 14	0.191	0.665	—	-0.102	0.392
Question 15	—	—	0.531	—	—
Question 16	0.166	0.720	0.100	—	—
Question 17	—	—	0.333	0.689	—
Question 18	0.171	0.305	—	-0.423	—

In the above table 9, it is clear that the questions that group together for Factor 1 are: 1, 2, 3, 4, and 6. For Factor 2, the associated questions are 7, 9, 12, 14, and 16. For Factor 3, the associated questions are 5, 8, 10, 13, and 15, and for Factor 4, questions 11, 17, and 18. No questions load onto Factor 5. Factor 1 is similar to Intent, but with question 12 removed. Factor 2 is essentially the Expertness factor, but with question 12 added. Factors 3 and 4 are a split of Stigma Tolerance. Note that there is substantial confusion about whether question 13 should be in Factor 2 or Factor 3 (loadings of -0.461 and 0.498 respectively), and mild confusion for questions 3, 11, and 14.

This grouping of factors was then tested using Confirmatory Factor Analysis to see if the RMSEA, TLI, and CFII could be improved. The results are shown in the table 10 below. For this new grouping of factors, the RMSEA was 0.075, TLI was 0.852, and CFI was 0.875, which are better than the previous set of factors, but the model still does not adequately account for the unique responses of the International Saudi students. It is clear that additional exploration of what is unique about Saudi students is warranted.

Table 9.

Factor grouping

– Latent variables

Parameter Estimate

p-value

(Factor 1: BAPS1

Similar to BAPS2

Intent ) BAPS3

BAPS4

BAPS6

1.00 (fixed)

0.90

0.85

0.87

0.72

—

0.000

(Factor 2: BAPS7

Similar to BAPS9

Expertness) BAPS12

BAPS14

BAPS16

1.00 (fixed)

0.81

0.88

0.95

0.87

—

0.000

(Factor 3: BAPS5

Partial BAPS8

Stigma BAPS10

Tolerance) BAPS 13

BAPS15

1.00 (fixed)

1.76

0.77

2.42

1.44

—

0.003

0.038

0.002

0.006

(Factor 4 BAPS 11

Partial St BAPS 17

Tolerance) BAPS18

1.00 (fixed)

0.92

-0.48

—

0.000

Analysis Questions nine through twelve, and questions fourteen and fifteen quantitatively explored the participants’ experiences with counseling and their attitudes towards counseling.

Question nine asked the participants who they received psychotherapeutic services from. Participants were allowed to select more than one response so though there were 54 people who responded. This implies that some participants used more than one type of helper. Twenty seven of the respondents (50.0%) reported that they went to a counselor, twenty two of the respondents (41.0%) stated they went to a psychologist, twelve of the respondents stated they went to a psychiatrist (22.0%), eight went to a family therapist (15.0%), five went to a social worker (9.0%), three participant reported they went to an Imam (6.0%), four participant (7.0%) indicated that nothing stopped him from obtaining psychotherapeutic services. Graph 1 below summarizes the data.

Graph 1:Who the participants received psychological/psychotherapist services from

Three participants selected the “Other” response wrote in:

A life coach,
General physician
I practice counseling sessions

The majority of the participants went to clinics and engaged counselors or psychologists to assist them in their problem solving. This was surprising because Arab Muslims have a tendency to go to imams rather than to professional counselors when facing mental distress. According to Blumberg (2015) people in the Muslim community will first seek out their spiritual leader for help with their personal problems. Ali, Milstein and Marzuk (2005) stated that Muslims have a God-centric view of healing so when Muslims have personal problems they are likely to consult with their imam. However, these results seem to imply that Saudi Arabians in the United States prefer to see counselors followed by psychologists, and that an Imam was least likely to be consulted. The qualitative data did not indicate or hint at why that may be, but it may be related to acculturation or simply availability. For example a counseling center on campus may be easier to access than an Imam. Given that only three person stated they went to see an imam, it could not be determined if the preference to see an Imam was related to age, gender or length of time in the United States.

Question ten asked the participants how satisfied they were with the counseling services. Thirty-nine participants responded. Seven respondents were very satisfied, 23 were satisfied, seven were unsatisfied, two were very unsatisfied. The results indicated that in regard to the participants, that males, people with master’s degrees, married people and people in the 26 – 30 year old age group were more likely to be unsatisfied with the counseling they received than other people were (see graph 2 and 3 below).

Graph 2:Case attributes of participants that were not satisfied with the counseling process.

Graph 3:Close up of age vs. dissatisfaction with the counseling process.

Most of the participants held master’s degrees so this may explain why so many more people with master’s degrees were dissatisfied. The average age of the participants was 28.8% that may be why people dissatisfied with the counseling clustered around the 26-30 year old age group. Since slightly more men than women responded to this question, it would be expected that perhaps slightly more men than women may have been satisfied or dissatisfied with the counseling process. In this case though, as shown on graph 3for the matrix query satisfaction vs. gender, men were about twice as dissatisfied with their counseling experiences than women were.

Question eleven asked where the respondents went for psychotherapeutic services; they were able to choose all that applied. Fifty-four participants responded. Thirty-five participants went to a clinic (65.0%), eight reposed “Other” (15.0%), seven participants went to a hospital (13%), five went to a mosque (9.0%), four had gone for online counseling (7.0%) as shown on graph 4. Those who selected “Other” wrote in the following responses:

My school in US offered
Counselors at classes
Therapists Office
In the school
School health center
Private practices

Graph 4:Where the respondents went for psychotherapeutic services.

Question twelve asked the participants, “What motivated you to seek counseling/psychotherapy services?” Fifty-three of the participants responded.Twenty-eight respondents stated that personal reasons motivated them (53.0%), nine were motived by a physician (17.0%), six of the participants were motivated by their family member (11.0%) and another six selected “Other” (11.0%), two participants stated none of these (4.0%) one person had been recommended to counseling by an Imam (2.0%), and one respondent said they were legally mandated (2.0%) see graph 5.

Three of the six people who chose the “Other” response wrote in the following:

I’m studying mental health counseling, so, we in class make sessions to each other.
Myself
To improve myself

Graph 5:What motivated you to seek counseling/psychotherapy services?”

Question Fourteen all respondents whether they previously attended counseling or not were asked, “If you experience difficult emotional and relational issues how likely are youto seek counseling/psychotherapy services in the future?” In all people responded and 74 of them (36.0%)indicated that they would not, were very unlikely to, or were somewhat unlikely to seek out counseling. 135 respondents (64.0%) were somewhat likely, likely, or very likely to seek out counseling if they experienced difficult emotional and relational issues as shown on graph 6. The men in the study were less likely to seek counseling than the women, 38.72% vs. 30.24%. This is consistent with many other studies that show men are less likely to seek counseling (Winerman, 2005).

Graph 6:“If you experience difficult emotional and relational issues how likely are you to seek counseling/psychotherapy services in the future?”

Question Fifteen wanted to know what kept people in the past from seeking out counseling services. All of the participants were asked and 208 people responded, with one person providing more than one response. The majority of the participants, 93 people (45.0%) stated that nothing kept them from seeking out counseling services,34 participants (16.0%) indicated that shame prevented them from seeking counseling in the past, 33 of the people (16.0%) reported a lack of availability of psychotherapist or counselors kept them from seeking out counseling, 23 participants (11.0%) selected “Other,” 11 participants (5%) reported economic reason had kept them from seeking out counseling, 10 people (5.0%) said family reason kept them from seeking counseling, and 4people (2.0%) indicated religious reasons kept them from seeking out counseling in the past.

Nine of the twenty-three people who chose the “Other” response wrote in the following:

I help people going through their problems.
The reputation of Saudi student seeking mental health in the western world (USA) would be bad for me due to reasons of possible recognition as an instable by the USauthorities.
no time for that
I personally used to think that if I know much about mental conditions; it can backfire in imagining every mental state or emotional state that occurs as a mental issue.
No knowledge
Not familiar in my culture
I don’t think they can help.
I am not really sure about its benefits
Waiting time and long questionnaires.
I didn’t believe I was having a serious problem. I was thinking that what I was facing, was just minor things so no need to see a counselor.
No enthusiasm
I wouldn’t share my issues with strange people.

These were interesting responses. Counselors are trained that in order to help others they need to be in a “good psychological space” themselves, yet the first response given for not seeking out counseling in the past was “I help people going through their problems.” This response came from a 34 year old married male who was probably a master’s degree student in counseling/psychology. This student also indicated that he was very unlikely to seek out counseling for difficult emotional and relational issues. He disagreed with the statements that counselors can help you with your problems; he agreed that seeing a counselor meant you were a weak person, and he slightly agreed with the idea that going to counseling can stigmatize your life. This gives pause to reflect on how many other counselors/helpers think this way, and how do these attitudes impact on the counseling process.

Another compelling response was “The reputation of Saudi student seeking mental health in the western world (USA) would be bad for me due to reasons of possible recognition as an instable by the US authorities. This response came from a 34 year old married male who had a bachelor’s degree. Since 9/11 some Americans have been very vocal about negative feeling they have about people from the Middle East and people who are Muslims. Even the United States presidential hopeful Donald Trump has made incendiary remarks about Muslim people, so it would not be surprising if this comment made by the participant may be reflection of the fears that some students from the Middle East may have about going to counseling. These qualitative responses may also indicate a fear of going to counseling because of possible incrimination related to being from the Middle East or for their religious faith:

I have seen three different psychologists. The first one was very helpful and caring, but I was very worried about what she would think of me because I’m a Muslim student seeking help for depression and sucidal thoughts. (P 3)

I was hesitating to consulate a doctor since I am a Saudi Student here at the USA. but I can’t afford going to Saudi for every time I need to see a psychiatric or therapist. So And after 4 years of not complaining I went to see one month ago when it (the health problem) started to impacted m ability to perform. (P 11)

What may also be important to note in regard these comments is that like the qualitative data, the quantitate data also revealed that culture may play a part related mental help-seeking behaviors and counseling outcome as the comments “Not familiar in my culture,” having “no knowledge” of counseling and “I wouldn’t share my issues with strange people”may all be comments related to culture. These comments, unlike those in the qualitative data section, came from individuals who had not received any counseling services. The first comment is obviously related to culture, whereas the other two are not. Nonetheless, having no knowledge of counseling seems like a comment attributed to someone outside of Western culture where numerous types of counseling and psychotherapy services are offered to students and the public. In Western culture, talking to a stranger, e. g. counselor/other helper is commonplace, but in other cultures talking to strangers about their personal problems is not, for example, Richards, Pennymon and Govere, (2004) found that in Zimbabwe it went against culture to talk to strangers about one’s personal problems.

Counseling and Stigma

Among all the participants, men were more likely to feel uneasy going to counseling because of what some people may think of them, then women were (62.7% vs 37.3%). Among participants who went to counseling, 66.7% males and 33.3% females were more likely to feel uneasy going to counseling because of what some people may think of them. In regard to SQ10, among all the participants, men were more likely to think that having received help from a psychotherapist stigmatizes a person’s life, then women were (57.3% vs 42.7%). Among participants who went to counseling, 66.7% males and 33.3% females were more likelyto think that having received help from a psychotherapist stigmatizes a person’s life.

Table 11:SQ5 Participants attended counseling Table 12:SQ5 All Participants

Table 13:SQ10 Participants attended counseling Table 14:SQ10 All Participants

There was a conspicuous difference between married people and single people who answered these two questions related to stigma. In regard to SQ5, for all the participants 41.1% single people and 58.9% married people would feel uneasy going to a psychotherapist because of what some people might think. For the people who attended counseling, 73.3% of married people and 26.7% of single people reported that they were more likely to think that having received help from a psychotherapist stigmatizes a person’s life. For SQ10, for all the participants, 63.2% married people and 36.8% single people were more likely to think that having received help from a psychotherapist stigmatizes a person’s life. For the people who attended counseling, 66.7% of married people and 33.3% of single people reported that they would feel uneasy going to a psychotherapist because of what some people might think.

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