Diversity as a Barrier to Group Psychotherapy

Diversity as a Barrier to Group Psychotherapy According to the Center for Collegiate Mental Health, the psychopathology of college students, and their demand for counseling services in university college centers (UCCs) has risen substantially over the last decade (Center for Collegiate Mental Health, 2014). Well, there are number of reasons why this is so. The most significant of these perhaps is that the modern-day college student faces significant psychological concerns in the form of anxiety, depression, substance abuse, suicidal ideation, and history of hospitalization resulting from lifestyle factors.

It is reported, for instance, that between 15 and 20% of college students today suffer from depressive symptoms, compared to between 5 and 6% ten years ago (Center for Collegiate Mental Health, 2014). For this reason, most UCCs have adopted and expanded the use of group psychotherapy platforms as an alternative to the traditional individual psychotherapy in a bid to address the rising demand.

Peters (2015) was in fact, able to show that in addition to addressing the issue of increasing demand, group psychotherapy platforms accord student-patients an opportunity to receive reinforcement from peers on how to form their adult identities. Worryingly, however, research has shown that these group psychotherapy programs are yet to realize the level of effectiveness inherent in the traditional counseling platforms. This is partly because the barriers that deter students from accessing the same are yet to be adequately addressed.

This text is intent on exploring the role of diversity as a potential barrier to group psychotherapy, and devising possible ways of minimizing its effect and improving overall health outcomes. The Problem As already mentioned, UCCs are expanding their use of group psychotherapy in counseling owing to its effectiveness in increasing access and providing developmental opportunities to student-patients. However, Lee (2014) and Peters (2015) were able to show that ethnic and racial minorities are less likely than their majority counterparts to attend such groups when referred by their physicians.

This is at the least dangerous, given the unprecedented transformation that the country is currently undergoing in its demographic make-up. The U.S. Department of Education (2013), for instance, showed that the percentage of ethnic and racial college students aged 25 and above had risen substantially over the last decade, while that of their white counterparts had declined by approximately 23%. Despite these diverse demographics, however, group work in clinical settings still continues to borrow heavily from attachment and psychodynamic theory, whose development was based primarily on white Americans.

This only implies that things in such group settings continue to be done the 'white' way, even as the demographic dynamics change. Most often, these group psychotherapy platforms fail to take into account that different demographic groups have different expectations and cultural values, which shape their worldviews differently. Separate studies by Harris (2012), Peters (2015) and Suri (2015) were able to show that most minority students either opt out or fail to participate at all in group psychotherapy because they feel that the group activities do not address their specific cultural needs.

It is important, therefore, that professionals in UCCs adequately understand the role of culture in shaping college students' expectations and attitudes about group psychotherapy; only then will they be able to respond effectively to the specific needs of their diverse student base in their group therapeutic sessions. The subsequent subsections are focused on showing how diversity acts as a barrier to effective utilization of group psychotherapy by college students.

Significance This text highlights the multicultural issues that shape college students' attitudes towards group psychotherapy with the aim of providing insight to UCCs and Student Affairs professionals on how to attract and retain minority students in such programs. The facts and findings presented herein shape my very own clinical practice as an individual as they increase my effectiveness as a professional in a multicultural setting and place me in a better position to respond adequately to the needs of my patients.

Generally, the findings will go a long way in making group psychotherapy sessions in UCCs more inclusive and favorable for minorities, and this will increase accessibility of mental care and improve the overall health outcomes of the community. Diversity as a Barrier Differences in Distress Management Strategies Literature has demonstrated that the distress management strategies preferred by college students differ with their diversity variables (Suri, 2015).

In other words, the distress management strategies that black students prefer are based on their cultural values and differ significantly from those preferred by white students or their Hispanic counterparts. According to Suri (2015), this is due to the fact that one's preferred distress management style is influenced by the demands of their immediate social environment (Suri, 2015). For instance, research has shown that black and Hispanic students, unlike their white counterparts, are more likely to seek out familial and religious support when facing situations of distress (Suri, 2015).

This, as Suri (2015) points out is because black and Latino cultures encourage the establishment of strong familial bonds and trusting social groups more than the white culture does. This poses as a potential reason why black and Latino students are less likely to enroll in UCC psychotherapy sessions. The situation is even worse if such sessions are conducted in groups consisting of predominantly white students because then, these students find it difficult to build small trusting groups with others whom they feel share their interests and cultural beliefs (Peters, 2015).

To minimize this effect, practitioners need to ensure that they include in their psychotherapy groups a significant number of minority students so that minorities feel like they belong and have the means to form trusting social groups as is part of their cultural norm (Suri, 2015). This, however, begins with understanding the distress management strategies likely to be preferred by students of different cultures; only then can UCC practitioners be able to devise corrective measures for minimizing the effect of the same.

Differences in Expectations of Group Members Every group therapy participant enters the group with a specific set of expectations for other participants (Suri, 2015). When one is unsure or uncertain about their expectations being met, they are likely to refrain from attending the same. Having a fear that one's expectations will not be met, therefore, poses as a barrier to one's involvement in group psychotherapy (Suri, 2015). In the case of group members, these expectations will often be based on the concept of racial and ethnic identity.

An individual will have expectations in regard to approaches to conflict or even group norms, and their continued participation in the group will depend on how well other members of the group meet these expectations. Students will often expect their group members to be people who share the same ethnicity and race as themselves because they may feel that such members are more likely to share in their cultural value systems and worldviews, and are more likely, therefore, to provide the requisite support needed to resolve their personal problems (Suri, 2015).

In the same way, Chinese student-patients may shun from taking part in group sessions that include students from such countries as Japan and Vietnam because they fear that conflict could erupt (Suri, 2015). Suri (2015), for instance, was able to show that Chinese and Japanese, Japanese and Korean, and Chinese and Vietnam students may not collaborate effectively in a group therapy session because of the historical and sociopolitical backgrounds of their countries.

It is prudent, therefore, that practitioners in UCC settings increase their awareness of historical factors such as these, which could pose as barriers to effective group psychotherapy. Besides the composition issue, there also is the issue of how group therapy sessions are conducted. Japanese, black, and Latino students may, for instance, expect that their race or ethnicity is brought up at some point during the session (Suri, 2015). Their level of attachment to the group, in this case, is highly dependent on whether or not this expectation is met.

If black participants feel, for instance, that the group activities do not give their race and culture significant recognition, their degree of participation is likely to dwindle. Understanding students' expectations in group psychotherapy sessions is, therefore, crucial towards increasing the attractiveness of such sessions to students. Differences in Expectations of Group Leaders Just as they hold expectations about their group members, participants in group psychotherapy also hold certain expectations about their group leader.

For instance, members will often expect their group leader to modify their strategy or technique to deal with challenges and cultural differences inherent in the group. Moreover, participants have an expectation that the group leader will be able to deal effectively with conflict to ensure that it does not escalate and influence outcomes negatively (Suri, 2015). Diversity variables shape student expectations in this case just as they do in the case of group members.

For instance, the group leader acts as a symbol of authority -- however, whereas white participants may view a white leader as an equal, Asians (whose culture demands distinct separation of authority) would view them as an authority figure. Towards this end, Asian participants may expect the leader to separate himself from the rest of the group and employ autocratic procedures to see it (the group) realize its outcomes.

Whites, on the other hand, whose culture encourages the mingling and interaction of leaders and followers, and a democratic atmosphere for decision-making, would expect the group leader to be one who freely interacts with, and relies on other participants for social capital. A leader who behaves in this manner would, however, not be in line with the expectations of Asian participants and hence, Asians may shun from such group sessions.

In the same way, participants, regardless of race and ethnicity, would expect the group leader to understand the core concepts of their cultural values. Black participants will often expect the group leader to have some understanding of black culture, and to perhaps have led a black team in the past (Suri, 2015). Moreover, in as much as such participants would love for other participants in the group to be members of their own race and ethnicity, they would often not expect the group leader to be of the same race (Suri, 2015).

In this regard, as Suri (2015) demonstrated, black, Asian, and Latino participants will often expect the leaders of their group to be white. Failure of groups to meet these client expectations will often pose as a barrier to their participation or continued involvement in group psychotherapy (Suri, 2015). It is prudent, therefore, that UCC practitioners understand their students'; expectations of group leaders so as to be able to maximize their participation in group psychotherapy.

The Inability to develop an Identity The diversity variables of race and ethnicity play a crucial role in this case, and need to be taken into account at all stages of the group's operation. People are naturally conditioned to want to identify with the things or people that they interact with -- a group's failure to offer this kind of identity poses as a barrier to effective group psychotherapy (Suri, 2015). There are a number of diversity-related elements that could hinder a student-patient from forming an identity in group psychotherapy.

Suri (2015), for instance, was able to show that white students may be prevented from forming such identities by the fear of being judged by participants from other races or ethnicities. According to the author, with all the emphasis being placed on making Americans more inclusive of other races and diverse cultures, white participants may shun from expressing their views freely in a racially-diverse group setting because they fear that such views may be taken as being insensitive and hence, socially unacceptable (Suri, 2015).

If a participant feels that their views are likely to be dismissed as racial, and are not likely to receive the validation of other participants, they are less likely to speak their mind during group activity, and hence, less likely to form an identity in the group. In the same way, Asian participants would be uncomfortable asking other participants for assistance or support in the fear of being judged as not being intelligent enough.

Asians are perceived as the 'model minority' because they are generally more educated and hardworking than other minority groups and the American population as a whole. For instance, it is estimated that 25.2% of the Asian-American population aged 25 and above possesses a Bachelor's degree, compared to only 15.5% of the general population in America (Perez et al., 2014).

These figures paint an image of Asian success that makes Asian participants in group psychotherapy less confident about voicing out their views, so they are not judged as 'the black sheep' that is not as intelligent as the rest of the population. Faced with such stereotypes, Asian participants may find it rather challenging to build an identity in group psychotherapy, and hence, they may be less willing to take part in the same.

Addressing Barriers to Effective Group Psychotherapy in UCCs This section outlines the specific measures that counseling professionals in UCCs could take to minimize the negative effects of diversity and ensure that group psychotherapeutic processes run smoothly, yielding positive health outcomes for the diverse student base. Pre-Group Screening Pre-group screening has been identified as an important step in the creation of unity and cohesion among teams and groups in therapy (Slone et al., 2015).

It entails selecting group members based on their suitability to fit and identify positively with other members of the group (Slone et al., 2015). Pre-group screening increases the likelihood that participants will be assigned appropriately to groups that best fit their cultural values and expectations (Slone et al., 2015). There is no exclusive and exhaustive selection criterion in this regard; group leaders will be forced to engage the potential members in some form of interview, and then select or deselect them based on their values and expectations.

Research has shown that minorities will often expect other participants in the group to be of the same race or ethnicity so that they are able to form an identity -- group leaders could rely on this as a criterion for selecting who to include and who not to include in their group. In this regard, group leaders could ensure that there is an acceptable number of same-race (same-ethnicity) participants so that individual participants have an acceptable number of persons to identify, and form a trusting social group with.

Slone and her colleagues (2015) found such screening at the initial stages of group formation to go a long way in minimizing the risk of premature dropouts while at the same time increasing the chances of positive health outcomes for participants. Their view is supported by Suri (2015), who demonstrated that "a greater group bond and/or cohesion forms amongst group members, when the group members" are properly-screened and prepared (p. 62).

Leadership Training Literature has shown the fear of being judged or stereotyped to be a significant barrier to student-patients' continued participation in group psychotherapy. Moreover, there is no way that a group leader would be able to work with people of diverse racial and ethnic backgrounds if they are not appreciative of races and ethnicities other than their own.

Towards this end, there is need for leaders to be engaged in training and outreach services meant to increase their understanding about different ethnicities and cultures, and the values that govern different groups. This will give leaders a clearer view of what to expect of members of other cultures, and will open up avenues for them to pass the same over to the participants in their group.

Continuous Learning through Information Technology Psychologists, like any other professionals in the medical industry, have a duty to engage in continuous learning in a bid to ensure that they remain relevant amidst the changing dynamics of the medical industry. Medical professionals need to engage in continuous learning to improve their understanding of among other things, cultural diversity. Advancement in technology has made the process of continuous learning.