Diversity as a Barrier to Group Psychotherapy in College

Introduction

According to the Center for Collegiate Mental Health, the psychopathology of college students and their demand for counseling services in university counseling centers (UCCs) has risen substantially over the last decade (Center for Collegiate Mental Health, 2014). There are a number of reasons why this is so. The most significant of these is perhaps that the modern-day college student faces significant psychological concerns in the form of anxiety, depression, substance abuse, suicidal ideation, and a 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 traditional individual psychotherapy in a bid to address rising demand. Peters (2015) was 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 have yet to realize the level of effectiveness inherent in traditional counseling platforms. This is partly because the barriers that deter students from accessing them have yet to be adequately addressed. This paper explores the role of diversity as a potential barrier to group psychotherapy and proposes ways of minimizing its effect and improving overall health outcomes.

The Problem of Diversity in University Counseling Centers

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 particularly concerning given the unprecedented demographic transformation currently underway in the United States. The U.S. Department of Education (2013), for instance, showed that the percentage of ethnic and racial minority 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 shifting demographics, group work in clinical settings still continues to borrow heavily from attachment and psychodynamic theory, whose development was based primarily on white Americans — meaning that things in such group settings continue to be done the "white" way, even as demographic dynamics change.

Most often, these group psychotherapy platforms fail to account for the fact that different demographic groups hold different expectations and cultural values, which shape their worldviews in distinct ways. Separate studies by Harris (2012), Peters (2015), and Suri (2015) were able to show that most minority students either opt out of 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 group therapeutic sessions.

This paper highlights the multicultural issues that shape college students' attitudes toward 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 here inform clinical practice by increasing effectiveness as a professional in a multicultural setting and enabling a more adequate response to the needs of diverse patients. More broadly, the findings stand to make group psychotherapy sessions in UCCs more inclusive and favorable for minorities, thereby increasing accessibility to mental health care and improving overall health outcomes for the community.

Diversity as a Barrier to Group Psychotherapy

Literature has demonstrated that the distress management strategies preferred by college students differ with their diversity variables (Suri, 2015). The distress management strategies that Black students prefer are grounded in their cultural values and differ significantly from those preferred by white students or their Hispanic counterparts. According to Suri (2015), one's preferred distress management style is influenced by the demands of their immediate social environment. 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 is because Black and Latino cultures encourage the establishment of strong familial bonds and trusting social groups more so than white culture does. This presents a potential reason why Black and Latino students are less likely to enroll in UCC psychotherapy sessions.

The situation is compounded when such sessions are conducted in groups consisting predominantly of white students, because minority students find it difficult to build small trusting groups with others whom they feel do not share their interests and cultural beliefs (Peters, 2015). To minimize this effect, practitioners need to ensure that they include a significant number of minority students in their psychotherapy groups so that minorities feel a sense of belonging 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 devise corrective measures for minimizing their inhibiting effect.

Every group therapy participant enters the group with a specific set of expectations for other participants (Suri, 2015). When one is uncertain about whether those expectations will be met, they are likely to refrain from attending. The fear that one's expectations will not be met therefore poses as a barrier to involvement in group psychotherapy (Suri, 2015).

In the context of group therapy, these expectations are often rooted in the concept of racial and ethnic identity. An individual will hold expectations regarding approaches to conflict and group norms, and their continued participation will depend on how well other members of the group meet those expectations. Students will often expect their group members to share the same ethnicity and race because they may feel that such members are more likely to share their cultural value systems and worldviews, and are therefore more likely to provide the support needed to resolve personal problems (Suri, 2015). In the same way, Chinese student-patients may be reluctant to participate in group sessions that include students from countries such as Japan and Vietnam because they fear that historical conflicts may resurface. Suri (2015) was able to show that Chinese and Japanese, Japanese and Korean, and Chinese and Vietnamese 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 such historical factors, which could pose as barriers to effective group psychotherapy.

Beyond the question of group composition, there is also the issue of how group therapy sessions are conducted. Japanese, Black, and Latino students may, for instance, expect that their race or ethnicity is acknowledged at some point during the session (Suri, 2015). Their level of attachment to the group is highly dependent on whether or not this expectation is met. If Black participants feel that the group activities do not give their race and culture meaningful recognition, their degree of participation is likely to decline. Understanding students' expectations in group psychotherapy sessions is therefore crucial to increasing the attractiveness of such sessions.

Just as they hold expectations about their group members, participants in group psychotherapy also hold certain expectations about their group leader. Members will often expect the group leader to modify their strategy or technique to address the challenges and cultural differences inherent in the group. Participants also expect that the group leader will be able to manage conflict effectively to prevent it from escalating and negatively influencing outcomes (Suri, 2015). Diversity variables shape student expectations of leaders just as they do expectations of peers.

For instance, the group leader acts as a symbol of authority — however, whereas white participants may view a white leader as an equal, Asian participants, whose culture demands a distinct separation of authority, would view the leader as an authority figure. Accordingly, Asian participants may expect the leader to maintain clear separation from the rest of the group and employ more directive procedures. White participants, whose culture encourages interaction between leaders and followers and a democratic atmosphere for decision-making, would expect the group leader to freely interact with and rely on other participants for social capital. A leader who behaves in this manner would, however, not align with the expectations of Asian participants, and Asians may therefore disengage from such group sessions.

Similarly, participants across racial and ethnic backgrounds 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, perhaps, to have led a predominantly Black group in the past (Suri, 2015). Notably, while such participants would prefer group members of their own race or ethnicity, they would not necessarily expect the group leader to share that background (Suri, 2015). As Suri (2015) demonstrated, Black, Asian, and Latino participants will often expect the leaders of their group to be white. Failure to meet these client expectations will frequently pose as a barrier to participation or continued involvement in group psychotherapy (Suri, 2015). It is prudent, therefore, that UCC practitioners develop an understanding of their students' expectations of group leaders in order to maximize participation.

The diversity variables of race and ethnicity play a crucial role throughout all stages of a group's operation and must be taken into account accordingly. People are naturally inclined to identify with those 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 prevent a student-patient from forming an identity within a group. Suri (2015) 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. With the growing social emphasis on inclusion and cultural sensitivity, white participants may refrain from expressing their views freely in a racially diverse group setting out of fear that their views may be perceived as insensitive and therefore socially unacceptable (Suri, 2015). If a participant feels that their views are likely to be dismissed as racially motivated and unlikely to receive the validation of other participants, they are less likely to speak their mind during group activity and, consequently, less likely to form an identity within the group.

Similarly, Asian participants may feel uncomfortable asking other participants for assistance or support out of fear of being judged as insufficiently intelligent. Asians are frequently perceived as the "model minority" because they are generally regarded as more educated and hardworking than other minority groups. For instance, it is estimated that 25.2% of the Asian-American population aged 25 and above holds a Bachelor's degree, compared to only 15.5% of the general American population (Perez et al., 2014). This image of Asian academic success can paradoxically make Asian participants in group psychotherapy less confident about voicing their concerns, lest they be seen as the exception to this stereotype. Faced with such pressures, Asian participants may find it challenging to build an identity within the group and may therefore be less willing to engage in the therapeutic process.

Conclusion

Group psychotherapy is increasingly being viewed as an effective alternative to individual psychotherapy, particularly in UCCs, owing to the rising demand for counseling services among college students. Research has shown, however, that for such platforms to succeed, practitioners in UCCs need to develop a thorough understanding of different cultures and the values that govern different cultural groups. Only then will they be able to fulfill the expectations of a diverse student population. This requires engagement in effective cultural competence training, pre-group screening, and continuous learning processes, so that practitioners are equipped to use diversity as a resource for maximizing the health outcomes of their student-patients.

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