Introduction

Professional mental health services such as counseling are an important resource for people suffering from mental illnesses, having difficulty adjusting or coping, or struggling with a search for meaning. Mental illnesses are a major contributor to the global burden of disease (Lopez, Mathers, Ezzati, Jamison, & Murray, 2001), and result in negative outcomes for individuals, families, and societies. Previous research has identified a high level of unmet need for mental health care around the world (Heppner, Leong, & Gerstein, 2008). In Taiwan, the prevalence of common mental disorders rose rapidly from 11.5% in 1990 to 23.8% in 2010, paralleling an increase in unemployment, divorce, and suicide over the same period (Fu, Lee, Gunnell, Lee, & Cheng, 2013).

Taiwanese aged 18 to 24 have significantly higher levels of depression than other age groups (Yeh & Lin, 2006). Taiwanese university students’ psychological distress is mainly related to relationships, emotions, career planning, and academic performance (Lin, 2002).

Mental illnesses are generally treatable, so providing effective psychological help for this and other populations is essential (Gulliver, Griffiths, Christensen, &

Brewer, 2012). The field of counseling appears to be playing a limited role in responding to this need. Globally, the majority of individuals who experience

psychological distress do not seek help from a counselor (Andrews, Issakidis, & Carter, 2001). Seeking counseling is often seen as a last resort (Hinson & Swanson, 1993; Lin,

2001b) and is commonly used only after informal help seeking has failed to be effective (Wills, 1992). The mean delay of seeking help from a counselor after the onset of mental illness is over ten years (Wang, Berglund, Olfson, & Kessler, 2004). Ethnic Chinese utilize professional mental health services less frequently than informal help, indigenous healing, and help from medical doctors (Kung, 2003; Mo & Mak, 2009; Tsai, Teng, & Sue, 1981).

Multicultural counseling offers a valuable perspective for understanding these important findings. Multicultural counseling emphasizes the importance of considering how cultural diversity impacts the counseling profession (Pedersen, 1999). Counseling developed in the context of white, middle- and upper-class social worlds of Western countries, and it appears that these mainstream Western values have deeply shaped counseling practice and research, including the theories, interventions, goals, and definitions of mental health and illness employed in counseling (Norsworthy, Heppner, Aegisdottir, Gerstein, & Pedersen, 2009; Sue & Sue, 2012) These culture-bound values in counseling appear to have significantly affected its ability to provide services to culturally diverse groups (Sue & Sue; Uba, 1994), and contributed to difficulties indigenizing counseling into Taiwan’s socio-cultural context (Chen, 2003; Leung &

Chen, 2009).

The diverse indigenous healing practices found in many cultures throughout the world present an opportunity to more effectively meet the mental health needs of culturally-diverse clients (Constantine, Myers, Kindaichi, & Moore, 2004).

Anthropologists have known that indigenous healing systems are embedded in local social worlds, share common worldviews and explanatory models for illnesses with clients, and are sensitive to individuals’ social and cultural contexts (e.g., Kleinman, 1980). Sue and Sue (2012) argue that by ignoring, delegitimizing, and failing to

integrate indigenous healing systems into mainstream healing systems, the field of counseling is missing a valuable opportunity to more effectively serve culturally diverse populations. Although the field of counseling psychology has acknowledged the role of indigenous healing in treating psychological distress, much progress remains to be made in research and practice.

In Taiwan, counseling and indigenous healing exist side-by-side. Counseling is a relatively new profession that is playing an increasingly important role in treating mental health problems. Counseling co-exists with a wide variety of indigenous Taiwanese healing systems such as fortune telling, religious rituals, shamanism, and Traditional Chinese Medicine that are deeply integrated into local cultural worlds (Yee, 1986).

Given the diversity and wide availability of indigenous healing, counseling researchers and practitioners in ethnic Chinese societies should work to better

understand the role that indigenous healing play, and find ways to integrate these with counseling interventions (Leung & Chen, 2009). To effectively respond to the mental health needs of culturally diverse groups of Taiwanese, it is essential for counseling researchers and practitioners to better understand how counseling, which includes an understanding of how counseling is integrated into Taiwanese cultural worlds and medical systems, how people view and evaluate counseling services, and what role counseling plays in individuals’ illness and help-seeking behaviors.

An important step in this direction is investigating the individual-level

psychological variables that are associated with utilization of counseling and indigenous healing. For mental health care professionals, understanding the factors that influence service utilization is important to more effectively provide services to those in need (Komiya, Good, & Sherrod, 2000). Past research has investigated psychological and

demographic factors that influence counseling attitudes and utilization, both in Taiwan (e.g., Wang, 2010) and internationally (e.g., Nam et al., 2013). In contrast, while there is some research on utilization of indigenous healing in Taiwan, there is much less

research on psychological factors associated with the utilization of indigenous healing.

The theory of individual traditionality-modernity (Yang, 2003) presents an intriguing possibility for better understanding help-seeking in Taiwan. This theory addresses the individual-level psychological changes that occur in Taiwanese people during the process of societal modernization. Because counseling is closely linked to societal modernization, modernity may be related to individuals’ orientations towards counseling, and since indigenous healing is closely associated with traditional culture, traditionality may influence orientations towards utilization of indigenous healing.