Suggestions for future research

The relationship between traditionality-modernity and help-seeking attitudes found in this study deserves further investigation. One important direction for future research is investigating whether traditionality-modernity are related to actual help-seeking behaviors. In this study, modernity was associated with positive counseling attitudes and lower indigenous healing stigma, so modernity should predict more frequent utilization of both counseling and indigenous healing. Traditionality was associated with negative counseling attitudes and an inconsistent relationship with

indigenous healing attitudes, so it should predict less frequent utilization of counseling, but may be unrelated to indigenous healing utilization.

However, it is also possible that future research will find a weak or non-existent relationship between modernity and counseling utilization because of idea-behavior dissociation (Yang, 1998). Idea-behavior dissociation means that during the process of societal modernization, ideas may change faster than their corresponding behaviors, resulting in a temporary dissociation between ideas and actual behaviors: “In the process of modernization, social change exerts a pressure for many traditional ideas and/or behaviors to change. However, because of the high observability and easy social monitoring of the behavior, direct behavioral change would be rather difficult” (Yang, 1998, p. 81). The relatively strong stigmatization of help-seeking in Chinese societies may result in a pattern where modernity causes relatively fast changes in counseling attitudes, but has a delayed effect on counseling utilization.

Future research can also further investigate mediating variables in the

relationship between traditionality-modernity and help-seeking. This study found that Anticipated utility and SSOSH significantly mediated the relationship between

MSCIM-BF and ATSPPH-SF. However, they only accounted for a small proportion of the effect (the estimated mediation effect coefficients are 0.023 and 0.021, respectively).

If future research can identify other mediating variables, this would enable researchers to have a more complete understanding of the processes by which traditionality-modernity influences help-seeking attitudes. Earlier in this chapter, we discussed the possible roles that symbolic language (Yee, 2005) and explanatory models (Kleinman, 1980) may play in the relationship between traditionality-modernity and help-seeking.

Other possible mediating variables include knowledge about counseling, ability to

afford counseling services, and local availability of counseling services (e.g., Kung, 2003).

Future research can utilize latent class analysis to identify subgroups within the sample, then analyze the relationships between variables subgroup by subgroup. This approach may provide a more accurate representation of the true relationships between variables than provided by only analyzing the relationships between variables within the sample as a whole. The independent variables in this study were unique yet

conceptually related, and both are comprised of multiple factors. Considering the complexity of the independent variables, and the fact that we are interested in understanding the help-seeking behaviors of different "types" of people, using latent class analysis may be a powerful way to find salient groupings of participants.

Future research should also consider the broad range of interventions found in counseling and psychotherapy, which vary on dimensions such as directive or non-directive, individual or family orientation, and past or present emphasis. Traditionality includes authoritarian orientation, familistic orientation, and past orientation (Yang, 2003), so it may be associated with more positive attitudes towards directive, family-oriented, or past-emphasis interventions. For example, Hodges and Oei (2007) found a high degree of compatibility between Chinese values and the directive, didactic nature of cognitive-behavioral therapy. Modernity includes egalitarian and self-expressive orientations (Yang), so higher levels of modernity may be related to more positive attitudes towards non-directive or individual-oriented approaches such as

psychodynamic and humanistic interventions.

Finally, future research can begin to investigate the relationship of traditionality-modernity to help-seeking in societies besides Taiwan. Yang’s theory of individual traditionality-modernity assumes that societal modernization is a process through which

all societies proceed at different rates. Thus, this theory is a framework for

understanding the individual-level changes that members of all modernizing societies experience in the process of societal modernization. Professional mental health services such as counseling appears to be linked with the process of societal modernization in a country (e.g., Gernstein et al., 2011). In many modernizing societies, counseling co-exists with the established indigenous healing systems of that society. As counseling is a profession closely linked with modernization, individuals with higher modernity should be more likely to utilize and benefit from counseling. Similarly, as indigenous healing is well-integrated in traditional social worlds, individuals with higher traditionality should be more likely to utilize and benefit from indigenous healing. A similar perspective was advanced in Kleinman’s model of modernization’s influence on

help-seeking behaviors. Kleinman (1980, p. 37) explained changing health care help-seeking behaviors in modernizing societies with reference to the socially constructed and culturally embedded nature of health care systems. Social realities and cultural contexts influence health care systems and health-related behaviors. Modernization causes a transformation of social reality via introduction of new worldviews, values, and institutions. These changing social realities in turn alter health care systems and health-related beliefs and behaviors. Future research may benefit from investigating if and how traditionality-modernity is related to help-seeking in other countries.