Theoretical implications

The main goal of this study was to investigate the relevance of the theory of individual traditionality-modernity for understanding individual differences in attitudes towards counseling and indigenous healing in Taiwanese university students. Past research has found that the theory of individual traditionality-modernity is useful for

understanding a wide range of phenomena related to societal modernization in Taiwan.

The results of this research indicate that individual traditionality-modernity is a relevant framework for understanding help-seeking.

A key contribution of this study was providing preliminary evidence that help-seeking attitudes are related to individual-level traditionality and modernity. Assuming we found the relationship we expected in hypothesis one, we also aimed to further investigate this relationship, including the relationship between different help-seeking attitudes, traditionality, and modernity, as well as identifying mediating variables.

As hypothesized, traditionality was associated with greater perceived value of indigenous healing. This finding is consistent with rationale two. In our additional analyses, we found that Submission to Authority was the only factor of MSCIT-BF that significantly predicted perceived value of indigenous healing. Submission to Authority refers to a set of trusting, respectful, and obedient attitudes towards authority in society and interpersonal relationships (Yang et al., 1991). In collectivistic cultures, healers are often elders or other authority figures who are respected because of their insight into human behaviors and ability to heal (Sue & Sue, 2012), so individuals with a trusting or respectful attitudes towards indigenous healers may believe that indigenous healers are wise and have the ability to heal, and therefore perceive a high value of utilizing indigenous healing.

Contrary to expectations, we found that traditionality was associated with greater perceived stigma of indigenous healing. One explanation for this finding is that traditionality may be associated with a general tendency to avoid any help-seeking outside the family. Consistent with this explanation, we found that traditionality was also associated with negative counseling attitudes. In our additional analyses, we found that Fatalism and Defensiveness, and Male Dominance were the only factors of

MSCIT-BF that significantly predicted indigenous healing stigma. Fatalism and Defensiveness describes an attitude of avoiding trouble, protecting and benefiting only oneself and one’s family (Yang et al., 1991). This finding is also consistent with the above

explanation. Fatalism and Defensiveness is an aspect of traditionality closely associated with avoiding trouble, especially in the context of one’s family, and it predicts stronger stigma towards indigenous healing.

As expected, we found that traditionality was associated with more negative counseling attitudes. This result is consistent with rationales one and five. Similar to the explanation proposed above, traditionality may be related to a desire to avoid any help-seeking outside the family. The same two factors of MSCIT-BF that significantly

predicted indigenous healing stigma (Fatalism and Defensiveness, and Male Dominance) also significantly predicted negative counseling attitudes, lending support for this

explanation.

For an explanation of the finding that Male Dominance significantly predicted greater indigenous healing stigma and more negative counseling attitudes, we turn to the concept of male gender role socialization. Males are commonly socialized according to a set of values and beliefs about masculinity and appropriate male behaviors that

includes restrictive emotionality, competition, rationality, and fear of dependence (Gilbert & Scher, 1999; O’Neil, 1981). Male gender role socialization is associated with resistance to seeking psychological help, including negative counseling attitudes and lower rates of help-seeking behavior (Good, Dell, & Mintz, 1989; Good & Wood, 1995).

In the present study, it is possible that among male participants, higher endorsement of Male Dominance was associated with more stigmatizing attitudes towards help-seeking for the reasons described above. However, it is unclear whether this relationship exists in our study for males, females, both, or neither.

Higher degrees of modernity were associated with reduced perceived stigma of indigenous healing, but not significantly related to perceived value of indigenous healing. This finding suggests that higher levels of modernity may lead individuals to have a greater acceptance of help-seeking from indigenous healers, but not perceive it as more or less effective. This may be related to the tolerating-of-others orientation

described by Yang (2003) as a conceptual category of Chinese individual modernity, and also the Egalitarianism and open-mindedness factor of MS-CIM (Yang et al., 1991).

Finally, as expected, modernity was associated with more positive counseling attitudes. This finding is consistent with rationales one, three, and four. This finding it implies that counseling-related attitudes and behaviors are functional-specific

psychological characteristics, and are therefore (during the process of societal modernization in Taiwan) becoming increasingly similar to the relatively positive counseling attitudes found in more modernized countries such as the United States. This finding also suggests that the relationship between Taiwan’s societal modernization and the growth of the field of counseling in Taiwan corresponds with a similar relationship on the individual level. This relationship may be due to an increasing degree of match between the culture-bound values of counseling and the values associated with

modernity in Taiwan.

The results of the present research also have implications for understanding how traditionality-modernity is related to help-seeking attitudes. Specifically, we identified Anticipated utility and Self-Stigma as significant mediators of the relationship between modernity and counseling attitudes. For possible explanations of why anticipated utility was a significant mediating variable, we refer to discussions on the importance of symbolic language (Yee, 2005) and explanatory models (Kleinman, 1980) in influencing health- and help-seeking. Yee proposed that the psychological language

used in counseling is different from the symbolic language commonly used in

traditional Taiwanese communities. Yee believes that the field of counseling in Taiwan has been unable to provide a culturally-appropriate symbolic language for intra-psychic events, and as a result, the acceptance of counseling is limited. Characteristics of societal modernization in Taiwan include increased reliance on science and technology, secularization of religion, and increased pluralism (Yang, 2005). It’s possible that trough the process of societal modernization, the traditional symbolic language used for understanding intra-psychic and interpersonal phenomena are being replaced by more modern symbolic languages more consistent with those upon which counseling is based.

High-modernity individuals may perceive that the symbolic language of counseling corresponds with the symbolic language they themselves use, resulting in an expectation that counseling can be useful for addressing one’s distress, and finally more positive attitudes towards counseling.

In addition, Kleinman (1980) argued that explanatory models (EM) are important factors in determining help- and health-seeking behaviors. EM refer to clients’ and healers’ beliefs about the etiology, symptoms, course, and treatment of illnesses (Kleinman). Like traditionality-modernity, EM are also strongly influenced by social and cultural contexts. Kleinman observed a number of situations in which

differences in the patient’s or healer’s traditional or modern/Western EM resulted in impaired clinical outcomes, and concluded that degree of match between the client’s and healer’s EM strongly influences their communication and the success of the treatment. Thus, it’s possible that modernity is associated with stronger belief in

counseling-compatible EM, which results in higher anticipated utility of counseling and more positive counseling attitudes.

The second significant mediator was the self-stigma associated with seeking help from a counselor. We found higher traditionality to be associated with greater counseling social and self-stigma, and greater indigenous healing stigma. In contrast, modernity was associated with lower counseling social and self-stigma, and lower indigenous healing stigma. Thus, it appears that modernity is related to a generalized reduction of help-seeking stigma, while traditionality is associated with a generally high stigma of any sort of help-seeking. This is consistent with research among

Asian-Americans that has found that endorsement of traditional Asian values is associated with stronger counseling stigma (Miville & Constantine, 2007; Shea & Yeh, 2008).

However, in the present study, the only significant stigma-related mediation effect was of self-stigma on the modernity-counseling attitudes relationship, suggesting that only the reduction of internalized self-stigma is responsible for leading to more positive counseling attitudes. We also found that social stigma and self-stigma significantly mediated the relationship between traditionality and indigenous healing stigma. This result is difficult to interpret. The measures of social stigma and self-stigma used in this study clearly referred to seeing a counselor or psychologist, while the measure of indigenous healing stigma refers to the stigma of seeing an indigenous healer. One possibility is that these variables are related to each other because they reflect a generalized stigma towards seeking help. In this case, the observed mediation effects may be due to conceptual overlap between variables rather than a true mediation effect.