臺灣大學生個人傳統性/現代性與對諮商、民俗療法的求助態度之相關及其中介效果探討研究

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(1)國立臺灣師範大學教育心理與輔導學系碩士論文. 指導教授：陳秉華博士、林世華博士. 臺灣大學生個人傳統性/現代性與對諮商、民俗療法的求助態度之相關及其中介效果探討研究. 研究生：Michael John Mullahy 撰. 中華民國一百零四年六月.

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(3) Department of Educational Psychology and Counseling National Taiwan Normal University Master’s Thesis. Advisors: Dr. Ping-Hwa Chen and Dr. Sieh-Hwa Lin. Taiwanese university students’ individual traditionality-modernity and attitudes towards counseling and indigenous healing. Michael John Mullahy. June, 2015.

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(5) Acknowledgements Thanks to my family for your support and advice from afar. Thanks to my all my friends and classmates in Taiwan for all the direct and indirect ways you helped me during the time I wrote this thesis. To everyone who completed the questionnaires, thank you for your time and willingness to participate. Special thanks to Professors Christine Yeh and Bruce Wampold for your valuable help as I struggled through the beginning stages of this research. Finally, thanks to my two fantastic advisors for your guidance, encouragement, and patience over the last few years.. i.

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(7) 摘要在台灣本土文化場域，民俗療法已具備完整的體系與規模，且經常用來處遇個人心理方面的困擾。相較之下，台灣心理諮商專業的發展歷史較短，學者普遍認爲諮商專業內涵深受西方文化的價值觀影響，在臺灣文化脈絡中，顯得格格不入。在台灣本土發展的個人傳統性/現代性理論常被用來解釋社會層級的現代化與個人層級的傳統性/現代性的雙向關係。本研究旨在探討台灣大學生的傳統性/ 現代性在解釋其心理諮商/民俗療法求助態度的適用性，進而探討上述解釋關係可能的中介變項。本研究主要採用典型相關分析與多元中介分析兩種方法來處理 223 位研究對象在問卷上的反應資料。主要獲得的研究結果如下：（一）兩組傳統性/現代性的線性組合分數與心理諮商/民俗療法求助態度的線性組合分數均達統計顯著水準。（二）典型相關分析結果顯示： a. 傳統性分數與所知覺求助民俗療法價值分數、所知覺求助民俗療法羞恥分數呈現正相關；與求助心理諮商分數呈現負相關。 b. 現代性分數與求助心理諮商分數呈現正相關與所知覺求助民俗療法羞恥分數呈現負相關。（三）預期效益分數與自我污名感分數可以顯著地中介解釋現代性分數與求助諮商態度之間的關係。社會污名感分數與自我污名感分數可以顯著地中介解釋傳統性分數與求助民俗療法的污名感之間的關係。本研究進一步討論研究發現對於學理的意涵、與諮商實務的關聯、後續研究可能的建議、與本研究的限制。. 關鍵字：求助行爲、求助態度、民俗療法、個人現代性/傳統性. iii.

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(9) Abstract In Taiwan, indigenous healing is frequently utilized for treating physical and psychological distress, is well-integrated into local cultural worlds. In contrast, the field of counseling wasn’t legally established in Taiwan until 2001, and contains Western culture-bound values that may conflict with Taiwanese cultural values. The theory of individual traditionality-modernity was developed to explain the individual-level psychological changes in members of societies undergoing modernization. The purposes of this study were to explore the utility of traditionality-modernity in explaining Taiwanese university students’ attitudes towards counseling and indigenous healing and to investigate possible mediation effects in this relationship. Questionnaire data from 223 Taiwanese university students were analyzed using canonical correlation analysis and latent variable analysis (lavaan). The main results were: (1) The linear composite of traditionality and modernity had two significant canonical correlations (one large effect and one small effect) with the linear composite of counseling attitudes, indigenous healing value, and indigenous healing stigma. (2) The results of the canonical correlation analysis showed: a. Traditionality was associated with greater perceived value of indigenous healing, greater perceived stigma of indigenous healing, and more negative counseling attitudes. b. Modernity was associated with more positive counseling attitudes and reduced perceived stigma of indigenous healing. (3) The relationship between modernity and counseling attitudes was significantly mediated by anticipated utility and self-stigma, and the relationship between. v.

(10) traditionality and indigenous healing stigma was significantly mediated by social stigma and self-stigma. Theoretical implications of these findings, relevance for counseling practice, suggestions for future research, and limitations of this study are discussed.. Keywords: help-seeking, counseling attitudes, indigenous healing, individual traditionality-modernity. vi.

(11) Table of Contents Acknowledgements…………………………………………………………………… i Chinese Abstract…………………………………….………………………………… iii English Abstract. ……………………………………….…………………………….. v Table of Contents……………………………………….…………………………….. vii List of Tables………………………………………………...……………………….. ix List of Figures………………………………………………...………………………. xi Chapter 1: Overview…………………………………………...……………………... 11 1.1. Introduction……………………………………………...……………........... 11. 1.2 Purpose of the study…………………………………………………………. 14 1.3 Significance of the study……………………………………………….......... 15 1.4 Research questions…………………………………………………………... 16 1.5 Hypotheses …………………………………………...……………………… 16 1.6 Definitions…………………………………………...………………………. 17 Chapter 2: Literature Review…………………………………….…………………… 11 2.1 Help-seeking in Taiwan’s socio-cultural context…………..………….......... 11 2.2 The theory of individual traditionality-modernity…………………………… 24 2.3 The relationship between traditionality-modernity and help-seeking……….. 31 Chapter 3: Methodology……………………………………………………………… 45 3.1 Research framework.……………………………………………………........ 45 3.2 Participants…………………………………………..…………………........ 45 3.3 Instruments…………………………………………………………………... 50 3.4 Procedure…………………………………………………………………….. 62 3.5. Data analyses………………………………………………………………… 63. vii.

(12) 3.6 Data screening…………………………………………..…………………... 165 Chapter 4: Results………………………………………………….……………........ 167 4.1 Main analyses……………………………………………………………...... 167 4.2 Additional analyses………………………………………………………..... 175 Chapter 5: Discussion…………………………………………...……………............ 177 5.1 Theoretical implications…………………………………………………….. 177 5.2. Relevance for counseling practice ………………………………….............. 182. 5.3 Suggestions for future research……………………………………………... 184 5.4 Limitations…………………………………………………………………...187 5.5. Summary and conclusions…………………………………………………... 189. References……………………………………………...…………….......................... 191 Appendices……………………………………………..………………..................... 113 Appendix A: Permissions to use measures………..………………………………113 Appendix B: Invitation email for permission to distribute questionnaires……..... 119 Appendix C: Script for verbal instructions to participants……………………..... 120 Appendix D: Pilot Study Questionnaire………………………………………...... 121 Appendix E: Main Study Questionnaire………………………………………..... 128. viii.

(13) List of Tables Table 2-1 Core characteristics of individual modernity across cultures…………………………. 27 Table 2-2 Conceptual categories of Chinese individual traditionality and modernity………….. 29 Table 2-3 Practicing licensed medical personnel in Taiwan………………………..…………… 34 Table 3-1 Demographic characteristics of pilot study participants……………………………... 47 Table 3-2 Demographic characteristics of main study participants…………………………….. 49 Table 3-3 Summary table of exploratory factor analysis of ATIHS using principal axis factoring....…………….……………….………………….………………………….. 56 Table 3-4 Means, standard deviations, and zero-order correlations among variables…………. 66 Table 4-1 Zero-order correlations between indicators in the canonical correlation model……. 68 Table 4-2 Correlations and standardized canonical coefficients for the first (χ) and second (η) canonical variates…………………………….…………….…………….…………... 68 Table 4-3 Test of the overall mediating effect from two IVs to three DVs.……………………… 73 Table 4-4 Tests of mediation effects from each IV to each DV.…………………………………. 74 Table 4-5 Tests of individual mediation effects..………………………………………………… 74 Table 4-6 Simultaneous regression analyses of the five MSCIT-BF factors onto ATSPPH-SF, ATIHS Value, and ATIHS Stigma…………………………..…………………………. 76. ix.

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(15) List of Figures Figure 2-1 Representation of the rationales for hypothesizing relationships between traditionality-modernity and help-seeking attitudes…………………………………... 32 Figure 3-1 Research framework...………………………………………………………………… 46 Figure 3-2 Hypothesized canonical correlation model………………………………………........ 65 Figure 4-1 Loadings and canonical correlations for the first and second canonical variate pairs…………………………………………………………………………………… 69 Figure 4-2 Indicators and path names in the multiple mediation model……................................. 72. xi.

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(17) Chapter 1: Overview This chapter aims to introduce the reader to the present research by describing the background of this research, the purpose and significance of this study, research questions, hypotheses, and definitions of terms.. 1.1 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, 1.

(18) 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. 2.

(19) 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. 3.

(20) 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.. 1.2 Purpose of the study K.S. Yang’s theory of individual traditionality-modernity is a well-tested and much-revised theory, and empirical findings show that it is relevant to understanding many aspects of Taiwanese attitudes and behaviors. At the theoretical level, the purpose of this study is to explore the utility of this theory as a framework for understanding help-seeking attitudes in Taiwanese university students. The internationalization of counseling in recent decades is occurring within the context of increasing globalization and modernization. In many modernizing societies, one finds a co-existence of traditional and modern values, ideas, and institutions (Leung & Chen, 2009; Yang, 1994). In Taiwan, this phenomenon is clearly reflected in the co-existence of traditional (e.g., indigenous healing) and modern (e.g., Western medicine and counseling) healing systems. Past research (e.g., Yang, Yu, & Yeh, 1991) has found that traditionality and modernity are multidimensional constructs related to numerous personality traits,. 4.

(21) attitudes, and behaviors. In this study, we will explore whether or not traditionalitymodernity is related to attitudes towards help-seeking in Taiwanese university students. If the expected relationships are found, we will further explore possible causal processes between traditionality-modernity and help-seeking attitudes by investigating mediation effects.. 1.3 Significance of the study Philips and Pearson (1996, p 433) suggested that the psychological changes of Taiwanese people in the process of societal modernization (reviewed by Yang, 1986, 1996) may be related to changes in evaluation of stress and coping methods. However, no previous research has directly investigated the relationship between traditionalitymodernity and psychological help-seeking. As described in the Literature Review chapter, we propose five empirical and theoretical rationales for hypothesizing a relationship between traditionality-modernity and help-seeking attitudes. The existence of these rationales suggests that the hypothesized relationship deserves to be investigated. The present research may have significance for Taiwanese indigenous psychology research and counseling practice. Taiwanese individuals’ help-seeking attitudes, beliefs, and behaviors do not exist in a vacuum, but instead influence and are influenced by the larger socio-cultural context. Therefore, utilizing an indigenous psychological theory such as individual traditionalty-modernity to investigate these individual-level phenomena is most appropriate. This research may serve to further advance the development of Taiwanese indigenous psychology research especially in the area of help-seeking.. 5.

(22) Implications for counseling practice in Taiwan include the possibility of better understanding future changes in help-seeking attitudes and utilization behaviors. In addition, by better understanding Taiwanese university students’ differing levels of traditionality-modernity and their diverse attitudes towards help-seeking, this study may advance the understanding of which individuals are likely to seek or not seek counseling, which factors influence the likelihood of help-seeking, and what interventions and referral strategies are most effective for diverse clients.. 1.4 Research questions Drawing on the research background described earlier in this chapter and the review of literature described in the next chapter, this study aims to answer the following research questions regarding the relationship between traditionalitymodernity and attitudes toward counseling and indigenous healing in Taiwanese university students. First, is the latent construct of traditionality-modernity (composed of two observed variables, traditionality and modernity) related to the latent construct of helpseeking attitudes (composed of two observed variables, counseling attitudes and indigenous healing attitudes)? Second, what are the major relationship patterns between specific variables in these sets of variables? Finally, if there are significant relationships between traditionality or modernity and counseling attitudes or indigenous healing attitudes, what are the major mediating variables?. 1.5 Hypotheses 6.

(23) Based on the research questions described above, we propose four hypotheses for this study. First, we expect that the linear composite of traditionality and modernity is significantly correlated with the linear composite of counseling attitudes and indigenous healing attitudes. Second, we expect that traditionality is positively correlated with indigenous healing attitudes and negatively correlated with counseling attitudes. Third, we expect that modernity is positively correlated with counseling attitudes, but not correlated with indigenous healing attitudes. Fourth, we expect that the six mediating variables (social stigma, self-stigma, anticipated utility, anticipated risk, self-disclosure, and subjective norm) have significant mediation effects on the relationships between the traditionality-modernity variables and the help-seeking attitudes variables.. 1.6 Definitions Help-seeking. Help-seeking refers to the process of seeking help for psychological distress. In the present study, our focus is on Taiwanese university students’ help-seeking from counselors and indigenous healers. Counseling attitudes. Counseling refers to mental health services provided by licensed professionals. In Taiwan, counseling and psychotherapy are conducted by counseling psychologists and clinical psychologists. Counseling attitudes refers to the attitudes that individuals have towards the act of seeking psychological help from a counselor. This study uses the Attitudes Towards Seeking Professional Psychological Help Scale-Shortened Form (ATSPPH-SF; Fischer & Farina, 1995) to measure counseling attitudes.. 7.

(24) Indigenous healing attitudes. Indigenous healing is defined as the “helping beliefs and strategies that originate within a culture or society and that are designed for treating the members of a given cultural group” (Constantine et al., 2004, p. 111). While different terms are used in different contexts to describe indigenous healers (e.g., “shamans”) and the methods they employ (e.g., “spirit healing”; Burnhill, Park, & Yeh, 2008), indigenous healing refers generally to the diversity of conceptualizations and responses to distress and abnormal behavior in different cultures (Constantine et al.). In modern Taiwan, indigenous healing includes two main sub-systems, Traditional Chinese Medicine (TCM) and folk healing. This study uses the Attitudes toward Indigenous Healing Scale (ATIHS; Yeh et al., 2008) to measure participants’ attitudes towards seeing indigenous healers for treatment of psychological distress. Traditionality. Traditionality, also referred to as individual traditionality, refers to “the typical pattern of more or less related motivational, evaluative, attitudinal, and temperamental traits that is most frequently observed in people in traditional Chinese society and can still be found in people in contemporary Chinese societies such as Taiwan, Hong Kong, and mainland China” (Yang, 2003; p. 265). In this study, traditionality is measured using the Multidimensional Scale of Chinese Individual Traditionality (MSCIT-BF; Kao & Lu, 2006). Modernity. Modernity, also referred to as individual modernity, refers to “the typical pattern of more or less related motivational, evaluative, attitudinal, and temperamental traits that is most frequently observed in people in contemporary highly industrialized societies, such as those in Europe and North America, and that has been gradually acquired to some extent by people in contemporary Chinese societies during the process of societal modernization” (Yang, 2003, p. 265). In this study, modernity is. 8.

(25) measured using the Multidimensional Scale of Chinese Individual Modernity-Brief Form (MSCIM-BF; Kao & Lu, 2006). Social stigma. Social stigma (also termed public stigma) refers to an individual’s perceptions of society’s stigmatizing attitudes towards seeking psychological help from a counselor (Komiya et al., 2000). In this study, social stigma is measured with the Social Stigma for Receiving Psychological Help scale (SSRPH; Komiya et al.) Self-stigma. Self-stigma refers to an individual’s internalization of social stigma for seeking help from a counselor and the possibility of negative self-evaluations that would occur in case of seeking help (Corrigan, 2004). In this study, self-stigma is measured using the Self-stigma of Seeking Help Scale (SSOSH; Vogel, Wade, & Haake, 2006). Anticipated utility. Anticipated utility refers to an individual’s expectations of the benefits associated with seeking psychological help from a counselor (Vogel & Wester, 2003). In this study, anticipated utility is measured with the Anticipated utility subscale of the Disclosure Expectations Scale (DES; Vogel & Wester). Anticipated risk. Anticipated risk refers to an individual’s expectations of the risk associated with seeking psychological help from a counselor (Vogel & Wester, 2003). In this study, anticipated utility is measured with the Anticipated risk subscale of the Disclosure Expectations Scale (DES; Vogel & Wester). Self-disclosure. Self-disclosure refers to an individual’s general tendency to disclose or conceal personal problems and psychological distress (Kahn & Hessling, 2001). In this study, self-disclosure is measured with the Distress Disclosure Index (DDI; Kahn & Hessling). Subjective norm. Subjective norm refers to “perceived social pressure from important others to perform or not perform a behavior” (Hammer & Vogel, 2013, p. 83).. 9.

(26) This study measures subjective norm using an adapted version of Mo and Mak’s (2009) three-item measure of subjective norm for help-seeking.. 10.

(27) Chapter 2: Literature Review The following literature review consists of three sections. The first section overviews help-seeking and describes help-seeking in Taiwan’s socio-cultural context. The second section introduces K.S. Yang’s theory of individual traditionality-modernity (IT-M). The third section describes the rationales for hypothesizing a relationship between IT-M and help-seeking and proposes six mediating variables in this relationship.. 2.1 Help-seeking in Taiwan’s socio-cultural context Medical anthropology emphasizes that help- and health-seeking behaviors exist within the broader context of illness behavior: the pattern of behaviors individuals tend to adopt throughout the course of an illness (Chrisman, 1977). The main categories of illness behaviors are (1) recognition and interpretation of illness, (2) communication of illness to others, (3) changing of social role, (4) seeking attention, help, or treatment, and (5) response to treatment. In summarizing research from medical anthropology, Zhang (2007) concluded, “Illness behavior and health-seeking strategies are complicated processes that respond to a complex of personal, social, and material exigencies and involve negotiating among diversified perspectives and resources available to patients and their families” (p. 2). To account for the diverse range of health- and help-seeking services in different cultures, medical anthropologists discuss the concepts of medical systems and medical sub-systems. Medical systems are coherent sets of illness-related beliefs, knowledge, and behaviors (Seijas, 1973), which consist of multiple overlapping medical sub-systems. Sub-systems are unique sets of illness-related etiological beliefs, explanatory models, definitions, classifications, diagnoses, treatments, assessments, prognoses, and prevention strategies (Chang, 1989, 11.

(28) p.119; Kleinman, 1980). Medical anthropologists have studied Taiwan’s diverse medical system extensively, and generally agree that Taiwan’s health-seeking subsystems include Western medicine, Traditional Chinese Medicine (TCM), and folk healing (Ahern, 1975; Chang; Gould-Martin, 1975; Kleinman; Wu, 1978). In creating a classification of help-seeking sub-systems for this research, we first considered the above classification of health-seeking sub-systems. Western medicine can be considered a help-seeking sub-system for two reasons: it includes the specialty of psychiatry, and is involved in treating and referral of patients who present to doctors with somaticized psychological distress. For example, 51% of first-visit attendees of a family medicine clinic in northern Taiwan had at least one Clinical Interview Schedule (CIS) psychiatric diagnosis (Liu, Chen, & Cheng, 2004). In addition, as will be discussed later, TCM and folk healing are used in treating both physical and psychological distress. Thus, we propose three main categories of help-seeking sources in Taiwan: (1) counseling, (2) Western medicine, and (3) indigenous healing which includes two main subcategories, TCM and folk healing. We include TCM and folk healing in the same category in order to draw a clear contast between counseling as a non-native healing system and indigenous healing as a set of healing systems developed over many generations in a specific cultural context. Tseng (1999) provided a concise overview of the similarities and differences between counseling/psychotherapy and indigenous healing:. “…‘psychotherapy’ will be defined broadly as a special practice involving a designated healer (or therapist) and an identiﬁed client (or patient), with the particular purpose of solving a problem from which the client is suffering or promoting the health of the client’s mind. The practice may take various forms,. 12.

(29) such as a religious healing ceremony, a special experience or professionally deﬁned interaction between the healer and the client. The fundamental orientation may be supernatural, natural, biomedical, socio-philosophical or psychological. In folk therapy, healing practices, ceremonies or healthpromoting exercises may be applied to resolve the problems, without being perceived as ‘psychological therapy.’ In contrast, in other practices, particularly professional psychotherapy, the therapist and the patient both recognize that the procedure is primarily for ‘treating or resolving a psychological problem’ and that they are engaged in an activity for that perceived purpose. Thus, there exists a broad spectrum of ‘psychotherapy,’ in terms of basic orientations, methods and goals to be achieved” (p. 132).. Thus, different types of help appear to have similar core characteristics. However, the differences are significant, especially in terms of the interaction between help systems and their socio-cultural contexts. This topic is further discussed later in this chapter.. 2.1.1 The development of counseling in Taiwan The field of counseling originated in the early 20th century vocational guidance movement in the United States, and then spread to Europe and other areas of the world, and is continueing to grow worldwide (Gerstein, Heppner, Stockton, Leong, & Ægisdóttir, 2011; Stockton, Garbelman, Kaladow, & Terry, 2007). There is a distinct internationalization movement characterized by a global perspective, international cooperation, and attention to the indigenization of counseling in diverse cultures (Leung et al., 2009).. 13.

(30) In Taiwan, the seed of the counseling profession was the school guidance and career counseling movement that was founded in response to the challenges faced by students in an era of rapid industrialization and urbanization (Bigelow, 1989; Brammer, 1967). In the 1970s, secondary schools began to employ “guidance teachers,” whose responsibilities included leading in-class activities, psychological assessment, career guidance, and individual and group counseling (Chen, 2003). A rising suicide rate combined with the devastating 921 earthquake in 1999 provided the impetus for the legal establishment of the counseling psychology and clinical psychology professions (Chen; Wang, Kwan, & Huang, 2011). In November 2001, the Psychologist Act was passed, defining counseling and clinical psychologists as medical professionals under the supervision of the Taiwan Ministry of Health, and establishing graduate training and licensure requirements for practice (Lin & Hsu, 2008; Wang et al., 2011). Currently, counseling psychologists in Taiwan work as counselors, consultants, and supervisors in a wide range of locations, including universities, non-profit organizations, primary and secondary schools, and community counseling centers (Lin, Hsieh, & Sun, 2008; Wang et al.).. 2.1.2 Indigenous healing in Taiwan Indigenous healing refers to the body of knowledge and practices developed in a culture to treat illnesses. The practices of counseling and indigenous healing both aim to heal, but their healing theories and techniques are different (Burnhill et al., 2008; Tseng, 1999). Central to all psychotherapies, whether Western or indigenous, is a focus on the place of the individual within society and the suffering experiences encountered in this social context Yee (2005, p. 906). Lee, Oh, and Mountcastle (1992) identified three common characteristics of indigenous healing across cultures, including facilitation of. 14.

(31) support via family and community networks, incorporation of local spiritual beliefs and practices, and shamanistic healing rituals. Most indigenous healing interventions possess the therapeutic factors that account for much of effectiveness of psychotherapy (Tseng, 1976; see also Kleinman, 1980, p. 244). Specific characteristics of indigenous Taiwanese healing systems that contribute to their popularity and efficacy include a focus on concrete improvements, shared healer/client explanatory models of illnesses, and healers’ attention to clients’ socio-economic contexts (Kleinman, 1980; Yee, 2005). In Taiwan, the two systems of indigenous healing used in treating psychological distress are TCM and folk healing (Kleinman, 1980; Unschuld, 1985; Xu, 1982). There is considerable overlap between the two systems, and diversity within them (Kleinman, 1980; Lin, 1980). TCM developed through the integration of practitioners’ clinical experiences and a variety of classical Chinese philosophical ideas, including yin/yang, the five phases, the concept of qi (Kleinman, 1980; Unschuld, 1985; Zhang, 2007), Taoism, Confucianism, and Buddhism (Chung et al., 2012), and the medicine of systematic correspondence (Unschuld, 1985). TCM is a holistic healing system in that it diagnoses and treats humans as a unified system embedded in social and natural contexts (Chi et al., 1996). Emotional disorders are treated as a distinct category of illnesses termed qingzhi bing, which correspond to various behavioral, somatic, and psychological symptoms (Zhang, 2007). TCM has seven categories of emotions: joy, anger, anxiety, pensiveness, grief, fear, and fright. Each organ produces essential qi, from which the different emotions arise. Emotions are intimately connected to specific organs: the heart corresponds with joy, the liver with anger, the spleen with pensiveness, the lungs with anxiety, and the kidneys with fear. Emotions are seen as natural reactions to environmental stimuli. However, when the intensity or duration of emotions surpass the body’s ability to cope, yin and yang become unbalanced and the circulation of blood. 15.

(32) and qi are blocked, resulting in disruption of the normal functioning of the corresponding organ. The relationship between emotions and the organs can also go in the opposite direction when disruptions of the normal functioning of organs can cause dysregulation of emotions. Like other illnesses, emotional disorders are treated with herbs, acupuncture, and qi manipulation techniques (Xu, 1982; Yang, Phelan, & Link, 2008) Past research provides a picture of the utilization of TCM in Taiwan. In 2001, 28.4% of Taiwanese used TCM services at least once, while in the six-year period from 1996 to 2001, 63% used TCM services at least once (Chen et al., 2007). Past research has identified demographic factors related to TCM utilization. Men and unmarried people are less likely to use TCM, while those with higher education levels or folk religion beliefs are more likely to use TCM (Chang et al., 2008; Chou, 2001; Shih, Liao, Su, Tsai, & Lin, 2012; Shih, Lin, Liao, & Su, 2009). The most commonly utilized TCM treatments were Chinese herbology (44.1%), therapeutic massage (24.8%), spooning (24.2%), massage (21.1%), medicinal herbs (18.6%), acupuncture (17.1%), and cupping (16.4%; Shao, Chang, Chou, Chen, & Hwang, 2011). The second main type of indigenous healing currently practiced in Taiwan is folk healing. Kleinman (1980) identified two types of Taiwanese folk healing, secular and sacred folk healing. Since then, Taiwan’s National Health Insurance (NHI) has begun to cover TCM treatments, which have significant overlap with secular, but not sacred, folk healing. Unfortunately, we were not able to find any studies on the changes in Taiwanese folk healing caused by the implementation of NHI. Sacred folk healing is an extension of Taiwanese folk religion that is used in the treatment of physical and psychological distress (Chang, 1989; Lee, 1985; Liu & Yee, 2005; Unschuld, 1985). Illnesses are viewed as resulting from supernatural causes, most commonly malevolent. 16.

(33) spirits, and therefore have treatments which focus on the supernatural (Chang). Sacred folk healing practitioners in Taiwan include shamans (such as jitong), spirit media (such as ang-i), chien interpreters, and Taoist ritual masters, with the most common interventions appearing to be exorcistic and spirit calling rituals (Chang; Kleinman, 1980; Lee; Lew-Ting, 2003; Yee, 1986). Among traditional Taiwanese folk healing practices, shamanism, divination, and fortune-telling are similar to Western counseling interventions in that they share a quasi-therapeutic relationship between practitioners and clients that is a key factor in their effectiveness (Tseng, Lee, & Lü, 2005). These three practices are discussed below. In 1979, Kleinman and Sung reported that spirit media called jitong played a significant role in psychiatric care, crisis intervention, and general health care in Taiwan. Jitong rituals begin when the healer enters a trance, during which he is believed to be possessed by a god and to have the ability to mediate between the world of humans and the spiritual world. Clients consult with supernatural beings through the jitong (Lin, 1980). To observers, the healing powers of jitong are ascribed to the healer’s authoritativeness, making suggestions, and instillation of hope (Tseng et al., 2005). Yee (1986) studied the characteristics of 138 clients of a jitong in Taipei. The majority of clients were female (81%) and came at least two times per week (70%). Most clients were of lower socioeconomic status, and they came to ask for advice or to resolve problems involving family members, interpersonal disputes, or somatoform disorders. In divination, the diviner or interpreter uses religious or supernatural methods to foretell the future. In Chinese cultures, temple-based chien interpretation is a common divination practice. Clients seek specific answers to important questions in their lives. After offering incense to the main god of a temple, clients choose a chien stick from a large basket. The answers on the chien are written in an esoteric way, so interpreters. 17.

(34) (often elderly) are available to interpret the answers into specific, concrete responses to clients’ questions. These answers usually include culturally-sanctioned coping strategies and culture values (Hsu, 1976). Finally, fortune-telling is based on the assumption that humans are a microcosm of the universe. The ancient text The Classic of Changes (Yi Jing) can be used to determine one’s fate based on the exact date and time of birth and number of strokes in the Chinese characters of their name. Like divination, fortune-telling practitioner-client interactions involve transmission of cultural values and concrete advice (Tseng et al., 2005). Yee (2005) ascribed the healing properties of fortune telling to guidance and symbolic meaning. Inconsistent findings exist for the utilization of folk healing in Taiwan. Yee (1986) found that the families of many Taiwanese university students who grew up in the 1960s and 1970s had experience with folk healing rituals such as spirit calling (41%), temple-based rituals (27%), making offerings to temple gods (60%), or visiting a jitong or Taoist ritual master (13%). In contrast, a nationally representative sample conducted in 2002 found that most respondents (86.1%) did not utilize sacred folk healing in the previous twelve months. Among those who did utilize, spirit calling (10.9%) was the most common, followed by jitong ceremonies (3.0%), fortune telling (2.8%), and Taoist rituals (2.6%; Lew-Ting, 2003). Although Kleinman (1980) reported anecdotal evidence that many well-educated Taiwanese were unwilling to use folk healing, no significant differences in the rate of sacred folk medicine utilization was found as a function of gender, age, or education level, but utilization was generally lower in larger cities (Lew-Ting). Wen (1998) found that the majority of individuals (84%) currently receiving psychiatric treatment reported previous utilization of folk healing, but in a different sample, Pan, Chen, Teng, Lu, and Shen (2005) reported that. 18.

(35) only 35% had previously used folk healing. These inconsistent findings on folk healing utilization may reflect the diversity of Taiwan’s folk healing systems or changes in folk healing in recent years.. 2.1.3 Help-seeking in Taiwan Values are a key feature of culture and cultural differences (Bond, 1996). Researchers such as Neville, Worthington, and Spanierman (2001) and Sue and Sue (2012) have presented compelling evidence that mainstream counseling contains culture-bound values. Counseling developed in the context of mainstream EuroAmerican cultures, and as a result, the assumptions and values of counseling largely reflect those of white, educated, middle- to upper-class Westerners (Das, 1995). These culture-bound values include an emphasis on the individual, an etic perspective that assumes mental health and illnesses are the same in all cultures, a dualistic view of mind and body, and the assumption that communication should be characterized by directness, assertiveness, emotional expressiveness, and self-disclosure (Corey, Corey, Corey, and Callanan, 2014; Lewis-Fernandez & Kleinman, 1994; Pedersen, 2003; Stiles, 1995). Despite the accelerating growth of counseling in Taiwan in recent decades, it is still often seen as a Western cultural product, with research and practice still heavily biased towards Western cultural content (Lin, 2001a), having not fully adapted to the values of Taiwanese (Leung & Chen, 2009) Past research (e.g., Hwang, 2009; Kwan, 2000; Saner-Yiu & Saner-Yiu, 1985) has identified Chinese values specifically relevant to psychological help-seeking, including filial piety, collectivism and hierarchy, social role expectations, emotional control, achievement orientation, reciprocity, high power distance, and high uncertainty avoidance. Traditional and modern Chinese cultures are strongly influenced by. 19.

(36) Confucianism, Daoism, and Buddhism (Yan, 2005; Zhang, Lin, Nonaka, & Beom; 2005). Confucianism has a particularly strong influence on help-seeking in Chinese societies because it is a philosophy of individual self-cultivation and interpersonal relationships, including specific concepts such as (1) the emphasis on ren (benevolent love), li (etiquette), and he (harmony) in interpersonal relationships, (2) zhongyong (the doctrine of the mean) as the ideal way of resolving problems, (3) emphasis on proper behavior within societal and familiar roles, and (4) self-cultivation as the route to happiness and maturity (Yan, 2005). Chinese Culture Connection (1987) identified four factors in the Chinese Value Survey, termed Integration, Confucian work dynamism, Human-heartedness, and Moral discipline. Bond (1996) identified four culture-level values in Chinese people: individualism-hierarchy, orderly autonomy, disciplineassertion, and human-heartedness. Many of the values described above appear to conflict with the culture-bound values of counseling, and may have implications for how Taiwanese view counseling. Lin (2001b, 2002) interviewed Taiwanese university students to understand their perspectives on seeking help from a counselor and help-seeking in general. Lin (2002) identified four fundamental helping-related beliefs. First, participants viewed helpseeking as a sign of weakness, preferring to solve problems on their own. Participants associated formal help-seeking with shame, weakness, and embarrassment. Second, participants would only seek formal help for serious conditions. Third, participants would prefer a helper familiar to them. Fourth, help from important others such as friends or family was the ideal source of help. A number of core beliefs about counseling were also identified (Lin, 2001b). Participants viewed counseling as a helpful resource for a range of issues, including academic and career problems, problems with interpersonal relationships, psychological. 20.

(37) symptoms, and physical symptoms such as sleep or eating abnormalities. Participants believed that counseling was most necessary for those with unresolved or severe problems in life, those without a strong support network, and those with specific personality characteristics such as pessimism or low self-esteem. Few participants expressed willingness to use counseling. If they had problems, they would seek help from friends, family, and others close to them first. Most participants viewed counseling as a last resort, but a few would never be willing to see a counselor due to discomfort, concern about confidentiality, or lack of perceived effectiveness. Unfortunately, there is currently insufficient data on help-seeking behaviors in Taiwan to identify clear patterns of utilization of different help sources, or to understand which factors influence help-seeking behaviors. Anthropological work conducted by Kleinman (1980) and Chang (1989) provides valuable information about factors that influence help-seeking in Taiwan’s socio-cultural context, Kleinman delineated ten factors that affected health care seeking and help-seeking behaviors in Taiwan: type and severity of symptoms, course of illness, type of sick role, sickness labels and etiological beliefs, evaluations of treatments, demographics of patient (i.e., age, sex, role in family, occupation, education), background of the patient’s family (e.g., socio-economic status, modern vs. traditional value orientation), urban or rural residence, proximity to treatment resources, and the patient’s social network and lay referral system. Similarly, Chang conducted anthropological fieldwork examining the socio-cultural, structural, and individual influences on the utilization of diverse medical sub-systems in a rural village in northern Taiwan. Socio-cultural factors were related to the village’s geography, economy, mass media, and the villagers’ religious beliefs and social activities. Structural influences included the availability and affordability of medical services. Individual factors included medical beliefs and individual characteristics.. 21.

(38) Notably, females and those with higher SES used health services more. Lower SES and older age were associated with more frequent use of folk healing, and younger age was associated with more frequent use of Western medicine. Two surveys of Taiwanese university students show that rates of counseling utilization appear to be low. Chang (2008) surveyed 995 first-year Taiwanese university students. Among the 316 students who reported experiencing distress in the previous month, a majority indicated seeking informal help from classmates or family members, while only 16 (5.1%) saw a doctor and 11 (3.5%) sought counseling in the previous month. In a sample of 666 Taiwanese university students, Wang (2010) found that 89 (13.4%) had previously seen a counselor, with significantly more females (58) than males (31) falling into this category.. 2.1.4 Help-seeking attitudes In the literature on help-seeking, there are many conceptual frameworks for understanding the factors which influence help-seeking. To date, however, none of these frameworks have gained broad acceptance (Gulliver et al., 2012). The theory of reasoned action (TRA; Ajzen & Fishbein, 1980) is perhaps the most commonly used framework for understanding the relationship between counseling attitudes and actual utilization (Nam et al, 2013; Vogel, Wade, & Hackler, 2007), although recent finding have called its validity into question (Hammer & Vogel, 2013). Because of the methodological difficulties involved with measuring prospective help-seeking, help-seeking research often uses various proxies for actual help-seeking, the most common of which is counseling attitudes (Nam et al., 2013). Counseling attitudes are consistently associated with previous counseling utilization (e.g., MacKenzie, Gekoski, & Knox, 2006; ten Have et al., 2010) with mostly medium or. 22.

(39) higher effect sizes (Elhai, Schweinle, & Anderson, 2008). To date, several studies have examined variables related to counseling attitudes in Taiwan. Mirroring international findings (e.g., Nam et al., 2010), females have more positive counseling attitudes than males (Chang, 2007; Chen, 2006; Wang, 2010; Yeh, 2002). Among Taiwanese adolescents and university students, higher levels of depressive symptoms are related to more negative counseling attitudes (Chang, 2007; Chen, 2006), interdependent and independent self-construals are positively correlated with counseling attitudes, and collective self-esteem is negatively correlated with counseling attitudes (Yeh). Wang found a number of psychological variables to be significantly correlated with counseling attitudes, including anticipated utility, anticipated risk, social stigma, self-stigma, selfesteem, and level of depression.. 2.1.5 Summary In summary, counseling is growing around the world, including in Taiwan, but the culture-bound values in counseling may be affecting its growth in non-Western countries. Past research has identified some core Taiwanese cultural values, many of which appear to conflict with the culture-bound values of counseling. Taiwan has a wide variety of indigenous healing systems that are integrated with local social worlds and traditional cultural beliefs. Past research conducted in Taiwan has investigated demographic variables associated with usage of counseling and indigenous healing, and a few studies have investigated psychological variables associated with Taiwanese university students’ help-seeking attitudes. Still, much more research is needed to provide a clearer picture of rates of help-seeking behaviors and the factors related to the choices of whether or not to seek help, and if help is sought, from where.. 23.

(40) 2.2 The theory of individual traditionality-modernity Beginning in the 1950s, Taiwan’s rapid economic development has resulted in deep social, cultural, and political changes (Leung & Chen, 2009; Yang, 1996). During the process of Taiwan’s societal modernization, there has been an ongoing integration of traditional and modern institutions, values, and worldviews (e.g. Kleinman, 1980; Leung & Chen). In the 1970s, K. S. Yang started to develop the theory of individual traditionality-modernity, aiming to “better understand the content, structure, and change of Chinese people’s psychological make-up during the process of societal modernization” (Yang, 2003, p. 264). This theory is the main theoretical framework of this study, so an overview of the theory appears below.. 2.2.1 Key concepts Three key concepts in the theory of individual traditionality include individual traditionality (or “traditionality”), societal modernization, and individual modernity (or “modernity”). Traditionality refers to the most common organized set of attitudes, concepts, values, and behaviors possessed by individual members of a traditional society. Yang (2003) formally defined Chinese individual traditionality as “the typical pattern of more or less related motivational, evaluative, attitudinal, and temperamental traits that is most frequently observed in people in traditional Chinese society and can still be found in people in contemporary Chinese societies such as Taiwan, Hong Kong, and mainland China” (p. 265). Yang proposes that “Chinese traditional psychological characteristics were formed in an agrarian society and are therefore most useful in adjusting to life in agricultural communities. Modern psychological characteristics were formed in modern industrial societies and are therefore most useful in adjusting to life in such a society” (p 276).. 24.

(41) Yang (1988) defined societal modernization as “a complex syndrome of interrelated economic, political, and sociocultural changes in a society” (p. 68). These changes include “industrialization, urbanization, bureaucratization, social mobility, occupational specialization, diminishing sex role specialization, reliance on legalrational authority and emphasis on formal education, material well-being, and achieved rather than ascribed social status” (Yang, 2003, p. 282; see also Inglehart, 1997). The theory of individual traditionality-modernity is based on a conceptualization of modernization as a distinct process from globalization and Westernization (Yang, 2003). Globalization has been defined as “a process by which cultures influence one another and become more alike through trade, immigration, and the exchange of information and ideas” (Arnett, 2002; p. 774). This process has resulted in a “global culture” is mainly characterized by Western values and ideas such as individualism, tolerance for pluralism, and emphasis on capitalism, which co-exists and interacts with local cultures (Arnett). For Yang, changes observed in non-Western societies such as Taiwan can include those resulting from Westernization and globalization, but the fundamental process of societal change is modernization. “Historically speaking, modernization is a recent phenomenon even in the West. As non-Western developing societies become industrialized, they manifest approximately the same attributes. Modernization in this sense has become a global process, and it can no longer be equated to Westernization as in classical modernization theory” (Yang, 2003 p. 282). Yang (1994) developed the societal convergence hypothesis and the psychological convergence hypothesis. The former proposed that characteristics of different societies will become increasingly similar in the process of modernization, while the latter proposes that the individuallevel psychological characteristics of members of modernizing societies will become increasingly similar over time.. 25.

(42) Yang theorized that societal modernization and individual modernity are interrelated: societal-level changes result in individual-level changes, and vice-versa (Yang, Yu, & Yeh, 1991). Individual modernity refers to the contents of individual modernization, the most common organized set of attitudes, concepts, values, and behaviors possessed by individual members of a modern society (Yang, et al.). More technically, Yang (2003) defined Chinese individual modernity as “the typical pattern of more or less related motivational, evaluative, attitudinal, and temperamental traits that is most frequently observed in people in contemporary highly industrialized societies, such as those in Europe and North America, and that has been gradually acquired to some extent by people in contemporary Chinese societies during the process of societal modernization” (p. 265). Yang (2005) proposed that societal modernization, individual modernization, and individual modernity are three distinct levels in a dynamic change process, with bi-directional causal relationship between levels. Specific aspects of societal modernization (e.g., high social mobility) affect specific aspects of individual. Table 2-1 Core characteristics of individual modernity across cultures. 1. Sense of personal efficacy 11. Cognitive and behavioral flexibility (antifatalism) 2. Low integration with relatives 12. Future orientation 3. Egalitarian attitudes 13. Psychological differentiation 4. Openness to innovation and change 14. Empathetic capability 5. Belief in sex equality 15. Need for information 6. Achievement motivation 16. Propensity to take risks in life 7. Individualistic orientation 17. Extralocal orientation (non-localism) 8. Independence or self-reliance 18. Secularization in religious belief 9. Active participation 19. Preference for urban life 10. Tolerance of and respect for others 20. Educational and occupational aspirations Note. Adapted from Yang (1988).. 26.

(43) modernization (e.g., emphasis on the future), which in turn affect specific aspects of individual modernity (e.g., future orientation). Causal effects in this process also occur in the opposite direction. Yang (1988) reviewed empirical literature to identify twenty distinct psychological and behavioral characteristics of individual modernity with crosscultural validity. These characteristics are listed in Table 2-1.. 2.2.2 Historical development of the theory of individual traditionality-modernity The theory of Chinese individual modernity/traditionality has developed through three main paradigms (Kao & Yang, 2011; Yang, 1996). In the first paradigm (from early 1970s to mid 1980s), individual traditionality/modernity was seen as a unidimensional psychological syndrome, with traditionality and modernity lying on opposite ends of a single continuum. In this stage, the Chinese Individual TraditionalityModernity Scale (CITMS) was developed and used as the main empirical measure of individual traditionality-modernity. Yang and colleagues switched research strategies in the mid-1980s, (Yang, 1996; Yang et al., 1991). This switch was inspired by the limited empirical utility of the unidimensional conceptualization of traditionality-modernity, as well as theoretical criticisms of modernization theory (such as world systems analysis) that view modernization in different societies as a non-homogenous process (e.g., Peacock, Hoover, & Killian, 1988; Wallerstein, 1974). Yang et al. reviewed three main criticisms of modernization theory, including that (1) it incorrectly expects the result of industrialization and economic development to be political, economic, social, and cultural changes paralleling those of early-developing nations; (2) it establishes an artificial dichotomy between so-called “traditional” and “modern” societies; and (3) that. 27.

(44) it assumes that the presence of traditional cultural characteristics in a society are obstacles to its modernization. In the second paradigm of research, Yang and colleagues’ approach to individual traditionality-modernity differed in four main ways from the first stage (Kao & Yang, 2011; Yang et al., 1991). First, they viewed individual traditionality and modernity as multidimensional psychological syndromes (rather than a unidimensional continuum). Second, they hypothesized that traditionality and modernity are both composed of multiple orthogonal factors of psychological and behavioral characteristics (rather than a one-factor, coherent syndrome). Third, they expected traditionality and modernity to vary across domains of life functioning. Finally, they hypothesized that the specific contents of individual traditionality and modernity would vary across cultures (rather than exhibit cross-cultural universality). In this second stage, Yang and colleagues developed two new instruments to measure individual traditionality-modernity as a multidimensional, multi-categorical construct: the Multidimensional Scale of Chinese Individual Traditionality (MS-CIT) and the Multidimensional Scale of Chinese Individual Modernity (MS-CIM; Yang et al., 1991).Yang et al. began by writing two items pools, one for traditionality and one for modernity, guided by conceptual schemes of content coverage of individual traditionality and modernity, with each scheme consisting of 14 overlapping categories (see Table 2-2). The content categories of traditionality were collected from psychological, anthropological, and sociological research conducted in Chinese societies, and the content categories of modernity were collected from relevant local and international research. Items in these pools represented as fully as possible different contents of eight different life domains: family life, education, career, economics and consumption, law and politics, religion, socializing and recreation, and relationships.. 28.

(45) Table 2-2 Conceptual categories of Chinese individual traditionality and modernity. Traditional psychological categories Modern psychological categories Collectivistic orientation Individualistic orientation Familistic orientation Institutionalistic orientation Particularistic orientation Universalistic orientation Submissive-to-nature orientation Domination-of-nature orientation Other-orientation Self-orientation Past orientation Future orientation Self-suppressive orientation Self-expressive orientation Authoritarian orientation Egalitarian orientation Dependent orientation Independent orientation To-be-similar orientation To-be-different orientation Modesty orientation Competition orientation External-control orientation Internal-control orientation Self-contentment orientation Achievement orientation Relationship orientation Tolerating-of-others orientation Note. Adapted from Yang (2003).. In writing items, the Yang et al. consulted previous scale items, mass media which represented either traditional or modern ideas, and the researchers’ own life observations. Yang et al. then conducted a pre-test of the resulting 299 items from MSCIT and 256 items for MS-CIM. An exploratory factor analysis found five-factor structures for both MS-CIT and MS-CIM. MS-CIT is composed of Submission to authority, Filial piety and ancestor worship, Conservatism and endurance, Fatalism and defensiveness, and Male dominance (Yang et al., 1991). Submission to authority describes an attitudes of obedience, respect, and trust towards authority, including in relationships (e.g., parents), society (e.g., leaders), and social norms. Filial piety and ancestor worship describes a mindset of filial piety towards one’s parents, which encompasses avoiding harming parents’ reputations or making them worry, caring for parents, and respecting parents’ wishes. In the Conservatism and endurance factor, conservatism describes an attitude of avoiding conflicts and avoiding knowing about others’ affairs, while endurance describes an attitude of acceptance of one’s situation, 29.

(46) and not pursuing change. Fatalism and defensiveness describes an attitude of avoiding trouble, protecting and benefiting only oneself and one’s family. Male dominance describes an attitude and belief that males are superior to females in many contexts, such as politics, employment, marriage, and family life. MS-CIM is composed of Egalitarianism and open-mindedness, Social isolation and self reliance, Optimism and assertiveness, Affective hedonism, and Sex equality (Yang et al., 1991). Egalitarianism and open-mindedness describes equalitarian concepts such as acceptance of criticism of authority and political freedoms, as well as a generalized attitude of openness and tolerance. Social isolation and self reliance describes a set of behaviors that includes acting independently, and avoiding excessive social interaction and others’ influence. Optimism and assertiveness describes a trusting, optimistic attitude regarding progress in technology, politics, economics, and society, as well as optimism about the possibility of improving the quality of one’s life. Affective hedonism describes the belief that emotional attachments should be the basis for interpersonal relationships such as friendships and marriages. Sex equality describes the belief that both genders should enjoy equality in various domains of life.. 2.2.3 Summary The theory of individual traditionality-modernity was developed to understand changes in the individual-level psychological characteristics of Taiwanese people in the process of societal modernization. This theory appears to be suited for the purposes of the present study, which is understanding what psychological characteristics are associated with attitudes towards a modern help-seeking system (counseling) versus more traditional help-seeking systems (indigenous healing). The theory of individual traditionality-modernity includes a number of concepts that are relevant to the present. 30.

(47) research which are described below in the rationales for hypothesizing a relationship between traditionality-modernity and help-seeking attitudes.. 2.3 The relationship between traditionality-modernity and help-seeking This section describes the five main rationales for hypothesizing this relationship. These rationales are based on the culture-bound values in counseling, the relationship between traditionality and indigenous healing, the relationship between societal modernization and the growth of counseling, the revised psychological convergence hypothesis, and finally the six hypothesized mediating variables.. 2.3.1 Rationale one: Traditionality-modernity and culture-bound values in counseling As discussed earlier in this chapter, the culture-bound values of counseling appear to be a key barrier to counseling service utilization in people from diverse cultural backgrounds (e.g. Sue & Sue, 2012). These culture-bound values include individualism, mind-body dualism, emotional expressiveness, self-disclosure, and direct, assertive communication. Examining Table 2-2 reveals that some categories of Chinese modernity seem to correspond to these culture-bound values, while some categories of Chinese traditionality seem to be in opposition to these values. Modernity includes individualistic orientation, independent orientation, and self-expressive orientation, which correspond with the culture-bound values of individualism, emotional expressiveness, and self-disclosure. Traditionality includes opposing characteristics such as collectivistic orientation, familistic orientation, and self-suppressive orientation. From this evidence, we hypothesize an inverse relationship between traditionality and 31.

(48) Figure 2-1 Representation of the rationales for hypothesizing relationships between traditionalitymodernity and help-seeking attitudes. b. Traditionality. Indigenous healing attitudes. a, e. Modernity. a, c, d, e. Counseling attitudes. Note. Solid lines indicate a direct relationship, and dashed line indicates an inverse relationship. a = rationale one; b = rationale two, c = rationale three, d = rationale four, e = rationale five.. counseling attitudes and a direct relationship between modernity and counseling attitudes.. 2.3.2 Rationale two: Traditionality and indigenous healing We further hypothesize a direct relationship between traditionality and attitudes towards indigenous healing. Earlier in this chapter, we discussed theoretical perspectives which argue that the popularity and effectiveness of indigenous healing is largely due to the degree to which it is integrated into local cultural worlds (e.g. Kleinman, 1980), suggesting that there may be a relationship between an individual’s level of adherence to traditional cultural values and psychological orientation towards indigenous healing services. Yang (2005) proposed a conceptual structure to understand how characteristics of individual traditionality arise from, and exert influence on, traditional Chinese cultural characteristics. Yang hypothesized a process in which great traditions manifest in peoples’ daily lives as little traditions. Great traditions refer to the 32.