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Article 22

Counseling International Students

Julia F. Kronholz

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Introduction and Historical Overview

The concept of traveling to foreign lands to learn from and teach others is not a new idea. For centuries, travel has played a central role in enlightenment and the spread of knowledge throughout the world. Scholars voyaged to far lands to disseminate the notion of Christianity in Biblical times, while visitors to Britain during the Industrial Revolution would report to their home countries on the innovations discovered in their travels (Zakaria, 2005). In more modern terms, Zakaria (2005) noted that the diffusion of knowledge leads to burgeoning growth and industrialization across the globe as individuals and countries learn from each other.

The International Institute of Education (IIE) defines international students as any foreign-born student engaged in learning at a U.S institution of higher education (IIE, 2012). According to the IIE’s 2012 Open Doors report, there are 764,495 international students studying in the United States, making up 3.7% of the collegiate population. The United States is the top destination for international students across the world (Li, Wong, & Toth, 2013). Beginning in the 1980s, the number of international students studying in the United States has steadily increased (Pedersen, 1991). The top locations of origin for these students is China (25.4%), India (13.1%), and South Korea (9.5%; IIE, 2013). International students, comprising both undergraduate and graduate level studies, bring their culture to the U.S. from other countries such as Canada, Japan, Mexico, Brazil, United Kingdom, and Germany. This important demographic information can be used to illustrate key issues that must be accounted for in counseling service delivery.

Presentation to Counseling Services

International students face many of the same issues as domestic students such as anxiety, depression, academic stressors, and homesickness, yet more recent research provides indications of the variety of specific challenges international students face. By becoming knowledgeable regarding issues specific to international students, counselors are able to determine the most appropriate counseling interventions.

Arthur (2004) indicated that international students face distinct difficulties when compared to domestic students. Such issues include culture shock, isolation, discrimination, homesickness, and language-related problems. Likewise, other investigations have found evidence suggesting international students encounter difficulties with financial stress, discrimination, cultural misunderstandings, dietary restrictions, and lack of support from American peers (Heggins & Jackson, 2003; Lin & Yi, 1997; Olivas & Li, 2006). In a longitudinal study investigating characteristics of first- year international students, English-speaking difficulties and social integration had negative effects on persistence in academics (Mamiseishvili, 2012). This suggests that students who are less fluent in English have more trouble integrating in peer groups and experience lower levels of academic tenacity. Similarity, a study by Poyrazli and Kavanaugh (2006) suggested that these various challenges often put international students at a greater risk for academic difficulties when compared to domestic students.

Finally, level of acculturation has also been found to be a factor in psychological adjustment. An investigation of Chinese students found that low acculturation was associated with psychological symptoms such as depression and suicide (Suinn, 2010; Wang & Mallinckrodt, 2006). Overall, the research suggests that the main concerns for international students include acculturation, financial stressors, and social barriers. Counselors are well-served to understand that while international students experience similar presenting concerns as domestic students in counseling, the literature asserts that there are specific concerns that affect international students. Unfortunately, even though a counselor may be aware of these specific concerns, the absence of empirical data on this population makes conceptualization and intervention planning difficult.

Current Research Status

Despite the increase in the number of international students in the United States, there is limited literature available regarding empirical research to guide counseling with this population. In what appears to be a seminal work regarding counseling international students, Pedersen (1991) noted that “Research on counseling international students has been characterized by isolated, uncoordinated, and fragmentary studies on specialized variables, with no clear application of results to comprehensive theory building or to practical implications for institutional policy” (p. 50). More recently, Yoon and Portman (2004) assert the need for additional diverse and detailed research on the topic of counseling international students. However, because literature suggests international students are much less likely to engage in the counseling process, the process of obtaining rich, relevant data to inform theory and practice is difficult (Hyun, Quinn, Madon, & Lustig, 2007; Nilsson, Berkel, Flores, & Lucas, 2004; Yakunina, Weigold, & McCarthy, 2011). Under-utilization of counseling services may be due to the perceived stigma associated with counseling, a cultural norm consisting of the avoidance of self- disclosure, uneasiness of seeking help, or because of a lack of language competence (Russell, Thomson, & Rosenthal, 2008).

In a meta-analysis of literature regarding international students, researchers determined five themes that suggest the need for further research in each of those areas (Pedersen, 1997; Yoon & Portman, 2004). Three of these themes most salient to the current manuscript include the counselors’ overemphasis of pathology in international students; the overgeneralization of research findings to international student populations; and sampling concerns of research studies investigating counseling with international students (Pedersen, 1997; Yoon & Portman, 2004). These themes reveal important information involving counseling international students and expose potential issues in clinical practice.

On the other hand, there is a vast amount of literature surrounding client variables. Pedersen, Draguns, Lonner, and Trimble (2002) noted that the focus of research on counseling and international students concentrates on client variables (e.g., presenting concerns, gender, country of origin) as opposed to counseling variables and empirical outcomes (e.g., efficacious intervention, service modality). Possessing extensive information on client variables is helpful as it provides insight into clients and aids counselors in determining which theories might be most appropriate to use with international students. For example, if a counselor meets with a male who identifies closely with Hispanic culture, the counselor might explore the client’s view of family or the notion of machismo. Acknowledging the literature available, this paper examines the theories that are hypothesized as most suitable to use when counseling international students, taking into consideration what research explains regarding the characteristics of this population.

Theoretical Basis

Because the research on this population is so varied and diffuse, it is challenging to obtain enough data to form a consistent theoretical base to utilize in counseling practice (Yoon & Portman, 2004). Yau, Sue, and Hayden (1992) described a consensus that many theoretical approaches may be inappropriate for international students. Moreover, Yoon and Portman (2004) noted the need to examine the current counseling literature related to international students because of the lack of theoretical basis. The majority of theories in use in college counseling centers were developed, piloted, and made for use in Western countries, namely, the United States (Heppner, 2006). Additionally, many psychological assessments were normed on Western samples, hindering the reliability and validity of results from non-Western examinees (Pedersen, 1997; Pedersen et al., 2002). Considering these limitations, Arthur and McMahon (2005) proposed the use of cross-counseling models as essential when counseling international students. Counselors should consider contextual forces in people’s lives and should clarify how cultural factors are influential in the counseling process.

A few thoughts are offered in regards to theoretical guidelines to utilize when working with international students. Reflecting upon the constructs of multicultural counseling practice, Pedersen (1990) discussed the importance of empathy and ability to accurately relate to others in an accepting manner. This aligns quite well with Carl Rogers’s idea of genuineness, empathy, and acceptance in person-centered theory (Corey, 2001). Additionally, the focus of being fully present and aware of self and client in person-centered theory is similar to the idea of self-awareness in multicultural counseling. Rogers stated that in order to facilitate change, the therapist must fully receive the client and in return, the client must feel understood and received by the therapist. By becoming fully aware of the self and the influence of culture, it is possible for a counselor to subscribe to the notion of being fully receptive toward international students in the counseling process, as suggested by person-centered therapy (Rogers, 1961).

Person-centered therapy also supports what Pedersen (1997) described as culture- free models. Serving as a central component to counseling international students, a culture-free model is described as a model used in counseling that attempts to develop measures that are not dependent on a particular cultural context and are free from cultural bias. This avoidance of cultural bias affecting therapy is similar to the person-centered theoretical approach to counseling. By removing cultural biases and furthering understanding of the client’s internal frame of reference, a counselor can provide unconditional positive regard and accurate empathetic understanding. Finally, because research shows that person-centered therapy is efficacious with a wide range of client problems (Corey, 2001), there is reasoning to incorporate this theory to address the varied concerns international students present in counseling. Ridding oneself of bias is certainly a challenge that counselors face, so perhaps a more realistic view of this notion is for counselors to continuously monitor and be aware of biases and incorporate this awareness intentionally into treatment to better manage its impact. This information provides a strong reasoning to incorporate person-centered theory in the counseling process with international students, though there is an absence of existing literature supporting this assertion.

Cognitive behavioral therapy is another theory that may be efficacious when working with international students. Cognitive behavioral therapy has generated more empirical research than any other therapy model (Corey, 2001). Because of the wide array of issues international students face (as described above), using a theory that is empirically supported to help a variety of presenting issues is appropriate with this population. Additionally, considering data suggests that international students desire a more directive approach to counseling (Barletta & Kobayashi, 2007; Yakunina et al., 2011; Yuen & Tinsely, 1981), Cognitive behavior therapy might be an appropriate model to integrate a client’s preference of counseling style because of its more directive method to problem-solving. Of course, discretion must be applied in counseling and each student must be treated as an individual. In this circumstance, the importance of professional judgment is magnified.

Counseling in Practice

As noted above, because it is so difficult to obtain data on this population, it is challenging to come to a consensus regarding specific empirical interventions to use when working with international students. Much of the existing research regarding the efficacy of counseling interventions implies that there is a lack of rigorous empirical evidence. Practical interventions are based on clinical knowledge, expert experiences, and theoretical writings (Yakunina et al., 2011). While this is certainly an important fact to consider and is a recommendation for further study, current literature suggests promising preliminary information regarding intervention and clinical practice.

Carr, Koyama, and Thiagarajan (2003) and Dipeolu, Kang, and Cooper (2007) suggested the efficacy of group counseling with international students. Psychoeducational behavioral groups have been found to be effective, aimed at assisting students gain confidence and skills in interpersonal and academic areas while maintaining their cultural identity (Smith & Khawaja, 2011). Other studies have found evidence of client preferences for the counseling process. For instance, though there is much diversity among international students in regards to acculturation, ethnicity, and heritage, the literature proposes that international students may prefer a more directive approach to counseling, viewing the counselor as the expert who provides clear advice (Barletta & Kobayashi, 2007; Yakunina et al., 2011; Yuen & Tinsely, 1981).

Siegle (1991) proposed a few techniques implemented to facilitate counseling sessions with international students, including having an international student advisor in the session, meeting the student where the student is (e.g., on a campus bench), or serving as part of a social action team to help the client navigate a new culture. While these techniques might seem sensible, Siegle does not offer empirical evidence supporting the efficacy of these interventions. Counselors should use judgment as to their applicability.

Although the theoretical underpinnings for counseling international students are lacking, there is evidence of empirically validated cross-counseling techniques that may be helpful in the counseling process. The American Psychological Association (APA) published a list of guidelines for best practices for counselors to use when working with international students (Barletta & Kobayashi, 2007). This APA sponsored document contains information that is aligned with previous research, incorporating matters such as counselor training and counseling techniques (APA, 1993, as cited in Khoo, Abu-Rasain, & Hornby, 2002). Guidelines offered include a broad range of issues, discussing the integration of counseling and ethnicity, family and community religion, communication, and prejudice. Specifically, counselors are encouraged to explicitly define roles and expectations for counseling with their client, integrate other important individuals in the counseling process (a fellow student or mentor), and facilitate skill building to help students learn and adapt to different situations (Barletta & Kobayashi, 2007).

Overall, the following suggestion is offered in order to overcome the absence of empirically supported data for counseling international students. Counselors should integrate cross-cultural models with the theoretical guidelines of person-focused and cognitive behavioral therapies, which might allow the counselor to leverage empirically supported therapies and efficacious counseling techniques that apply to a broad range of individuals for positive outcomes with this population.

The Counselor’s Role

The counselor has a central role in the process of counseling with international students. Sue et al. (1982; as cited in Pedersen et al., 2002) discussed the importance of cross-cultural counseling and the three dimensions of therapist variables, which are awareness, knowledge, and skills. This can be conceptualized as awareness of self, client, and potential barriers in the counseling process; knowledge of culture-specific norms and values; and skill to transform such knowledge to appropriate interventions (Sue, 1982; as cited in Pedersen et al., 2002). Counselors may best serve international students by recognizing their own ethnocentrism and integrating awareness in the counseling process. It could be argued that counselor self-examination is a central component in the counseling process, particularly when working with international students.

Pedersen (1997) posited that counselors should be aware of overemphasizing or underemphasizing cultural differences between themselves and the student. It is also suggested that the counselor offer a clear orientation to counseling, take initiative to learn about specific cultures in order to treat each student as an individual, and help students monitor the ways in which their values and perceptions impact the result of their time in the United States (Pedersen, 1997). Similar to other studies, Pedersen (1997) suggested bringing another person into counseling (e.g., a fellow national, a trusted administrator, a friend) to enhance support systems, while also encouraging strengthening bonds between international students as a support system. Though the empirical evidence is lacking for Pedersen’s rationale for a support system, it could be compared to the efficacy of group interventions with international students, as proposed by Carr et al. (2003) and Dipeolu et al. (2007).

Counselor Training

It is important to consider counselor training when reflecting on clinical applications of counseling international students. Davidson, Sanford-Martens, & Oksana (2008) suggested that the process of counseling international students should start in counselor training programs, with a greater influence directed at multiculturalism and diversity, specifically with international students. Possessing a greater competency of multicultural considerations may be the central component when enhancing services provided to international students (Davidson et al., 2008). On the other hand, Yoon and Portman (2004) noted that while every accredited counseling program includes coursework in multicultural counseling, there may be a lack of specific training in regards to counseling and international students. Because of this, continuing education and training for counselors in training and seasoned professionals are fundamental to determine how to best serve the specific needs of international students (Davidson et al., 2008). As Pedersen (1994) suggested, it could be that the problem is not in the tools in counseling, but in the counselors themselves.

Issues for Further Study

There is a clear need for additional research on this topic. Current research provides a robust background of this population while also stipulating what is to come. There are areas of growth to learn more about international students in counseling, and the current literature has provided a strong background to transition the focus from client variables towards efficacious treatment.

Davidson et al. (2008) suggested that university counseling center staff may be more effective in serving international students by continuously evaluating the effectiveness of treatment for this population, paying attention to any particular patterns that international students may exhibit when presenting for counseling. Additionally, Yoon and Portman (2004) noted the need for more research examining the counseling process variables, client variables, and outcome variables in order to provide more exhaustive recommendations for empirically supported counseling interventions for international students. Finally, it should be brought to attention that amidst the process of creating this manuscript, it became noticeable that there is a distinct research focus on only a few areas. Research found had a tendency to examine Asian populations, client variables affecting service-seeking behavior, and differences between international and domestic students in relation to counseling. It is interesting that the amount of diverse literature does not reflect the level of diversity in this field.

Conclusion

There is a propensity to view international students as very different from domestic students, but perhaps these students aren’t quite as different as assumed (Popadiuk & Arthur, 2004). It is possible that the lack of theory regarding counseling with international students is due to an absence of extreme differentiation between domestic and international students. Of course, this population may have unique concerns of which counselors should be aware, but it is proposed that counseling international students might not be exceedingly different than counseling domestic students. It might be that the information gleaned from themes in the international student counseling literature can be used to take what is already known to be effective and integrate that with cross-cultural knowledge as opposed to seeking out differences among groups. A thought is offered that the most central component of counseling international students is the integration of culture-free models in counseling.

It is vital to recognize the contributions that international students bestow on American higher education and society. Just as international students come to America to learn and grow, native-born citizens also flourish from the experiences gained through interaction with their international contemporaries. Parr, Bradley, and Bingi (1992) celebrated this notion by stating that U.S. institutions of higher education ensure “creative efforts to convey the message that international students are cherished guests who enrich our college campuses” (p. 25). Counselors are able to show such hospitality by integrating knowledge and appreciation of self and others while providing an empathetic atmosphere for client growth and understanding.