Seeking Help in a Foreign Land: International Students' Use Patterns for a U.S. University Counseling Center.

This archival study examined the use of a university counseling center's services by international students during a 5-year period. Variables analyzed included clients' presenting concerns, students' demographic characteristics, number of counseling sessions attended, and reasons for termination. Implications for counselor training, outreach activities, and counseling services on college campuses are discussed. ********** According to the 2003-2004 statistics on international enrollment at U.S. universities, 572,509 international students attended U.S. institutions f higher education (Chin, 2004). Given this large number, greater attention has been directed toward the psychological and cultural adjustment of students from abroad (e.g., Constantine, Anderson, Berkel, Caldwell, & Utsey, 2005; Mori, 2000; Swagler & Ellis, 2003; Yoon & Portman, 2004). Although the number of international students on campuses continues to increase, only a limited number of recently published studies have examined how international students use student services such as counseling centers or the types of mental health issues that may cause them to seek help (e.g., Nilsson, Berkel, Flores, & Lucas, 2004; Yi, Lin, & Kishimoto, 2003). The field of counseling has done tremendous work examining college students' psychological needs and has led the way in the area of multiculturalism on college campuses. However, a stronger focus on international students is still needed in the counseling literature. Results of the studies that do exist have indicated that international students experience adjustment difficulties (i.e., change in the level of functioning) that may be academic, social, or psychological in nature (Constantine et al., 2005; Lee, Koeske, & Sales, 2004; Mallinckrodt & Leong, 1992; Parr, Bradley, & Bingi, 1992; Sandhu, 1994; Yoon & Portman, 2004). Although these difficulties are experienced by both native-born and international students, the extant research indicates that international students may tend to experience adjustment difficulties to a greater degree than do their native-born counterparts (Pedersen, 1991; Sandhu & Asrabadi, 1994; Yoon & Portman, 2004). Among the specific psychoemotional difficulties encountered by international students are clashes of cultural values (Brinson & Kottler, 1995); loss of social support systems (Lee et al., 2004); culture shock (Sandhu, 1994); feelings of inferiority (Sandhu, 1994); and loneliness, feeling different, and loss of identity (Brinson & Kottler, 1995; Lewthwaite, 1997). Atkinson, Morten, and Sue (1998) reported that international students, once they arrive in the United States, are under constant pressure to acculturate. This pressure can create corresponding intergenerational conflict within families of international students, such that older adults in the family may not approve of younger family members conforming to the host culture. In addition, international students may be negatively influenced by forces of racism and xenophobia (i.e., fear or hatred of foreigners), which they may encounter on college campuses with a predominantly White student population (Boyer & Sedlacek, 1989; Constantine et al., 2005). For example, events that have an international impact, such as the September 2001 terrorist attack on the United States or the U.S. involvement in foreign wars, may cause international students to deal more frequently with fears about acts of retaliation that could affect them (Bassinger, 2001; Hoofer, 2001). Although international students are most likely to seek help first from friends, academic advisers, medical health care professionals, or faculty (Aubrey, 1991), the extent of the difficulties experienced by international students may at some time result in their self-referral or referral by others to counseling centers. Mental health services that are both sufficient and readily accessible to international students are a significant factor in helping them adjust (Mori, 2000; Yoon & Portman, 2004). …