1. Introduction

Previous researches have shown that young people who experience mental health or psychological problems underutilise professional psychological help services ^{[1, 2, 3]}. The underutilisation of professional psychological services could be due to fear of going through the helping process and being labeled by others as problematic students ^{[4, 5, 6]} and negative attitudes towards professional help and the social stigma related to professional psychological help ^{[7, 8]}. Very often, young people with personal and psychological problems prefer to turn to friends and family members for help ^[2].

A review of a variety of previous empirical studies indicated a few possible variables that are related to the likelihood of seeking professional psychological help among students and adults. One of them is fears of psychological treatment. Zartaloudi and Madianos ^[9] explored the link between treatment fearfulness and help-seeking behavior among 290 participants who sought help from the community mental health center in Greece. The participants comprised of students, skilled workers, and professionals. They found that individuals with less treatment fearfulness had more positive attitudes toward seeking professional psychological help and the time taken for these individuals to visit a mental health service center was shorter. In an exploratory study of people’s reasons for delaying or avoiding help seeking among 70 individuals with ages ranging from 14 to 72 in Australia, Amato and Bradshaw ^[10] found that fear and stigma associated with help seeking was one of the most important clusters of reasons given by respondents to avoid psychological help. The other four possible reasons for delaying or avoiding help seeking are problem avoidance and denial; suitability and availability of a helper; perceived external barriers; and desire to maintain independence. A systematic study on the multidimensional construct of treatment fears and service avoidance among university students was done by Kushner and Sher ^[6]. Participants comprised of 92 clinical subjets who were clients at the university psychological service centers and 501 non-clinical subjects. Based on the history of treatment seeking and treatment history, those non-clinical subjects were divided into avoider, seeker, and never-needed treatment group. They reported that there was a significant difference in the level of treatment fears between the avoider group and never-needed treatment group. Based on their findings for both clinical and non-clinical subjects, they concluded that increased treatment fears would lead to service avoidance. Their study on treatment fearfulness was replicated and extended by Deane and Chamberlain ^[11] and found that treatment fearfulness was related to the likelihood of seeking professional psychological help. Although the relationship between treatment fearfulness and the likelihood of seeking professional psychological help among students was well established ^{[6, 10, 11]}, the relationship can be rather weak and influenced by the type of problems as found by Cepeda-Benito and Short ^[12], that treatment fearfulness was the significant predictor for the likelihood of seeking help for academic related concerns, but not for interpersonal and psychological concerns or drug use concerns. It is also the focus of this study to explore whether fears of psychological treatment influences the likelihood of seeking professional psychological help according to type of problems.

Another variable that is related to the likelihood of seeking professional psychological help among students is attitudes towards seeking professional psychological help. Studies have found that young people who have positive attitudes towards seeking professional psychological help coincide with the greater likelihood to seek help ^{[13, 14, 15]}. The relationship between attitudes towards seeking professional psychological help and likelihood of seeking counseling was studied by Kelly and Achter ^[16] using 260 students from two introductory level psychology courses who attended classes on the day of the study were used as subjects. They found that attitudes towards seeking professional psychological help were positively correlated to the intentions to seek professional psychological help from the university counseling center. A similar study was done by Cepeda-Benito and Short ^[12] using a larger number of undergraduates, selected from introductory and upper level psychology classes over two semesters in Texas A & M University. They concluded that positive attitudes towards psychotherapy significantly predicted the greater perceived likelihood of seeking help.

Previous research findings have shown consistently that the likelihood of seeking professional psychological help is related to the participants’ previous help-seeking experience. For example, Solberg et al. ^[17] did a survey on 596 undergraduate and graduate Asian American students and found that previous help-seeking experience was related to greater willingness to seek help for academic, interpersonal and substance abuse concerns. Similarly, Atkinson, Lowe and Matthews ^[3] found that Asian Americans students with previous psychological help-seeking experience indicated greater willingness to see a counselor than those with no previous such experience for both personal and academic problems. Besides that, Clary and Fristad ^[18] also revealed that college freshmen with previous counseling experience sought help at a campus counseling centre more often than those who had not had prior counseling experience.Most of these studies used campus setting involving mostly Asian Americans as participants and were conducted in Western countries. The present study seeks to explore whether the same scenario applies to Malaysians in the school setting.

Many empirical studies in the area of psychological help seeking suggested that female students were more likely than male students to seek professional psychological help ^{[11, 13, 19]}. Although many research findings found that gender is generally related to professional psychological help seeking, with women more likely to seek psychological help than men, there are some contradictory research findings that found no significant gender differences related to the professional psychological help seeking among students ^{[3, 20, 21]}.

In conclusion, there is inconsistency in the research findings regarding the differences in the likelihood of seeking professional psychological help between males and females. Given these contradictory findings, there is a need to explore whether gender difference can influence the likelihood of professional psychological help seeking among Malaysian students. Many researches regarding relationships of these four variables aforementioned have been done in Western countries, but there is no research of that nature has been undertaken in Malaysia. In view of this, a research is needed to explore and examine the relationship of these four variables in the Malaysian context in order to have a deeper understanding regarding the phenomenon of underutilisation of professional psychological help services in schools. The purpose of this study was to explore the factors that can influence the likelihood of students seeking professional psychological help. The findings may be helpful to counselors and other mental health professionals on how to promote help-seeking behaviors for individuals who need psychological help.

2. Methods

Participants were students selected from secondaryschools that have at least one full time school counselor in Malaysia. A total of 320 students aged between 15 to 17 were involved with 150 males and 163 females, the balance did not indicate gender. Among the participants, only 53 of them had prior contact with a counselor with 24 participants seeing counselor on their own voluntary initiative whereas the other 29 were referred by others. A total of 267 participants had no prior contact with a counselor, of which 81 of them had thought of seeing a counselor but never make it and the other 182 participants had never thought of seeing a counselor.

Thoughts About Psychotherapy Survey (TAPS), developed by Kushner and Sher ^[6]was used to assess participants’ fears of psychological treatment. The TAPS consists of 19 items rated on a 5-point Likert Scale with no concern (1) to very concerned (5). The total possible scores range from 19 to 95 with higher scores reflecting greater concerns and thus, greater fears towards psychological treatment. An adaptation was done to make the instrument more suitable to be used in the Malaysian school context. The adaptation involved the change of the terminology “therapist” to “counselor” because the term counselor is more widely used and known among the school students in Malaysia.

Attitudes Towards Seeking Professional Psychological Help Scale (ATSPPHS) was developed and standardised by Fischer and Turner ^[22] to measure the attitudes of people towards seeking professional help for psychological disturbances. It consists of 29 items rated on a 4-point scale from disagree (0) to agree (3). 11 items are positively stated whereas 18 items are negatively stated. The total score for a participant can range from 0 to 87 with higher scores indicating more favourable attitudes towards seeking professional psychological help. Both the TAPS and ATSPPHS were translated into Bahasa Malaysia version. Back translation method was used to ensure that the essence of meaning for all items in the original version for each instrument was retained.

The final part of the instrument measured the likelihood of students seeking professional psychological help in schools if they encountered the problem mentioned in each item. It consists of 34 items which are problems relevant to Malaysian students in schools. Problems were divided into seven categories namely, health problems related to substance abuse, socialisation problems, social psychological problems, personal psychological problems, family problems, career and study problems, and school work adjustment problems. Each item was rated in a 6-point scale with 1 (very likely to seek help) to 6 (very unlikely to seek help). Higher scores indicated that students were more likely to seek psychological help in schools if they were having problems.

Questionnaires were administered personally by the researcher in classroom. Participants were informed regarding the purpose of the study and briefed about the instructions on answering the questionnaires. Participation in this study was voluntary and information given was confidential and was only used for this research. After informed consent was obtained from participants, they were given ample time to fill up the questionnaire forms anonymously.

3. Results

One way repeated measures ANOVA was used to analyze the mean differences in the likelihood of seeking professional psychological help according to types of problems. Table 1 and Table 2 present the descriptive statistics and the result of ANOVA respectively for the likelihood of seeking professional psychological help according to each type of problems. 315 valid cases were used in analysis after the listwise deletion of missing data. The result showed a significant difference in the likelihood of seeking professional psychological help for different types of problems,F(6, 1882) = 84.58, p< 0.0005. A Tukey HSD test revealed that the likelihood of seeking professional psychological help differed significantly from one problem to another with exception of that between social psychological problems (M = 3.21) and family problems (M = 3.14). The highest mean likelihood of seeking professional psychological help occurred for school work adjustment problems (M = 4.05), followed by career and study problems (M = 3.90), personal psychological problems (M = 3.70), social psychological problems (M = 3.21), family problems (M = 3.14), socialization problems (M = 2.95), and lastly health problems related to substance abuse (M = 2.64).

Table 1. Descriptive Statistics on the Likelihood of SeekingProfessional Psychological Help. According to Types of Problems

Download as

PowerPoint Slide

Larger image(png format)

Tables index

Veiw figure

View current table in a new window

View next table

Table 2. Summary of One Way Repeated Measure ANOVA on the Likelihood of Seeking Professional Psychological Help by Types of Problems

Download as

PowerPoint Slide

Larger image(png format)

Tables index

Veiw figure

View current table in a new window

View previous table

View next table

Seven standard mutliple regressions were performed using predictor variables of ATSPPHS, TAPS, gender, and prior contact with the likelihood of seeking professional psychological help for seven types of problems (see Table 3). Results showed that only five out of seven regression models were significant (p <.01). TAPS had the greatest beta weight and was a significant predictor of the likelihood of seeking professional psychological help for social psychological problems (β = .180, p < .01), personal psychological problems(β = .193, p < .01), career and study problems (β = .208, p < .01), and school work adjustment problems(β = .163, p < .01). The analysis showed that participants with greater fears of psychological treatment were more likely to seek professional psychological help when experiencing social psychological problems, personal psychological problems, career and study problems, and school work adjustment problems.

Table 3. Multiple Regression Predicting Likelihood of Seeking Professional Psychological Help. According to Types of Problems

Download as

PowerPoint Slide

Larger image(png format)

Tables index

Veiw figure

View current table in a new window

View previous table

Besides fears of psychological treatment, attitudes towards seeking professional psychological help was also found to be a significant predictor of the likelihood of seeking professional psychological help for school work adjustment problems (β = .155, p < .01). The analysis showed that participants with more favorable attitudes towards seeking professional psychological help were more inclined to have greater likelihood of seeking professional psychological help for school work adjustment problems. Apart from fears of psychological treatment, prior contact with counselor was also found to be a significant predictor of the likelihood of seeking professional psychological help for social psychological problems (β = -.168, p < .01). However, the prior contact with counselor had a suppression effect on the likelihood of seeking professional psychological help. The correlation between prior contact with counselor and the likelihood of seeking professional psychological help for social psychological problems was negative (r = -.160, p < .01). The analysis showed that participants who had prior contact with counselor were less inclined to seek professional psychological help when facing social psychological problems. Among the four predictor variables, gender was the only variable that had no significant impact on the likelihood of seeking professional psychological help for all the seven types of problems.

4. Discussion

The likelihood of seeking professional psychological help is very much influenced by the types of problems faced by participants. The descriptive analysis reveals that participants have the greatest likelihood of seeking professional psychological help for school work adjustment problems, followed by career and study problems. Since participants are school students, they may perceive these two problems, which are academic in nature, as the most relevant problems to be brought to counseling. Students generally hold the perceptions of counseling as suitable for those who were academically weak. The likelihood of seeking professional psychological help decreases as the problem becomes more personal and intimate. Students also seem to be more reluctant to seek professional psychological help for family problems. This is probably because participants find it difficult to trust and share personal as well as family problems with counselors. It is the Asian cultural norm that personal and family problems should be shared only among close circle of family and friends. They may feel discomfort and shame to share personal problems with counselors as indicated by findings from Yoon and Jepsen ^[23] among Asian International students in an American public university. As a result, they may prefer to turn to their friends and family members for help as indicated by the previous research ^[2]. Due to the Asian values of emotional self-control, collectivism, and filial piety, students may be encouraged to exercise emotional restraints and show respect to authority figures in a family. To seek professional psychological help for personal and family problems may be seen as a sign of weakness and bring shame to the family ^[24].

The results reveal that participants have the least likelihood of seeking professional psychological help for health problems related to substance abuse. These problems are considered as serious disciplinary problems in most schools. They are closely associated with punishment and disciplinary actions. Thus, students may find it threatening to discuss these problems with a counselor for fear that disciplinary actions will be taken against them. Students may not trust counselors who are also teachers and carry out disciplinary responsibilities. In schools, most clients with these problems are referred by school authorities after they have been identified through urine tests or other means.

The finding demonstrates that fears of psychological treatment is the most significant factor that can influence the likelihood of seeking professional psychological help for social psychological problems, personal psychological problems, career and study problems, and school work adjustment problems. It implies that the higher the level of fears of psychological treatment, the greater will be the likelihood of seeking professional psychological help. When individuals face problems in life, they may be motivated to seek professional psychological help and thus, the likelihood of seeking help increases. At the same time, the fears of psychological treatment will also increase because they may be concerned about the therapist’s competence and professionalism, about what may happen during the psychological helping process and how others will look at them. These thoughts which contribute to fears of psychological treatment will eventually act as an inhibiting factor to seek professional psychological help. Hence, the finding strengthens the proposition of Kushner and Sher ^[25], that is fears of psychological treatment will be activated as the likelihood of seeking professional psychological help becomes more real for an individual. Fears will act as one of the inhibitory factors and will be counteracted by motivational factors. The net result of these two conflicting factors will determine the actual act of seeking professional psychological help. Therefore, the likelihood of seeking professional psychological help may be high among students but it does not guarantee that they will actually seek help when they have problems. The predictability of fears of psychological treatment for the likelihood of seeking professional psychological help is only applicable for social psychological problems, personal psychological problems, career and study problems, and school work adjustment problems. It is not applicable for health problems related to substance abuse, socialisation problems, and family problems. This finding is consistent with that of Cepeda- Benito and Short ^[12] in which fears of psychological treatment predicted the intention to seek help for academic problems but not interpersonal or drug problems.

In order to increase the usage of professional psychological help services in schools, school counselors need to address the fears of psychological treatment among students. According to Kushner and Sher ^[6],fears of psychological treatment is a multidimensional construct consists of fears about the competence and professionalism of the counselor, fears of being judged negatively by others and fears of coerced by the counselor. It is important that school counselors work towards reducing the negative perceptions that are related to seeking professional psychological help services by challenging the misconception and educating potential clients about the counseling process ^[26].It is good for school counselors to discuss openly about the counseling process and what is expected from the counselor. This will help to encourage more students to seek professional psychological help willingly on their own accord rather than being forced to see the counselor by the school authority.

5. Conclusion

Although the results of the present study indicate that fears of psychological treatment is the most significant predictor variable for the likelihood of seeking professional psychological help, the proportion of the variance accounted for by all the seven regression models is very small, less than 10%. There may be other variables such as social stigma, self disclosure, and emotional self-control which could have contributed to the likelihood of seeking professional psychological help, but are not included in the present study. Another concern is the small number of participants who have prior contact with counselor and majority of them are referred clients. The likelihood of seeking professional psychological help among participants may not reflect the actual help seeking behaviours. Future studies may find it helpful to include the actual help seeking behavior using a bigger sample of voluntary clients.

In conclusion, despite these limitations, the present study provided useful information to school counselors regarding the likelihood of seeking professional psychological help among students. Students are more likely to seek professional psychological help for problems related to academic work. Fears of psychological treatment is the most significant factor influencing the likelihood of students seeking professional psychological help related to social psychological problems, personal psychological problems, career and study problems, and school work adjustment problems.

References

[1]	Yeh, C.J., “Taiwanese students’ gender, age, interdependent and independent self-construal, and collective self-esteem as predictors of professional psychological help-seeking attitudes”. Cultural Diversity and Ethnic Minority Psychology, 8, 19-29, 2002.
	In article		CrossRef PubMed
[2]	Oliver, J.M., Reed, C.K.S., Katz, B.M., & Haugh, J.A., “Students’ self-reports of help seeking: The impact of psychological problems, stress, and demographic variables on utilization of formal and informal support,” Social Behavior and Personality, 27, 109-128, 1999.
	In article		CrossRef
[3]	Atkinson, D.R., Lowe, S., & Mattews, L., “Asian American acculturation, gender, and willingness to seek counseling,” Journal of Mutlicultural Counseling and Development, 23, 130-138, 1995.
	In article		CrossRef
[4]	Vogel, D.L. & Wester, S.R., “To seek help or not to seek help: The risks of self-disclosure,” Journal of Counseling Psychology, 50, 351-361, 2003.
	In article		CrossRef
[5]	Kuhl, J., Jarkon-Horlick, L., & Morrissey, R.F., “Measuring barriers to help-seeking behavior in adolescents,” Journal of Youth and Adolescence, 26, 637-650, 1997.
	In article		CrossRef
[6]	Kushner, M.G., & Sher, K.L., “Fear of psychological treatment and its relation to mental health service avoidance,” Professional Psychology: Research and Practice, 20, 251-257, 1989.
	In article		CrossRef
[7]	Garland, A.F., & Zigler, E.F., “Psychological correlates of help-seeking attitudes among children and adolescents,” American Journal of Orthopsychiatry, 64, 586-593, 1994.
	In article		CrossRef PubMed
[8]	Leaf, P.J., & Bruce, M.L., “Gender differences in the use of mental health related services: A reexamination,” Journal of Health and Social Behavior, 28, 171-183, 1987.
	In article		CrossRef PubMed
[9]	Zartaloudi, A. & Madianos, M.G., “Mental health treatment fearfulness and help-seeking,” Issues in Mental Health Nursing, 31, 662-669, 2010.
	In article		CrossRef PubMed
[10]	Amato, P. R., & Bradshaw, R. “An exploratory study of people’s reasons for delaying or avoiding help seeking,” Australian Psychologist, 20, 21-31, 1985.
	In article		CrossRef
[11]	Deane, F. P., & Chamberlain, K., “Treatment fearfulness and distress as predictors of professional psychological help-seeking,” British Journal of Guidance and Counselling, 22, 207-217, 1994.
	In article		CrossRef
[12]	Cepeda-Benito, A., & Short, P.,“Self-concealment, avoidance of psychological services, and perceived likelihood of seeking professional help,” Journal of Counseling Psychology, 45(1), 58-64, 1998.
	In article		CrossRef
[13]	Morgan, T., Ness, D., Robinson, M., “Students’ help-seeking behaviours by gender, racial background, and student status,” Canadian Journal of Counselling, 37(2), 151-166, 2003.
	In article
[14]	Good, G. E., Dell, D. M., & Mintz, L. B., “Male role and gender role conflict: Relations to help seeking in men,” Journal of Counseling Psychology, 36, 295-300, 1989.
	In article		CrossRef
[15]	Halgin, R. P., Weaver, D. D., Edell, W. S., & Spencer, P. G., “Relation of depression and help-seeking history to attitudes toward seeking professional psychological help,” Journal of Counseling Psychology, 34, 177-185, 1987.
	In article		CrossRef
[16]	Kelly, A. E., & Achter, J. A., “Self-concealment and attitudes toward counseling in university students,” Journal of Counseling Psychology, 42(1), 40-46, 1995.
	In article		CrossRef
[17]	Solberg, V. S., Ritsma, S., Davis, B. J., Tata, S. P., & Jolly, A., “Asian-American students’ severity of problems and willingness to seek help from university counseling centers: Role of previous counseling experience, gender, and ethnicity,” Journal of Counseling Psychology, 41, 275-279, 1994.
	In article		CrossRef
[18]	Clary, E. G., & Fristad, M. A., “Predictors of psychological help seeking on a college campus,” Journal of College Student Personnel, 28, 180-181, 1987.
	In article
[19]	Ang, R.P., Lim, K.M., & Tan, A.G., “Effects of gender and sex role orientation on help-seeking attitudes,” Current Psychology, 23(3), 203-214, 2004.
	In article		CrossRef
[20]	Masuda, A., Suzumura, K., Beauchamp, K.L., Howells, G.N., & Clay, C., “United States and Japanese college students’ attitudes toward seeking professional psychological help,” International Journal of Psychology, 40(5), 303-313, 2005.
	In article		CrossRef
[21]	Bee-Gates, D., Howard-Pitney, B., LaFromboise, T., & Rowe, W.,“Help seeking behavior of native American Indian High School students,”Professional Psychology: Research and Practice, 27, 495-499, 1996.
	In article		CrossRef
[22]	Fischer, E. H., & Turner, J. L., “Orientations to seeking professional help: Development and research utility of an attitude scale,” Journal of Consulting and Clinical Psychology, 35, 79-90, 1970.
	In article		CrossRef PubMed
[23]	Yoon, E., &Jepsen, D. A., “Expectations of and attitudes toward counseling: A comparison of asian international and U.S. graduate students,” International Journal for the Advancement of Counselling, 30(2), 116-127, 2008.
	In article		CrossRef
[24]	Shea, M., &Yeh, C. J., “Asian american students' cultural values, stigma, and relational self-construal: Correlates of attitudes toward professional help seekin,” Journal of Mental Health Counseling, 30(2), 157-172, 2008.
	In article
[25]	Vogel, D.L., Wester, S.R., & Larson, L.M., “Avoidance of counseling: Psychological factors that inhibit seeking help,” Journal of Counseling and Development, 85(4), 410-422, 2007.
	In article		CrossRef
[26]	Kushner, M.G., & Sher, K.L., “The relation of treatment fearfulness and psychological service utilization: An overview,” Professional Psychology: Research and Practice, 22 (3), 196-203, 1991.
	In article		CrossRef