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Culture-Centered Psychotherapy Preferences for Polynesian Americans: An Interpretative Phenomenological Approach

International Journal for the Advancement of Counselling volume 44, pages 604–627 (2022)Cite this article

Abstract

The purpose of this study was to understand Polynesian American (PA) values, preferences, and beliefs about psychotherapy in light of their culture. An Interpretative Phenomenological Analysis (IPA) was conducted to collect and analyze culturally relevant preferences and expectations of psychotherapy with Polynesian Americans. The study consisted of 13 in-depth interviews with individuals of Pacific Islander descent who are currently living in the United States. The results of the analysis showed three culturally informed themes shared by study participants that informed this sample’s expectations and preferences of psychotherapy: ʻOhana (family), Lōkahi (harmony) and Aloha (warmth, compassion, love). These values provide unique insights to therapy adaptations that should be emphasized when working with Polynesian American clients, such as using a family centered approach to therapy that takes into account the collective needs of a client’s entire family, participating in therapist self-disclosure and the sharing of personal backgrounds, looking at clients challenges through a holistic lens, and demonstrating genuine warmth in the client-counsellor relationship. We discuss clinical implications and recommendations for Polynesian Americans in future research.

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References

  • Allen, G. E. K., Cox, J., Smith, T. B., Hafoka, O., Griner, D., & Beecher, M. (2016a). Psychotherapy Utilization and Presenting Concerns Among Polynesian American College Students. The Counseling Psychologist, 44(1), 28–49. https://doi.org/10.1177/0011000015617534

    Article  Google Scholar 

  • Allen, G. E. K., Garriott, P. O., Reyes, C. J., & Hsieh, C. (2013). Racial identity, phenotype, and self-esteem among biracial Polynesian/white individuals. Family Relations, 62(1), 82–91.

    Article  Google Scholar 

  • Allen, G. E. K., & Heppner, P. P. (2011). Religiosity, coping, and psychological well-being among Latter-Day Saint Polynesians in the U.S. Asian American Journal of Psychology, 2(1), 13–24. https://doi.org/10.1037/a0023266

    Article  Google Scholar 

  • Allen, G. E. K., Kim, B. S., Smith, T. B., & Hafoka, O. (2016b). Counseling attitudes and stigma among Polynesian Americans. The Counseling Psychologist, 44(1), 6–27. https://doi.org/10.1177/0011000015618762

    Article  Google Scholar 

  • Allen, G. E., & Smith, T. B. (2015). Collectivistic coping strategies for distress among Polynesian Americans. Psychological Services, 12(3), 322.

  • Allen, G. E. K., Conklin, H., & Kane, D. K. (2017). Racial discrimination and psychological health among Polynesians in the U.S. Cultural Diversity and Ethnic Minority Psychology, 23(3), 416–424. https://doi.org/10.1037/cdp0000133

    Article  PubMed  Google Scholar 

  • Allan, R., & Eatough, V. (2016). The use of Interpretive Phenomenological Analysis in Couple and Family Therapy Research. The Family Journal, 24(4), 406–414. https://doi.org/10.1177/1066480716662652

    Article  Google Scholar 

  • Anglin, D. M., Alberti, P. M., Link, B. G., & Phelan, J. C. (2008). Racial differences in beliefs about the effectiveness and necessity of mental health treatment. American Journal of Community Psychology, 42(1–2), 17–24. https://doi.org/10.1007/s10464-008-9189-5

    Article  PubMed  PubMed Central  Google Scholar 

  • Arday, J. (2018). Understanding mental health: What are the issues for black and ethnic minority students at University? Social Sciences, 7(10), 196. https://doi.org/10.3390/socsci7100196

    Article  Google Scholar 

  • Austin, A. A. (2007). Doing good work and finding a sense of purpose: The nature and treatment of substance abuse among Native Hawaiians. In P. Culbertson, M. N. Agee, & C. Makasiale (Eds.), Penina Uliuli: Contemporary challenges in mental health for Pacific peoples (pp. 180–195). University of Hawai’i Press.

    Google Scholar 

  • Austin, A. A., & Marsella, A. J. (2005). Understanding substance use and violent behavior in a Native Hawaiian community. In A. J. Marsella, A. A. Austin, & B. Grant (Eds.), Social change and psychosocial adaptation in the Pacific Islands: Cultures in transition (pp. 29–51). Springer Science + Business Media. https://doi.org/10.1007/0-387-23289-3_3.

  • Bean, R. A., & Titus, G. (2009). Cultural intersection of Asian Indian ethnicity and presenting problem: Adapting multicultural competence for clinical accessibility. Journal of Multicultural Counseling and Development, 37(1), 40–51. https://doi.org/10.1002/j.2161-1912.2009.tb00090.x

    Article  Google Scholar 

  • Benish, S. G., Quintana, S., & Wampold, B. E. (2011). Culturally adapted psychotherapy and the legitimacy of myth: A direct-comparison meta-analysis. Journal of Counseling Psychology, 58(3), 279–289. https://doi.org/10.1037/a0023626

    Article  PubMed  Google Scholar 

  • Biggerstaff, D., & Thompson, A. R. (2008). Interpretative Phenomenological Analysis (IPA): A qualitative methodology of choice in healthcare research. Qualitative Research in Psychology, 5(3), 214–224. https://doi.org/10.1080/14780880802314304

    Article  Google Scholar 

  • Chang, T., & Subramaniam, P. R. (2008). Asian and Pacific Islander American men’s help-seeking: Cultural values and beliefs, gender roles, and racial stereotypes. International Journal of Men’s Health, 7(2).

  • Cherbosque, J. (1987). Differential effects of counselor self-disclosure statements on perception of the counselor and willingness to disclose: A cross-cultural study. Psychotherapy, 24(3), 434–437. https://doi.org/10.1037/h0085736

    Article  Google Scholar 

  • Chu, J. P., & Sue, S. (2011). Asian American Mental Health: What we know and what we don't know. Online Readings in Psychology and Culture, 3(1). https://doi.org/10.9707/2307-0919.1026

  • Eatough, V., & Smith, J. A. (2017). Interpretative phenomenological analysis. The Sage handbook of qualitative research in psychology, 193–209.

  • Eisenberg, D., Hunt, J., Speer, N., & Zivin, K. (2011). Mental health service utilization among college students in the United States. The Journal of Nervous and Mental Disease, 199(5), 301–308.

  • Ellsworth, J. R., Lambert, M. J., & Johnson, J. (2006). A comparison of the outcome questionnaire‐45 and outcome questionnaire‐30 in classification and prediction of treatment outcome. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 13(6), 380–391.

  • Gary, F. A. (2005). Stigma: Barrier to mental health care among ethnic minorities. Issues in Mental Health Nursing, 26, 979–999. https://doi.org/10.1080/01612840500280638

    Article  PubMed  Google Scholar 

  • Gee, G. C., Ro, A., Shariff-Marco, S., & Chae, D. (2009). Racial discrimination and health among Asian Americans: evidence, assessment, and directions for future research. Epidemiologic Reviews, 31(1), 130–151.

  • Goldspink, S., & Engward, H. (2018). Booming clangs and whispering ghosts: Attending to the reflexive echoes in IPA research. Qualitative Research in Psychology, 16(2), 291–304. https://doi.org/10.1080/14780887-2018.1543111

    Article  Google Scholar 

  • Griner, D., & Smith, T. B. (2006). Culturally adapted mental health intervention: A meta-analytic review. Psychotherapy: Theory, Research, Practice, Training, 43(4), 531–548. https://doi.org/10.1037/0033-3204.43.4.531

    Article  Google Scholar 

  • Hafoka Kanuch, O., Smith, T. B., Griner, D., Allen, G. K., Beecher, M. E., & Young, E. (2021). Psychotherapy utilization, presenting concerns, and outcomes among Pacific Islander and Asian American Students. Counselling Psychology Quarterly, 34(2), 183–200.

  • Hall, G., Berkman, E. T., Zane, N. W., Leong, F., Hwang, W. C., Nezu, A. M., Nezu, C. M., Hong, J. J., Chu, J. P., & Huang, E. R. (2021). Reducing mental health disparities by increasing the personal relevance of interventions. The American Psychologist, 76(1), 91–103. https://doi.org/10.1037/amp0000616

    Article  PubMed  Google Scholar 

  • Hall, G. C. N., Ibaraki, A. Y., Huang, E. R., Marti, C. N., & Stice, E. (2016). A meta-analysis of cultural adaptations of psychological interventions. Behavior Therapy, 47(6), 993–1014. https://doi.org/10.1016/j.beth.2016.09.005

    Article  PubMed  Google Scholar 

  • Harrington, R. B., Harvey, N., Larkins, S., & Redman-MacLaren, M. (2021). Family planning in Pacific Island Countries and Territories (PICTs): A scoping review. PloS one, 16(8), e0255080.

  • Heppner, P. P. (2006). The benefits and challenges of becoming cross-culturally competent counseling psychologists: Presidential address. The Counseling Psychologist, 34(1), 147–172. https://doi.org/10.1177/0011000005282832

    Article  Google Scholar 

  • Heppner, P. P., Leong, F. T., & Chiao, H. U. N. G. (2008). A growing internationalization of counseling psychology. Handbook of Counseling Psychology, 4, 68–85.

    Google Scholar 

  • Hooker, K., Phibbs, S., Irvin, V.L., Mendez-Luck, C.A. Doan, L.N., Li, T., …& Choun, S. (2019). Depression among older adults in the United States by disaggregated race and ethnicity. The Gerontologist, 59(5), 886-891. https://doi.org/10.1093/geront/gny159

  • Inman, A. G., Gerstein, L. H., Wang, Y.-F., Iwasaki, M., Gregerson, M., Rouse, L. M., Dingman, S., Ferreira, J. A., Watanabe-Muraoka, A., & Jacobs, S. C. (2019). Supporting disaster relief efforts internationally: A call to counseling psychologists. The Counseling Psychologist, 47(4), 630–657. https://doi.org/10.1177/0011000019877407

    Article  Google Scholar 

  • Jankovic, J., Parsons, J., Jovanović, N., Berrisford, G., Copello, A., Fazil, Q., & Priebe, S. (2020). Differences in access and utilisation of mental health services in the perinatal period for women from ethnic minorities—a population-based study. BMC Medicine, 18(1). https://doi.org/10.1186/s12916-020-01711-w

  • Jenkins, K., & Harte, H. M. (2011). Traditional Maori parenting. An historical review of literature of traditional Maori child rearing practices in pre-European times. Te Kahui Mana Ririki. http://www.ririki.org.nz/wp-content/uploads/2015/04/TradMaoriParenting.pdf

  • Kaholokula, J.K.A, Okamoto, S.K., & Yee, B.W. (2019). Special issue introduction:Advancing Native Hawaiin and other Pacific Islander health. Asian American Journal of Psychology, 10(3),197. https://psycnet.apa.org/doi/https://doi.org/10.1037/aap0000170

  • Kearney, L. K., Draper, M., & Barón, A. (2005). Counseling utilization by ethnic minority college students. Cultural Diversity and Ethnic Minority Psychology, 11(3), 272.

  • Kim, B. S. (2011). Client motivation and multicultural counseling. The Counseling Psychologist, 39(2), 267–275. https://doi.org/10.1177/0011000010375310

    Article  Google Scholar 

  • Kim, B. S. K., Hill, C. E., Gelso, C. J., Goates, M. K., Asay, P. A., & Harbrin, J. M. (2003). Counselor self-disclosure, East Asian American client adherence to Asian cultural values, and counseling. Journal of Counseling Psychology, 50(3), 324–332. https://doi.org/10.1037/0022-0167.50.3.324

    Article  Google Scholar 

  • Kim, J. E., & Zane, N. (2016). Help-seeking intentions among Asian American and White American students in psychological distress: Application of the health belief model. Cultural Diversity and Ethnic Minority Psychology, 22(3), 311.

  • Kvale, S. (1996). Interviewing: An introduction to qualitative research interviewing. Sage.

    Google Scholar 

  • Lee, E., & Mock, M. R. (2005). Asian Families: An Overview. In M. McGoldrick, J. Giordano, & N. Garcia-Preto (Eds.), Ethnicity and family therapy., 3rd ed. (pp. 269–289). The Guilford Press

  • Lincoln, Y. S., & Guba, E. G. (1985). Establishing Trustworthiness. Naturalistic Inquiry, 289(331), 289–327.

    Google Scholar 

  • Lockard, A. J., Hayes, J. A., Graceffo, J. M., & Locke, B. D. (2013). Effective Counseling for Racial/Ethnic Minority Clients: Examining Changes Using a Practice Research Network. Journal of College Counseling, 16(3), 243–257. https://doi.org/10.1002/j.2161-1882.2013.00040.x

    Article  Google Scholar 

  • Matt, G. E., & Navarro, A. M. (1997). What meta-analyses have and have not taught us about psychotherapy effects: A review and future directions. Clinical Psychology Review, 17(1), 1–32. https://doi.org/10.1016/S0272-7358(96)00042-6

    Article  PubMed  Google Scholar 

  • Mau, M. (2010). Health and healthcare of Native Hawaiian and other Pacific Islander older adults. In Periyakoil, V. S. (Ed.). eCampus. http://geriatrics.stanford.edu/ethnomed/hawaiian_pacific_islander/

  • McLaughlin, L. A., & Braun, K. L. (1998). Asian and Pacific Islander cultural values: Considerations for healthcare decision-making. Health and Social Work, 23, 116–126. https://doi.org/10.1093/hsw/23.2.116

    Article  PubMed  Google Scholar 

  • Miranda, J. (1996). Introduction to the special section on recruiting and retaining minorities in psychotherapy research. Journal of Consulting and Clinical Psychology, 64(5), 848–850. https://doi.org/10.1037/0022-006X.64.5.848

    Article  PubMed  Google Scholar 

  • Miranda, J., Lawson, W., & Escobar, J. (2002). Ethnic Minorities Mental Health Services Research, 4(4), 231–237. https://doi.org/10.1023/a:1020920800686

    Article  PubMed  Google Scholar 

  • Mokuau, N. (2011). Culturally based solutions to preserve the health of Native Hawaiians. Journal of Ethnic & Cultural Diversity in Social Work, 202, 98–113. https://doi.org/10.1080/15313204.2011.570119

    Article  Google Scholar 

  • Mizelle, N. D. (2009). Counseling white Americans. In The professional counselor's desk reference (pp. 247–254). New York: Springer Publishing Company.

  • Nilsson, J. E., Wang, L. F., & Chung, Y. B. (2019). Working globally: Advancing international competencies in counseling psychology. The Counseling Psychologist, 47(4), 566–577. https://doi.org/10.1177/0011000019883893

    Article  Google Scholar 

  • Pukui, M. K., Haertig, E. W., & Lee, C. A. (1972). Nana I Ke Kumu [Look to the Source] Vol. 2. Hui Hanai.

  • Sandelowski, M. (1999). Focus on qualitative methods: The call to experts in qualitative research. Research in Nursing &Health, 21(5). 467–471. https://onlinelibrary.wiley.com/doi/epdf/https://doi.org/10.1002/%28SICI%291098-240X%20899810%2921%3A5%3C467%3A%3AAID-NUR9%3E3.0.C0%3B2-Lorg/10.1080/14780880802699092

  • Shaw, R. L. (2010). Embedding reflexivity within experiential qualitative psychology. Qualitative Research in Psychology, 7(3), 233–243. https://doi.org/10.1080/14780880802699092

    Article  Google Scholar 

  • Shaw, R. L. (2011). Women’s experiential journey toward voluntary childlessness: An interpretative phenomenological analysis. Journal of Community & Applied Social Psychology, 21(2), 151–163. https://doi.org/10.1002/casp.1072

    Article  Google Scholar 

  • Smith, J. (2019). Participants and researchers searching for meaning: Conceptual developments for interpretative phenomenological analysis. Qualitative Research in Psychology, 16(2), 166–181. https://doi.org/10.1080/14780887.2018.1540648

    Article  Google Scholar 

  • Smith, T. B., & Sylva, L. (2011). Ethnic identity and personal well-being of people of color: A meta-analysis. Journal of Counseling Psychology, 58, 42–60. https://doi.org/10.1037/a0021528

    Article  PubMed  Google Scholar 

  • Smith, T. B., Rodríguez, M. D., & Bernal, G. (2011). Culture. Journal of Clinical Psychology, 67(2), 166–175. https://doi.org/10.1002/jclp.20757

    Article  PubMed  Google Scholar 

  • Sobralske, M. (2006). Olakino Maika'i: health care in Pacific Island culture. Journal of the American Association of Nurse Practitioners, 18(3), 81.

  • Spiers, J., & Smith, J. A. (2019). Interpretative phenomenological analysis. SAGE Research Methods Foundations. https://doi.org/10.4135/9781526421036813346 

  • Sprenkle, D. H. (2012). Intervention research in couple and family therapy: A methodological and substantive review and an introduction to the special issue. Journal of Marital & Family Therapy, 38(3), 3–29. https://doi.org/10.1111/j.1752-0606.2011.00271.x

    Article  Google Scholar 

  • Subica, A. M., Aitaoto, N., Sullivan, J. G., Henwood, B. F., Yamada, A. M., & Link, B. G. (2019). Mental illness stigma among Pacific Islanders. Psychiatry Research, 273, 578–585.

  • Subica, A. M., & Wu, L. T. (2018). Substance use and suicide in Pacific Islander, American Indian, and multiracial youth. American Journal of Preventive Medicine, 54, 795–805. https://doi.org/10.1016/j.amepre.2018.02.003

    Article  PubMed  PubMed Central  Google Scholar 

  • Sue, S. (1998). In search of cultural competence in psychotherapy and counseling. American Psychologist, 53(4), 440–448. https://doi.org/10.1037/0003-066X.53.4.440

    Article  PubMed  Google Scholar 

  • Sue, S. (1999). Science, ethnicity, and bias: Where have we gone wrong? American Psychologist, 54(12), 1070–1077. https://doi.org/10.1037/0003-066X.54.12.1070

    Article  PubMed  Google Scholar 

  • Sunderani, S., & Moodley, R. (2020). Therapists’ perceptions of their use of self-disclosure (and nondisclosure) during cross-cultural exchanges. British Journal of Guidance & Counselling. https://doi.org/10.1080/03069885.2020.1754333

    Article  Google Scholar 

  • Sussman, L. K., Robins, L. N., & Earls, F. (1987). Treatment-seeking for depression by black and White Americans. Social Science & Medicine, 24(3), 187–196. https://doi.org/10.1016/0277-9536(87)90046-3

    Article  Google Scholar 

  • Ta, V. M., Juon, H., Gielen, A. C., Steinwachs, D., & Duggan, A. (2007). Disparities in use of mental health and substance abuse services by Asian and Native Hawaiian/other Pacific Islander women. The Journal of Behavioral Health Services & Research, 35(1), 20–36. https://doi.org/10.1007/s11414-007-9078-y

    Article  Google Scholar 

  • Tracy, S. J. (2020). Qualitative Research Methods: Collecting evidence, crafting analysis, communicating impact (2nd ed.). Wiley. Blackwell. https://doi.org/10.1080/22041451.2019.1688620

  • Trimble, J. E., & Bhadra, M. (2013). Ethnic gloss. In K. Keith (Ed.). Encyclopedia of cross-cultural psychology (pp. 500–504). John Wiley. https://doi.org/10.1002/9781118339893.wbeccp204

  • Uehera, E. (2001). Understanding the dynamics of illness and help-seeking: Event-structure analysis and a Cambodian-American narrative of “spirit invasion.” Social Science and Medicine, 52, 519–536.

    Article  Google Scholar 

  • U.S. Bureau of the Census. (2010). People: Fact finder. http://www.census.gov/population

  • Wang, C. D. C., & Çiftçi, A. (2019). Social justice and international competencies: Positioning counseling psychologist for the global era. The Counseling Psychologist, 47(4), 608–629. https://doi.org/10.1177/0011000019879967

    Article  Google Scholar 

  • Whealin, J. M., Yoneda, A. C., Nelson, D., Hilmes, T. S., Kawasaki, M. M., & Yan, O. H. (2017). A culturally adapted family intervention for rural Pacific Island veterans with PTSD. Psychological Services, 14(3), 295–306. erl.lib.byu.edu/https://doi.org/10.1037/ser0000186

  • Yee, B. W., DeBaryshe, B. D., Yuen, S., Kim, S. Y., & McCubbin, H. I. (2007). Asian American and Pacific Islander families: Resiliency and life-span socialization in a cultural context. Handbook of Asian American Psychology, 2, 69–86.

  • Yeh, C. J., Arora, A. K., & Wu, K. A. (2006a). A new theoretical model of collectivistic coping. In P. T. P Wong and L. C. J. Wong (Eds.), Handbook of Multicultural Perspectives on Stress and Coping (pp. 56 – 60). New York: Springer ScienceBusiness Media. https://doi.org/10.1007/0-387-26238-5_3

  • Yeh, C. J., Inman, A. G., Kim, A. B., & Okubo, Y. (2006b). Asian American families’ collectivistic coping strategies in response to 9/11. Cultural Diversity and Ethnic Minority Psychology, 12(1), 134–148. https://doi.org/10.1037/1099-9809.12.1.134

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Counseling Psychology and Special Education, MCKB 340, BYU, Provo, UT, USA

    Beth Cutrer-Parraga, G. E. Kawika Allen, Erica Miller, Rachel Chapman, Bango Gancinia, Meilani Roan & Abby Norton

  2. Counseling and Psychological Services, MCKB 340, BYU, Provo, UT, USA

    Hoku Conklin & Cameron Hee

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  1. Beth Cutrer-Parraga
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Appendix 1 – Interview Protocol

Appendix 1 – Interview Protocol

  1. 1.

    Please share your thoughts regarding the process of psychotherapy?

  2. 2.

    If you were to choose to see a mental health therapist, what do you expect from them?

  3. 3.

    If you had total control over a mental health session, what would you like to happen?

  4. 4.

    What would be most helpful for you during therapy?

  5. 5.

    What goals do you think you would want to have during a mental health session?

  6. 6.

    When you think of psychotherapy and culture what comes to mind?

  7. 7.

    Some people believe it would be important to see a Polynesian therapist, others believe it would not matter. What are your thoughts?

  1. a)

    Would it be important to you if your therapist was Polynesian or not?

  1. 8.

    What would you like your therapist to do or say during therapy?

  2. 9.

    What are your thoughts about therapists sharing vs not sharing personal information during a therapy session?

  3. 10.

    How important would it be to you for a therapist to focus on family or friends during sessions?

  4. 11.

    What would help you feel safe?

  5. 12.

    When you have a problem, how do you go about solving it?

  6. 13.

    Please share what helps you feel psychologically healthy- if anything?

  7. 14.

    Where do you think is the source of psychological problems?

  8. 15.

    What role do you think relationships play when it comes to psychological health – if any?

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Cutrer-Parraga, B., Allen, G.E.K., Conklin, H. et al. Culture-Centered Psychotherapy Preferences for Polynesian Americans: An Interpretative Phenomenological Approach. Int J Adv Counselling 44, 604–627 (2022). https://doi.org/10.1007/s10447-022-09472-2

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Keywords

  • Culture-centered psychotherapy
  • Polynesian Americans
  • Mental health