There are growing numbers of cases involving mental health issues. An alarming 60% to 80% of students who needs psychological services do not seek professional help (Eisenberg, Hunt, & Speer, 2012; Lipson et al., 2015). Thanks to news outlet and social media, more people are getting aware of the mental health problems one may encounter. Along with that, there are a number of cases shown of students having mental health concerns and some even going as far as committing suicide. According to Erikson’s Theory (1968), students aged 12 to 18 are starting to explore their independence and own identity. These students may feel confused or insecure about how they fit in in the society. Finding one’s true identity is not as easy as the movies would depict it rather, it’s a process that can cause psychological distress to most students. On the other hand, college students are more focused on forming intimate and loving relationships with other people. Both stages may be different but both development stages can cause psychological distress to students. Thus, mental health professionals can be an important aid.
Professional help can come from counselors, psychologists, psychiatrists, social workers, and other professionals working towards the well-being of people. The most accessible means of professional psychological help for students is the school counselor. It is a requirement for all schools to have a school counselor. Students are more willing to seek professional help from a counselor than a psychiatrist (Mateo & Pinggolio, 2018). With that, school counselors should know and understand the different professional help seeking behaviors of the students in order to better help them. It is important to note the every student is different. School counselors focus on three areas in the students’ lives: personal-social area, academic area, and career development area. Psychological distress in these three areas can be dealt by a school counselor.
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It is no secret that students have their own problems from school works to career issues to family concerns. A study by Sharp and Theiler (2018) shows that a poorer academic outcome is linked to students’ distress. Personal-social factors like family functioning and personal and emotional concerns can also cause distress to students (Al-Krenawi, Graham, & Slonim-Nevo, 2002; Amr, Amin, & Saddichha, 2013; Strubbe, 1989). Career related concerns such as making plans for the future and feeling confused or uncertain also revealed to be stressors for the students (Strubbe, 1989). These problems are common in students in both high school and college. However, the reluctance of students to seek professional help can be a great challenge to effective intervention and prevention of mental health concerns.
Professional Help Seeking
It is important for those who are suffering from poor mental health to communicate to others their difficulties to seek assistance and further treatment options (Rickwood, Thomas, & Bradford, 2012). Self-disclosure affects the likelihood of seeking professional help (Hinson & Swanson, 1993; Vogel & Wester, 1993; Vogel, Wester, Wei, & Boysen, 2004). With this, it is important for individuals to not just reach out to sources such as family and peers but also to formal sources such as mental health professionals. Help seeking behavior can be defined as problem focused, planned behavior, involving interpersonal interaction with a selected health-care professional (Cornally and Mccarthy, 2011). In context to professional help, help seeking is any action carried out by an individual who sees herself or himself as in need of personal, psychological, affective assistance from professionals like counselors, psychologists, or other mental health practitioners (World Health Organization,). Given that professional help seeking context is not new, there are already existing scales measuring this construct.
Previous Conceptualizations. One way to measure professional help seeking is to measure the attitudes towards help seeking. There are three common psychological tools in this approach. First is the Attitudes toward Seeking Professional Psychological Help Scale (Fischer & Turner, 1970). This tests measures four factors namely recognition of personal need for psychological help, stigma tolerance associated with psychological help, interpersonal openness regarding one’s problem, and confidence in mental health professionals. Second is the Inventory of Attitudes toward Seeking Mental Health Services (Mackenzie et al., 2004). The test consists of 24 items within three sub-scales: psychological openness, help-seeking propensity, and indifference to stigma. However, there are questions regarding co-workers and spouse. Third is the Mental Help Seeking Attitudes Scale (Hammer, Parent, & Spiker, 2018). The MHSAS is a 9-item instrument designed to measure respondents’ overall evaluation (unfavorable vs. favorable) of their seeking help from a mental health professional if they found themselves to be dealing with a mental health concern. A higher score indicates a more positive attitude toward seeking help.
Another different approach to professional help seeking is through intentions to seek help. There are also three common scales in this approach. First is the Intentions to Seek Counseling Inventory (Cash et al., 1978). The test presents 17 unknown influencers of poor mental health (such as anxiety and loneliness) and asks how likely they would seek counseling for each of these influencers. Second is the General Help Seeking Questionnaire (Wilson et al., 2005). The test measures future help-seeking intentions and recent past help-seeking experiences. Besides from evaluating the intention to seek help from professionals, the test also assesses the intention to seek help from informal sources. Third is the Intentions to Seek Professional Help Questionnaire (Connor et al., 2014). The test consists of five questions on willingness to use professional help and how proactive they would be in seeking treatment.
All the scales mentioned above failed to account for an individual’s personal traits. Another way that can greatly provide an addition to the context the professional help seeking is to consider the person’s personality trait. In agreement with this, Schomerus, Appel, Meffet, and Luppa (2012) found that personality related factors are important components of help-seeking. Thus, in this the construction of this scale, personality traits specifically the attachment styles will be used as a predictor of professional help seeking behavior.
The Role of Attachment Styles on Professional Help Seeking Behavior
It is true that a person’s intention and attitude towards professional help seeking behavior can influence the therapeutic relationship. However, the success of the therapeutic relationship is dependent on the relationship between professional providers and those who needs help (Adams, Wrath, & Meng, 2018). Attachment theory (1969) provides a great framework for understanding individual traits that can affect interpersonal relationships. It was suggested by Bowlby (1958) that attachment can be explained as an evolutionary context where in the primary caregiver or mother is a source of safety and security for the infants. Attachment is a deep and ever-lasting emotional bond that connects an individual to another individual across time (Ainsworth, 1973; Bowlby, 1969). Researchers have provided empirical support for the link between attachment and help-seeking (Moran, 2007; Ten Have et al., 2010; Turan & Erdur-Baker, 2014).
There are three most commonly used attachment styles: secure, anxious, and avoidant. Adult attachment is one variable that contributes to the individual differences (Lopez, Melendez, Sauer, Berger, & Wyssmann, 1998).
Secure Attachment. Secure individuals are those who have a positive view of his or her self as well as a positive view of others. Research has found that secure individuals are usually confident in their decisions, confident that they can manage their stress, and confident that they can cope with emotional distress (Mikulincer, Shaver, Sapir-Lavid & Avihou-Kanza, 2009; Mikulincer & Shaver, 2007; Mikuliner & Florian, 1995). Secure individuals have a strong perceived social support. Secure individuals commonly describe their peers as trusting and are open to depending on their partner. Thus, they believe that others will be able to provide support when needed (Fraley & Davis, 1997; Collins & Read, 1990; Bartholomew & Horowitz, 1991). A study by Sroufe, Fox, and Pancake (1983) found that secure individuals sought out less support from teachers compared to those insecure individuals; however, they sought out more support when injured, ill or upset. Thus, secure individuals have a strong perceived social support but will know when they are in difficult situations and will seek for professional help.
Anxious Attachment. Unlike secure individuals, anxious individuals are those who see themselves negatively and see others positively (Pietromonaco & Barrett, 2000). They have a high tendency to express anger, anxiety, inability to regulate emotions, and random personal information (Consedine, Fiori, & Magai, 2012; Bartholomew & Horowitz, 1991). Since anxious individuals perceive others positively, they tend to over emphasize their distress to get others to help (Lopez & Brennan, 2000). According to Miller (2008), anxious individuals may misinterpret minor psychological symptoms as severe illness and seek persistent and sometimes unnecessary help. Psychologically distressed anxious individuals perceive weak social support from family and friends; thus, leading them to seek professional help (Vogel & Wei, 2005). With this, anxious attachment can be a strong predictor of professional help-seeking behavior. Dozier (1990) found that those who are anxiously attached were most comfortable disclosing to a counselor. Thus, a person with an anxious attachment will most likely seek excessive professional help due to his or her ineptness to regulate emotions and weak perceived social support.
Avoidant Attachment. The same with anxious individuals, avoidant individuals also perceive weak social support from family and friends; however, unlike anxious individuals, avoidant individuals do not seek professional help (Vogel & Wei, 2005). Individuals with avoidant attachment style perceive themselves positively and perceive other negatively (Pietromonaco & Barrett, 2000). They tend to devalue the importance of others and avoid relying on others for help (Lopez & Bernnan, 2000; Shaver & Mikulincer, 2002). A study by Wigman, Graham-Kevan, and Archer (2008) found that avoidant individuals reported low dependency to others but showed emotional reliance and self-reliance. It is important to note that high levels of emotional reliance are associated with poor mental health (Turner, Taylor, & Van Gundy, 2004). Avoidant individuals restrict themselves from sharing personal information, forming close blonds, and expressing emotion (Ducharme, Doyle, & Marckiewicz, 2002). A study by Fraley and Shaver (1998) found that avoidant individuals will limit closeness with others when experiencing stressful situations. A study by Vogel and Wei (2005) found that avoidant individuals denied their distress and most likely don’t seek professional help. Thus, those with avoidant attachment styles will most likely not seek professional help due to their ineptness to own and express emotions. They may tend to avoid relying on others even when experiencing psychological distress.
Toward a Definition and Operationalization
Previous scales were measuring the individual’s attitude and intention towards professional help seeking behavior. Until now, there are no scales that accounts for the importance of traits in the context of professional help seeking behavior. Drawing on the Attachment Theory, I argue that there are dispositional individual differences in how people seek for professional mental help. There are three components to be considered: attachment style, psychological distress, and social support. Psychological distress will be considered since attachment styles inhibit help seeking from mental health professionals for illness (Feenye & Ryan, 1994). The professional help seeking behavior of a secure individual is to reach to family and friends for social support first but will seek for professional mental help when in pain and psychological distress. A secure individual knows when to seek for professional help. The professional help seeking behavior of an anxious individual is to seek for excessive professional mental help since they have a weak perceived social support and they tend to over emphasize their distress. The professional help seeking behavior of an avoidant individual is to most likely not seek professional mental help even if he or she has a weak perceived social support since they usually deny distress.
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