..
i .3 a:

 

.1 a!
.A 1...!
.

8‘.

l.

u?

 

 

 

 

4

t...
r03}
.)
fishy—m“. NM.
«.20 5.1::
, fiwflfiufiu ‘1.
31.1}.3fifluwu.‘ 3
n huh... Fifi-m. ...x.
1:12.: J3... is...
I 1.. .2 £3ch .
cuff” a
31m?

 

$913.
.2 (.12.. .
.35
1.. M.

£53.? . 3.3m”

 

. . .:.
.wmnfivv.‘ 44...;
figs?

v’ll

u
n M." ,
.u’

L #1.
(1.14:3.

. X
i .
.r

 

 

$3:

 
 

figfiwfiufi$

 

flgfifiéfia

 

 

Efifig .... .1“

 

1 4.35..“ >WM$¢W$MA

cw...

 

ulifl .
O .

 

 

 

[115»? B A
LIBRARY

£1 Michigan State
3 00 5 University

 

 

 

This is to certify that the
dissertation entitled

CONTEXTUAL FACTORS AND ATTITUDES TOWARD
FAMILY THERAPY AS A HELP-SEEKING OPTION AMONG
MIDDLE-CLASS AFRICAN AMERICANS

presented by
MONICA MOUTON SANDERS

has been accepted towards fulfillment
of the requirements for the

Doctoral degree in Philosophy

in Family and Child Ecology,
Marriage and Family Therapy Specialization

MM 3* MAW
Matti 3/05

Date

 

MSU is an Affirmative Action/Equal Opportunity Institution

 

PIACE IN REIURN BOX to remove this checkout from your record.
To AVOID FINES return on or before date due.
MAY BE RECALLED with earlier due date if requested.

 

DATE DUE

DATE DUE

DATE DUE

 

FEB 25 2013

 

@227 33

 

 

 

 

 

 

 

 

 

 

 

 

 

2/05 chTRC/DateDueJndd-pJS

 

CONTEXTUAL FACTORS AND A'I'I'ITU DES TOWARD FAMILY THERAPY
AS A HELP-SEEKING OPTION AMONG MIDDLE-CLASS
AFRICAN AMERICANS
By

Monica Mouton Sanders

A DISSERTATION

Submitted to
Michigan State University
In partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY
Department of Family and Child Ecology
2005

ABSTRACT
CONTEXTUAL FACTORS AND ATTITUDES TOWARD FAMILY THERAPY AS
A HELP-SEEKING OPTION AMONG MIDDLE-CLASS AFRICAN AMERICANS
BY

Monica Mouton Sanders

The purpose of this study is to explore attitudes toward family therapy
among middle-class African Americans. An ecologically sensitive approach
accounting for the interplay between race, social class, and culture is utilized to
understand how contextual factors influence attitudes toward family therapy as a
help-seeking option among an underresearched group of African Americans.
Contextual factors considered include gender, racial socialization that includes
beliefs about religious and extended family involvement, perceived social support
and perceived access to mental health services. Help-seeking comfort, that is,
how comfortable a person is with seeking help from others in time of stress, is
examined as a variable that potentially moderates the relationship between
contextual factors and attitudes toward family therapy.

A sample of 135 participants was selected from a southern community within
the United States. Both male and female participants were asked to complete a
survey within a group setting. Survey items pertained to contextual issues,
including gender, perceived social support, racial socialization attitudes regarding
spirituality and caregiving from within the extended family context, and perceived
access to mental health services and help-seeking comfort. Attitudes toward

family therapy include issues of need, stigma, openness to services, and

confidence in the ability of family therapists to address interpersonal distress.
Results demonstrate that women tend to exhibit more positive attitudes toward
family therapy than men, though, overall, both exhibit positive attitudes toward
family therapy. Analyses were used to explore whether or not one's comfort with
help-seeking accounts for the relationship between contextual factors and
attitudes toward family therapy. However, prerequisite factors, necessary to
detect the effect of a moderator variable, were not present. Thus, help-seeking
could not be treated as an intervening variable in the present study.
Nevertheless, perceived access to mental health resources, gender, and help-
seeking comeIt were found to predict attitudes toward family therapy in the
present study. Implications for future research, policy initiatives and clinical

perspectives are discussed.

Copyright by
Monica Mouton Sanders

2005

DEDICATION

I would like to take this opportunity to dedicate this manuscript to those who
came before me. Those persons, along with their ancestors, paved the way so
that my parents and their children would have hope for something that racial
barriers (of that time) would not allow-- a quality education. | write their names
as a remembrance of the sacrifice that they made as servants, sharecroppers,
washwomen, lumbermen, and common laborers so that a college education
could be attainable for my parents and generations to come. I write their names
to recognize their knowledge of life that far outweighed their elementary level
education.

I write their names as l honor them for their diligence, hardwork, and faith as
Christians. They were known for living their faith, not just as persons attending
church, but as individuals who worked hard to provide a stable home life so that
their children and their children’s Children might know that through the journey of
marriage and family life, unconditional love and support are forever unwavering.

And so, to my grandparents Vera Mouton, Mattie Derouen Mouton, Frank
Polk Sr., and Rhea Polk Mitchell, I dedicate this manuscript to you. May you
forever know how much you meant to your families during your time here. I hope
and pray that you are looking down on us with a smile, satisfied that your seeds
of wisdom and sacrifice have allowed many to blossom, now and for years to

come.

ACKNOWLEDGEMENTS

Scripture tells us, “In all thy ways acknowledge Him, and He shall direct thy
path” (Proverbs 3:6). To that end, I would first like to give honor and praise to
God, my Creator. Through Jesus Christ, as lead by the Holy Spirit, I have been
filled with such grace that has allowed me to grow in fa_ith_ that God does exist,
Log for a time when God’s children will be as one, and m for all humankind. I
am so honored that through this graduate experience, God has touched me in a
way that allows me to be forever changed and for that I am truly grateful.

Through this conversion, I have found that faith, perseverance, good times,
sacrifice, and “the village” are essential to completion of a task of this magnitude-
--a metaphor for life. Again, for this lesson, I am forever grateful.

To my “village dwellers,” there are too many to mention. Nevertheless, know
that in my effort to be all inconclusive, I hope that each and everyone of you
know how you personally touched my life. Your support and faith in me, a little
ole’ southern girl from “Lou-si—ana,” gave me the strength to complete this
process. For that, I am forever grateful.

To Dr. Marsha Carolan, my marriage and family therapy mentor, your support
and faith in me carried me through the joys and Challenges of completing the
marriage and family therapy program. Thank you.

To Dr. Deborah Johnson, my research mentor, your wisdom and confidence

in me paved the way for me to soar even in times of self-doubt. Thank you.

vi

To Drs. Harriette McAdoo and Dorothy Harper Jones, your support during the
most challenging phase of this process has confirmed that anything is possible
with lots of hardwork and patience. Thank you.

To my “research assistants”, I am humbly grateful. Data collection at a
distance is difficult, if not seemingly impossible at times, but with your hard work
and commitment to this project, we persevered! Thank you!

To Paul Burton, my statistician, thanks so much for all of your hardwork and
faith in my ability to “get this thing done” in a timely manner. To my writing group
members, Tina, Robin, and Natasha, thanks SO'much for the “Beaners” chats,
feedback and support during this difficult process. I look forward to our continued
work together. Also, to Maresa, my doctoral “buddy”, thanks for the words of
encouragement, reality checks, “Beaners” runs, “crazy laughter” and “Martin”
moments. Girl, the people finally got the song!

To my friends, both near and far, thanks for your support, questions of
curiosity, and “I’m so proud of you” moments. I am honored to call each and
every one of you “friend.”

To my extended family, they say it takes a village to raise a child, but oh, how
I know that means so much more to me! Through your unconditional love and
support you have shown me what true family means, fueling my desire to love
and help other marriages and families to thrive. Thank you!

To my immediate family, Shawn, Yvonne, Brandon (and Stacy, Tony, Blake),
Jayden (and sibling[s]), Mama Wanda, Daddy Hube, and Kim (“Nannie”), thank

you for who you are. Your presence in my life has allowed me to appreciate the

vii

gift of family and the journey of family life and for that I am forever grateful. Love
ya!

Special thanks to Kim, aka “Nannie”-—-Gab’s third parent. Know that we could
not have gotten through this year so smoothly without you!

To my parents, Joseph Curley Mouton and Earline Polk Mouton, you believed
in me as a little girl and allowed me to feel invincible in my quest to be the very
best I am called to be in this life. People ask, “Why a doctoral degree?” and I
respond, “Why not?” Thank you for all of your hard work and confidence in my
ability to complete this process. I love you.

To Hubert, my husband and best friend, Gabrielle, my first born (“dissertation
baby") and others to come (God-willing), thank you for the gift of marriage and
family life. I am honored to be witness to your spirit and the divine in you. I will be
forever grateful for the life lessons you have taught and continue to teach me. I
love you and look forward to each and every moment I am allowed to spend with

you.

viii

TABLE OF CONTENTS

 

LIST OF FIGURES
LIST OF TABLES

 

CHAPTER 1: Introduction

5.

 

Background

 

 

Attitudes and Family Intervention

 

Need and Family Intervention

 

Family Therapy as an Effective Intervention

 

Culture

 

Social Class

 

Race
Additional Contextual Factors to Consider

 

Gender

 

Perceived access to mental health services

 

Help-seeking comfort

 

Statement of Problem

 

Statement of Purpose

 

Theoretical Framework

Vanaaoomwwwmhbma<

 

Conceptual Framework

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Definitions of Key Conceptual Terms 21
Research Questions 22
Summary 22
CHAPTER 2: Literature Review 24
Help-Seeking and Intervention Among African Americans 24
Informal Help-Seeking Among African Americans 26
Help-seeking among family 26
Help-seeking among friends 27
Formal Help-Seeking Among African Americans 28
Religious/spiritual involvement 28
Medical and mental health agency sectors 29
The Paradox of lnforrnal and Formal Help-Seeking Options—-—-—-30
Family Therapy as a Formal Help-Seeking Option 31
A need for family intervention 31
Family therapy and African Americans 32

Contextual Correlates of Attitudes Toward Formal Help-Seeking
Among African Americans 34
Gender 35

Racial Socialization: religious/spiritual coping and ‘

extended family caring 37
Perceived social support 39
Perceived Access to Mental Health Services 39
Help-Seeking Comfort as a Potential Intervening Factor 41

 

ix

Attitudes Toward Formal Therapeutic Intervention Among African

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Americans 42
Research Trends 43
Openness to mental health services 44

Cultural influences and attitudes toward mental health
services 44

Attitudes toward therapy among middle-Class African

Americans 45
A Demographic Profile of Middle-Class African Americans 47
What Constitutes the African American Middle Class?————47
Income 48
Home ownership and residential lifestyle 49
Educational background 50
Occupation 51
Summary 51
CHAPTER 3: Methodology - 53
Instrumentation 54
Racial Socialization 54
Religious/Spiritual Coping Socialization 56
Extended Family Caring Socialization 56
Perceived Social Support 56
Perceived Access to Mental Health Services 57
Attitudes Toward Family Therapy 58
Help-Seeking Comfort 59
Demographic Form 59
Conceptual and Operational Definitions 51
Research Questions and Hypotheses 64
Research Question #1 64
Hypothesis 1 64
Research Question #2 65
Hypothesis 2 66
Hypothesis 3 66
Hypothesis 4 66
Hypothesis 5 66
Hypothesis 6 67
Research Question #3 67
Hypothesis 7 68
Hypothesis 8 68
Hypothesis 9 68
Research Design 68
Targeted Participants 68
Procedure 70
Confidentiality 71
Data Collection Procedure 72

 

 

Analyses 73

 

Summary 74

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CHAPTER 4: Results 75
Demographic Profile of the Participants 76
Attitudes Toward Family Therapy (ATFT) 86
Contextual Factors 89

Perceived Social Support (P88) 89

Extended Family Caring Socialization (EFCS) 89

Religious/Spiritual Coping Socialization (RSCS) 90

Perceived Access to Mental Health Services (ACCESS) 92

Help-Seeking Comfort (HSC) 92

Gender 94

Contextual Correlates of Attitudes Toward Family Therapy 94

What Accounts for Attitudes Toward Family Therapy? 98

Summary of Findings 104

Research Question #1 104

Hypothesis 1 . 104

Research Question #2 105

Hypothesis 2 105

Hypothesis 3 105

Hypothesis 4 106

Hypothesis 5 106

Hypothesis 6 107

Research Questions #3 107

Hypothesis 7 107

Hypothesis 8 108

Hypothesis 9 108

Post Hoc Findings 110

CHAPTER 5: Conclusion 114

Discussion of Key Findings 114
Middle-class African Americans and Attitudes Toward Family

Therapy 114

Contextual Factors and Attitudes Toward Family Therapy---—--1 16

Gender 1 16

Religious/spiritual Coping Socialization (RSCS)--—----1 17

Extended Family Caring Socialization (EFCS) 117

. Perceived Social Support (P88) 118

Perceived Access to Mental Health Services (ACCESS)- 119

Help-Seeking Comfort (H80) 120

Limitations 121

Implications 123

Policy 123

Clinical Focus 125

 

 

APPENDICES 127

xi

Appendix A

Appendix B: Copyright Materials

References

 

Informed Consent Form

 

 

Survey

Help-Seeking Comfort

 

 

Perceived Social Support
Extended Family Caring Socialization and Religious! Spiritual

Coping Socialization

 

 

 

xii

128
129
130
142
143
144

145

146

LIST OF TABLES

Table 1: Conceptual and Operational Definitions of Independent, Dependent, and
Potential Moderator Variables 62

 

Table 2: Demographic Profile of African American Sample: Gender, Age,
Level of Education ‘ 71

 

Table 3: Demographic Profile of African American Sample: Relationship and

 

 

Parental Status - 78
Table 4: Demographic Profile of African American Sample: Home Ownership and
Income 80
Table 5: Occupational Categories for African American Sample 82

 

Table 6: Demographic Profile of African American Sample: Self-rating of Social

 

 

 

 

Class and Hollingshead Social Status Ranking 84
Table 7 Demographic Profile of African American Sample: 85
Table 8: Descriptive Values for Attitudes Toward Family Therapy Scores 88

Table 9: Descriptive Values for Perceived Social Support, Extended Family

Caring Socialization and Religious/Spiritual Coping Socialization Scores—“~91

Table 10: Descriptive Values for Perceived Access to Mental Health Services

and Help-Seeking Comfort Scores 93

Table 11: Bi-variate Correlations Between Attitudes Toward Family Therapy and
Contextual Factors 97

 

Table 12: Predictors of Attitudes Toward Family Therapy: Summary of
Coefficients for Unrestricted and Restricted Regression Models 103

 

xiii

LIST OF FIGURES
Figure 1: Garcia Coll and Colleagues Conceptual Integrative Ecological Model-16

Figure 2: A Conceptual Model of Contextual Factors and Attitudes Toward Family
Therapy as a Help Seeking Option Among Middle-Class African Americans—~20

Figure 3: A Revised Conceptual Model of Contextual Factors and Attitudes
Toward Family Therapy as a Help-Seeking Option Among Middle-Class African

Americans 1 13

 

xiv

CHAPTER 1
Introduction

The purpose of the present study is to identify attitudes toward family therapy
among middle-class African Americans. High rates of ethnic mental health
disparities, across social Class, suggest that a major undertaking is needed in
assessing help-seeking patterns among African Americans. While scholars have
targeted culturally sensitive research in the area of individual psychopathology, a
dearth of research exists in the area of emotional and psychological distress
within the family context. Thus there exists a place within mental health research
for family therapy clinicians and researchers to begin addressing how African
American communities respond to family therapy as a help-seeking option.

The following sections begin with topics relative to a comprehensive
discussion of African Americans’ responses to family intervention. The sections
include: a discussion of attitudes and needs as related to family intervention,
consideration of family therapy as an effective intervention, and the consideration
of context related factors such as culture, social class and race. Additional
factors such as gender, perceived access to mental health services, and help-
seeking comfort are considered, as an ecological lens is used to better
understand the role that context plays in shaping attitudes and behaviors. Finally,
a statement of problem and purpose followed by theoretical frameworks outlining

the conceptual lens of the present study is presented.

Background

African Americans have been targeted within the field of family therapy as an
ethnic group that benefits from family-based services (e.g., McGoIderick, 1996;
Bean, Perry, & Bedell, 2002). Postmodern theories have been promoted in an
effort to redefine how traditional models are used for treatment within African
Americans’ cultural context. A legacy of resilience and survival interwoven into a
cultural fabric of communal coping has shaped family existence among African
Americans. Yet therapists have begun to recognize how sociocultural stressors,
such as public policy and employment inequality, social Class barriers and a
historical context of oppression, have led to intergenerational disconnectedness
and the breakdown of the family unit (Boyd-Franklin, 1989).

With a heightened awareness of the potential for “effective” intervention within
the family context, family therapy scholars have begun to address the needs of
African American families from a culturally sensitive orientation (e.g., Hardy &
Ariel, 1999). Accomplishing this task includes: 1) gaining knowledge of the
cultural experiences of African American families (Pinderhughes, 1989); and 2)
acknowledging the differences that exists between therapists/researchers and
these families, and the families and larger society (Searight, 1997; lmber—Black,
1988).

To date, the study of distress within the family context has primarily targeted
middle-class Caucasian and lower income African Americans. Limited emphasis
has been placed on exploring the cultural experiences of middle-class African

Americans (Bean, Perry, & Bedell, 2002;McAdoo,1999; Bagarozzi, 1995). Given

that middle—class households account for at least 30% of the 5 million African
Americans currently present in the United States (McKinnon, 2002; US Census,
2002), family therapists are challenged to account for class-related help-seeking
attitudes among African Americans. The present study Informs this area of study
by accounting for both class and culture-related factors among a middle-Class

sample of African Americans.

Attitudes and Family Intervention

Identifying attitudes toward formal intervention is critical to understanding the
cultural experiences that shape help-seeking patterns among middle-class
African Americans. In the study of family therapy among African Americans, this
becomes an important question as research demonstrates that overall utilization
of formal mental health services is low for this population (Gibbs, Snowden, &
Huang, 1996; Alvidrez, 1999; Snowden, 2001). In order to better understand the
gap between theory that suggests that African Americans benefit from family
therapy and utilization trends, family therapy researchers must first take a
fundamental step towards assessing the attitudes toward family therapy among
African Americans. Taking that culturally relevant step means also
acknowledging “within group” variations that emerge based on contextual factors
such as social class, gender, spirituality, extended family involvement, social
support and access to mental health services (Duncan, 2003; Bagley & Carroll,
1998; Stevenson, 1994).
Need and Family Intervention

A lack of clear findings exists when tackling the issue of need for family
intervention among African Americans. A historical context of “race-based
exclusion from health, educational, social and economic resources translates into
socioeconomic disparities" often leading to high rates of depression, anxiety and
phobic related mental illness among African Americans (US Surgeon General,
2001). This phenomenon ultimately impacts African Americans both at the

individual and familial level; however, empirical evidence is limited (US Surgeon

General, 2001). Reasons for inconclusive evidence has included: mistrust
leading to minimal reporting of psychological distress and a lack of culturally
sensitive research with large enough data sets of African Americans (US
Surgeon General, 2001).

A need for family intervention can be inferred from a national study that
looked at the use of police contact as a formal intervention among African
Americans (Washington, 1996). It was found that “interpersonal” distress, such
spousal/partner and parent-child conflict, was the most prevalent problem
reported. Additionally, Neighbors (1985) found that the majority of respondents
reported “interpersonal difficulty" as the most common problem encountered
compared to economic, physical, emotional, and death related problems. To that
end, the need for family intervention capable of addressing interpersonal conflict
seems apparent in the study of help-seeking among African Americans
(Washington, 1996).

Family Therapy as an Effective Intervention

Embedded in a systems theory perspective, the field of marriage and family
therapy recognizes that families function within larger systems which then in turn
influence family and individual outcomes (Goldenberg & Goldenberg, 2000).
Emphasizing parent-child and spousal communication patterns makes family
therapy uniquely different from traditional approaches that solely emphasize
individual behavior and mental processes. Different from traditional

psychotherapeutic models, the field of marriage and family therapy fosters more

opportunities to explore therapeutic intervention within the family system (Becvar
& Becvar, 2000).

Family therapy has the potential to be an effective intervention among African
Americans as family harmony and resilience is generally considered to be part of
their cultural framework (McGoldrick & Giordano, 1996; Boyd-Franklin, 1989).
The field of marriage and family therapy incorporates the assumption that
contextual experiences of family life, both harmony and disconnectedness,
ultimately shape the development of individuals (Beavers & Hampson, 1990).
Cultural traditions that are based on collectivism, that is, the view that
interpersonal harmony is central to individual functioning, cany this same familial
theme (Kaniasty & Norris, 2000). Thus, the collectivist ideology within African
American culture would appear to be particularly conducive to the family therapy
context. Yet, while researchers and clinicians promote family therapy as an
effective intervention, African Americans have not been “empowered” to inform
the field of their attitudes toward family therapy (Boyd-Franklin, 1989). This
suggests that a gap exists between theoretical ideologies and the reality of the
family therapy context within African American communities. A culturally sensitive
approach that accounts for the contextual interplay between culture, social class,
and race is needed as to transcend monolithic assumptions about attitudes and
functioning among African Americans.

Culture. The ways in which culture manifests among African Americans has to
be inferred from general help-seeking literature, as little is written about the role

culture plays in influencing attitudes toward family therapy. Traditionally, African

Americans’ cultural context suggests a reliance on informal interventive options,
such as seeking counsel with a family member or neighbor, in addition to more
formal interventive options, such as consulting with a religious figure, physician
or psychologist (Snowden, 2001, Broman, 1996). The cultural context of social
support and adaptive behavior often involves a range of supports including
emotional, social, and financial (Caldwell 8. Koski, 1997). Regarding support for
emotional and psychological distress, formal contacts such as ministers and
physicians are often pursued in conjunction with informal sources (Neighbors &
Jackson, 1985; Neighbors, Musik, & Williams, 1998). Mental health professionals
are considered, but only in cases where there is threat of “severe mental illness,”
also commonly referred to as a “nervous breakdown” (Neighbors, 1985; Mays,
Caldwell, 8. Jackson, 1996). These issues of multiple sources and problem
severity have been found to shape help-seeking patterns among African
Americans. Thus, a culturally sensitive paradigm considers family intervention
within the context of multiple supports and African Americans’ identification of
family distress as a significant problem.

Social class. With regard to social class, African Americans are found to be
diverse in their access to resources, mobility, and levels of achievement (Frazier,
1957; Billingsley, 1968; McAdoo, 1997). Yet, despite scholarly efforts (e.g.,
McAdoo, 1978), the majority of empirical study has been done with middle- class
European Americans and lower class African Americans with minimal exploration
of the experience of middle-class African Americans (Boyd-Franklin, 1989; Bean,

Perry, & Bedell, 2002).

In a recent content analysis, Bean, Peny and Bedell (2002) found that a lack
of empirical family therapy research has been conducted with middle-class
African Americans. This population deserves attention given that sociof
contextual factors unique to this group make needs and outcome vary from the
above-mentioned groups. Issues of poverty and limited access to resources
differentiate the lower income context from this group, while less exposure to
blatant experiences of racial discrimination and prejudice make the Caucasian
middle-class context varied as well (Bagarozzi, 1995). Issues such as the
maintenance of upward mobility across generations, political empowerment
within a racially hostile society, and acculturation (e.g., maintaining a sense of I
both racial and class-related legacies) make the middle-class experience unique
(Haynes, 2001 ). The study of family intervention among African Americans
requires empirical exploration counter to monolithic approaches that make no
effort to articulate class or other characteristics within racial groups (Hardy,
1995). Therefore, the middle-class, as a sub group within the African American
population, is targeted in this study in an effort to contribute to a body of literature
that articulates group experiences when accounting for middle-class status.

Race. Finally, when considering race, adaptation has been a central theme in
the survival of African American individuals and families functioning within a
traditionally hostile socio-cultural environment. One way that African Americans
prepare their Children for optimal adaptation to such an environment is through
the transmission of racial messages that prepare children for racially hostile

conditions (Johnson, 2001). Referred to as racial socialization, this means of

racial adaptation has been documented as a central element in the socialization
behaviors found within African American families (Boykin & Toms, 1985;
Stevenson, 1994). From a multidimensional perspective, Stevenson articulates
racial socialization across four key domains—spirituallreligious coping, extended
family caring, cultural pride reinforcement, and racial awareness teaching.
Spiritual/religious coping and extended family caring are particularly relevant to
the adaptive culture of help-seeking, as the church and extended family contexts
have been environments through which intervention is often pursued (Stevenson,
1993). These factors have particular relevance as the field of marriage and
family therapy is challenged to consider the role of religion/spirituality and
extended family in conjunction with class, thus transcending the traditional “myth
of sameness” in addressing the diverse needs of African Americans (Hardy,
1 995).
Additional Contextual Factors to Consider

Gender. Other factors such as gender can also shape family functioning and
adaptive experiences among African Americans (Garcia Coll, Lamberty, Jenkins,
McAdoo, Cmic, Wasik , & Garcia, 1996). Middle-class African American men and
women, even within their integrated neighborhoods and job settings, experience
discrimination as common occurrences (Boyd-Franklin, 1989). However, their
socialization experiences often result in differences in coping and help-seeking
behaviors. Women are often socialized to believe that self-reliance and
autonomy emerge at the expense of relationships and other mechanisms of

social support. This was particularly promoted during the 19605 when the single-

mother family structure was promoted as the predominant African American
family paradigm that minimized the role of men and their help-seeking options.
This paradigm, which is still promoted today, continues to make it difficult for
African American men to reach out for help within their communities without
being ridiculed or labeled as deficient.

In the area of family intervention, women tend to initiate help-seeking more
readily than men (Boyd-Franklin, 1989). Still, it is suggested that men do in fact,
value psychological services (Duncan, 2003), though little is known about their
attitudes toward family intervention. To that end, there exist the need to expand
the understanding of attitudes toward family intervention both for women and
men.

Perceived access to mental health services. Potential barriers often impact
the dissemination of services to those who can benefit from them. With regard to
family intervention, a primary barrier that has been prevalent among racial
minority groups is perceived access to mental health services. Given that mental
health services are often imposed on African Americans by courts, schools, and
social welfare agencies, resistance to self-referral is heightened (Boyd-Franklin,
1987). Furthermore, due to limited analysis of middle-class African Americans,
treatment options are often generalized from research with lower income African
Americans or middle-class European Americans (Ham, 2003). Additionally, little
research has been recently conducted with middle-class African Americans
which limits the knowledge of their current attitudes regarding access and

utilization of mental health services.

10

Help-seeking comfort. Finally, people are often reluctant to seek help for
distress because either they believe it does not exist or because they are
uncomfortable. Comfort with asking for help is often a predictor of whether or not
a person receives help (Kaniasty & Norris, 2000). To that end, help-seeking
comfort can present as a possible asset or barrier to therapeutic services.
Regarding help-seeking among African Americans, Duncan (2003) notes that
cultural mistrust and self consciousness are associated with a willingness to
pursue formal support services. Given that formal help-seeking has been low
among African Americans in general, investigation of “help seeking comfort”
warrants a comprehensive assessment of factors accounting for attitudes toward
family therapy.

Statement of Problem

Family life has played a central role in the survival of African Americans.
Rooted in communal interdependency and family cohesion,‘the African proverb
of “I am because we are” has set the foundation for this survival despite a
historical context of racial hardships and barriers (Sudarkasa, 1997). Family,
church, and neighborhood communities have preserved African Americans'
overall sense of self worth and value (Ellison, 1997; Johnson 1995). Yet, despite
the existence of such institutions, African Americans still suffer from high rates of
depression, anxiety and familial distress (US Surgeon General, 2001). The
collective identity within African American culture suggests that the functioning of
the individual is highly dependent upon the functioning of the family, especially

within the middle-class context (see McAdoo, 1997). While African American

11

researchers and clinicians recognize the value of family therapy, utilization is low
within most African American communities (Alvidrez, 1999; Diala, Muntaner,
Walrath, Nickerson et al, 2000; Whaley, 2001).

Since a gap exists between scholars’ promotion of family therapy and
knowledge about its perceived value among African Mencans, it is imperative
that attitudes toward family therapy as a help-seeking option be examined. A
study of the middle class-informs the literature of attitudes among this population
given that the majority of mental health studies of African Americans tend to
focus primarily on lower income or working class populations.

Statement of Purpose

The purpose of this study was to explore middle-class African Americans’
attitudes toward family therapy as a formal help-seeking option. Specifically, the
aim was to a) identify attitudes toward family therapy among a middle-class
sample of African Americans; b) examine whether or not contextual factors
account for attitudes toward family therapy among this sample; and c) assess
whether or not one’s comfort with help-seeking influences the relationship
between contextual factors and attitudes toward family therapy. Help-seeking
comfort (HSC) was incorporated as an intervening variable as it has been found
that comfort is related to help-seeking attitudes and behavioral outcome (Gary,
Leashore, Howard 8. Buckner-Dowell, 1982; Rogler & Malgady, 1989; Kaniasty &
Norris, 2000). Furthermore, literature suggests that contextual factors such as
extended family caring socialization (Stevenson, 1994), religious/spiritual coping

socialization (Stevenson, 1994), perceived social support (Delphin & Rollock,

12

1995), gender (Leaf & Bruce, 1987), and perceived access to mental health

services (Snowden, 2001) have been associated with attitudes and help-seeking

behavior. Therefore, these variables were incorporated within this model as

contextual factors that potentially impact attitudes toward family therapy.
Theoretical Framework

The guiding theoretical perspective of this study is based on an ecological
framework. Informing the framework are two major models: 1) Bronfenbrenner’s
(1999) ecological paradigm and 2) Garcia-Coll, Lamberty, Jenkins, McAdoo,
Cmic, Wasik and Garcia’s (1996) integrative model, which incorporates
ecological factors relevant to adaptation and functioning of families of color.

The ecological approach allows for consideration of contextual factors as they
relate to attitudes toward family therapy. Bronfenbrenner’s ecological paradigm
(1986) is widely used within family-based and ecological research (Westney,
1993). Recognizing that a person is constantly engaging in multiple contexts, this
model has evolved from the awareness of context (Bronfennbrenner, 1986) to
the recognition that it is a person’s interaction with varied contexts that shapes
behavioral outcomes (Bronfennbrenner, 1999). Referred to as the bioecological
or person-process-context model, Bronfenbrenner uses this paradigm to state
that person-environment processes vary as a function of the interplay between
personal characteristics and contextual factors (Bronfenbrenner, 1999). This is
reiterated in Magnusson and Stattin’s (1998) presentation of holistic
interactionism. Like Bronfenbrenner, they suggest that individual outcomes are

dependent upon processes involving the interchange between mental,

13

behavioral, social and cultural aspects of the environment. While it is impractical
to operationalize an exhaustive ecological model, the key to effective context-
sensitive research is articulation of the level at which multicontextual complexity
is being examined (Magnusson 8: Stattin,1998).

Regarding middle-class African Americans’ attitudes toward family therapy,
Bronfenbrenner’s ecological approach allows for a multivariate model that moves
beyond bi-variate relationships. The ecological lens provides a framework
through which context-related variables may be incorporated, allowing the
researcher to move beyond mere correlational links between demographic and
outcome variables. Bronfenbrenner’s person-process-context model (1999)
serves as the foundation of this study as it articulates how contextual factors may
account for or predict attitudes toward family therapy.

Additionally, the theoretical framework of Garcia-Coll, Lamberty, Jenkins,
McAdoo, Cmic, Wasik, and Garcia (1996) as the culturally sensitive expansion of
Bronfenbrenner's paradigm is utilized for the present study. Conceptualized as
ecologically relevant to children and their families, this paradigm integrates social
class, race, and cultural factors that are often overlooked within the ecological
literature (Garcia-Coll et al, 1996). This multidimensional and comprehensive
approach incorporates key context— relevant factors when examining
development and functioning among families of color. These factors include
“social position” variables such as class, gender, and ethnicity; “social
stratification” factors such as a) racism, prejudice, and discrimination and; b)

social and psychological means of segregation; “promotingfrnhibiting”

l4

environments such as neighborhoods and health care environments; “adaptive
culture” factors such as cultural legacies and economic history; “individual
characteristics” such as temperament and age; “family factors” such as
religious/spiritual coping socialization and extended family caring socialization;
and “developmental competencies (outcomes)” such as a person’s behavioral or
cognitive functioning (Garcia Coll et al., 1996, p. 1896).

Figure 1 is an illustration of Garcia-Coll and colleagues’ original
conceptualization of culturally relevant contextual areas. Each numbered‘section
represents a factor that is identified as key in the ecological assessment of areas
that mediate and/or influence developmental outcomes for children and families
of color. Though an exhaustive inclusion of all facets of the Garcia-Coll and
colleagues’ integrative model would take this study beyond its intended scope,
several contexts of this model, together with Bronfenbrenner’s overarching
paradigm, shapes the conceptual framework through which middle-class African

Americans’ attitudes toward family therapy are examined.

15

«5733.5 JIMIIHIIEOE o. >8 EU 3.22.5 3.85:. c. 3.828% .EcoEasgoc Co 33m 05 .2 63:. 9:909...
E .68: same a .582. .250 .8222 £25.. €353 .__oo «.28 .5 88.28 .89.. 9:88.... o... a c2339 a a. we; .

 

 

mafia o.Eo...oooo_oow.
cow-H.308 5.31.
330 a $9.3 Scan?
36.. 9...... 9:62am.
83%.; 2.53.

5%

 

Lx

 

 

Egon”. 5.3 9.300.
Em__EB_:o_m.
0.3.39.3.
.mcoaoEw.
_m_oow.
93:600.
86:83:30

 

moan—coo
$35.30 2250.
5:232:02 a c8895..
8.3%.:

.828 a 259.com.
8.8%..
.9330 a 28.68%
23.30 05:23

 

 

 

 

 

hat

 

9.00 5.3:.
885.35%.
209.8.
8555.35
2.332...
3.50595
3..

 

3.8.2.25

a 300%.
HEocoow.

35.8%
”scammocmom.
3.33 2522.00!
cow-8:385 300m

at

 

 

 

 

 

 

.3coan_o>oo

 

 

./

 

8358820 Bags.
298“. .3865.
«35m 5.3:.
EOEEOQEOP.
Om<.
monotonic—.0 .3232:

 

 

 

 

c2323?
:ofiEEEOQ.
3.3.2....
Enema.
2.32.2.3:
coascugm
30cm

 

.0250.
b.2c5m.

mam—O
_N_8w.

comm.
no_na_._a>
:oEoom
_a_oom

9%

 

 

 

 

. ._ouoE _no_mo_ooo @2533... .moammo_.oo cam :00 £290. .9 2:9“.

16

Conceptual Framework

Common in person-centered research is the hermeneutic principle. As stated
by Habermas (1971), “the aim of the hermeneutic principle is to achieve an
intersubjective understanding in spite of cultural differences.” This principal as
viewed through the ecological lens, acknowledges the experience of a population
by allowing the participants to share in the meaning behind their personal
attitudes. Thus, this study seeks to acknowledge middle-class African Americans’
attitudes toward family therapy. It is believed that this research informs the field
of family therapy in three key ways. First, this present study increases the
understanding of M middle-class African Americans view formal help-seeking
for family distress outside of their traditional help-seeking context. Secondly,
taking into consideration factors such as gender and perceived social support
contributes to a comprehensive discussion of what contextual elements may
account for certain attitudes. Finally, findings empirically inform scholars of
attitudes toward family therapy through the lens of a middle-class African
America sample which ultimately influences theory, treatment and policy
implications regarding this population.

Figure 2 is an illustration of factors relevant to the ecological context of African
Americans as adapted from the Garcia-Coll et al. model (1996). Items located in
white boxes under each factor heading, represent contextual factors unique to
this study. Though the goal was not to revise the integrative model, the intention
is to identify those contextual items that represent aspects that Garcia-Coll and

colleagues identify as important to an ecological understanding of the

17

experiences of African American families. For example, gender as a social
position factor is primary in shaping the socio-cultural position of individuals in
American society (Garcia-Coll et al., 1996). Given the association that has been
found between gender and help-seeking attitudes (e.g., Leaf 8. Bruce, 1987;
Gary, Leashore, Howard, Buckner-Dowell, 1982), it is assumed that a
relationship will exist between gender and attitudes toward family therapy.

Additionally, perceived access to social support as a social stratification
mechanism incorporates a person’s perceived access to resources that foster
healthy emotional and social well-being (Garcia-Coll et al., 1996). Given that
research demonstrates an association between perceived access and attitudes
toward mental health service use (e.g., Stefl 8: Prosperi, 1985), it is assumed that
there will be a relationship exists between perceived access and attitudes toward
family therapy.

Furthermore, racial socialization domains such as religious/spiritual coping
and extended family caring are included as family socialization factors, as they
have been found to buffer the effects of distress among African Americans as
well as foster heightened self-esteem and identity (Demo & Hughes, 1990). Thus
it is hypothesized that as traditional racial coping mechanisms, religious/spiritual
coping and extended family caring may be more valued than family therapy as
help-seeking options.

Finally, help-seeking comfort (HSC) as an individual characteristic is
incorporated as research demonstrates that how comfortable one is with asking

for help is associated with utilization and openness to seek both formal and

18

informal interventive options (Kaniasty & Norris, 2000). Thus it is assumed that a
relationship exists between help-seeking comfort and attitudes toward family
therapy. In addition to a bi-variate association, help-seeking comfort is treated as
a moderator variable, that is, one that influences the relationship between
predictor and outcome factors. Thus, as an individual characteristic, it is
hypothesized that help—seeking comfort (HSC) moderates the relationship
between contextual factors and attitudes toward family therapy. No known
empirical study confirms this association, but this theoretical model does suggest
that one’s level of comfort with help— seeking potentially impacts how individual
factors such as gender and perceived social support are associated with
attitudes.

Finally, attitudes toward family therapy as a cognitive outcome factor are
relevant as attitudes involve cognitive processes that shape beliefs and values
about certain phenomena, which can ultimately influence behavioral patterns
(Paolucci, Hall, 8. Axinn, 1977). Attitudes toward family therapy are considered
relevant to this component of the model as the present study provides insight into

the way in which middle-class African Americans view family therapy.

19

32-5030 .. E 0.260 2.5 090...... 05...... c. 8.2.2888 0.58.223 .0 .03... o... .o. .08... 02.0.09... .2 .80: .... 0.200
0 .0 1.83 .0. .250 _... .8085. .0 05.8.. .0 .3853 ..0 ...00 0.200 3 0.829% .08... 02.0.02... 2.. .o 8.0.800 :0 m. 2....

00.203003. 2000?... :0 00.00.09 00.00.00 0:0 0.0.00. I
0.6.. >0... ow... 00:02.... u Ali 0003.00 0.5000003. 0.0.09.6 u Al .lglmlo .. axloElo u E .o m.

 

 

ZO_P<N_._<_U°m
2 02_¢<O >J_:<n_ OWDZWPXW ..
was... f x... N“. a a a.” .u. 0.... .,. .... .. ..

 

 

n... ./.

 

 

 

 

. 50.500 . .
m 020.000 .30: w . .
{$.05 AL .. .. .. . a. a. a...» . . 5.20...
>n=s<u_ . . . . .u... .._.... n ...<..,. ‘ .. .. .. . : u—(PZW:
9.559 fl ., .. w... ,. .. 0. 00000...
0003...: ,. . . 0020000..

...... x.

 

 

 

 

mm0_>¢mm

 

w, 20.55.5000 .H
02.000 000.0300

 

 

 

at...

 

 

 

 

 

 

 

 

 

.N.

, . . . ... 50.000 W. .. a.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

mmozmo

 

 

 

 

 

 

0000006.... :00...< 30.00.02,: 9.00.0 00.50
00:80-90... 0 00 30.0... 2.0.0. 0.0.50. 0000....0 0:0 0.0.00. .0:.x0...00 .o .000... 00.000000 < .N 0.00.“.

20

Definitions of Key Conceptual Terms
Contextual Factors

Racial socialization domains: extended family caring socialization and
religious/spiritual coping socialization: pertains to attitudes regarding the value of
race-related messages typically transmitted within the family context. For
purposes of this study, these will include attitudes toward messages about the
role that extended family plays in child-rearing and social support and the role
that spirituality and religious involvement play in helping one to cope with race-
related stressors.

Perceived social support: pertains to one’s belief about his or her access to
social support in the form of emotional, financial or task-completion assistance 2
from either family or friends.

Perceived access to mental health services: pertains to one’s belief about his
or her access to mental health services through the following means: a)
workplace, church, private practice, hospital, or community agency; b)health
insurance or other financial means; c)time availability; and d) presence of
therapists in one’s community. Mental health services involve formal individual or
family counseling or psychotherapy.

Intervening or Moderator Factor

Help-seeking comfort: pertains to how comfortable one feels with asking

others (either friends or family) for help in dealing with emotional stress, material

needs, task completion or decision-making.

21

Dependent or Outcome Factor

Attitudes toward family therapy: pertains to one’s perceived value, that is, how
positive are one’s views toward considering family therapy as an effective help-
seeking option.

Research Questions

With the intention of providing an ecological assessment of family therapy
attitudes among a middle-class sub-sample of African Americans, specific
research questions include:

1) What are attitudes toward family therapy-given the interplay
between race (African American), social class (middle-class status) and .
culture (contextual factors)?

2) Considering context-sensitive factors such as gender, racial socialization
attitudes, perceived social support, and perceived access to mental health
services, how might such factors influence attitudes toward family .
therapy?

3) Given that how comfortable one feels with help-seeking may impact
attitudes toward family therapy, does help-seeking comfort account for the
relationship between contextual factors and attitudes toward family
therapy?

Summary
The aim of Chapter 1 was to assess help-seeking needs among African
Americans and their families, the role of therapeutic family intervention in

addressing family based needs, and the role that contextual factors such as

22

social class status, culture and race play in shaping help-seeking attitudes and
beliefs. Furthermore, given the discussion of ecological theory, examining
attitudes toward family therapy from an ecological perspective means
incorporating a theoretical paradigm that considers the role that environmental
factors play in shaping attitudes. This includes recognizing bi-variate
relationships between contextual factors and attitudes as well as potential
intervening factors.

In subsequent chapters, the content of the research questions will be
specifically addressed from a context-sensitive orientation. Chapter 2 is a
presentation of relevant research that suggests the need for an empirically
supported understanding of help- seeking needs and attitudes toward family
therapy among African Americans. Chapter 3 involves a presentation of the
methodology, hypotheses, operational and conceptual definitions of key
variables, as well as data collection and analytical procedures relevant to
research questions. Chapter 4 provides a summary of the sample’s demographic
profile, descriptive findings, preliminary analyses, findings relative to research
questions and hypotheses, and post hoc findings. Chapter 5 consists of a
interpretive discussion of key findings, limitations and implications with regard to

future study, policy and clinical relevance to this population.

23

CHAPTER 2
LITERATURE REVIEW

Issues of access to resources and discrimination often plague families of color
(Montalvo & Gutierrez, 1995),.while factors such as gender and socioeconomic
status add to diverse within group contextual experiences (Hardy, 1995).
Therefore, it is appropriate to examine contextual factors as relevant to this
discourse on family therapy. The following review of literature explores the help-
seeking context as related to therapeutic intervention among African Americans
and their families. Themes of informal and formal help-seeking options will be
explored as research suggests that both are utilized by African Americans
(Snowden, 2001). Family therapy as a formal help-seeking option will be
explored, given the strong theoretical assumptions about its effectiveness with
African American families. The ecology of African American families that
encompasses contextual factors such as gender, racial socialization (e.g.,
extended family caring domain; religious/spiritual coping domain), perceived
social support and perceived access to mental health services will also be
explored. Middle-class demographic trends and findings regarding attitudes
toward therapy among middle-class African Americans will be presented followed
by a conclusive summary of the above-mentioned areas as related to research
questions being targeted by the proposed study.

Help-Seeking and Intervention Among African Americans
Mental health was originally defined as an individual’s level of “psychological

well-being and resilience” and was used prior to the community mental health

24

movement of the 1950s (Vega & Rumbaut, 1991). This term, mental health, was
often used in an attempt to broaden traditional psychiatric terms often used in the
in-patient treatment of clinical populations. However, in recent decades, mental
health as a description of psychological well-being has been introduced and
promoted as more appropriate when addressing the need and level of distress
that occurs among non-clinical populations. While mental health often referred to
an individual’s level of psychological distress, minimum focus has been placed
on contextual factors such as race, ethnicity, socioeconomic status or
interpersonal experiences (Vega 8- Rumbaut, 1991).

Given a heightened awareness of psychological distress among African
Americans (see Theriot, Segal & Cowsert, 2003; US Surgeon General, 2001;
Snowden, 1999), scholars ha begun to broaden the discussion of help-seeking
among African Americans by exploring those contextual factors that promote
and/or inhibit optimal functioning of individuals and their families. One outcome of
this research has been the recognition of informal and formal help-seeking
networks as contexts that assist African Americans with coping or confronting
mental health issues.

Help-seeking as a process is comprehensive and multidimensional in nature
(Leong, Wagner, 8. Tata, 1995). While social class and culture have been
correlated with help-seeking patterns (Leong et al, 1995), little is empirically
known about the influence of both social class and culture on African American

help-seeking patterns in the family context.

25

say . —

To that end, the following section highlights perspectives in the literature that
examine the use of both informal and formal help-seeking options. Additionally,
family therapy, as a potential help-seeking option among African Americans is
also examined.

Informal Help-Seeking Among African Americans

A common thread in the intervention literature is recognition that African
Americans tend to rely either on informal sources of help or informal in
conjunction with formal sources for a range of problems (Neighbors & Jackson,
1984; Snowden, 2001). Informal help-seeking (Taylor, Hardison, & Chatters,
1996) has traditionally included a reliance on family and friends (Snowden,
2001). These networks of non-fictive and fictive kin, that is, blood and non-blood
relationships, have been more commonly relied on in dealing with daily stressors
(Tatum, 1997). Though help is sought for a range of problems including finances
and childrearing (Hofferth, 1984), it has been found that help-seeking for
emotional and interpersonal problems are also associated with informal networks
(Broman, 1996).

Help-seeking among family. Family kinships, both nuclear and extended, have
been found to be traditionally fundamental help-seeking networks among African
Americans, not only for lower income, but for middle -class as well (McAdoo,
1997). In their analysis of a data set from the National Survey of Black Americans
(Jackson, 1991), Taylor, Hardison, and Chatters (1996) found that the majority
(83%) of respondents reported that they sought help from their family network. In

the family context, McCabe, Clark, and Barnett (1999) found that family kinship

26

and social support enhanced parental wannness toward children and buffered
the relationship between behavioral problems among children and family
stressors. Carolan and Allen (1999) found, in their qualitative analysis of middle-
class African Americans, that spousal support played a role in coping with the
emotional stress associated with racial discrimination. Thus, family networks play
an instrumental role among African Americans as they are commonly relied on
for a range of distress-related needs.

Help-seeking among friends. In addition to a reliance on family kinships,
African Americans often seek help among friends. In fact, an increased number
of friendships and close proximity of friends are associated with happiness
among older African Americans (Keith, 1997; Ellison, 1990). Clinton and
Anderson (1999) found that among upwardly mobile African Americans, those
with more close friendships tend to express less social loneliness. Sherman
(1997) notes in a multicultural study of friendships, that across the life span,
friendship positively influences social development, particularly among African
Americans. Godfrey (1997) suggests that among African American women,
friendships often modify the effect of conflict that may exist between a woman
and her mother. Mattis, Murray, Hatcher, Heam, Lawhon, Murphy, & Washington
(2001) through a study of African American men found that spirituality was a
predictor of perceived support in same sex friendships. Thus, friendships as
informal networks, seem to play a fundamental social support role in the overall

positive well being of both African American men and women.

27

Formal Help-Seeking Among African Americans

Formal help-seeking, that is, the reliance on church community, physicians or
mental health professionals, is prevalent among African Americans, usually in
conjunction with informal networks (Neighbors & Jackson, 1984; Snowden,
2001). There exists a reality that in addition to informal networks, African
American families do not function with a vacuum and therefore, often must rely
on other support contexts (McCubbin, F utrell, Thompson, 8 Thompson, 1998).

Religious/spiritual involvement. Traditionally, the church community has
played a critical role in meeting the spiritual, social, physical and emotional needs
of African Americans and their families (Bagley & Carroll, 1998). In the study of
Black preaching within African American churches, Pipes (1997) found that the
cathartic atmosphere often fostered by Black sermons resulted in an emotional
release that countered the daily frustrations of inequality African Americans often
encounter. Haight (1998) echoes the reliance of African Americans on the church
environment in an ethnographic study of the role Sunday school plays in
promoting resilience among African American children. Findings suggest that
positive teacher-child interaction emphasizing child-centered scriptural teaching,
common in many churches, fosters positive well-being. Furthermore, African
American ministers have been found to engage in two critical tasks within African
American communities: serving as a primary help-seeking option and; serving as
“gatekeepers” in referring church members to mental health professionals
(Neighbors, Musick, 8. Williams, 1998). Furthermore, Musick in a study of private

(i.e., Bible reading, prayer) and public (i.e., church attendance) religious

28

involvement found that both private and public involvement had positive effects
on subjective health among older African Americans. Given the role that
churches, ministers, and spiritual life have played among African Americans,
religious/spiritual coping via these avenues are critical to the psychological well
being of individuals and their families.

Medical and mental health agency sectors. In addition to informal and
religious networks, medical and mental health sectors are thought of as help -
seeking options among African Americans. In an early study of formal services
utilized, Neighbors (1985) found using a National Survey of Black Americans
sample, that the majority of participants utilized hospitals and physicians as a first
line of help for high levels of distress. More recently, it is suggested that African
Americans still rely heavily on use of hospitals and private physicians for
emotional distress (Snowden, 2001). One explanation is that while patients often
present with physical symptoms such as panic attacks or high blood pressure,
these are often identified as somatic signs of distress associated with anxiety or
phobia related stressors (Snowden, 1999). In addition, the mental health sector
in the form of community agencies and private practices has been targeted within
the help seeking literature. However, though low utilization can be found across
social class, underutilization exists particularly among middle-class African
Americans though they tend to have greater access to private insurance
compared to their lower income counterparts (US Surgeon General, 1999). One
explanation may be that given the level of authority that ministers and physicians

have within African American community, utilization trends are higher within

29

medical and church contexts (Gibbs, Snowden, & Huang, 1996). Furthermore,
psychologists and psychiatrists who may often represent a non-African American
orientation toward mental health, fuel feelings of distrust that may contribute to
the lack of success of these sectors as help-seeking options among African
Americans (Thompson, Sanders, Akbar, & Bazile, 2002). Still, scholars suggest
that African Americans, across social class, benefit and utilize formal means of
intervention for mental health. In fact, recent studies (e.g., Theriot, Segal, &
Cowsert, 2003; Bean, Benjamin & Bedell, 2002) call attention to alternative
mental health sectors such as self-help agencies and family therapy intervention
in an effort to broaden the discussion of options yet to be promoted within African
American help-seeking literature. 1
The Paradox of lnfonnal and Formal Help- Seeking Options

When considering the mesa-context of help-seeking, that is, the link between
informal systems (e.g., family and friendships) and formal systems (e.g.,
churches, hospitals, private/public agencies), a potential paradox exists. Rogler,
Malgady, and Rodriguez (1989) expound on this through their presentation of
Alternative Resource Theory. The underlying premise of this perspective is the
following paradox: that the lnfonnal system is viewed as both a “help—giving
system” and as a “source of distress” (Rogler et al., 1989).

Goldenberg and Goldenberg (2000) further state that for people of color, the
family context can be viewed as counter to the context of therapeutic
intervention, which tends to view the family as the source of dysfunction. On the

other hand, Rogler and colleagues add that help-seeking behaviors for

30

individuals are typically seen “in the context of interpersonal relations and
networks, all in juxtaposition with the mental health agency system” (p. 49). Thus
the following question is posed: Can lnfonnal resources (i.e., family system)
coexist with formal services (i.e., family therapy)? This question is relevant to
African Americans as an empirical debate is present regarding the congruency
and incongruency in help-seeking among informal social networks and formal
services (see Diala, Muntaner, Walrath, Nickerson, LaVeist, & Leaf, 2001; Leaf,
Bruce, Tischler, & Holz, 1987; Neighbors, 1984; Snowden, 1998).
Family Therapy as a Formal Help-Seeking Option

A need for family intervention. One of the most widely used studies
addressing help-seeking behavior and intervention among African Americans has
been the National Survey of Black Americans (NSBA)(Neighbors & Jackson,
1996). Given the comprehensive nature of this study, it represents the first in
recent decades to articulate multiple sociocultural experiences among a non-
clinical sample of African Americans.

Neighbor’s (1985) assessment of problem severity and type was related to the
utilization of formal intervention among 1322 respondents from the NSBA.
Problem severity was defined as “the point of a nervous breakdown” and “the
problem at some level of distress below the nervous breakdown point.”
(Neighbors, 1985, p. 158). Findings suggest that the majority of respondents
reported a high level of problem severity (at or above the point of a nervous
breakdown). Also, 41% of respondents stated that “interpersonal difficulty" was

the problem type that burdened them most, followed by economic (22%) and

31

physical (12%) problems. Several points can be made about these findings. First,
it is interesting to note that the majority of respondents stated that “interpersonal
difficulty” was the most common problem experienced. Secondly, although
several professionals were listed that included physicians, clergy and
psychotherapists, there was no inclusion of family therapists as mental health
professionals. To that end, findings from this national study suggest that there is
a need for discussion that explores the role of family therapy as a help-seeking
option given that family therapy originates from an interpersonal paradigm.

Family therapy and African Americans. In addition to traditional help seeking
networks, the context of family therapy has been articulated as an effective
intervention that addresses the role that family functioning plays in promoting
and/or inhibiting emotional and mental distress among individuals (Hines & Boyd-
Franklin, 1996). Scholars and clinicians through case study analyses (e.g.,
Laszloffy & Hardy, 2000), inform the field of family therapy as they suggest
African American families mnefit from family therapy, especially therapy that
stems from a culturally sensitive orientation.

A prevailing issue in the study of family therapy with any family of color is the
awareness of culture as context (Ariel, 1999). Carter (1995) refers to culture as
the “transmission of knowledge, skills, attitudes, behaviors, and language from
one generation to the next...” (p. 12). Via this definition, Carter suggests that
culture is the process of transmitting behaviors that help give meaning to one’s
experience. To be sensitive to culture means being sensitive to behaviors and

values that give meaning to an experience within a given context.

32

Family therapy literatures of recent decades have begun to promote an
awareness of the cultural context, particularly within African American
communities. Boyd-Franklin (1995) leads this trend as she identifies several
themes universal to the cultural context of African American families. Some of
these themes include: the bond of the extended family, a strong religious
orientation and cultural diversity. Kinship networks, both non-fictive (blood) and
fictive (non-blood), are regarded as proximal systems that foster adaptation and
coping among individuals and families. Religion and spirituality play a central role
as noted by Carolan and Allen (1999), who found that among African American
couples, spirituality and religious devotion are associated with high levels of
intimacy. Cultural diversity pertains to the awareness that there is variation in
family structure, gender roles, social class status, and family based adaptation
and distress (Hardy & Laszloffy, 1992). Hardy (1989) explored the cultural
context by challenging family therapists to move beyond homogeneous ways of
describing family functioning and adaptability by illuminating the presence of
cultural diversity. Through his “theoretical myth of sameness (T MOS)” paradigm,
Hardy notes that there is a prevalence of “neglect of context" particularly in many
theoretical frameworks of the field. He argues that a “contemporary view of
TMOS" recognizes the primary role that context assessment has in
understanding the diverse experiences and needs of African American families.

A conclusion based on the above findings and theoretical perspectives is four-
fold. First, empirical findings suggest that both informal and formal options are

utilized among African Americans although the use may be paradoxically

33

intertwined. Secondly, the majority of findings across studies suggest that formal
services are, in fact, perceived as help-seeking options among African
Americans. Third, the lack of reference to family therapy, yet the presence of
interpersonal difficulty as a significant problem-type offers an opportunity for
family therapy to be explored as a formal help-seeking option among African
Americans. Fourth, family therapy as a formal intervention must take into account
the variations within the cultural context of African American family life. There
exists “universal” themes of strong kinship networks and religious/spiritual coping
which have been linked to optimal functioning of African American’s and their
families. Thus a valid examination of family therapy as a help-seeking option
considers the interplay of culture, social class and race in assessing culturally
sensitive treatment options among African Americans.
Contextual Correlates of Attitudes Toward Formal Help Seeking
Among African Americans
Informal and forrnals contexts are generally considered as help-giving
systems that encompass a range of contextual factors that influence outcome
(Jackson, 1991). However, minimal emphasis is placed on factors as correlated
with attitudes toward such help-giving systems among the middle-class (Mannino
8 Shore, 1984). This view is particularly prevalent in the treatment of African
American families (Hardy, 1989). The following section informs this discourse, as
contextual factors typically associated with attitudes toward formal help-seeking

among African Americans are presented.

34

Gender

Gender as a contextual factor is pertinent as men and women experience
values and ways of being according to gender role experiences (Boyd-Franklin 8
Franklin, 1998; Vecchio, 1998). Attitudes toward help-seeking are often shaped
by such gendered experiences. In a recent study of help-seeking among African
American male college students, Duncan (2003) found that students tend to
exhibit positive attitudes toward seeking psychological help. In an early study of
help-seeking among African American men, Gary, Leashore, Howard, and
Buckner-Dowell (1982), found that men would be willing to seek help from both
informal and formal help sources. Forty-four percent stated that they believed
that friends, family or their wife would be a source of assistance when facing an
emotional problem. Forty-two percent stated they would be willing to use a
hospital, physician, psychiatrist or community mental health center, while 14%
stated that they would rely on self.

With regard to women, in the area of family intervention, it has been found
that African American women tend to initiate help-seeking more readily than
African American men (Boyd-Franklin, 1989). However, Mays, Caldwell, 8
Jackson (1996) suggest that for emotional problems, women tend to pursue help-
seeking options within community mental health centers in addition to other
informal sources instead of private practice offices.

Traditionally, while men and women have been open to multiple help-seeking
options, both formal and informal, theoretical explanations account for variation in

issues that may affect gendered experiences within the family context. Boyd-

3S

Franklin and Franklin (1998) note that racism and paradoxical expectations result '
in gendered experiences that often place women and men in a conflictual
relational position. While it is promoted that men are to assert themselves as
providers for their families, this assertiveness is often interpreted as aggression
and is therefore, discouraged in society or the workplace. Furthermore, partners
may label men as “inadequate” when they do not convey a level of assertiveness
in the home (Boyd-Franklin 8 Franklin, 1998). Women on the other hand, receive
messages suggesting that their independence is paramount, yet they are
socialized from a young age to desire the interdependency of a male-female
relationship (Dickson, 1993). These mixed messages poses several concerns. .
On the one hand, mixed messages about independence and assertiveness
potentially foster an environment of role-conflict oppose to role—complementarity
within the couple or family system. Secondly, this socialization process may
result in the absence of help-seeking in the couples or family context, which may
lead to isolation and minimal coping skills that result in higher levels of
dysfunction or “interpersonal distress” as was noted in earlier NSBA studies
(Neighbors, 1985; Broman, 1996).

In summary, given the finding that gender is predictive of formal help-seeking
outcome (Leaf 8 Bruce, 1987; Washington, 1996), the promotion of family
therapy treatment as a help-giving system must account for gendered
experiences. This perspective is relevant to the present study as family therapy

has the potential to challenge African American couples and families to create

36

healthy relational paradigms that are based on present needs oppose to habit or
obsolete intergenerational traditions.
Racial Socialization

Racial socialization as a family process is the way in which African Americans
receive race-related messages that can be protective and proactive in nature
(Hughes 8 Chen, 1997; Stevenson, Reed, 8 Bodison, 1996; Demo 8 Hughes,
1990). Socialization that occurs among African American girls and boys highly
effects attitudes about roles and behaviors they are to exhibit as adults (Dickson,
1993). In a study of racial coping skills among middle class parents and their
children, Johnson (1994) found that parents who exhibited proactive racial coping
methods had children who had a diverse range of coping methods. Though much
of the racial socialization literature has pertained to children, attitudes toward
racial socialization and racial group identification among adults have been
targeted (e.g., Parham 8 Williams, 1993; Demo 8 Hughes, 1990). In a study of
racial socialization experiences among adults, Sanders Thompson (1994) found
that the majority of participants stated that they had encountered some
discussion of race either with their parents (79%) and/or other family members
(85%). Furthermore, in addition to race-related messages, the interpersonal
dynamics with family and friends within this socialization context also is found to
impact adult attitudes and identity development (Demo 8 Hughes, 1990).

Racial socialization: religious/spiritual coping and extended family caring.
Regarding help-seeking and racial socialization, several points exist. First, both

adults and children tend to encounter socialization within the nuclear or extended

37

family context. Stevenson (1994) suggests that the multidimensional nature of
racial socialization encompasses multiple domains which include proactive
and/or protective ways of dealing with one’s minority status and racial group
orientation within a traditionally hostile societal context. Second, given that help
seeking behaviors such as coping and enhancing of self worth often occur within
the socialization context of the family, family therapists must be cognizant of
attitudes regarding racial socialization if culturally sensitive intervention is to
occur (Stevenson, 1994). Thirdly, Stevenson (1995) identifies positive attitudes
toward religious coping and extended family caring as strong indicators of racial
socialization among adults and adolescents, which are consistent with universal
themes of religious COping and extended family involvement as help-seeking
behaviors. Emphasis is placed on these two factors given that help-seeking
literature suggests that spirituality/religion and extended family ties are
associated with attitudes and utilization of formal therapeutic services (see Diala
et al, 2001; McRae, Carey, 8 Anderson-Scott, 1998; Neighbors, Musick 8
Williams, 1998). This is reiterated by Boyd-Franklin’s (1989) presentation of
extended family network and religious involvement as factors that are key
contributors of optimal functioning among African Americans.

Given the positive association between these factors and positive
psychological well being, it is thus important to explore whether or not African
Americans who value religious/spiritual coping socialization and extended family
caring socialization would consider family therapy as an help seeking option

given the presence of these race-based alternative coping mechanisms.

38

Perceived Social Support

In addition to racial socialization, perceived social support has also been
found to play an intricate role in the adaptation and functioning of African
Americans'. As a contextual factor, social support pertains to the supportive
behavior received from significant relationships (Myers, 1996). Two elements of
social support have gained wide attention in the social support literature:
received social support and perceived social support. Received social support
pertains to “naturally occurring behaviors that are being provided”, while
perceived social support pertains to the “belief that such helping behaviors would
be provided if needed” (Norris 8 Kaniasty, 1996). Emphasis is placed on
perceived social support as there is evidence that one’s perception of support is
directly related to emotional and psychological well being (Walls, 1992). In a
study of suicide risk and perceived social support among African Americans,
Palmer (2001) found that higher perceived social support significantly correlated
with lower suicide risk. Looking at correlates of life satisfaction, Vauhn-Sharp
(2001) found that perceived social support was positively associated with higher
life satisfaction among African Americans. These findings suggest that
perceptions of social networks of family and friends impact coping outcome. In
assessing the family therapy context, this is relevant to a comprehensive
understanding of help-giving systems as the presence or lack of access to
support networks may impact attitudes toward formal supports for families

experiencing serious personal or interpersonal problems.

39

Perceived Access to Mental Health Services

As a contextual factor, perceived access to mental healthcare has been a
major healthcare disparity issue, particularly for African Americans (Wells, Klap,
Koike, 8 Sherboume, 2001). In a study of older African Americans, it was found
that lack of access to mental healthcare is attributed to insufficient resources,
lack of outreach services, lack of transportation, and lack of publicityflnformation
about services that do exist (Biegal, Farkas, 8 Song, 1997). While this study
targeted an older population, a theme of limited access to mental health services
(e.g.., publicity, outreach services) has been generalized across age and social
class (Snowden, 2001).

Kliman (1998) identifies assumptions that illuminate the role that social class
plays. One key theme is that “class position governs access to resources” (p.
53). While managed care and private insurance coverage would seem to
increase access to mental health services among the middle- class, low rates of
utilization exists highest among this group. In fact, higher rates of utilization occur
among their lower income counterparts who tend to rely more on community
centers and public welfare agencies (Snowden, 1998). Thus, while access to
private mental health services may exist among middle-class African Americans,
low utilization rates raise question about non-income related factors that may
influence help-seeking within the mental health service sector.

This section raises a contextual question for the field of family therapy. That
is, given that the social context of middle-class African Americans, what factors

account for utilization rates or overall openness to family intervention? To begin

4O

this discourse, knowledge about attitudes toward family therapy is critical if the
field of family therapy desires to succeed in authentic and context sensitive
outreach.

Help-Seeking Comfort as a Potential Intervening Factor

The comfort that an individual feels in seeking assistance from another is
associated with help-seeking behaviors (Hobfoll 8 Lerman, 1989). Kaniasty and
Norris (2000) note that “the most direct predictor of whether or not an individual
receives help is that person’s willingness to receive help” (p. 546). In a recent
study of help-seeking comfort for an emergency crisis across three ethnic groups
(i.e., Latina/o, African Americans, Caucasians), African Americans demonstrated
the highest level of help-seeking comfort. It was also found that help-seeking
comfort is a strong predictor of help-seeking behavior (Kaniasty 8 Norris, 2000).
Furthermore, Halgin, Weaver, Edell, and Spencer (1987) found that help-seeking
comfort is associated with positive help-seeking attitudes. Thus, it can be
concluded that help-seeking comfort is potentially associated with help-seeking
outcome among African Americans.

Ecological literature suggests that an assessment of relationships between
variables that considers the role of intervening variables, offers a more context-
sensitive examination of phenomenon. Help-seeking comfort allows for the
consideration of a personal attribute that may intervene in the relationship
between contextual factors and attitudes. Given that help-seeking attitudes play a
role in the accessibility of effective intervention of personal or interpersonal

distress (Gellis, Huh, Lee, Kim, 2003; Yeh, 2002), it is imperative to explore

41

people’s level of comfort with this process as related to their value of family
intervention.

Given the discussion of ecology and implications for family therapy among
African Americans, several points are relative to the present study. In an effort to
widen the focus of effective intervention among African American families, the
field of family therapy must take into account multiple ecological factors. Issues
of family socialization, social class, gender, perceived social support and access
to mental health services must be examined as they shape a family’s ability to
adapt, cope, and restructure to a level of homeostasis that leads to optimal
functioning of individuals in the context of their daily culture. Also, if family
therapy as a formal option is to be considered in the empirically valid study of
help-seeking among African Americans, then a research orientation that is
“systemic and context oriented” is needed, as person-centered ecological
research considers the context in which behavior and outcome emerge (Spencer,
1999). Including a context-sensitive variable such as help-seeking comfort,
meets this challenge, as it allows for a multivariate approach that goes beyond
the bi-variate relationship between predictor and outcome variables.

Attitudes Toward Formal Therapeutic Intervention
Among African Americans

Beliefs about a phenomenon often influence reactions to that phenomenon
(Paolucci, Hall, 8 Axinn, 1977). Based on this premise, beliefs regarding a
particular intervention will influence the willingness to embrace that intervention

as a help-seeking option. Given that beliefs often translate into behavior to be

42

carried out (Paolucci et al., 1977), understanding attitudes toward family therapy
can assist scholars and clinicians in understanding the gap between the
promotion and utilization of family therapy a help-seeking option.

With regard to attitudes toward help-seeking within the family context, much
has to be inferred from the help-seeking literature. While two known studies
(Richards, 1993; Duncan, 2003) explore attitudes toward therapy among middle-
class African Americans, little is known about attitudes toward family therapy
among a non—clinical population of African Americans.

As literature suggests, there are no known current epidemiological studies of
family therapy among African Americans (Bean, Perry, 8 Bedell, 2002). Apart
from single clinical case studies, empirical research regarding African American
attitudes toward family therapy is non-existent. Thus, to inform the present study,
a trend of research on African Americans' general attitudes toward mental health
intervention is presented. Also, one known study exploring attitudes towards of
psychotherapy among middle-class African Americans are presented in an effort
to infer from findings, the benefits of exploring attitudes among African
Americans from a particular context (e.g., social class).

Research Trends

Shared beliefs and behaviors combine to shape attitudes toward mental
health services among cultural groups (Dana, 1998). These experiences
influence the acceptability and credibility of such help-giving systems (Dana,
1998). Non-institutionalized African Americans traditionally have not had access

to formalized mental health services (Vega 8 Rumbaut, 1991). Thus, a reliance

43

on help seeking-options (e.g., family, religion/spirituality) within their cultural
framework has taken precedence.

Openness to mental health services; Despite limited access, low rates of self-
referrals, and early termination rates (Barbarin, 1996), it is suggested that African
Americans do value mental health services (Leaf, Bruce, Tischler, 8 Holzer,
1984). In a recent analysis of a national probability sample, findings suggest that
African Americans, both from a clinical and non-clinical context, have positive
attitudes toward seeking mental health services (Diala, Muntaner, Walrath,
Nickerson, LaVeist, and Leaf, 2001). As efforts are made to address low
utilization rates, these findings suggests that other contextual issues may be
influencing the incongruency between attitudes and utilization outcomes.

Cultural influences and attitudes toward mental health services. It has been
postulated that the cultural experiences of African Americans influence their
attitudes about mental health services. Delphin and Rolluck (1995) found that
ethnic identity and alienation experiences among African American college
students affect attitudes and knowledge of mental health services. For example,
those students who had a Pro-blacklAnti-white ethnic identity orientation were
less likely to value such services. Consequently, those who had experienced
campus alienation and minimal access to mental health resources were also less
likely to value services. Another finding was that knowledge and attitudes predict
mental help-seeking (Delphin 8 Rolluck, 1995). The theme of cultural relativity is
echoed in Thompson, Akbar, and Bazile’s (2002) study of attitudes toward

psychotherapy among African Americans. In their qualitative study involving 201

participants, key barriers to mental help-seeking included: cultural stigma of
mental illness, mistrust, expense, culturally insensitive service delivery and
cultural misunderstanding (on the part of both potential clients and practitioners).
Findings further suggested that cultural sensitivity and outreach on the part of
mental health professionals are factors important in combating a cultural context
of low utilization (Thompson et al., 2002). Thus, facets of the cultural context of
help-seeking among African Americans may ultimately impact African Americans’
attitudes and utilization of services.

Attitudes toward therapy among middle-class African Americans. Racism in
the form of institutional glass ceilings and cultural indifference, often lead to
feelings of isolation and heightened levels of distress among middle-class
families. Thus, it is imperative that assessment and treatment of African
Americans and their families taken into account social class (Hardy 8 Laszlofly,

1 992).

There is no readily known empirical study of family therapy that considers the
middle class social context. However, Richards (1993) explores underutilization
of mental health intervention among this social class, emphasizing areas of
cultural mistrust, reluctance to self-disclose and alternative coping strategies. In a
study of middle-class African Americans and their European American
counterparts, Richards found that middle-class African Americans and European
Americans both seem willing to seek therapy. This finding is in despite of the fact
that African Americans reported higher cultural mistrust than European

Americans. Furthermore, African Americans reported a greater reliance on

45

extended family, friends, and the religious community than their European
American counterparts. Other findings suggest that middle-class African
Americans are no more likely to use passive coping mechanisms and are no
different in the level of disclosure to therapists compared to European Americans
in the sample. Similarly, with regard to gender, it was found that women,
regardless of race, prefer a same sex therapist more so than men. Finally, a
reliance on family coupled with gender accounted for willingness to seek therapy
for both racial groups.

Several conclusions are made from this study. For instance, though the
sample size (i.e., 59 African Americans; 48 European Americans) may have
affected the statistical validity of the predictability of several factors, credibility
exists in that among this middle-class sample, for African Americans, the use of
informal networks co—exists with an openness to seek therapy. Also, the effort to
explore attitudes within an under researched social class population introduces
opportunity for further comparative studies to be done that examine context
related variables within this sociocultural milieu. Moreover, given that gender and
social support account for willingness to seek therapy, it can be concluded that
these factors are pertinent to a context-sensitive study of help-seeking among a
middle-class sample of African Americans. Finally, the non-deficit based
orientation of comparing African Americans and European Americans promotes
an asset-based paradigm for studying mental health attitudes that can be
generalized to various areas of mental health including the family therapy

context.

46

A Demographic Profile of Middle-Class African Americans

Considering the cultural context of African Americans, this study proposes
that social class as a determinant of social position can influence access to
resources and attitudes that ultimately impact service utilization. The following
section presents current trends of middle-class African Americans, an
underrepresented population within current help-seeking literature.
Characteristics of “middle-class” status and demographic trends are presented.
What Constitutes the African American Middle Class?

There is no clear consensus on how middle-class is defined (Pattillo-McCoy,
1999). In fact, the US Census does not officially designate what constitutes
middle—class (US Census Bureau, 2000). Yet throughout history, indexes based
on access to land and homeownership, occupation, educational attainment,
household income and self-affiliation have been consistent in efforts to clarify
ranks of economic and social categories (Frazier, 1957; US Census Bureau,
2000; Haynes, 2001). With regard to African Americans, sociological discourse
on the middle-class status did not fully blossom until the 1950s, with designations
based on characteristics such as skin color and educational access. Likewise,
plantation and family affiliation as well as ex-slave versus free Black status
fostered social ranking during the time of slavery and the post slavery
reconstruction periods (Billingsley, 1968). With the attainment of land, education
and geographical mobility during the World War I and II, and the Civil Rights
eras, a trend of social and economic differentiation continued to expand within

African American communities. Despite the establishment of communities of free

47

Blacks in the North during the late 1800s and early 19005, it was the free
communities of the South that achieved the greatest class structural divide
(Frazier, 1957). Though many African Americans migrated to the North during
the industrialization period, a! “New South” migration is taking place. Of the total
increase in thejpopulation of African Americans, 58% has occurred within the
South, with a growing middle and upper class on the rise, according to recent
Census data (Frey, 2001). To that end, despite an inconsistent declaration of
what constitutes middle-class, a discussion of characteristics associated with
middle-class status is necessary in an effort to identify this social context as
related to unique social needs and attitudes pertinent to this population of African
Americans.

Income. Despite the unofficial description of middle-class status, there is still
much discussion about the categorizing of households and individuals within this
class designation. Recent census data suggests that households earning at or
above the $50,000 income range are well into what is categorized as the “middle-
class” income bracket. Findings suggest that 3 out of 10 (30% of African
American family households) have an income of $50,000 or above, which
constitutes a middle-class or higher status (Frey, 2003). Robinson (1997), a
Harvard statistics researcher, studied the African American middle-class trends
between the 19703 through 1994. His findings support research that implies that
the “Black middle- class” has varied income-based designations. Robinson noted
that in 1994, analysis trends and self-ratings placed middle-class African
American households between $15,000 and $49,999. Yet, he suggested that it is

48

more accurate to identify the income range as $25,000 and $49,999 given that
the 1994 poverty line for a family of four was set at $15,141 (Robinson, 1997).
More recently, dividing household income into ten categorical ranges, the 2002
Census data showed that among African American households, at least 29%, fell
into the 7th and 8‘" categories which included the $25,000-49,000 income range.
Fifteen percent fell into the 9‘" wtegorical range of $50,000-74,999, which
constituted upper middle-class and lower upper-class categories. A 10th
category, ranging $75,000 and over, constituted the upper-class range. Thus,
taking into account data from Robinson’s research and the 2002 Census, there is
a substantial number of African American households that fall within the
seemingly middle-class economic bracket, despite the decline of middle-class
status since the 1970s (McAdoo, 1997; Robinson, 1994).

Home ownership and residential lifestyle. Middle-class migration has been
and still is intended for the inquiring of improved housing, low crime community
living, increased access to competent school systems and an improved lifestyle
now affordable with higher income (Pattillo-McCoy, 1999). In a recent study of
Nepperhan-Runyon Heights, one of the first intergenerational middle-class
suburbs of metropolitan New York, Haynes (2001) assesses the lifestyle and
residential aspirations of this predominately African American community.
Emerging from a working-class population of Southern migrants and West Indian
immigrants, the aim of this community was an opportunity for quality living and
economic stability. A qualitative and statistical analysis of historical and census

records suggest that occupational security leading to ownership of private

49

property, interconnectedness and intermarriage of generations of upwardly
mobile residents, along with political opposition to regress to impoverished _
standards of living, were hallmark to this community (Haynes, 2001). Though the
study of Nepperhan-Runyon Heights is a case study of the middle-class
progression of one community, the theme of home ownership and quality
residential occupation are central to the discourse of the hope of upward mobility
among African Americans.

Educational background. Educational attainment is yet another characteristic
commonly associated with middle-class status. Since the time of slavery, where
literacy was forbidden, to current agendas promoting quality education, there has
always existed an association between access to education and upward mobility.
In a recent study involving sociocultural characteristics of the middle class,
educational level was as a determinant of middle-class status (see Alba, Logan,
8 Stults, 2000). In an analysis of Census 2002, Frey (2003) identifies,
“knowledge workers,” those middle-class African Americans characterized as
having both “middle-class” incomes and a college education. He notes that in the
top 15 metropolitan areas with African American college graduates (e.g., San
Jose, CA; Atlanta, GA), African American middle class populations have both a
college education and at least a middle-class income. Though scholars suggest
that middle-class status has declined and stabilized since the 1970s and 1980s,
a steady rise in college attainment among African Americans (e.g., 8.3% in 1980,
to 11.4% in 1990, to 14.3% in 2000) (Frey, 2003), suggests a progressive

increase in educational attainment among African Americans.

50

Occupation. Job position has also been commonly associated with middle-
class status. Current trends suggest that numbers of African Americans in
middle-class job positions have increased (Smith and Horton; 1997). In their
analysis of such middle-class trends, Smith and Horton found that only 385,586
African Americans had obtained what constituted middle class positions (e.g.,
business owners, managers, officials) by the 1960s. However, that number grew
to well over 1 million by the 1980s with an increase to 7 million by 1995 (Smith 8
Horton, 1997). Recent census data shows that service occupations, managerial,
and professional positions are among the highest ranking positions among
African Americans (US Census Bureau, 2002). However, these positions, which
have traditionally been affiliated with upward mobility, are not always positively
correlated with movement to higher social class levels (Pattillo-McCoy, 1998).
This outcome is often due to job and salary increase discrimination, low
patronage of many black owned businesses and a societal devaluing of
traditional positions (e.g., teaching) thus altering the role that occupation plays in
upward mobility trends for African Americans. This reality gives a context-
sensitive picture of the disproportionate relationship between occupation and
middle-class status.

Summary

Chapter 2 provides an overview of key theoretical frameworks and research
findings with regard to help-seeking patterns and behaviors among African
Americans. Emphasis was placed on looking at contextual factors critical to this

study, that is, gender, perceived social support and access to mental health

51

services as well as family socialization attitudes that all are found to be
associated with help-seeking among African Americans. Finally, middle-class as
a complex and multidimensional construct was presented. Chapter 3 provides
specific methodological procedures that were used to operationalize research

questions pertinent to this study.

52

CHAPTER 3
METHODOLOGY

The aim of the present study is to add empirical evidence of the attitudes

towards family therapy among middle class African Americans to the family

therapy literature. Specific objectives of this study is to:

1.

identify how likely will a sample of middle-class African Americans view
family therapy as an intervention option within their help-seeking context;
explore the influence of contextual factors such as gender, racial
socialization domains such as religious/spiritual coping and extended
family caring, perceived social support, and perceived access to mental
health services on attitudes toward family therapy;

examine whether or not one’s comfort with help-seeking, influences the
relationship between contextual factors and attitudes toward family
therapy;

increase empirically based knowledge of attitudes toward family therapy
among African Americans from a specific social class and contextually
sensitive perspective;

better understand help-seeking behavior among middle-class African
Americans to promote effective intervention and family health policy

initiatives that take into account this sociocultural context.

53

Instrumentation

The following section is a description of each instrument that was used to
operationalize variables of interest in the present study. lnfonnation includes a
description of the variable being operationalized, the name of the instrument, the
author and purpose of the instrument, sample questions, administration and
standardization procedures, number of scale items in the original instrument,
subscale information and reliability information. Finally, demographic information
pertinent to the present study is identified.
Racial Socialization

The parent version of the Scale of Racial Socialization for African Americans
(SORS—P) was utilized in the present study. This measurement tool examines to
what extent do adults value messages about religious/spiritual coping as
effective coping and self-empowennent mechanisms that are transmitted from
African American parents to their children. In 1993, Howard Stevenson,
beginning with a 35-item pilot study, devised the original complete scale. The
purpose of this scale was to assess African Americans’ level of acceptance of
race-related messages reflecting protective (e.g., extended family caring) and
proactive (e.g., racial pride) elements of their cultural framework (Stevenson,
1993; Stevenson, 1996).

The 35-item self-administered scale initially included items that were scored
on a 4-point Likert style scale ranging from strongly disagree (1) to strongly agree
(4). Based on themes common in the racial socialization literature (see Demo 8

Hughes, 1990; Boykin 8 Toms, 1985), content areas of the original scale include

54

race-related messages pertaining to education, extended family involvement,
spirituality, racism and society, African American heritage and pride (Stevenson,
1996). Reliability analyses resulted in the adding of 10 items to improve
representation of specified domains. Also, the preliminary 4-point Likert style
scale was changed to a 5-point scale to allow for greater response variability
(Stevenson, 1996).

Stevenson (1994) administered a final 45-item, 5-point Likert-style scale
version to 200 African American adolescents who were participating in a summer
job program. Based on Stevenson’s factor analysis, four factors from a five-factor
model were determined to be most significant. The four factors that emerged
were spiritual/religious coping (a=.74); extended family caring (a=.70); cultural
pride reinforcement (0 =63); and racism awareness teaching (a
=.60)(Stevenson, 1996). Though life achievement struggling was a fifth factor, it
was omitted from the model due to low internal consistency.

While emphasis was placed on administering the total scale to adolescents
(e.g., SORS—A), the original compiling of items came from racial socialization
themes also found to be present among African American adults (see Marshall,
1995; Parham 8 Williams, 1993; Sanders Thompson, 1994). Thus, construct
validity have been found to remain consistent among adults. Nevertheless,
continued analyses are currently underway with the parent version of this scale
(SORS-P), which was administered to adults (H. Stevenson, personal

communication, January 27, 2004).

55

Religious/spiritual coping socialization. In the present study, spiritual/religious
coping socialization (SRCS) as a subscale is used since many African Americans
report experiencing a family environment that promotes prayer, faith in God, and
church attendance as effective ways of coping with distress and hostile social
conditions (McRae, Carey, 8 Anderson-Scott, 1998). This subscale has
moderately high reliability
(0: =.74) and includes items such as “It is important for families to go to church or
mosque where spiritual growth can happen” and “A belief in God can help a
person deal with tough life struggles.”

Extended family caring socialization. Extended family caring socialization
(EFCS), a subscale, pertains to those messages that convey the importance of
extended family involvement in child rearing and management of family life
(Stevenson, 1996). With one of the higher reliability scores (or =.70), this
subscale was used in the proposed study as research confirms that many African
American families often rely on extended family involvement and social support
in the effective rearing of children (Stevenson, Reed, 8 Bodison, 1996). Thus,
EFCS is used to identify attitudes pertaining to this domain of socialization that
includes statements such as “Relatives can help Black parents raise their
children” and “Children who have good times with their relatives become better
people.”

Perceived Social Support
The Perceived Social Support Scale (PSSS) is utilized for the present study in

order to assess to what level do individuals rely on family, friends or a significant

56

other for support for emotional, problem solving and decision-making needs
(Blumethal, Burg, Barefoot, Williams, Haney, 8 Zimet, 1987). This 24-item
instrument has a 5-point Likert scale ranging from strongly disagree (1) to
strongly agree (5). In addition to tallying a total score, 3 subscale scores may be
obtained which include receiving support from family, friends, or a significant
other. Examples of questions include “There is a special person who is around
when I am in need” and “I get the emotional help and support I need from my
family.”

Initially standardized from a sample of 275 students at Duke University, the
PSSS has a fairly high level of internal reliability for the total scale (ci=.88) as well
as for the subscales (e.g., family 0 =87; friends 0 =85; significant other a =.91)
(Blumethal et al., 1987). Test-retest reliability for the total and subscales (ranged
from a=.85-.72) confirmed maintenance of internal reliability.

Perceived Access to Mental Health Services

In an effort to identify people’s perceived access to mental health services,
four descriptive items were developed for the present study. Specifically, items
were operationalized where participants provided a “yes” or “no” response to
questions such as: “I have mental services available to me or my family through
a workplace, church, school, private practice office, hospital, or community
agency" and “I could afford mental health services either through health

insurance or some other financial means.”

57

Attitudes Toward Family Therapy

The Attitudes Toward Seeking Professional Psychological Help Scale
(ATSPPHS) (Fischer 8 Turner, 1970) was adapted for the present study. The
adaptation involved replacing such statements as “Although there are pflijps for
people with mental health troubles, I would not have much faith in them” with
“Although there are therapeutic offices for couples and families with relationship
tgppplpp, I would not have much faith in them.”

The ATSPPH Scale was devised in collaboration with clinical psychologists.
These trained professionals had been experience in multiple mental health
settings, which included statel‘federal hospitals, clinics, schools, and private
practices devised the original attitude items. Construct validity was established
as the original items were randomly ordered and subjected to judgment by a
panel of qualified psychologists and psychiatrists (Fischer 8 Turner, 1970).

Several waves of testing were conducted with administration to different
groups of college students (total n=815). Upon final standardization procedures,
29 remaining items were considered as the final version with a 4-point Likert
scale varying from probable disagreement (0) to probable agreement (3). An
alpha of .83 suggests fairly high internal reliability.

In an effort to account for greater variability in scores, the adaptation, the
Attitudes Toward Family Therapy Scale expands the likert scale from 4 to 5
points. This allows for greater consistency with other instruments given that that

the 5-point scale is a more commonly used rating scale (Kent, 2001).

58

Help-Seeking Comfort

Hobfoll and Lerman (1989) devised a 10-item measure to quantify
participants’ comfort with seeking help for various needs from family and friends.
Examples include, “How comfortable do you feel requesting material aid from
friends if you are in need of such aid?” and “How difficult is it for you to request
emotional support from family if you have problems or are undergoing a crisis?”

There were three waves of administration of the help-seeking comfort items.
Phase 1 involved an administration to 101 females who were accompanying
children with medical needs. A Cronbach alpha-of .81 suggests fairly high
internal reliability for this phase. Phase 2 involved a follow up administration that
occurred 11 months to 1 year after Phase 1 completion. To confirm objectivity of
self-assessments with the social support scales, Phase 2 involved an
administration to females (n=101) and their spouses (n=78). Mean scores
between Phase 1 (29.88) and Phase 2 (28.65) suggests that scores remained
reliable for the female participants despite about a one-year lapse between
Phase 1 and Phase 2. Correlation analyses yielded decent agreement between
female and spousal scores (r=.58) which also adds to the validity of the comfort
seeking items (Hobfoll 8 Lerman, 1989).

Demographic Form

In order to gain a comprehensive assessment of a majority middle-class
sample, the demographic form requested that participants provide their age,
gender, highest degree earned, occupation, income level, home ownership

status, self-rating of social class, marital status, parental status, religious

59

affiliation, and age. Screening of participants for middle-class status was based
on an assessment of the demographic questions in addition the following criteria:
the completion of at least a bachelor's level college degree or a dual earner
family income. The selection of these factors was based on recent census
analyses and studies of social class among African Americans that suggest that
a college education and dual earner household income level tend to account for
upward mobility with regard to a middle-class social category (Frey, 2003; Pattilo-
McCoy, 1999).

To be as concise as possible with regard to the class category of participants,
Hollingshead’s Factor Index of Social Status (1975) was utilized. This
multidimensional index incorporates one’s educational level with a range of “less
than 7th grade [1]” to “graduate professional training [7]”; occupational level
ranging from a score of 1 (e.g., “service workers”) to a score of 9 (e.g., “higher
executive”). For a total score calculation, occupation is typically given a factor
weight of 5, while education is given a factor weight of 3 (Hollingshead, 1975).
Thus, a person scoring of 8 for occupation and 7 for education yields a total
score of 61 (8x§=40; 7x§=21; 40+21=6_1). However, updated use of this scale
switches factor weights (e.g., education=5; occupation=3) among African
Americans as educational level, more so than occupation, has been found to
carry more factorial weight when detecting social status within this population

(McAdoo, 1978).

60

Conceptual and Operational Definitions
The following section encompasses the following components: a) a
presentation of variables of interest and instruments that are utilized to
operationalize these variables; b) a description of research questions and
hypotheses; c) the research design format; e) a description of participants,
procedures, analyses and a chapter summary.
Table 1 is an illustration of variables and the methods used to operationalize

them.

61

Table 1. Conceptual and operational definitions of independent, dependent, and

potential moderator variables.

 

CONCEPTUAL DEFINITION

OPERATIONAL DEFINITION

 

Independent Variables

 

1. Gender

1. Designation of “male” or “female”
on the demographic form

 

2. Spiritual/religious coping
socialization (value of religion
[spirituality within the family, as an
effective racial coping mechanism)

2. Score obtained from the 7 item-
Religious Coping subscale of the Scale
of Racial Socialization for African
Americans (Stevenson, 1993a)
Sample questions:

. It is important for families to go to a
church/mosque for spiritual growth.

. A belief in God can help a person
cope through life struggles.

 

3. Extended family caring
socialization
(value of extended family
involvementin child-rearing as an
effective racial coping mechanism)

3. Score obtained from the 11 item-
Extended Family Caring subscale of
the Scale of Racial Socialization for
African Americans (Stevenson, 1993a)
Sample questions:

a Relatives can help African American
parents raise their children.

. Children who spend a lot of good
time with their relatives become
better citizens.

 

4. Perceived social support (how
one views the level of support
obtained from a significant other,
family, or friends)

4. A total score obtained from the 12 item
Perceived Social Support Scale
(Blumenthal, Burg, Barefoot, Williams,
Haney, 8 Zimet, 1987).

Sample questions:

. There is a special person who is
around when I am in need.

. I get the emotional help and support I
need from my family.

 

5. Perceived access to mental
health services (whether or not an
individual has access to mental
health services based on locale,
finances, time availability and the
presence of a therapist in the

 

 

5. Designation of “no” (0) or “yes” (1) on
the demographic form (4 items)
Sample questions:

0 l have access to mental health
services for a family member or
myself throulh my workplace,

 

62

 

 

community)

church, a private office, hospital, 95
community agency.

0 I could afford mental health

services either through health
insurance or some other financial
means.

 

Degndent Variable

 

6. Attitudes toward family therapy
(values that people hold toward the
use of family therapy as a help-
seeking option)

6. A total score obtained from the 29-item

Attitudes Toward Seeking Professional
Psychological Help Scale (Fischer 8
Tumer, 1970)(adapted for present
study)

DOMAINS:

1) need for family therapy

2) stigma associated with family

therapy

3) openness to family therapy

4) confidence in the success of family

therapy

“Adapted“ sample questions:

. Although there are therapeutic
offices for couples and families with
relationship troubles, I would not
have much faith in them.

0 People with serious couples or
family disturbances would probably
feel most secure in a good
therapeutic office setting.

 

Potential Moderator Variable

 

7. Help seeking comfort (identifies
level of comfort with asking friends
or family for help with emotional
stress, material needs, task
completion or decision-making)

 

 

7. A total score obtained from the 10-item

Help Seeking Comfort Scale (Hobfoll

and Lorman, 1989)

Sample questions:

0 How difficult is it for you to request
emotional support from friends if you
have problems or are undergoing a
crisis?

0 How difficult is it for you to request
advice or information from family
when you need it?

 

63

 

Research Questions and Hypotheses

The following section is a presentation of two key research questions
established for the proposed study. Each question includes theoretical themes as
related to variables of interest, followed by selected hypotheses. For clarity
purposes, all independent variables are referred to as contextual factors. Help
seeking comfort (HSC) is presented as a variable that potentially moderates the
relationship between contextual factors and attitudes toward family therapy.
Research Question #1:

What are attitudes toward family therapy given the interplay between race
(African American), social class (middle-class status) and culture
(contextual factors)?

As research suggests, utilization of mental health services are low. Yet,
studies have been found to show that for serious emotional distress, African
Americans do consider mental health treatment as an help-seeking option.
Articulating this for the middle-class is complex, given that there is minimal
empirical data found on their attitudes toward therapeutic intervention (Bagarozzi,
1995). Nevertheless, Richards (1992) found that although middle-class African
Americans exhibited greater cultural mistrust, they are no different in their
willingness to seek therapeutic intervention when compared to their Caucasian
counterparts. Thus, it is was hypothesized that:

Hypothesis 1: Middle-class African Americans will have

moderate to very positive attitudes toward
family therapy.

Research Question #2:
Considering context-sensitive factors such as gender, racial socialization
domains such as religiouslspirltual coping and extended family caring,
perceived social support, and perceived access to mental health services,
how might such factors influence attitudes toward family therapy?
Gender differences and similarities often shape help-seeking attitudes and
beliefs. While this is a universal theme, it has also been found among African
Americans (Plowden 8 Miller, 2000; Snowden, 2001). Gendered socialization
can often hinder or foster healthy attitudes toward formal intervention. Moreover,
variation exists in men and women’s help-seeking attitudes and beliefs with
regard to family based intervention(Pearlmutter, 1996). Thus, the following is
hypothesized:

Hypothesis 2: Women tend to exhibit more favorable attitudes
toward family therapy than men.

Racial socialization factors such as religious/spiritual coping (RSCS) and
extended family caring (EFCS), are associated with culturally sensitive
childrearing within families and self-competency among African American adults
(Stevenson, 1996; Demo 8 Hughes, 1990). As coping mechanisms, these
processes provide experiences that buffer the impact of personal and societal
stressors on families, thus potentially minimizing an interest in outside or formal
intervention. Thus it is hypothesized that attitudes toward family therapy

intervention are negatively associated with heightened religious/spiritual coping

65

and extended family caring socialization. This is specifically outlined in the
following hypotheses:

Hypothesis 3: As positive RSCS attitudes increase, there

is a decrease in positive attitudes toward
family therapy.

Hypothesis 4: As positive EFCS attitudes increase, there is a
decrease in positive attitudes toward family
therapy.

Perceived social support (PSS) pertains to whether or not individuals believe
that they can rely on family and friends for help (Ulbrich 8 Warheit, 1989).
Though African Americans traditionally perceived that they can rely on family and
friends for social support, help-seeking within this network lessens with the
presence of emotional distress. Furthermore, reliance on family decreases when
there is interpersonal distress (Taylor et al., 1996). Thus, African Americans may
be more open to family therapy when they perceive that social support is low.
Therefore, the following is hypothesized:

Hypothesis 5: As PSS decreases, there is an increase in
positive attitudes toward family therapy.

Access to mental health services has increased in recent decades with the
advent of community mental health agencies and managed healthcare programs.
Whether or not individuals perceive that they can access such services can
influence beliefs and utilization trends (Thompson, Akbar, 8 Bazile, 2002). With

greater access to educational and financial resources, middle-class African

Americans are more likely to have access to mental health services compared to

66

their lower income counterparts (Neighbors, 1990). Given the association
between utilization attitudes and accessibility (Stefl 8 Prosperi, 1985), the
following is hypothesized:

Hypothesis 6: Those who have perceived access to mental
health services have more positive attitudes
toward family therapy.

Research Question #3:

Given that how comfortable one feels with help-seeking may impact
attitudes toward family therapy, does help-seeking comfort account for the
relationship between contextual factors and attitudes toward family
therapy?

Leaf and Bruce (1987) suggest that intervening variables may account for
the relationship between various factors and help-seeking attitudes. How
comfortable one is with asking for help is associated with help-seeking
attitudes and behaviors (Kaniasty 8 Norris, 2000). Diala and colleagues
(2001) found that, among African Americans, those who felt “very” or
“somewhat” comfortable talking with a mental health professional also had
positive attitudes towards mental health services. Thus, help-seeking comfort
(HSC) may exist as a moderating factor, that is, one that may help to explain
the relationship between contextual factors and attitudes toward family
therapy. It should be noted that when incorporating a moderator variable,
several points should be made. First, in a design model involving a moderator

variable, it is assumed that significant relationships must exist between

independent and dependent variables. Secondly, a significant relationship

67

should exist between the moderator and the dependent variables.
Additionally, a moderator variable is treated as a categorical variable for
statistical clarity, thus it is typically established as a high/low variable (Baron
8 Kenny, 1986). For example, it may be assumed that someone with access
to mental health services and high help-seeking comfort may have more
positive attitudes toward family therapy than someone with the same access
to mental health services but who reports low help-seeking comfort.
Therefore, the following is hypothesized:

Hypothesis 7: Women with high HSC have more positive
attitudes toward family therapy compared to
women with low HSC.

Hypothesis 8: Men with high HSC have more positive attitudes
toward family therapy compared to men with low
HSC.

Hypothesis 9: When there is high HSC, there is a change in the
relationship between contextual factors and
attitudes toward family therapy.

Research Design
This study was carried out in a quasi-natural setting and is cross sectional in
nature. A convenience sample of African American male and female participants
was identified, majority of whom are of a middle-class social status. This
inferential survey design utilized multivariate analyses.
Targeted Participants
The 2002 Census Bureau of the United States suggests that there has been

steady economic progress since 1990 in two geographical regions- the Midwest

68

and the South. Despite the mobility decline of the 19703 through the 90s, recent
analyses suggest that there are suburban and metropolitan areas of the South
that are gradually advancing in access to college education, and professional or
managerial jobs (e.g., Lewis Mumford Center, 2002). In fact, Frey’s (1999) recent
analysis of the 1990s population growth suggests that 58% of the African
American growth occurred in the South. He also found that “New Blacks” of the
South have a middle-class status- 19% college graduate, and 30% professionals
and managers in the workplace. To that end, a non-random convenience sample
of a middle-class population from a southern community within United States was
selected for the present study. This researcher, given her status as native to this
area of the country, contacted local educators, ministers, social organizations,
and churches in order to generate a list of names of potential participants. The
researcher through a snowball sampling process (Babble, 1998), then identified
participants based on middle-class screening and inquired about their knowledge
of other potential participants.

A minimum of 120 participants was selected based on a power analysis
completed for this study (see the following “Procedure” section). Oversampling
occurred to account for incompletion or missing items. Adults 21 years and older
were targeted. In an effort to establish an equal distribution of males and
females, a recruiting of males through spousal contacts and local men’s social
organizations occurred. As previously stated, there was an attempt to control for
middle.class status as participants were screened for home ownership, college

completion, occupational history, and/or income level as these have been status

69

symbols that are typically used when identifying middle-class category
distinctions (e.g., Alba, Logan, 8 Stults, 2000; PattilIo-McCoy, 1999). Self-rating
of middle-class status was also obtained as this criteria has been included in
efforts to comprehensively assess this status affiliation (see McAdoo, 1997)
among the present sample.
Procedure

Power analysis, the process through which statistical calculations are
conducted as to identify an appropriate sample size, is a critical step in current
social science research trends. In the social science field, a statistical calculation
for sample size, commonly referred to as the “effect size” (i.e., d= some value)
ranges from small (d=.10 to .25), medium (d=.25 to .50 range), and large (d=
greater than .50) (Cohen, 1988). Identifying the effect size (d) informs the
researcher of the sample size needed in order to detect significant variations
between variables and units of analysis (Cohen, 1992). Furthermore, power of
significance is an additional calculation that informs the researcher of the
probability of rejecting a hypothesis that states that an insignificant relationship
occurs between variables. For the present study, an effect size (d=.70) was
determined. Analyses revealed that this effect size yielded a power of .91 in
order to detect a significant relationship between the moderator variable (help-
seeking comfort) and the dependent variable (attitudes toward family therapy).
For the main effect, that is, a detection of significant relationships between
independent (contextual) and dependent (attitudes) variables, the effect size of

.70 yielded a power of .79. A power analysis accounting for these effect sizes

70

and power of significance suggests that a minimum sample size of 120

participants be used in order to obtain statistically significant detections of the

main effects of independent (contextual factors) and moderator (help-seeking

comfort) variables on the dependent variable (attitudes toward family therapy).

Confidentiality

In accordance with the Michigan State University Committee on Research

Involving Human Subjects (UCHRIHS), the following precautions were taken as

to minimize any potential risks to participants and researcher biases:

1) The consent form included the following:-

a.

b.

A brief description of the study;

A option to voluntarily withdraw from the study at any time;

A notice in the consent form stating that names and individual
demographic information will not be analyzed. Rather, analyses of
grouped data will take place;

A statement suggesting that questions may be directed to the
doctoral committee co-chairs, researcher, and/or Dr. Peter
Vasilenko, Chair of UCHRIS;

A statement suggesting that minimal psychological risks are
present, particularly given that names will not be identified in the
final analysis of the group data set;

A statement informing the participants of anticipated time (30-50
minutes) and offer of refreshments, information to take home

regarding family therapy services, a $7 gift card to a local

71

restaurant and an opportunity to have one’s name drawn for a $100
raffle.

2) Participants were asked to personally detach consent forms from survey
packets to be placed in a separate envelope upon completion of the
survey.

3) Research assistants were informed of UCHRIS guidelines and asked to
double check survey completion by participants only with consent forms
detached from survey.

4) Data was coded and entered by the Michigan State University Institute for
Public Policy and Social Research as to minimize researcher bias.

Data Collection Procedure

This researcher and assistants contacted individuals who had been identified
as potential participants. The purpose of this initial phone contact was to
introduce the participants to the study and to inquire about interest and
availability. During this initial phone contact, the researcher or assistant a)
explained the initial intent of the study; b) requested that the participant verbally
commit to at least one of the several scheduled group administration times; and
d) requested that the individual refer the researcher or assistant to two or more
individuals that may be interested in the study.

A group format was utilized for the present study. This consisted of

administering surveys to groups of individuals in a local library as donated by a
local elementary school principal. Survey administration involved providing

participants with survey materials and pencils. An initial presentation by this

72

researcher took place and involved a general explanation of the study and the
procedure of survey completion. Participants were asked to read and sign the
consent forms. They were then asked to detach the consent form from the survey
packet. A research assistant placed all forms in a designated envelope.
Participants were allowed up to two hours to complete the survey. Refreshments
were provided during this time. Participants were also provided with educational
materials regarding family therapy as a profession after survey completion. A
raffle slip was attached to the initial consent form and consent forms were
gathered. The raffle for $100 was announced after the final group administration
took place and the winner was notified via phone call and mailed a money order.
Analyses

Several procedures were used to examine the relationship between
contextual factors and attitudes toward family therapy. Descriptive statistics were
calculated in order to determine the demographic profile of this sample. This
included a frequency distribution and central tendency findings for each of the
independent variables (contextual factors), and the dependent variable (attitudes
toward family therapy). Correlational analyses were conducted as to identify how
significant the relationship is between the independent variables and dependent
variable. T-tests were conducted as post-hoc analyses in order to test for
significant within-group differences.

Additionally, multiple regression analyses were conducted to determine which
model (independent variable accounting for the dependent variable) is the best fit

when other independent variables are controlled for. This included a hierarchical

73

regression analysis in order to identify which contextual variables are more likely
to account for or predict attitudes toward family therapy in comparison to others.

Finally, a moderator variable (help-seeking comfort)(HSC) was analyzed as
the intervening variable possibly affecting the strength or direction of the
relationship between contextual factors and attitudes toward family therapy.

Summary

Chapter 3 is an outlined presentation of key objectives, operational and
conceptual definitions of factors most relevant to this study. Research questions
and hypotheses were presented along with procedures that involved efforts to
maintain confidentiality and objective data collection. Intentions for statistically
analyses were also presented with the consideration of specialized analyses
when considering the role that a moderator may play within a bi-variate
(independent variable-dependent variable) model. ~

The following chapters include findings as related to research questions and
hypotheses. Specifically, Chapter 4 is a presentation of the demographic profile
of the identified sample and statistical findings. Chapter 5 is an interpretative
discussion of key findings, followed by limitations and implications as related to

policy and clinical relevance to this population.

74

CHAPTER 4
RESULTS

The present study examined attitudes toward family therapy (ATFT) among a
sample of middle-class African Americans from a southern community within the
United States. Findings suggest that participants exhibit positive attitudes toward
family therapy as a help-seeking option. Also, it was found that participants
perceive that they have lnfonnal social supports (e.g., family, friends) (PSS),
while still believing that family therapy can be an effective formal intervention.

It was also found that participants value religious/spiritual coping socialization
(RSCS) and extended family caring socialization (EFCS) while still valuing family
therapy as an effective family support option. Additionally, participants reported a
belief that they have access to mental health services in their community
(ACCESS). Such belief also seems to predict positive attitudes toward family
therapy.

Furthermore, participants reported a moderately high level of comfort with
seeking help (HSC) in time of need. Results also suggest that this comfort level
predicts attitudes toward family therapy.

Finally, it was found that both women and men exhibit positive attitudes
toward family therapy, though women tend to exhibit more positive attitudes
compared to men. Also, as with access to mental health services and one’s help-
seeking comfort, gender was found to predict attitudes toward family therapy.

. This chapter is a presentation of the above-mentioned findings after data

coding and statistical analyses were conducted with this sample. The chapter is

75

divided into the following sections: a) demographic profile of the participants, b)
descriptive findings as related to attitudes toward family therapy (ATFT), c)
descriptive findings as related to contextual factors, d) findings illustrating
preliminary correlations between attitudes toward family therapy and contextual
factors, e) preliminary analyses as related to identifying those factors accounting 3
for attitudes toward family therapy, f) research questions and hypotheses
findings, and 9) post hoc findings.

A Demographic Profile of the Participants

A sample size of 135 participants was included in the final analysis. This
number of participants was appropriate given that the power analysis for the
present study suggested a minimum of 120 participants. A total of 146
participants initially completed the series of measures compiled for the present
study. However, missing values existed for various sections of the survey. In an
effort to increase the likelihood that survey items accurately represented variable
constructs, a listwise deletion procedure was conducted. This procedure allowed
the researcher to set the sample size at a number that reflects only those
participants who answered items for all variables (Vogt, 1999).

As presented in Table 2, the sample consisted of 81 women (60%) and 54
men (40%). Majority of participants were over 40 years of age with a mean age
of forty-eight. Most participants (66.6%) had obtained an undergraduate college
degree or graduate degree. The remaining participants had acquired either a
high school diploma/equivalent or partial college/specialized training. Only two

participants reported obtaining less than a high school diploma.

76

Table 2
Demographic Profile of African American Sample: Gender, Age, Level of

Education (N= 135)

 

n (%) M SD

 

Gender .60 .492
Female (1) 81 (50)

Male (0) 54 (40)

Age 48 13.49
Under 40 (1) - 37 (27.4)

Over 40 (2) 95 (70.4)
No response 3 (2.2)

Level of education 5.85 1.10
Graduate degree (7) 44 (31.9)
Undergraduate degree (6) 48 (34.7)

High school diploma or equivalent (5) 21 (18.1)
Partial college/specialized training (4) 18 (13.9)
Partial high school (3) 1 (.7)
Junior high school (2) 1 (.7)
Less than seventh grade (1) 0 0

N

No response (1.5)

 

77

Table 3 reveals that most of the participants are married while others fall into
other categories (i.e., widowed, never married, divorced, or separated).
Furthermore, results indicate that most participants are parents with the
remaining group falling into the non-parent or sole-parent categories.

Table 3 '
Demographic Profile of Afiican American Sample: Relationship and Parental

Status (N=135)

 

n (%) M SD

 

Relationship status . 4 1.23
Never married:
No present relationship (1) 7 (4.8)
In a relationship (< 3 yrs.) (2) 8 (5.5)
Long-term relationship (3) 6 (4.1)
Married (4) 106 (72.6)
Separated (5) 4 (2.7)
Divorced (6) 5 (3.4)
Widowed (7) 10 (6.8)
Cohabitating 0 0
Parental status 1.89 .419
Non-parent (1) 19 (14.1)
Parent (or guardian) (2) 105 (7%.?)
Sole parent (full custody) (3) 5 ((4:43
No response 6

 

78

Given that home ownership and income level are often associated with
middle-class status within the literature, information regarding these areas was
obtained. Table 4 illustrates that the majority of participants own their own home
with 71% earning an annual household income between $35,000 and over
$75,000. Given that this range exists in income, Hollingshead index findings are
most relevant to this sample, given that occupation and educational level have
been found to be better determinants of a middle-class status among African

Americans than solely basing status on income.

79

Table 4

Demographic Profile of African American Sample: Home Ownership and Income

 

 

(N=135)
n (%) M SD
Home Ownership 1.51 1.34
Yes (1) 1 16 (86)
No (0) 17 (1 3)
No response 2 (1.5)
Income . - 4 1.19
75,000 and over (5) 30 (22.2)
50,000 to 74,999 (4) 38 (28.1)
35,000 to 49,999 (3) 28 (20.7)
20,000 to 34,999 (2) 26 (19.3)
Below 20,000 (1) 6 (4.4)
No response 7 (5.2)

 

8O

Occupational categories of this sample are also presented. Initially,
approximately 80 occupational categories were identified given that participants
were given the option of specifying their particular occupation. These
occupational categories were narrowed down to 18 key occupational categories
based on how the 80 categories grouped together. Table 5 illustrates these 18
categories where participants reported either current occupation or retired status

with a listing of his or her prior occupation.

81

Table 5

Occupational Categories for African American Sample (N=135)

 

Occupation n (%)
No mention 7 (5.2)
Teacher/Educator 63 (46.6)
Bus Driver 2 (1.5)
Law Enforcement 2 (1.5)
Skilled Laborer 8 (5.9)
Sales/Customer Services - 4 (3.0)
Clerical/Secretarial 10 (7.4)
Attomeleudge 2 (1 .5)
Social Worker 3 (2.2)
House Keeper/Maid 1 (0.7)
Custodian 4 (3.0)
Accountant 1 (0.7)
Nurse 1 (0.7)
Managerial 7 (5.2)
Computer Programmer 2 (1.5)
Retired Misc.‘ 5 (3.7)
Misc.” 13 (9.6)

 

‘refers to those retired persons who did not designate from which occupation they are
retired.

t’refers to those occupations that have been categorized as “other“ which pertains to
occupational categories that did not fall into the major categories listed.

82

In an effort to identify how people perceived their social class status, a self-
rating of social class was obtained. Table 6 suggests that the majority of
participants rated themselves as middle-class. However, individual perceptions of
social status often vary due to socialization experiences, along with the
inconsistency within literature regarding what defines middle class (Pattillo-
McCoy, 1999). Thus, the Hollingshead’s Factor Index of Social Status (1975)
formula, which takes into account educational level and occupation in identifying
one’s social category, was utilized. This was in an attempt to comprehensively
assess the middle-class status of this sample. Table 6 suggests that based on
the Hollingshead assessments of those participants reporting occupation and
educational level, most participants are at the lower middle-class range or above.
Of those reporting both educational and income levels, only one person fell

below the middle-class level.

83

Table 6
Demographic Profile of African American Sample: Self-rating of Social Class and

Hollingshead Social Status Ranking (N=135)

 

n (%) M so

 

Self-rating of social class 2.24 .599
Upper class (1) 7 (5.2)
Middle class (2) 87 (64.4)
Working class (3) 30 (22.2)
Lower income (4) - 4 (3.0)
No response 7 (5.2)
Hollingshead social strata categoriesa --" 48.29 9.75
Upper class range (66-55) 42
Upper middle class range (54-40) 50
Middle class range (39-30) 17
Lower middle class range (29—20) 6
Lower class range (19-8) 1
No response 19

 

' For a total score calculation, occupation is given a factor weight of 3, while education is given a
factor weighton thus, a person scoring 8 for occupation and 7 for education would yield a total
score of 59 (8x§=24; 7x§=35; 24+35= Q).

" Given that social class items were based on educational and occupational categories, no
percent values were obtained for the Hollingshead ranges. Only frequencies are reported.

84

Finally, religious affiliation was reported for this sample. Results from Table 7
suggest that the majority of participants are either Protestant (54%) or Catholic
(42.2%). A small percent (3.7%) of participants identified themselves has having
no religion or some other unidentified religious affiliation.

Table 7

Demographic Profile of African American Sample: Home Ownership and Income

 

 

(N=135)
n (%)
Religious Affiliation
Catholic 57 (42.2)
Protestant
Baptist 39 (28.9)
Methodist 8 (5.9)
Church of Christ 3 (2.2)
Congregationalist 2 (1 .5)
Nondenominational 1 3 (9.6)
Full Gospel 6 (4.4)
Other misc. Christian 2 (1.5)
Muslim 0 0
Jewish 0 0
No religion 3 (2.2)
Other 2 (1.5)

 

85

Attitudes Toward Family Therapy

Attitudes toward family therapy were obtained via the use of an adaptation of
the Attitudes Toward Seeking Professional Psychological Help Scale (Fischer 8
Turner, 1970). The adaptation, the Attitudes Toward Family Therapy (ATFT)
Scale was utilized for the purpose of this study (see appendix A). The ATFT
scale, a 5-point likert scale, measures attitudes toward family therapy and is
divided into adapted subscales that assess attitudes regarding need for family
therapy, stigma associated with family therapy, openness to seeing a family
therapist, and confidence in the ability of a family therapist to effectively address
couple or family related problems.

Table 8 presents descriptive values for the ATFT Scale as well as its
subscales. The Cronbach alpha coefficient suggests that high reliability (a=.89)
was achieved in the ability of this scale to accurately measure attitudes toward
family therapy. Additionally, alpha ranges (a=.79-.60) for the Need, Openness,
Confidence, and Stigma subscales also suggest high to moderate reliability.
Findings suggest that participants’ score range is moderate to high suggesting
moderate to very positive attitudes toward family therapy. This is confirmed
given that the average score (M=104.23) fell closer to the maximum possible
score.

In addition to total score findings, Table 8 also presents results from the four
subscales of the ATFT Scale. Though standard deviation coefficients suggest
less variability of items (due to smaller item number), mean scores suggest that

participants’ scores are moderate to high when assessing how scores fall in

86

relation to the possible score range. This suggests that participants, overall,
believe that there is a need for family therapy: believe that stigma would not
prevent them from pursuing or encouraging another to pursue family therapy;
exhibit openness to family therapy as a therapeutic option; and are confident that
family therapists can effectively address problems/concems as related to their
couple or family relationships. Though emphasis is placed on the total score
findings for purposes of this study, these subscale findings are presented in order
to identify how scores fall for specific attitude-related constructs (i.e., need,

stigma, etc).

87

Table 8

Descriptive Values for Attitudes Toward Family Therapy (A TFT) Scores (N=135)

 

M (SD) min. max. Cronbach

 

f Alpha
ATFT Scale ' 104.23 (14.36) 64 142 _ .89
Eossible Score 29 145
flange (PSR)
ATFT Subscales
NEED 27.07 (5.01) 12 - 40 .74
(PSR) 8 40
STIGMA 17.51 (2.09) 10 22 .60
(PSR) 5 25
OPENNESS 23.99 (4.81) 13 34 .71
(PSR) 7 35
CONFIDENCE 32.56 (5.19) 20 45 .79
(PSR) 9 45

 

88

Contextual Factors
Perceived Social Support

The Perceived Social Support (PSS) Scale is utilized to assess to what level
do individuals rely on family, friends, or a significant other for support as related
to emotional, problem-solving, and decision-making needs. Based on Table 9,
this 5-point likert scale exhibits a Cronbach alpha coefficient that suggests high
reliability in this scale’s detection of a person’s perceived level of social support.
A mean score close to the possible maximum score suggests that participants
perceive that they have a high level of social support among friends, family, and
a significant other.

Extended Family Caring Socialization (EFCS)

Extended family caring socialization (EFCS) pertains to what extent does a
person value messages conveying that extended family play an important role in
child-rearing among African Americans. This is measured via the use of the
extended family caring socialization subscale of the SORS (Scale of Racial
Socialization for African Americans). Based on a 5-point scale, high scores
(closest to 55) suggest that one highly values such attitudes regarding the
involvement of extended family. Table 9 illustrates a fairly high cronbach alpha
which suggests that this subscale accurately measures extended family caring
socialization. The mean fell closest to the maximum possible score, and
suggests that participants highly value the belief that extended family
involvement in child-rearing is an important coping mechanism among African

Americans.

89

Religious/Spiritual Coping Socialization (RSCS)

Religious or spiritual coping socialization pertains to what extent does a
person value religious/spiritual coping as an effective help-seeking option. This
construct is operationalized via the use of the religious/spiritual coping subscale
of the SORS scale. According to Table 9, though a moderate cronbach alpha
exists, results of the mean suggest that participants scored closer to the
maximum possible score. This suggests that overall, participants value
religious/spiritual coping as an effective help-seeking option among African

Americans.

90

Table 9

Descriptive Values for Perceived Social Support (PSS), Extended Family Caring
Socialization (EFCS) and Religious/Spiritual Coping Socialization (RSCS) Scores
(N= 135)

 

M (SD) min. max. Cronbach

 

Alpha
PSS Scale 53.10 (6.90) 27 60 .86
Possible Score 12 60
Range (PSR)
EFCS Scale 45.72 (5.41) 30 55 .70
Possible Score 11 55
Range (PSR)
RSCS Scale 35.69 (3.24) 27 40 .65
Possible Score 8 40
Range (PSR)

 

91

Perceived Access to Mental Health Services (ACCESS)

Given that the researcher could not identify a scale measuring a person’s
perception about his or her access to mental health services, 4 items were
developed for the present study. Items pertained to access with regard to a
person’s belief that he or she has access through locale and financial means as
well as time and therapist location. Level of access was identified by scoring a 1
(for access) or a 0 (for no access) on each of the four items. Table 10 shows a
low Cronbach alpha (a=.42) for the ACCESS construct. Nevertheless, descriptive
results reveal that the majority of participants (64.4%) perceive that they have
access to mental health services given that they scored a 1 on each of the 4
items. As suggested in literature, this heightened perception of access seems to
be reflective of the social class category of the given sample.

Help-Seeking Comfort (HSC)

Help-seeking comfort pertains to how comfortable a person is with seeking
help for emotional, crisis-related, information, material, and financial needs. A 10-
item measure (Hobfoll 8 Lerman, 1989) was utilized and is based on a 5-point
likert scale. Table 10 presents findings suggesting that a very high Cronbach
alpha (a=.92) exists for this construct. Mean values suggest that participants
have a moderate to high level of help-seeking comfort with much variability in

score ranges as identified by the standard deviation value.

92

Table 10

Descriptive Values for Perceived Access to Mental Health Services (ACCESS)
and Help-Seeking Comfort (HSC) Scores (N=135)

 

M (SD) min. max. Cronbach

 

Alpha
ACCESS Scale 3.50 (.791) O 4 .42
Possible Score 1 4
Range (PSR)
HSC Scale 37.60 (9.51) 12 50 .92
Possible Score 10 50
Range (PSR)

 

93

Gender

It is important to note that gender is considered as a contextual factor in the
present study. Descriptive information presented earlier in this chapter, suggests
that more women are present in the study compared to men. T-test findings
suggest that women and men do not vary in reported perceived access to mental
health services (t=.04, p=.97); perceived social support (t=.1.43, p=.154); help-
seeking comfort (t=.61, p=.54); extended family caring socialization (t=-1.35,
p=.18); and religious/spiritual coping socialization (t=-.92, p=.36). However, t-test
findings (t=4.19, p<.01) reveal that there is a statistically significant difference
between men and women with regard to how their scores varied on attitude
toward family therapy items. It was found that women have an average score
(M=108.21) approximately 10 points higher than men (M=98.25). Still, given that
the minimum possible score is 29 and the maximum possible score is 145, both
men and women exhibit moderate to very positive attitudes toward family
therapy. Thus, these findings call into question the idea that men are not open to
engaging in therapy while supporting literature that states that women have a
greater propensity to seek therapy compared to their male counterparts.

Contextual Correlates of Attitudes Toward Family Therapy

Table 11 is an illustration of bi-variate correlations among attitudes toward
family therapy and contextual factors. Results indicate that significant
associations exist between attitudes toward family therapy (ATFT) and contextual
factors. Specifically, the correlation (r=.27) suggest that ATFT is significantly

associated with perceived social support (PSS)(p<.01) which indicates that

94

individuals with perceived higher levels of social support, are also more likely to
have positive attitudes toward family therapy.

The significant correlation (r=.19) between ATFT and extended family caring
socialization (EFCS)(p<.05) suggests that as there is an increase in the value of
that extended family caring as an effective coping mechanism within African
American families, there is an increase in positive attitudes toward family
' therapy. Also, the significant correlation (r=.18) between ATFT and
religious/spiritual coping socialization (RSCS) (p<.05) suggests that as there is
an increase in one’s value of religious beliefs or spirituality as effective coping
mechanisms, there is an increase in positive attitudes toward family therapy.

The significant correlation (r=.33) between ATFT and perceived access to
mental health services (ACCESS) (p<.01) suggests that as the belief that one
has access to mental health services increases, there is an increase in positive
attitudes toward family therapy. Furthermore, a significant correlation (r=.34)
between ATFT and gender (p<.01) suggests that women tend to have more
positive attitudes toward family therapy than men. Finally, a significant correlation
(r=.27) between ATFT and help-seeking comfort (HSC)(p<.O1) suggests that as
there is an increase in one’s comfort with asking for help, there is also an
increase in positive attitudes toward family therapy.

Thus it can be concluded that those with highly perceived social support,
perceived access to mental health services, extended family caring socialization,
and religious/spiritual coping socialization tend to exhibit more positive attitudes

toward family therapy, with women exhibiting slightly higher attitudes than men.

95

However, it is important to note that in addition to significant associations existing
between ATFT and contextual factors, significant associations were also found
among contextual factors as illustrated in Table 11.

Specifically, correlational coefficients suggest that there is a significant
association between EFCS and RSCS (r=.50, p<.01), as well as, PSS and HSC
(r=.65, p<.01). Furthermore, HSC seems highly associated with all contextual
factors except ACCESS and GENDER. Given that contextual factors are more
highly correlated with each other (i.e., r=.65, .50) than with attitudes toward family
therapy, the significant associations that exist among these factors (known as
multicollinearity) may be accounting for the positive association between these

contextual factors and attitudes toward family therapy.

96

Table 11

Bi-variate Correlations Between Attitudes Toward Family Therapy and

Contextual Factors (N=135)

 

 

Variable 2 3 4 5 6 7
Attitudes Toward Family .27** .19“ .18“ .33" .34” .26“
Therapy (ATFT) (1)

Perceived Social Support —- .26“ .36“ .15* .12 .65“
(PSS) (2)

Extended Family —- .50** .29** -.12 .34**
Caregiving Socialization

(EFCS) (3)

Religious/Spiritual --- .32” -.08 .43“
Coping Socialization

(RSCS) (4)

Perceived Access to -- .00 .17*
Mental Health Services

(ACCESS) (5)

Gender (GENDER) (6) —- .05

Help-Seeking Comfort
(HSQU)
** p< .01

*p<.05

97

What Accounts for Attitudes Toward Family Therapy?

While research questions and hypotheses will later address how specific
contextual factors may account for attitudes toward family therapy, this section
will present preliminary analyses necessary to establish a model that
incorporates those contextual factors (independent variables) that explain the
variance in attitudes toward family therapy.

Multiple regression is often a statistical procedure used to test how two or
more independent variables predict or account for a dependent variable
(Schroeder, Sjoquist, and Stephan, 1986). While correlation analyses look at
positive or negative associations between variables, multiple regression takes
these associations one step further by examining how multiple variables,
independent of one another, might be accounting for the dependent variable.
More specifically, with hierarchical regression, the researcher theoretically
predicts how variables account for a dependent variable and enter those
variables into that model. The aim is to answer the following two questions: Is
there a significant increase or decrease in the dependent variable when there is
a one unit change in a given independent variable when controlling for other
independent variables? How much of the dependent variable is explained by a
given independent variable when controlling for other independent variables?
These questions are best answered via the use of the regression line. This line is
set on a multidimensional plane with Y (dependent variable) and X (independent

variable) axes. By identifying the way in which data points cluster around the

98

regression line, the researcher will be informed of how much X may be
accounting for Y for a given sample.

In the present study, the following questions were raised: Is there a significant
increase or decrease in the attitudes toward family therapy score when there is a
unit change in contextual factor scores? How much of the attitude score is
explained by a given contextual factor when controlling for other contextual
factors? To answer these questions, a standard regression equation model is
used:

Y = a + b1(X1)+...b.,(X,,) + e,

where Y= the dependent variable (attitudes toward family therapy); a= the point
at which the regression line intersects the Y axis; b= the slope measuring the
intersection of Y and X; X= a given independent variable; and e= error, which is
the amount of unexplained variance not accounted for in the model. Referring
back to the six independent variables (PSS=perceived social support; EFCS=
extended family caring socialization; RSCS= religious/spiritual coping
socialization; ACCESS= perceived access to mental health services; HSC= help-
seeking comfort; and GENDER) and the dependent variable (ATFT= attitudes
toward family therapy), the following unrestricted (UR) equation model was
established:
ATFT=a+b1(PSS)+b2(EFCS)+b3(RSCS)+b4(ACCESS)+b5(GENDER)+b5(HSC)+e

To identify how the above-mentioned variables potentially account for

attitudes toward family therapy, statistical analyses were conducted using this

99

model. Table 12 provides a summary of coefficients pertinent to identifying the
level of significance of the model with all independent variables included.

Based on this model, a R2 of .27 means that 27% of the variance in attitudes
toward family therapy (ATFI') seems to be explained by this model. However,
only two (3.39, 34.32) out of six values are significant which suggests that only two
(ACCESS, GENDER) out of six contextual factors significantly account for ATFT
in this model. Therefore, this model may be weak in the ability of all contextual
factors to explain attitudes toward family therapy. .

Given the level of insignificant findings for this UR model, the issue of
multicollinearity must be taken into account. As noted in Table 11, the result of
these significant interrcorrelations among contextual factors may be accounting
for some of the variance in attitudes toward family therapy, thus potentially
influencing the lack of significance of this UR model. Though the issue of
multicollinearity could potentially invalidate findings, which suggest that
significant correlations exist between contextual factors and attitudes toward
family therapy, procedures exist that allow the researcher to address this issue
as to prevent the nullification of the theoretical model. The following section
addresses this concern.

To address the issue of multicollinearity, a statistical calculation was
conducted that identifies the variance inflation factor (VIF). This factor consists of
a configuration that accounts for the amount of variance in a given independent
variable that is potentially being explained by other independent variables

(Crown, 1998). Furthermore, the VIF suppresses any effect that interrelationships

100

among independent variables may have on the ability of these variables to
account for the dependent variable (McDaniel, 2001). For the UR model, VIF
calculations revealed that high multicollinearity no longer exists once PSS,
EFCS, and RSCS were deleted from the model. The revised model that
remained is the following:

ATFT: a+ b1(ACCESS)+b2(GENDER)+b3(HSC)+e

To determine the significance of this model, a regression analysis was
conducted for this restricted (RE) model. Table 12 is a summary of contextual
factors and their regression coefficients.

Based on the RE model, ACCESS, GENDER, and HSC factors are
statistically significant as noted by the significant values for all three variables.
Thus the following can be concluded: 1) For a unit increase in ACCESS scores,
there is a 5.39 unit increase in ATFT scores when controlling for GENDER and
HSC; 2) Women score 9.63 units higher than men on the ATFT scale when
controlling for ACCESS and HSC; 3) As HSC scores increase, there is a .29 unit
increase in ATFT scores when controlling for GENDER and ACCESS.

However, the following question is raised: Given that PSS, EFCS, and RSCS
were initially thought to theoretically account for attitudes toward family therapy,
how will omitting them affect the overall level of significance of the RE model in
its ability to explain attitudes toward family therapy? One criteria involves
measuring how the model accounts for the sum of squared error (SSE), that is,
the model’s ability to minimize the effect that unexplained error may have in

explaining the variance in attitudes toward family therapy. An F test calculation

101

(McDaniel, 2001) was conducted in order to measure SSE and compare
differences between the UR and RE models. This allowed for a gauging of
whether or not deleting variables from the original model would affect its
theoretical relevance:

F= [(SSRag-SSRUR)/deE-dfua)]l[SSRUR)/(n-k-1)]

Referring to Table 12, coefficients were plugged into the formula to calculate F:

F [(20383.401 5-20055.647)/6-3)]I[(20055.647)/(1 35-6-1)]

F .69727

To test for the statistical significance of this coefficient, a critical value
equal to 2.68 was determined (p<.05). An F score below this critical value would
confirm that there is no significant difference between the UR and RE models
with regards to how much variance in attitudes toward family therapy is being
significantly explained. Thus an F score of .69727 suggests that there is no
difference between the models and therefore, omitting PSS, EFCS, and RSCS

variables does not alter the statistical validity of the model.

102

Table 12

Predictors of Attitudes Toward Family Therapy: Summary of Coefficients for

Unrestricted (UR) and Restricted (RE) Regression Models (N= 135)

Unrestricted Model (UR)

 

 

 

 

 

Variable B SE B t
PSS .18 .21 .9
EFCS .24 .24 1.03
RSCS -.03 .42 -.07
ACCESS _ 4.96 .14 3.39“
GENDER 9.73 2.25 4.32
HSC .17 .16 1.09
R2=.27

SSE Residual = 20055.647

(E [6, 128] = 8.06, p<.01)

Restricted Model (RE)

Variable B SE B t
ACCESS 5.39 1 .38 3.9““
GENDER 9.63 2.19 4.49”
HSC .29 .11 2.56"
R2=.27 A

SSE Residual = 20383.4015
-(E [3,131] =15.53, p<.01)

 

103

Summary of Findings

In an effort to clearly articulate findings as related to proposed hypotheses,
the following section is divided based on specific research questions.
Hypotheses relevant to a given research question is located immediately
following that research question followed by findings that either support or refute
that hypothesis.

Research question #1

What are attitudes toward family therapy given the interplay between race
(African American), social class (middle-class status), and culture (contextual
factors)?

Hypothesis 1: Middle-class African Americans will have moderate to very
positive attitudes toward family therapy.

Findings (referring back to Table 8, p. 89) reveal that with an average score of
106 with a possible minimum/maximum score range of 29 to 145, it is concluded
that for this sample of middle-class African Americans, there are moderate to
very positive attitudes toward family therapy as an effective help-seeking option.
Furthermore, subscale findings suggest that participants tend to believe that
there is a need for family therapy, that stigma should not prevent one from
pursuing family therapy, that helshe would be open to participating in or referring
one to family therapy, and that family therapists are competent in their ability to

address couple and/or family related problems.

104

Research question #2

Considering context-sensitive factors such as gender, perceived social
support (PSS), extended family caring socialization (EFCS), religious/spiritual
coping socialization (RSCS), and perceived access to mental health services
(ACCESS), how might such factors account for attitudes toward family therapy
(ATFT)?

Hypothesis 2: Women tend to exhibit more positive attitudes toward family
therapy than men.

Though correlational results confirm this hypothesis, the RE model more
accurately supports this hypothesis given that the issue of intercorrelation among
independent variables is being addressed in this model. Referring to Table 12
(p.104) the restricted (RE) regression model suggests that women tend to score
9.63 units higher on the ATFT scale which means that they tend to exhibit more
positive attitudes toward family therapy compared to men when controlling for the
effects of ACCESS and HSC factors. This is also supported by previously
discussed t-tests that suggest that there is a mean score difference between men
and women for the attitudes toward family therapy total score.

Hypothesis 3: As positive RSCS attitudes increase, there is a decrease in
positive attitudes toward family therapy.

Referring to Table 11(p.98) correlational findings suggest that RSCS is
positively correlated with attitudes toward family therapy. This refutes this
hypothesis that suggests that a negative relationship exists between RSCS and

ATFT. However, multicollinearity suggests that the relationship between RSCS

105

and other factors may be accounting for this correlation. Furthermore, the beta
coefficient for the unrestricted (UR) regression model (see Table 12) suggests
that as RSCS increases, there is a decrease in positive attitudes toward family
therapy. However, this finding is statistically insignificant and thus RSCS is
removed from the model as illustrated in the RE model. Therefore, it cannot be
concluded that RSCS significantly accounts for attitudes toward family therapy
with this particular sample.

Hypothesis 4: As positive EFCS attitudes increase, there is a decrease in
positive attitudes toward family therapy.

As with RSCS, Table 11 suggests that EFCS is positively associated with
attitudes toward family therapy, which does not support this hypothesis.
However, considering that a high correlation between EFCS and other contextual
factors, and EFCS’ insignificance in the UR regression model, it cannot be
concluded that EFCS significantly accounts for attitudes toward family therapy
with this particular sample when controlling for ACCESS and gender variables.

Hypothesis 5: As PSS decreases, there is an increase in positive attitudes
toward family therapy.

Table 11 illustrates that PSS is significantly associated with attitudes toward
family therapy, however through a positive association. Thus, hypothesis 5 is not
supported. Rather, preliminary findings suggest that as PSS increases, so does
positive attitudes toward family therapy. However, given that this variable is

insignificant in the UR model and thus was removed in the RE model, it cannot

106

be concluded that PSS significantly accounts for attitudes toward family therapy
for this particular sample.

Hypothesis 6. Those who have perceived access to mental health services
(ACCESS) have more positive attitudes toward family therapy.

Table 11 findings suggest that as ACCESS scores increase, so do positive
attitudes toward family therapy. This is confirmed in both the UR and RE
regression models (see Table 12), independent of the effects that other
contextual factors are having on attitudes toward family therapy. Thus, it can be
concluded that participants’ perceived access to mental health services accounts
for attitudes toward family therapy. This is supported by the RE model that
suggests that as there is an increase in ACCESS scores, there is a 5.39 unit
increase in ATFT scores when controlling for gender and help-seeking comfort.
Research question #3

Given that how comfortable one feels with help-seeking may impact attitudes
toward family therapy, does help-seeking comfort, as a contextual factor,
account for the relationship between other contextual factors and attitudes
toward family therapy?

Hypothesis 7: Women with high HSC (help-seeking comfort) have more
positive attitudes toward family therapy compared to women with low HSC.

T-tests were used to determine whether or not a difference in mean scores
exists for attitudes toward family therapy when comparing those women with high
help-seeking comfort to those with low help-seeking comfort. Findings suggest

that women with high help-seeking comfort (M: 111.22) tend to score, on

107

average, approximately 6 points higher than women with low help-seeking
comfort (_M= 105.16) on the ATFT Scale. Furthermore, a t-test reveals that this
conclusion is significant (t=-2.09, p<.05). Therefore, a difference does exist
suggesting that women with high help-seeking comfort tend to exhibit more
positive attitudes toward family therapy than those with low help-seeking comfort.

Hypothesis 8: Men with high HSC have more positive attitudes toward family
therapy compared to men with low HSC.

Similar to that of women, t-tests were conducted in order to measure whether
or not there are mean score differences amongmen with high help-seeking
comfort compared to those with low help-seeking comfort with regard to attitudes
toward family therapy. Findings reveal that men with high help-seeking comfort
have a mean score (M=102.32) that is approximately 8 points higher than the
mean score for men with low help-seeking comfort (M=94.18) on the ATFT
Scale. Thus, it can be stated that according to this mean difference, men with
high help-seeking comfort tend to exhibit more positive attitudes toward family
therapy compared to men with low help-seeking comfort. This was confirmed by
a t-test (t=-2.26, p<.05) suggesting that the mean difference is statistically
significant.

Hypothesis 9: When there is high HSC, there is a change in the relationship
between contextual factors and attitudes toward family therapy.

It was found that with the total sample (N=135), there is approximately a 6
.point mean score difference among those with high help-seeking comfort

(M=107.20) compared to those with low help-seeking comfort (M=101.12) on the

108

ATFT Scale. This is confirmed by a t-test (t=-2.90, p<.01) suggesting that this
difference in mean scores is significant. Moreover, as noted in Table 11 (p.98)
high intercorrelating exists between HSC and other contextual factors suggesting
that there is possibly an interaction or pathway between HSC and these variables
that is not being accounted for in the theoretical model of this present study.
Initially, Hypothesis 9 aimed to treat help-seeking comfort as a potential
moderator variable set at a high and low level. However, in order to treat an
independent variable as a moderator variable, key assumptions must be true: 1)
the potential moderator variable must be independent of other independent
variables; and 2) must be significantly correlated with the dependent variable
(Baron and Kenny, 1986). In the case of help-seeking comfort, it is significantly
correlated with attitudes toward family therapy (r=. 264, p<.01) and significantly
accounts for attitudes toward family therapy within the RE regression model
(B=.29, p<.01)when controlling for gender and access to mental health services.
However, help-seeking comfort is also highly correlated with several independent
variables thus the first key assumption is not supported. To that end, pre-
requisites needed to test help-seeking as a moderator variable were not met.
Nevertheless, help-seeking comfort remains significant with regard to those with
high help-seeking comfort reporting more positive attitudes toward family therapy
compared to those with low help seeking comfort. Also, the ability for help-
seeking comfort to account for attitudes in the RE model suggest that it is an
important variable to re-examine as an explanatory model accounting for

attitudes toward family therapy emerges.

109

Post Hoc Findings
Findings suggest that three (HSC, ACCESS, GENDER) out of six contextual
factors account for 27% of the variance in attitudes toward therapy within this
sample. However, given that the sample slants toward upper middle-class
teachers who are married, the following question is proposed: Are those
participants who are not of the above-mentioned demographic profile scoring
differently on the ATFT scale? To answer this question, a series of post hoc tests
were run included t-tests that revealed whether or not there are mean group
differences for the following groups with regard ,to how they are scoring on the
ATFT items: teachers versus nonteachers and married versus nonmarried.
Results revealed that for marital status (t=-.896, p=.37), there is no difference
between married and non-married individuals in how they score on the ATFT
scale. However, regarding teacher status (t=2.83, p<.01), there is a statistically
significant difference in mean ATFT scores. Nevertheless, when addressing
specific hypotheses, group differences were not found to impact the overall
statistical validity of the RE model for this particular sample.
Summary
The overall purpose of this chapter was to present findings based on
descriptive and statistical analyses. With regards to attitudes toward family
therapy, participants exhibit moderate to very positive attitudes toward family
therapy. Moreover, participants tend to perceive that they have social support.
Additionally, extended family involvement with childrearing and religious/spiritual

coping as racial coping mechanisms are valued socialization themes among

110

participants. Also, participants believe that they do have access to mental health
services and are comfortable with asking for help with various needs.

With regards to specific hypotheses, it was confirmed that women exhibit
more positive attitudes than men. It was hypothesized that as there is an
increase in perceived social support, a value extended family caring socialization
and religious/spiritual coping socialization, there would be a decrease in positive
attitudes toward family therapy. Contrary to what was expected, participants with
moderate to high levels of perceived social support, extended family caring
socialization and religious/spiritual coping socialization exhibited positive
attitudes toward family therapy, though these associations were later found to be
insignificant in the regression model. It was found that participants perceived that
they have access to mental health services and that this, along with gender and
help-seeking comfort, significantly predict positive attitudes toward family
therapy.

Finally, it was expected that help-seeking comfort accounts for attitudes
toward family therapy and potentially accounts for the relationship between other
contextual factors (i.e., PSS, GENDER) and attitudes toward family therapy. It
was found that help-seeking comfort significantly predicts attitudes toward family
therapy when controlling for gender and access to mental health services.
However, prerequisites needed to determine help-seeking comfort as a
moderating variable were not met. Nevertheless, it can be concluded that both
men and women with high help-seeking comfort levels tend to have more

positive attitudes toward family therapy compared to men and women with lower

111

help-seeking comfort levels. The findings also confirm that interrelationships
exist among contextual factors as noted in Figure 3. Though an analysis of such
relationships is beyond the scope of this study, future analyses will address how
these findings inform the comprehensive study of contextual factors and
confounding issues yet to be addressed.

The following chapter incorporates a discussion of the above-mentioned

findings, limitations and recommendations for future study.

112

05:09.00 1.010. E.|0.o...0.>. 0.0 0.....0. 00.0..00 3000.5 0. 00.000.00E00 .800E0o_0>00 .0 >030 00. .0. .000E 02.0.8.0. 5.. .800: .1 0.0.00
a ..m 2.00.5 ..v_ 6.0.0 :1 609.65. ..m 60.0.00... :0 5.02.00.— ..0 .__00 0.0.00 >0 0002.900 .0090 02.0590. 05 .0 02.0.0000 00 0. 0.0.. _.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

 

 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

002000000. 3000?... 005000.. 0E8.=o 000 0.0.00.
8.8055 u 417 6820.. 0.58.0.0. 0.002.... n AI 3280.033 1 E Mala _
20.03.3000
02.05 >025. 00020.00.
m .
1 50.200 _
20.55.5000
_ 02.2000 50: _ 02. 000 000.0300 P is 0005000
. o . . . 25.00...
€5.05 A\\ v .5202
5.2.... 02552 W/ . 0. 00000...
000005.. /A 4». 0020000..
/ 0000.50 N
.5000 00200000
. M
000200
..

 

 

 

.0000..0E< 000...< 000.00.00.E 000.00 02.00

002000-900 0 00 >000... 2.0.0. 0.02.0. 0003.00 000 0.0.00. _03x0.000 .0 .0000. .03000000 000.>0. < .m 0.30.“.

113

CHAPTER 5
CONCLUSION

The purpose of this present study was to explore attitudes toward family
therapy among a sample of middle-class African Americans. The study was
specifically aimed at determining the nature of their attitudes toward family
therapy; examined whether or not contextual factors account for attitudes toward
family therapy among this sample; and whether one’s comfort with help-seeking
accounted for the relationship between other contextual factors and attitudes
toward family therapy. The focus of this chapter will be to: a) present an
interpretive discussion of key findings; b) explore limitations of the present study;
and c) provide implications with regard to future study, policy and clinical
relevance with this population.

Discussion of Key Findings

Middle-class African Americans and Attitudes Toward Family Therapy

Findings from the present study reveal that among a sample of middle—class
African Americans, moderate to very positive attitudes toward family therapy
exist. Participants believe that there is a need for family therapy. Specifically, the
majority of participants: 1) believe that time and expense should not deter one
from valuing family therapy, 2) believe that sometimes emotional difficulties
within couples or families only work out with formal intervention, and 3) convey a
willingness to pursue family therapy if family or couple-related problems exist.
Participants also believe that stigma should not deter one from pursuing family

therapy. For example, majority of participants stated that they would not feel

114

uneasy if others knew that they were attending family therapy. Also, the majority
of participants stated that they do not believe that people who participate in
family therapy should feel shameful for pursuing such services. Participants
report openness to family therapy as demonstrated by disagreeing with the
following statement: “I resent a person—professionally trained. . .who wants to
know about my personal family difficulties”; and agreeing with the following
statement: “I would willingly confide intimate matters to an appropriate person if I
thought it might help me, my partner, or my family."

Moreover, participants displayed an overall sense of confidence in family
therapists’ ability to effectively assist with couple or family related issues as
majority of participants stated that they would recommend family therapy to a
friend who may ask for advice about a relational problem. Participants also stated
that they would be first inclined to get professional attention if they were
ovenrvhelmed with a couples or family related problem. Finally, participants
reported feeling confident that family therapy would provide relief for family or
couple-related crises.

African Americans have not been “empowered” to inform the field of family
therapy about their attitudes with regard to whether or not family therapy is a
viable help-seeking option (Boyd-Franklin, 1989). Research suggests that African
Americans, do, in fact, value mental health services (Leaf et al., 1984; Diala et
al., 2001). Richards (1993) supports these assumptions as her research findings

suggest that middle~class African Americans value psychotherapy as an effective

115

help-seeking option. However, no known study has specifically explored attitudes
toward family therapy among a middle-class sample of African Americans.

The present study informs this area of research as this sample of middleoclass
African Americans reports, overall, positive attitudes toward family therapy as an
effective help-seeking option. This includes the belief that there exists a need for
family therapy; that stigma about pursuing therapy should not prevent the pursuit
of such intervention; that openness to family therapy exists; and that there is
confidence in the ability for a family therapist to effectively address family or
couple-related problems. Thus, despite reports of underutilization of mental
health services among this population of African Americans (US Surgeon
General, 1999), this study supports the assumption that middle-class African
Americans exhibit positive attitudes toward therapeutic intervention.

Contextual Factors and Attitudes Toward Family Therapy

Gender. Prior discussion of gender suggests that women tend to initiate family
therapy more often than men (Boyd-Franklin, 1989). Thus, the assumption may
be that women tend to value or regard family therapy more positively than men.
This assumption is supported in the current study as women exhibited more
positive attitudes toward family therapy. Nevertheless, when mean scores were
considered, overall, it was found that despite the difference between men and
women, both exhibit moderate to positive attitudes toward family therapy. To that
end, while it has been concluded within the field of familytherapy that African
American women tend to initiate therapy more often than men, significant

findings from this study suggest that men from a middle-class sample are at least

116

demonstrating an interest in family therapy and recognize benefits of family
therapy as a help-seeking option.

Religious/spiritual coping socialization. Religious or spiritual coping has often
been considered an effective coping option among African Americans (Carey &
Anderson-Scott, 1998; Neighbors et al., 1998). Also, Stevenson (1994) suggests
that an understanding of racial socialization such as the process utilizing religious
or spiritual coping within the familial context can assist family therapists in
effectively working with African Americans. The current study supports the belief
that religious or spiritual coping socialization is a valued coping mechanism
among this sample of African Americans. Findings suggest that there is a
positive association between attitudes toward family therapy and
religious/spiritual coping socialization. This offers an opportunity for future
research to further explore this association, particularly given the role that
religious/spiritual coping has as a fundamental component of African American
reslience.

Extended family caring socialization. Similar to religious/spiritual coping
socialization, extended family caring socialization is viewed as a coping
mechanism. The belief is that messages conveying the importance of extended
family involvement are highly embraced among African Americans and that
extended family involvement is often viewed as a help-seeking option in
conjunction with formal mental health options (Neighbors 8: Jackson, 1984;
Snowden, 2001). For the present study, it was proposed that extended family

involvement may buffer one from the effects of race-related distress, resulting in

117

little need or interest in formal intervention. Conversely, results from the present
study affirm findings by Neighbors & Jackson as well as Snowden as participants
not only value extended family caring as a coping option, but they also value
family therapy. The positive association found between attitudes regarding
extended family involvement and attitudes toward family therapy confirmed this
outcome. On the other hand, further analyses suggest that extended family
caring socialization does not predict specific attitudes toward family therapy. Still,
the association that exists between the two offers an opportunity for future
research to examine this relationship and the paradoxical argument suggesting
that the family is often seen both as the source of coping and source of distress
(Rogler et al., 1989).

Perceived social support. It has been suggested that one’s perception that
s(he) has access to social support is clearly related to emotional and
psychological well-being (Walls, 1992). In the present study, it was hypothesized
that a strong social support network might result in less interest in family therapy
as a formal help-seeking option, assuming that there would be no need for such
intervention. Findings reveal that participants not only perceive that they have a
strong social support network, but that this is positively associated with attitudes
toward family therapy. This supports NSBA findings (Snowden, 2001),
suggesting that lnfonnal support networks are valued in juxtaposition with formal
intervention. While the ability for perceived social support to predict attitudes
toward family therapy was insignificant, the association between these two

factors provides opportunity for future research to explore the role that social

118

supports in conjunction with formal support services increase help-seeking
options among African Americans and their families.

Perceived access to mental health services. It is stated that social-class tends
to position one in society in a way that allows greater access to a variety of
resources (Kliman, 1998). Thus it would be assumed that given the role of
managed healthcare and private insurance options, middle-class African
Americans have greater access to family therapy options compared to their
lower-income counterparts. However, utilization is found to be higher among
lower-income African Americans who often rely 'on community centers and public
welfare agencies (Snowden, 1998). A primary step in tackling the question of
utilization among middle-class African Americans is to explore their beliefs about
therapy and access to mental health options. In the present study, it was
hypothesized that participants who perceived that they have access to mental
health services would also value family therapy assuming that a perception of
access would be positively associated with openness to services. Findings
supported this hypothesis as it was revealed that participants not only perceive
that they have access to mental health services, but that this perception
significantly predicts positive attitudes toward family therapy. This informs both
the mental health and family therapy field as results suggest that among a
sample of middle-class African Americans, there is a belief that mental health
service options exist and that family therapy as one help-seeking option is
valued. This provides an opportunity for future research to further examine how

this conclusion may relate to utilization trends.

119

Help-seeking comfort. In this study, help-seeking is viewed as a contextual
factor that potentially moderates or predicts the association between other
contextual factors and attitudes toward family therapy. This is due to the belief
that a person’s “willingness” to receive help often predicts whether or not a
person receives help (Kaniasty & Norris, 2000). Furthermore, it has been stated
that help-seeking attitudes play a pivotal role in obtaining appropriate intervention
for personal or interpersonal distress (e.g., Gellis, Huh, Lee, Kim, 2003; Yeh,
2002). In the present study it was hypothesized that help-seeking comfort would
moderate the relationship between contextual factors and attitudes toward family
therapy. Nevertheless, prerequisites for exploring such association were not met.
Instead, it was found that help-seeking is highly correlated with other contextual
factors compared to attitudes toward family therapy. For example, help-seeking
is so highly correlated with perceived social support that it is theorized that
participants may have perceived comfort with help-seeking and having others
available in times of help-seeking as interchangeable. Though further analyses
suggest that help-seeking comfort significantly predicts attitudes toward family
therapy, given its level of association with other contextual factors, it could not be
set up as a moderator factor in the proposed model. Still, was found that those
with high help-seeking comfort tended to exhibit more positive attitudes toward
family therapy than those with low help-seeking comfort. Future research that
examines the relation of help-seeking comfort to other contextual factors (e.g.,
gender) can provide clarity as to whether or not help-seeking comfort is a

predictor of contextual factors associated with attitudes toward family therapy or

120

a variable that accounts for the relationship between other contextual factors and
attitudes toward family therapy. .

Overall, the present study successfully incorporated the theoretical paradigms
of Bronfenbrenner and Garcia-Coll and colleagues. Emphasizing that multiple
contextual factors are associated with and account for attitudes toward family
therapy allows the researcher to gain comprehensive insight into those
environmental experiences that can shape attitudinal outcome. Furthermore,
maintaining cultural sensitivity that takes into consideration the experience of
culture and class also transcends monolithic conclusions about African American
attitudes and behavior.

Limitations

This study is successful in contributing knowledge to the literature regarding
attitudes toward family therapy among a sample of middle-class African
Americans. However, limitations exist. For instance, a non-random sample of
middle-class African Americans from a southern community presents limitations
in the ability for the present study to exhibit reliable external validity. A
demographic profile consisting of a large number of middle-class African
American females, who are married Christian parents, though representative of
this region, may be less representative of middle-class communities around the
country.

Secondly, while this study contributes knowledge about attitudes toward
family therapy, little continues to be known about actual behavioral outcome. A

paradox exists in that literature signifying that middle-class African Americans

121

tend not to primarily utilize mental health services for personal distress. Yet, this
study along with earlier studies, suggests that they do value mental health
services as a help-seeking option. Thus, there lies a continued gap in
understanding the link between attitudes and behavioral outcome.

Thirdly, due to limited statistical findings, help-seeking comfort could not be
incorporated in the design model as a moderator variable, as was hypothesized
through the theoretical model. While it is assumed that one’s comfort with help-
seeking would affect associations between attitudes toward therapy and gender,
perceived social support, extended family caring, religious/spiritual coping, or
perceived access to mental health services, findings suggest that there must first
be clarity as to how help-seeking comfort relates to or predicts these contextual
factors.

Fourth, a non-random and limited sample size may be contributing to the
multicollinearity issues and lack of significance in the ability of several variables
to significantly predict attitudes toward family therapy. Thus, future study calls for
a larger sample size and attempts to expand to a national random sample if
findings are to be appropriately generalized to a larger population of middle-class
African Americans.

Finally, primary focus has been on the relationship between contextual factors
and attitudes toward family therapy, thus limiting the exploration of
interrelationship among contextual factors. Though such analyses would take
one beyond the scope of this present study, post dissertation analyses of the

compiled dataset will explore relationships among contextual factors and how

122

they are asSociated with help-seeking comfort and attitudes toward family
therapy. Additionally, it is important to acknowledge that other factors such as
age and family structure are variables that would add to an understanding of
generational influences and family structure in shaping attitudes. While these
factors add to the multi-variate complexity of this research, they are not included
here. Future examination of the dataset from the present study will target these
areas in an effort to expand knowledge of multiple contextual factors that are
associated and potentially predictive of attitudes toward family therapy.
Implications .

Policy

With regard to policy, several implications exist based on findings from the
present study. For example, results from this study suggest that there is interest
in family intervention among middle-class African Americans. Yet, local and
state-funded community outreach services are often utilized by lower-income
families. Such services often address poverty related issues such as stable
housing, income and adequate food as these factors often take precedent with
this population. On the other hand, middle-class European Americans may have
community-based wellness programs that fall short of addressing issues of
discrimination and historical oppression that often plague families of color,
regardless of social class affiliation. Thus, local and statewide programs are
obligated to consider the needs of middle-class African Americans as issues

(e.g., glass ceiling barriers, acculturation strain) unique to this social class make

123

their needs varied from their lower-income and European middle-class
counterparts.

Additionally, legislative promotion of partnerships between community mental
health programs and local social organizations, churches, and school systems
can begin addressing the gap that exists between attitudes and utilization as
middle-class African Americans are often found in leadership positions within
these social systems, but yet are often plagued with a threat of stigma when it
comes to attending to their own mental health and family-related needs.

Policy makers, both at the government and university level, have the
opportunity to provide incentives for researchers to establish partnerships with
participants of a given community by encouraging open-ended feedback as well
as providing materials that educate research participants on family-therapy
services available locally and at the national level. An example of successful
outcome of such a partnership is present with this current study. For instance,
while data collection involved survey completion, it was conducted in a group
format with the researcher remaining open to questions and comments related to
participants’ feedback regarding administered surveys. Upon completion of the
survey, participants were given a brochure educating them about the field of
marriage and family therapy and services available to them in their area. This
researcher observed on several occasions, an appreciation for this information
as directly stated by participants. Furthermore, it was later discovered that a local
therapist inquired about the work of this study, after hearing about it through word

of mouth and exhibited an interest in findings given his outreach to middle-class

124

African Americans and their families. Thus, there is great potential for
collaboration and partnerships to exist between researchers and communities
and agencies.

Finally, The question of interest in family therapy among middle-class African
Americans is particularly pertinent to the field of family therapy as legislative
efforts are underway to have family therapists designated as reimbursable health
care professionals across the United States (AAMFT Government Affairs Staff,
April 2003). This study confirms interest in family therapy and its relevance to
emotional and mental well-being of individuals. Furthermore, results provide
evidence of the value of family therapy and its important role within the
healthcare context.

Clinical Focus

In addition to policy implications, findings are also relevant to the work of
clinicians. First, findings inform the field of family therapy, perhaps for the first
time, of overall attitudes toward family therapy among a sample of middle-class
African Americans, an often neglected group in family therapy literature
(Bagarozzi, 1995). Results confirm that for this group of African Americans,
culture and class can coexist and complement each other in the treatment
process. For instance, African American cultural history has involved a reliance
on family, friends, and church communities for coping with life stressors. On the
other hand the middle-class experience in America tends to incorporate a
psychotherapeutic approach to mental health and family wellness. To that end, to

be effective, intervention among middle-class African Americans must take into

125

account both culture-related and class-related legacies. This present study
suggests that African Americans exhibit a culture of coping through family and
community support, as well as and interest in a middle-class value of formal
clinical support.

This study also informs family therapy theory. For example, the Solution
Focused approach says that the goal of therapy is to discover what works (what
leads to optimal functioning) in a family and to do more of that behavior or
interaction. Findings for this study confirms that extended family caring and
religious/spiritual coping are help-seeking mechanisms that work. Thus an
exploration of how these factors may contribute to successful treatment
outcomes is relative to a culturally sensitive approach to working with this group
of African Americans.

Finally, the Cognitive-Behavior approach, which pertains to matching one’s
cognitive image of functioning with successful behavioral outcome can also
benefit from results of this study. For example, participants from this sample of
African Americans believe that family therapy is a needed and valued help-
seeking option. Yet, it has been suggested that a utilization gap exists between
such beliefs and utilization trends. Bridging the gap between beliefs and behavior
must be targeted, both by clinicians and researchers. Future qualitative
assessment of how clients move from belief to behavior is the next step in
examining the ways in which cognitive processes can match behavioral outcome
in the attempt to increase optimal functioning among this population of African

Americans.

126

APPENDICES:

127

APPENDIX A:
1) Informed Consent Form

2) Sample Survey

128

INFORMED CONSENT FORM

Title of Research Study: Contextual Factors and Attitudes Toward Family Therapy as a Help-
Seeking Option Among Middle-Class African Americans

You have been invited to participate in this study that will explore attitudes about family life,
social support, and professional intervention among African American families. Family
therapy as a professional intervention will refer to counseling or other forms of therapy that
may include a couple, parent and child or entire family.

0 You will be asked to complete a survey that will include a range of questions addressing
social support, spiritual/religious and extended family values you have encountered or teach
your children, your perception about access to mental health services in your community and
your attitudes about the use of family therapy within African American communities.

. The survey will be administered in a group setting. This means that general instructions will
be given in a group format You will then have time to complete the survey at your table, as
the questions will be self-explanatory.

0 Your participation is completely voluntary and you are free to withdraw from the study
without any penalty.

. All information will be kept confidential. Your answers will be coded in such a way that only
group data will be analyzed. You will be assigned a participant # as to maintain confidentiality
of your name. Consent forms will be placed in a secure file, separate from survey packets.

. If you have questions about the study, please contact Deborah Johnson, Ph.D., Principal
Investigator (517-432-9115)(email: iohn1442@msu.edu). In case you have questions or
concerns about your rights as a research participant, please feel free to contact Peter
Vasilenko, Ill, Ph.D., Michigan State University’s Chair of University Committee on Research
Involving Human Subjects (phone: 517-355-2180)(email: uchris@msu.edu) (address: 202
Olds Hall, East Lansing, MI 48824).

c We foresee no physical or psychological risks to you during the administration of this survey.
However, you are always able to ask about your participation and survey procedures at any
time.

o It is anticipated that your completion of this survey will take between 35-50 minutes. Upon
completion of the survey you are asked to tear off your consent form and place it in the
designated envelope. You will be provided with tokens of gratitude that will include: 1)
refreshments; 2) A gift ($7) certificate to a local restaurant; and 3) An option to participate in a
$100 raffle.

0 Once you hand in your completed survey, you will be provided with literature regarding the
profession of family therapy in America.

Sign and Date (to confirm that you have read this consent form):

 

PLEASE REFER TO THE NEXT PAGE TO GIVE YOUR CONSENT TO
PARTICIPATE IN THIS STUDY.

Participant #

129

 

 

Participant #

 

AFRICAN AMERICAN

ATTITUDES SURVEY

We would like to find out: 1) what your experiences are in areas that
deal with family life and friendships and; 2) what are your attitudes about
African American families and professional intervention.

This survey should take between 35—50 minutes to complete. If there
are questions regarding the clarity of survey items, please see Monica
Sanders.

Remember that all responses will remain anonmous, as final scores
will be tallied for group analysis only.

Thank you,
Monica Mouton Sanders, MA, LLMFT

 

130

 

SECTION A: We are Interested In how you feel about the following statements. Please read
eggh statement carefully. Indicate how you feel about each statement.

m; the 1 if you Strongly Disagree
the 2 if you Mildly Disagree
the 3 if you are Neutral
the 4 if you Mildly Agree
the 5 if you Strongly Agree

Strongly Mildly Neutral Mildly Strongly

Disagree Disagree Agree Agree

1. There is a special person who is

around when I am in need. 1 2 3 4 5
2. There is a special person with

whom I can share joys and 1 2 3 4 5

sorrows.
3. My family really tries to help me. 1 2 3 4 5
4. I get the emotional help and

support I need from my family. 1 2 3 4 5
5. l have a special person who is a

real source of comfort to me. 1 2 3 4 5
6. My friends really try to help me. 1 2 3 4 5
7. I can count on my friends when

things go wrong. 1 2 3 4 5
8. I can talk about my problems with

my family. 1 2 3 4 5
9. l have friends with whom I can

share my joys and sorrows. 1 2 3 4 5
10. There is a special person in my

life who cares about my feelings. 1 2 3 4 5
11. My family is willing to help me

make decisions. 1 2 3 4 5
12. I can talk about my problems with 1 2 3 4 5

my friends.

PLEASE CONTINUE

131

SECTION B: The next section ls about how comfortable you are seeking aid from someone
else. Please read each statement carefully. Indicate how comfortable you are with each
scenario.

PLEASE NOTE: The following images have a distorted manner due to the need to alter

their appearance for publication purposes.

13.

14.

15.

16.

17.

18.

19.

How comfortable do you feel
requesting material aid
(money, furniture, etc.) from
friends if you are in need of
such aid?

How difficult is it for you to
request emotional support
from friends if you have
problems or are undergoing
a crisis?

How comfortable do you feel
requesting friends just to be
with you during a crisis or
when you have a problem?

How difficult is it for you to
request advice or
information from friends
when you need it?

How comfortable do you feel
requesting help from friends
in order to get something
done (taking care of
children, ride to work,
shopping, etc.) when you
are undergoing a

crisis?

How comfortable do you feel
requesting material aid
(money, furniture, etc.) from
family if you are in need of
such aid?

How difficult is it for you to
request emotional support
from family if you have
problems or are undergoing
a crisis?

- Very
Uncomf
ortable

1

Very
Difficult

Very
Uncomf
ortable

1

Very
Difficult

Very
Uncomf
ortable

Very
Uncomf
ortable

1

Very

Difficult

1

Somew
hat
Uncom
fortable
2

Somew
hat
Difficult

Somew
hat
Uncom
fortable

Somew
hat
Difficult

Somew
hat
Uncom
fortable
2

Somew
hat
Uncom
fortable

2

Somew
hat
Difficult
2

132

Neutral

Neutral

Neutral

Neutral

Neutral

Neutral

Neutral

Somewhat
Comfortable

Somewhat
& Difficult

Somewhat
Comfortable

Somewhat
N93, Difficult

4

Somewhat
Comfortable

Somewhat
Comfortable

Somewhat
N93 Difficult

Very
Comfortable

Not Difficult
At All

Very
Comfortable

5

Not Difficult
At All

5

Very
Comfortable

Very
Comfortable

Not Difficult
At All

20. How comfortable do you feel Very Somew Neutral Somewhat Very

requesting family just to be Uncomf hat Comfortable Comfortable
with you during a crisis or ortable Uncom
when you have a problem? fortable

1 2 3 4 5

21. How difficult is it for you to

request advice or Very Somew Neutral Somewhat Not Difficult

information from family Difficult Dipfiactult mt Difficult At All
when you need it? 1 2 3 4 5
22. How comfortable do you feel Very Somew Somewhat Very

requesting help from family
in order to get something
done (taking care of
children, ride to work,
shopping, etc.) when you
are undergoing a crisis?

Uncomf hat Neutral Comfortable Comfortable
ortable Uncom -
fortable

1 2 ' 3 4 5

PLEASE CONTINUE

133

SECTION C. Please indicate your agreement with the following statements about Afrlcan
American family life. Please circle a number depending on whether or not you: 1: Strongly
Disagree; 2= Disagree; 3=Don’t Know; 4= Agree; 5= Strongly Agree
Strongly Don’t Strongly
Disagree Disagree Know Agree Agree
23. Grandparents are
important in helping
parents make decisions. 1 2 3 4 5
24. It is important for families
to go to a church or
mosque for spiritual
growth.
25.Relatives can help African
American parents raise 1 2
their children.

26. Religion is an important
part of a person’s life. 1 2 3 4 5

27. Racism and
discrimination are the
most difficult problems a 1 2 3 4 5
Black child has to face.

28. My friends really try to
help me. 1 2 3 4 5

29. Having large families can
help African American
families survive life 1 2 3 4 5
struggles.

30. Parenting children
includes teaching them to
be proud to be Black.

31. Children should be taught
that all races are equal. 1 2 3 4 5

32. Children who spend a lot
of good time with their
relatives become better 1 2 3 4 5
citizens.

33. A belief in God can help a
person cope through life
struggles.

34. Spending quality time with
relatives is important for
parents as it is for
children.

134

35.

37.

38.

39.

40.

41.

Depending on religion
and God can help you
make good life decisions.

. Families who talk about

religion or God help their
children to grow.

Getting a good education
is still the best way for a
Black child to survive
racism.

“Don’t forget where you
came from, because you
may want to go back
someday."

Spiritual battles that
people fight are more
important than the
physical battles.

“Train a child in the way
he or she should go, and
he or she will not depart
from it.”

“Black children should
know at an early age that
God can protect them
from racial hatred.”

Strongly
Disagree Disagree

1 2

1 2

1 2

1 2

1 '2

1 2

1 2
PLEASE CONTINUE

135

Don’t
Know

Agree

4

Strongly
Agree

5

SECTION D.

Instructions: Below are a number of statements pertaining to couples and family issues.
Read each statement carefully and Indlcate whether you highly disagree (1), disagree (2),
are neutral (3), agnee (4), or highly agree (5). Please express your frank opinion in rating
the statements. There are no “wrong” answers, and the only right ones are whatever you
honestly feel or believe.

PLEASE LECT N FTHE FOLL WING:

1=ngth Disagree
2=Disagree
3=Neutral
4=Agree

5=Highly Agree

Highly Disagree Neutral Agree Highly
Disagree Agree
42. Although there are clinical offices
for family or couples with relationship 1 2 3 4 5
troubles, I would not have much
faith in them.

43. If a good friend asked my advice

about a relational problem, I might 1 2 3 4 5
recommend that slhe see a family

or couples therapist.

44. I would feel uneasy going to a
family or couples therapist because 1 2 3 4 5
of what some people would think.

45. A person with a strong character

can get over relational problems by 1 2 3 4 5
him/herself, and would have little

need for a family or couples

therapist.

46. There are times when I have felt

completely lost and would have 1 2 3 4 5
welcomed professional advice for a

family or couples problem.

47. Considering the time and

expense involved in family or 1 2 3 4 5
couples therapy, it would have

doubtful value for a person like me.

48. I would willingly confide intimate

matters to an appropriate person if I 1 2 3 4 5
thought it might help me, my partner

or my family.

136

49. I would rather live with certain
family or couples conflict than go
through the ordeal of getting formal
help.

50. Emotional difficulties tied to
family or couples problems, like
many things, tend to work out by
themselves.

51. There are certain problems which
should not be discussed outside of
one’s immediate family.

52. People with serious family or
couples disturbances would probably
feel most secure in a good
therapeutic office setting.

53. lfl believed I was mentally]
emotionally ovenlvhelmed as the
result of a family or couples problem,
my first inclination would be to get
professional attention.

54. Keeping one’s mind on a job is a
good solution for avoiding family or
couples-related worries and

concerns.

55. People who have been treated
for family or couples problems have
a blot (stigma) on their life.

56. I would rather be advised by a
close friend than by a couples or
family therapist, even for an
emotional problem.

57. People with couples or family
problems are not likely to solve them
alone; they are likely to solve them

with professional help.

58. I resent a person—professionally
trained or not—who wants to know
about my personal family difficulties.

59. I would want to get professional
attention (help) for my family if I was
worried or upset about couples or
family-related problems for a long
period of time.

Highly Disagree
Disagree

1 2
1 2
1 2
1 2
1 ' 2
1 2
1 2
1 2
1 2
1 2
1 2

137

Neutral

Agree Highly

Agree
4 5
4 5
4 5
4 5
4 5
4 5
4 5
4 5
4 5
4 5
4 5

60. The idea of talking about
problems with a couples or family
therapist strikes me as a poor way to
get rid of relationship conflicts.

61. People treated for couples or
family problems carry with them a
burden of shame.

62. There are experiences in my
family life I would not discuss with
anyone.

63. It is probably best not to know
“everything" about oneself or family.

64. If I were experiencing a serious

couples or family crisis at this point
in my life, I would be confident that I
could find relief in couples or family
therapy.

65. There is something admirable in
the attitude of a couple or family who
is willing to cope with their conflicts
and fears without resorting to
professional help.

66. At some future time I might want
to have couples or family therapy.

67. Couples or families should work
out their own problems; getting
family counseling would be the last
resort.

68. Had I, my partner, or my family
received treatment in a clinical office
setting, I would act feel that it ought
to be “covered up.”

69. lfl thought I, my partner, or my
family

needed professional help for couples
or family problems, I would get it no
matter who knew about it.

70. It is difficult to talk about personal
affairs with professionals such as
doctors, teachers, and clergymen.

Highly Disagree
Disagree

1 2
1 2
1 2
1 _ 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2

138

Neutral

Agree

Highly
Agree

PLEASE CONTINUE

SECTION E: This section deals with questions about family stress and Illness. Please read
each question carefully and giggle the number that best represents your agreement or
disagreement with each statement.

1 2 3 4 5
Highly Disagree Not Agree Highly
Disagree Sure Agree
71. If a person caring for a spouse
or parent diagnosed with a
memory-loss illness (ex. 1 2 3 4 5

Alzheimer's, dementia, “going
senile”) were experiencing family
distress, I would encourage that
person to contact a family
therapist.

72. If I were diagnosed with a

memory-loss illness and knew that

my family might experience a great 1 2 3 4 5
deal of distress, I would be open to

seeing a family therapist

73. The emotional distress that a
family experiences when a family

member hasa memory-loss illness 1 2 3 4 5
is a personal matter that should not
be discussed outside of the home.
74. PM the following based on what you believe to be the most important problem

that African American communities are currently facing:
(1=most important problem, 2:2” most important, 3=3rd most important, 4:4th most
important, 5=Ieast important)

Marital or Couples relationship problems _

Parent-child conflict _

Conflict with family of origin (the family that a person grows up in) _
Conflict between siblings _

Other (please fill in the blank) _

9.0-9.5!"

75. l have mental health services available to me or my family through a
workplace, church, school, private practice office, hospital, or community agency.
Yes or No

76. I could afford mental health services either through health insurance or
some other financial means. Yes or No

139

77. I could make time to commit to attending therapy sessions either weekly or
monthly. Yes or No

78. I believe that there are therapists/counselors in my community that could meet the
needs of people in my community. Yes or No

ONE MORE PAGE TO GO .............

140

SECTION F: DEMOGRAPHIC INFORMATION—-—-Please gimle the statement that describes
your background:

75Mfl
1. Under 40
2. Over 40
76. Year of Birth:
77. Gender
1. Female
2. Male

78. Highest Level of Education Completed:
Less than seventh grade
Junior high school (9"‘rade g rade‘)‘
Partial high school (10 or 11 grade)

Partial college (at least one year) or specialized training

High school graduate or equivalent

Undergraduate college or university degree (e.g., BS, BA)
Graduate professional degree (MA. MS, PhD. MD. EdD. etc.)

swwéwwe

79. Self-rating of social class:
Upper class
Middle class
Working class
Lower income

+9»-

80. Relationship status:
1. Never married (please select#1,2,9_r 3)

1. no present relationship

2. in a relationship (less than 3 years)

3. long-term relationship (3 or mora years)
Married
Separated
Divorced
Widowed
Cohabitating (living with someone)

9’99?!“

81. Parental (or guardian) status:
1. Non-parent (non-guardian)
2. Parent (guardian)
3. Sole parent (Have full custody or child[ren] are with me most of the time)

82. Income range (annual Maggy)
Below $20,000
$20,000 to 34. 999
$35. 000 to 49. 999
$50. 000 to 74,999
575, 000 and over

9'?pr

83.Doyouownyourownhome? Yes or No

84. Religious affiliation:
1. Catholic Christian
2. Protestant Christian (Please circle one of the following)
1. Baptist
2. Lutheran
3. Methodist
4. Episcopalian
5. Other Protestant
Muslim
Jewish
No religion
Other

9’99.“

 

85. What is your occupation (if retired, prior to retirement)?
A AIN THANK Y .

 

141

APPENDIX B

Copyright Materials

142

 

<0

LIPPINCOTT
WILLIAMS 6:: \X/ILKINs

January 28, 2004

Monica Mouton Sanders, MA, LLMFT
Doctoral Candidate

Department of Family and Child Ecology
Marriage and Family Therapy Specialization
Michigan State University

3128 Trapper Cove Trail, 2A

Lansing, MI 48910

VIA EMAIL TO: mgutonmgamsuedg January 28, 2004
FEE: NONE

RE: Blumenthal, Burg, Barefoot, Williams, Haney, and Zimet, "Social Support, Type A Behavior, and
Coronary Artery Disease”
Psychosomatic Medicine 1987;49:331-340 The Perceived Social Support Scale

USE: Dissertation is to explore what contextual factors predict attitudes toward family therapy among
middle class Afiican Americans.

CONDITION OF AGREEMENT

Permission is granted upon the return of this signed agreement to Lippineott Williams Jr. Wilkins (LWW). Please
sign and date this form and return to:

Lippincott Williams & Wilkins
David O’Brien, Worldwide Copyright Management
351 W Camden Street, 4 North
Baltimore, MD 21201
USA

Permission is granted and is subject to the following conditions:

1) A credit line will be prominently placed and include the journal article author and article title, journal title,
volume number, issue number, and the inclusive pages.

2) The requestor warrants that the material shall not be used in any manner, which may be derogatory to the
title, content, or authors of the material or to LW.

3) Permission is granted for one~time use only as specified in your correspondence.

4) Permission granted is non-exclusive, and is valid throughout the world in English.

5) LWW cannot supply the requestor with the original artwork or a “clean copy”.

6) Permission is valid if the borrowed material is original to a LWW imprint (Lippincott-Raven Publishers,
Williams 8r. Wilkins, Lea 8r Febiger, Harwal, lgaku-Shoin, Rapid Science, Little Brown & Company,
Harper & Row Medical, American Journal of Nursing Co., and Urban & Schwarzenberg-English language.)

Requestor accepts: Watt 1 1 c9 3! 0‘1;

 

143

.552... ems/mum
5.0:. no ummm

6.8.0. 05 ceases ecu acumen: or 352359". .9565 .o 2.5
.o m. on; >3“..me £5. 3 £5 :0 etc; Econ. 29: no; Soc... .23» 05 on: 2 53$an 30> 03m _ .__mEo £5 >m

.moEos. Loco

was: 038 sentence 8 gamma—om ”om 33.3.5
32 one 38 .8 Sense .aeeem seem
E§W.a§oglmuwdd§ 3H.

:83: .m 53on HEP—m

II. 0382 3.5in I...

mEmg 0.3» 33059 3 co_mm_Eon_ ”3“. 383.5

52 8” z 38 .3 32:2. .583» 3:8
Aauoij©oEcoSoEv "oh
Aaoo.:mE©oEc2:oEv afloocmm 5:55. 8:85... "E2“.

 

 

 

Esteem eon-so: «2:02

144

eozsozvm .8 828m 29880

£8-3§ E 322825

“ovum 8:83 ochm

Efiwoum $88598; .3820 BBQ 28 5:88:80 ._conom

88833582“ .8 b.8955

in am :98?on @838: .338

Amen 05 so» am; _ :5 888.888 9 c8: m. $5 08388 05 5.3 x83 88$ :38 288 rage: 2: 888m
833:3 8:8 5 moocoeotmu £8.98 3 Be: 85 8:888 8388—888 888 85 E tom—88688622.:—

.8 388mm 32 .88 so» .88: 85 .8 080m .8 888% 05 .8 23 .8 28 8: b8 so» nos? 85 mm ecumowwsm
.38 >2 383 8o» 3 “men 05 .8» fit: _ 89:95 .88» wfioom S Haze.“ 382 m 98 88.8% >8 gas 98>

Sig—OE 8: 808.5% .8 8883‘ 8a 33.3.5

:2 new 88 .R 888.. .583. seem

 

Ililiv'lllll

Seesaw 8:82 @8882 8%
898.8% @838: "Be...”—

ll- owmmmoz Hamming .....

145

REFERENCES

Alba, R., Logan, J., & Stults, B. (2000). How segregated are middle-class African
Americans? Social Problems, 47(4), 543-558.

Alvidrez, J. (1999). Ethnic variations in mental health attitudes and service use
among low-income African American, Latina, and European American
young women. Community Mental Health Journal, 35(6), 515-530.

American Association for Marriage and Family Therapy Government Affairs Staff.
(2003, April). Political Action Committee (PA C) letter. Retrieved 1/27/04,
from h_ttg://www.flnft.orgjmembers/Advocacv/PAC Letter 4-03 weghtm

Ariel, S. (1999). Culturally competent family therapy. Westport, CT: Praeger.

Babble, E. (1998). The Practice of Social Research (8th ed.). Belmont, CA:
Wadsworth.

Bagarozzi, D. (1995). Family therapy and the Black middle class: A neglected
area of study. In F. Turner (Ed.), Differential diagnosis and treatment in
social work (pp. 1029-1268). New York: Free Press.

Bagley, C., & Carroll, J. (1998). Healing forces in African American families. In H.
McCubbin, E. Thompson, A. Thompson, & J. Futrell (Eds), Resiliency in
African-American families (pp. 117-142). Thousand Oaks: Sage.

Barbarin, O. (1996). Use of the CAKSI to assess preparedness for delivery of
mental health services to African Americans. In R. Jones (Ed.), Handbook
of tests & measurements for Black populations (Vol. 1). Hampton, VA:
Cobb & Henry.

Baron, R., & Kenny, D. (1986). The moderator-mediator variable distinction in
social psychological research: Conceptual, strategic, and statistical
considerations. Joumal of Personality and Social Psychology, 51(6), 1173-
1 182.

Bean, R., Perry, 3., & Bedell, T. (2002). Developing culturally competent
marriage and family therapists: Treatment guidelines for non-African-
American therapists working with African-American families. Journal of
Marital and Family Therapy, 28(2), 153-164. ‘

Beavers, W., & Hampson, R. (1990). Successful families: Assessment and
intervention. New York: WW. Norton 8 Co.

146

Biegel, D., Farkas, K., & Song, L. (1998). Barriers to the use of mental health
services by African-American and Hispanic elderly persons. Journal of
Gerontological Social Work, 29(1), 23-44.

Billingsley, A. (1968). Black families in White America. New York: Simon &
Schuster, Inc.

Blumenthal, J., Burg, M., Barefoot, J., Williams, R., Haney, T., 8. Zimet, G.
(1987). Social support, type A behavior, and coronary artery disease.
Psychosomatic Medicine, 49, 331-340.

Boyd-Franklin, N. (1987). The contribution of family therapy models to the
treatment of Black families. Psychotherapy, 24(3S), 621 -629.

Boyd-Franklin, N. (1989). Black families in therapy: A multisystems approach.
New York: Guilford Press.

Boyd-Franklin, N. (1995). Five key factors in the treatment of Black families. In G.
Saba, B. Karrer, & K. Hardy (Eds), Minorities and family therapy (pp. 53-
69). New York: The Haworth Press.

Boyd-Franklin, N., & Franklin, A. (1998). African American couples in therapy. In
M. McGoIderick (Ed.), Re-visioning family therapy: Race, culture, and
gender in clinical practice (pp. 268-281). New York: Guilford Press.

Boykin, A., & Toms, F. (1985). Black child socialization. In H. McAdoo, 8. J.
McAdoo (Eds), Black children: Social, educational, and parent
environments. Beverly Hills: Sage.

Broman, C. (1996). Coping with personal problems. In H. Neighbors, & J.
Jackson (Eds.), Mental health in Black America (pp. 117-129). Thousand
Oaks: Sage.

Bronfenbrenner, U. (1986). Ecology of the family as a context for human
development: Research perspectives. Developmental Psychology, 22,
733-742.

Bronfenbrenner, U. (1999). Environments in developmental perspective:
Theoretical and operational models. In S. Friedman, & T. Wachs (Eds),
Measuring environment across the life Span: Emerging methods and
concepts (pp. 3-28). Washington, DC: American Psychological
Association. '

Caldwell, C., 8 Koski, L. (1997). Child rearing, social support, and perceptions of
parental competence among African American mothers. In R. Taylor, J.

147

Jackson, & L. Chatters (Eds.), Family life in Black America (pp. 185-200).
Thousand Oaks: Sage.

Carolan, M. A., K. (1999). Commitments and constraints to intimacy for African
American couples at midlife. Joumal of Family Issues, 20(1), 3-24.

Carter, R. (1995). The influence of race and racial identity in psychotherapy:
Toward a racially inclusive model. New York: John Wiley & Sons, Inc.

Clinton, M., & Anderson, L. (1999). Social and emotional loneliness: Gender
differences and relationships with self-monitoring and perceived control.
Journal of Black Psychology. 25(1), 61 -77.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale,
NJ: Lawrence Erlbaum Associates.

Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155-159.

Crown, W. (1998). Statistical methods for the social and behavioral sciences:
Multiple regression and limited-dependent variable models. Westport:
Praeger.

Dana, R. (1998). Understanding cultural identity in intervention and assessment.
Thousand Oaks: Sage.

Delphin, M., & Rolluck, D. (1995). University alienation and African American
ethnic identity as predictors of attitudes toward, knowledge about, and
likely use of psychological services. Journal of College Student
Development, 36(4), 337-346.

Demo, 0., & Hughes, M. (1990). Socialization and racial identity among Black
Americans. Social Psychology Quarterly, 53(4), 364-374.

Diala, C., Muntaner, C., Walrath, C., Nickerson, K., LaVeist, T., & Leaf, P. (2001).
Racial/ethnic differences in attitudes toward seeking professional mental
health services. American Joumal of Public Health, 91(5), 805-807.

Dickson, L. (1993). The future of marriage and family in Black America. Joumal
of Black Studies, 23(4), 472-491.

Duncan, L. E. (2003). Black male college students' attitudes toward seeking
- psychological help. Joumal of Black Psychology, 29(1), 68-86.

Ellison, C. (1990). Family ties, friendships, and subjective well-being among
Black Americans. Journal of Maniage and the Family, 52(2), 298-310.

148

Ellison, C. (1997). Religious involvement and the subjective quality of family life
among African Americans. In R. Taylor, J. Jackson, 8 L. Chatters (Eds),
Family life in Black America (pp. 117-131). Thousand Oaks: Sage.

Fischer, A., 8 Shaw, C. (1999). African Americans' mental health and
perceptions of racist descrimination: The moderating effects of racial
socialization experiences and self-esteem. Journal of Counseling
Psychology, 46(3), 395-407.

Fischer, E., 8 Turner, J. (1970). Orientations to seeking professional help:
Development and research utility of an attitude scale. Journal of
Consulting and Clinical Psychology, 35(1), 79-90.

Frazier, E. (1957). The Negro in the United States (Revised ed.). New York:
Macmillan Company.

Frey, W. (2001). Migration to the South brings us. Blacks full circle. Population
Today, 29(4), 3-4.

Frey, W. (2003, October). America's money in the middle. American
Demographics, 27-31.

Garcia-Coll, C., Lamberty, G., Jenkins, R., McAdoo, H., Cmic, K., Wasik, B., 8
Garcia, H. (1996). An integrative model for the study of developomental
competencies in minority children. Child Development, 67, 1891-1914.

Gary, L., Leashore, B., Howard, C., 8 Buckner-Dowell, R. (1982). Help-seeking
behavior among Black males (Final Report). Washington DC: Howard
University, Mental Health Research and Development Center, Institute for
Urban Affairs and Research.

Gellis, 2., Huh, N., Lee, S., 8 Kim, J. (2003). Mental health attitudes among
Caucasian-American and Korean counseling students. Community Mental
Health Journal, 39(3), 213-224.

Gibbs, J., Snowden, L., 8 Huang, L. (1996). The help-seeking questionnaire as a
psychotherapeutic intervention with depressed low-income patients in an
outpatient clinic. In R. Jones (Ed.), Handbook of Tests & Measurements
for Black Populations (Vol. 1). Hampton, VA: Cobb 8 Henry Publishers.

Godfrey, J. (1997). Factors which influence the role of female friendships in the
lives of heterosexual African American women. Dissertation Abstracts
lntemational: Section B: The Sciences and Engineering, 58(1-B), 0456.

Goldenberg, l., 8 Goldenberg, H. (2000). Family therapy: An overview (5th ed.).
Belmont, CA: Wadsworth/Thompson Learning.

149

Haberrnas, J. (1971). Knowledge and human interests. Boston: Beacon.

Haight, W. (1998). "Gathering the spirit" at First Baptist Church: Spirituality as a
protective factor in the lives of African American children. Social Work,
43(3), 213-221.

Halgin, R. R, Weaver, D.D., Edell, W.S., 8 PG. Spencer. (1987). Relation of
depression and help-seeking history to attitudes toward seeking
professional psychological help. Journal of Counseling Psychology, 34(2),
177-185.

Ham, 3. (2003, May 22). Minorities get different mental health care in rich
neighborhoods. Retrieved 2/8/04, from
http://wwwcfah.org/hbns/news/richhoog05-2_2-03.cfm

Hardy, H. (1995). The theoretical myth of sameness: A critical issue in family
therapy training and treatment. In G. Saba, B. Karrer, 8 K. Hardy (Eds),
Minorities and Family Therapy (pp. 17-33). New York: The Haworth Press.

Hardy, K., 8 Laszloffy, T. (1992, June). Training racially sensitive family
therapists: Context, content, and contact. Families in Society.

Haynes, B. (2001). Red lines, black spaces. New Haven: Yale University Press.

Hines, P., 8 Boyd-Franklin, N. (1996). African American families. In M.
McGoIderick, J. Giordano, 8 J. Pearce (Eds), Ethnicity and family therapy
(2nd ed., pp. 66-84). New York: The Guilford Press.

Hobfoll, S., 8 Lerman, M. (1989). Predicting receipt of social support: A
longitudinal study of parents' reactions to their child‘s illness. Health
Psychology, 8(1), 61-77.

Hofferth, S. (1984). Kin networks, race, and family structure. Journal of Marriage
and the Family, 46(4), 791-806.

Hollingshead, A. (1975). Four factor index of social status. Unpublished
manuscript, Yale University.

Hughes, 0., 8 Chen, L. (1997). When and what parents tell children about race:
An examination of race-related socialization among African American
families. Applied Developmental Science, 1(4), 200-214.

lmber-Black, E. (1988). Families and larger systems: A therapist's guide through
the labyrinth. New York: Guilford.

150

Jackson, J. (Ed.). (1991). Life in Black America. Newbury Park, CA: Sage.

Johnson, C. (1995). Determinants of adaptation of oldest old Black Americans.
Journal of Aging Studies, 9(3), 231 -244.

Johnson, D. (1994). Parental racial socialization and racial coping among middle
class Black children. Paper presented at the XIII Empirical Conference in
Black Psychology, Madison: University of Wisconsin.

Johnson, D. (2001). Parental characterisitics, racial stress, and racial
socialization processes as predictors of racial coping in middle childhood.
In A. Neal-Bamett, J. Contreras, 8 K. Kems (Eds.), Forging links: African
American children and clinical developmental perspectives (pp. 57-74).
Westport, CT: Praeger.

Kaniasty, K., 8 Norris, F. (2000). Help-seeking comfort and receiving social
support: The role of ethnicity and context of need. American Journal of
Community Psychology, 28(4), 545-581.

Keith, V. (1997). Life stress and psychological well-being among married and
unmarried Blacks. In R. Taylor, J. Jackson, 8 L. Chatters (Eds.), Family
life in Black America (pp. 95-116). Thousand Oaks: Sage.

Kent, R. (2001). Data construction and data analysis for survey research. New
York: Palgrave.

Kliman, J. (1998). Social class as a relationship: Implications for family therapy.
In M. McGold rick (Ed.), Re-visioning family: Race, culture, and gender in
clinical practice (pp. 50-61). New York: Guilford Press.

Laszloffy, T., 8 Hardy, K. (2000). Uncommon strategies for a common problem:
Addressing racism in family therapy. Family Process, 39(1), 35-50.

Leaf, P., 8 Bruce, M. (1987). Gender differences in the use of mental health-
related services: A re-examination. Journal of Health and Social Behavior,
28(2), 171-183.

Leaf, P., Bruce, M., Tischler, G., 8 Holzer, C. (1987). The relationship between
demographic factors and attitudes toward mental health services. Joumal
of Community Psychology, 15, 275-284.

Leong, F. T., Wagner, NS, 8 Tata, S. P. (1995). Racial and ethnic variations in
help-seeking attitudes. In J. M. Casas J. G. Ponterotto, L.A. Suzuki ,8
CM. Alexander (Ed.), Handbook of multicultural counseling. Thousand
Oaks: Sage.

151

LewisMumfordCenter. (2002, June). Regional divisions dampen '903 prosperity:
New census data show economic gains vary by region. Retrieved 3/3/04,
from

http://mumford1 .dynd ns.org/cen2000/CitvProfiles/SOC Regort/gage1 .html

 

Magnusson, D., 8 Stattin, H. (1998). Person-context interaction theories. In R.
Lerner (Ed), Handbook of child psychology (5th ed., pp. 81 -91 ). New
York: Wiley 8 Sons, Inc.

Mannino, F., 8 Shore, M. (1984). An ecological perspective on family
intervention. In W. O'Conner, 8 B. Lubin (Eds), Ecological approaches to
clinical and community psychology (pp. 75-93). New York: John Wiley 8
Sons.

Marshall, S. (1995). Ethnic socialization of African American children:
Implications for parenting, identity development, and academic
achievement. Joumal of Youth and Adolescence, 24, 377-396.

Mattis, J., Murray, Y., Hatcher, C., Heam, K., Lawhon, D., Murphy, E., et al.
(2001). Religiosity, spirituality, and the subjective quality of African
American men's friendships: An exploratory study. Journal of Adult
Development, 8(4), 221 -230.

May, V., Caldwell, C., 8 Jackson, J. (1996). Mental health symptoms and service
utilization patterns of help-seeking among African American women. In H.
Neighbors, 8 J. Jackson (Eds), Mental health in Black America (pp. 161-
176). Thousand Oaks: Sage.

McAdoo, H. (1997). Upward mobility across generations in African American
families. In H. McAdoo (Ed), Black families (3rd ed., pp. 139-162).
Thousand Oaks: Sage.

McAdoo, H. (1999). Families of color: Strengths that come from diversity. In H.
McAdoo (Ed), Family ethnicity: Strength in diversity (2nd ed., pp. 3-14).
Thousand Oaks: Sage.

McCabe, K., Clark, R., 8 Barnett, D. (1999). Family protective factors among
urban African American youth. Journal of Clinical Child Psychology, 28(2),
1 37-1 50.

McCubbin, H., Futrell, J., Thompson, E., 8 Thompson, A. (1998). Resilient
factors in an ethnic and cultural context. In H. McCubbin, E. Thompson, A.
Thompson, 8 J. Futrell (Eds), Resiliency in African American families (pp.
329-351). Thousand Oaks: Sage.

152

McDaniel, T. (2001). Regression Analysis. 2001 ICPSR Summer Program:
University of Michigan.

McGoIderick, M., 8 Giordano, J. (1996). Overview: ethnicity and family therapy.
In M. McGoIderick, J. Giordano, 8 J. Pearce (Eds), Ethnicity and family
therapy (2nd ed., pp. 1-27). New York: Guilford Press.

McKinnon, J. (2003). The Black Ppopulation in the United States: March 2002.
Washington, DC: US Census Bureau, Current Population Reports.

McRae, M., Carey, P., 8 Anderson-Scott, R. (1998). Black churches as
therapeutic systems: A group process perspective. Health Education 8
Behavior, 25(6), 778-789.

Montalvo, B., 8 Gutierrez, M. (1995). Nine Assumptions for Work with Ethnic
Minority Families. In G. Saba, G. Karrer, 8 K. Hardy (Eds), Minorities and
family therapy (pp. 35-52). New York: The Haworth Press.

Moynihan, D. (1965). The Negro famiy: The case for national action. Washington,
DC: US. Department of Labor, Office of Policy Planning and Research.

Myers, H. (1996). The social resources and social supports questionnaire: A
multidimensional inventory. In R. Jones (Ed), Handbook of tests 8
measurements for Black populations (Vol. 1). Hampton, VA: Cobb 8
Henry.

National Center for Opinion Research (2000). Excerpt from "New work new
families: America 's juggling act— Who is the Middle Class? Retrieved
3/1/04 from
http:Ilwww.wksu.org/news/featureslfamilyserieslmiddleclass_transcript2.ht
ml

Neighbors, H. (1985). Seeking professional help for personal problems: Black
Americans' use of health and mental health services. Community Mental
Health Journal, 21(3), 156-166.

Neighbors, H., 8 Jackson, J. (1984). The use of informal and formal help: Four
patterns of illness behavior in the Black community. American Journal of
Community Psychology, 12(6), 629-644.

Neighbors, H., 8 Jackson, J. (1996). Mental health in Black America:
Psychosocial problems and help-seeking behavior. In H. Neighbors, 8 J.
Jackson (Eds), Mental health in Black America (pp. 1-13). Thousand
Oaks: Sage.

153

Neighbors, H., Musick, M., 8 Williams, D. (1998). The African American minister
as a source of help for serious personal crises: Bridge or barrier to mental
health care? Health Education 8 Behavior, 25(6), 759-777.

Norris, F., 8 Kaniasty, K. (1996). Received and perceived social support in times
of stress: A test of the social support deterioration deterrence model.
Journal of Personality and Social Psychology, 71(3), 498-51 1.

Palmer, C. (2001). African Americans, depression, and suicide risk. Joumal of
Black Psychology, 27(1), 100-111.

Paolucci, 3., Hall, 0., 8 Axinn, N. (1977). Family decision making: An ecosystem
approach. New York: John Wiley 8 Sons.

Parham, T., 8 Williams, P. (1993). The relationship of demographic and
background factors to racial identity attitudes. Journal of Black
Psychology, 19, 7-24.

Pattillo-McCoy, M. (1999). Black picket fences: Privilege and peril among the
Black middle class. Chicago: University of Chicago Press.

Pearlmutter, L. (1996). Using culture and the intersubjective perspective as a
resource: A case study of an African American couple. Clinical Social
Work Joumal, 24(4), 389-401.

Pinderhuges, E. (1989). Understanding race, ethnicity, and power: The key to
efficacy in clinical practice. New York: Free Press.

Pipes, W. (1997). Old-time religion: Benches can't say "amen". In H. McAdoo
(Ed), Black families (pp. 41-66). Thousand Oaks: Sage.

Plowden, K., 8 Miller, J. (2000). Motivators of health seeking behavior in urban
African American men: An exploration of triggers and barriers. Journal of
National Black Nurses Association, 11(1), 15-20.

Richards, M. (1993). Attitudes of middle-class African Americans toward therapy.
Dissertation Abstracts lntemational, 53(11-A), 4097.

Robinson, A. (1997, February). The two nations of Black America: Contemporary
perspectives on the state of the Black middle class. Retrieved 3/1/04, from
h_ttp://www.gbs.org/wgbh/gageslfrontline/shows/rgce/economicslanaIvsis.h
t_ml

Rogler, L., Malgady, R., 8 Rodriguez, 0. (1989). Hispanics and mental health: A
framework for research. Malabar, FL: Robert E. Krieger.

154

Sanders Thompson, V. (1994). Socialization to race and its relationship to racial
identification among African Americans. Joumal of Black Psychology, 20,
175-188.

Schroeder, L. D., Sjoquist, D.L., 8 Stephan, PE. (1986). Understanding
regression analysis: An introductory guide. Newbury Park: Sage.

Searight, H. (1997). Family-of-origin therapy and diversity. Washington, DC:
Taylor 8 Francis.

Sherman, M. (1997). Friendship and mental health across the lifespan.
Dissertation Abstracts lntemational: Section B: The Sciences and
Engineering, 58(5-B), 2724.

Smith, J., 8 Horton, C. (Eds). (1997). Statistical record of Black America (4th
ed). Detroit: Gale Research Press.

Snowden, L. (1998). Racial differences in inforrnal help seeking for mental health
problems. Journal of Community Psychology, 26(5), 429-438.

Snowden, L. (1999). African American folk idiom and mental health services use.
Cultural Diversity and Ethnic Minority Psychology, 5(4), 364-370.

Snowden, L. (2001a). Barriers to effective mental health services for African
Americans. Mental Health Services Research, 1(4), 181-187.

Snowden, L. (2001b). Social embeddedness and psychological well-being
among African Americans and Whites. American Joumal of Community
Psychology, 29(4), 519-536.

Spencer, M. (1999). Social and cultural influences on school adjustment: The
application of an identity-focused cultural ecological perspective.
Educational Psychologist, 34(1), 43-57.

Stefl, M., 8 Prosperi, D. (1985). Barriers to mental health services utilization.
Community Mental Health Joumal, 21(3), 167-178.

Stevenson, H. (1993). Validation of the scale of racial socialization for African
American adolescents: A preliminary analysis. Psych Discourse, 24(12),
7-1 0.

Stevenson, H. (1994). Validation of the scale of racial socialization for African
American adolescents: Steps toward multidimensionality. Joumal of Black
Psychology, 20(4), 445-468.

155

Stevenson, H. (1995). Relationship of adolescent perceptions of racial
socialization to racial identity. Journal of Black Psychology, 21(1), 49-70.

Stevenson, H. (1996). Scale of racial socialization for African American
adolescents. In R. Jones (Ed), Handbook of tests and measunnents for
Black populations (Vol. 1). Hampton, VA: Cobb 8 Henry.

Stevenson, H., Reed, J., 8 Bodison, P. (1996). Kinship social support and
adolescent racial socialization beliefs: Extending the self to family. Journal
of Black Psychology. 22(4), 498-508.

Sudarkasa, N. (1997). African American families and family values. In H. McAdoo
(Ed), Black families (3rd ed., pp. 9-40). Thousand Oaks: Sage.

Tatum, B. (1997). Out there stranded? Black families in white communities. In H.
McAdoo (Ed), Black families (pp. 214-233). Thousand Oaks: Sage.

Taylor, R., Hardison, C., 8 Chatters, L. (1996). Kin and nonkin as sources of
informal assistance. In H. Neighbors 8 J. Jackson (Ed), Mental health in
Black America (pp. 130-145). Thousand Oaks: Sage.

Theriot, M., Segal, S., 8 Cowsert, M. (2003). African Americans and
comprehensive service use. Community Mental Health Journal, 39(3),
225-237.

Thompson, V., Akbar, M., 8 Bazile, A. (2002, August). African Americans'
perceptions of psychotherapy and psychotherapies. Paper presented at
the 1101h Annual Convention of the American Psychological Association,
Chicago, Illinois.

Ulbrich, P., 8 Warheit, G. (1989). Social support, stress, and psychological
distress among Older Black and White adults. Journal of Aging and
Health, 1(3), 286-305.

US Census Bureau. (2000). Data highlights on the middle class-analysis.
Retrieved 1/31/04, from
h_ttp://www.censusgov/hhgs/incomelmidclasslmidclsan.html

US Census Bureau. (2002, March). Table 14. Total money income in 2001 of
households by type, and race and Hispanic origin of householder. Current

Population Survey, Racial Statistics Branch, Population Division. Intenet
Release date: April 25, 2003.

US Surgeon General. (1999). Overview of cultural diversity and mental health
services. Retrieved 218/04, from

http://wwwsurgeongeneral.gov/Iibram/mentalhealth/chagterZ/sec8.html

156

US Surgeon General. (2001). Mental health care for African Americans.
Retrieved 2/8l04, from

h_ttg:/Iwww.mentalhealth.orglcre/ch3 need for ment_al health care.asp

Vaughn-Sharp, D. (2001). An examination of life satisfaction, religious
involvement, and social support of African Americans. Dissertation
Abstracts lntemational: Section B: The Sciences and Engineering, 62(6-
B), 2996.

Vecchio, K. (1998). Dismantling White male privilege within family therapy. In M.
McGold rick (Ed), Re-visioning family therapy: Race, culture, and gender
in clinical practice (pp. 159-175). New York: Guildford Press.

Vega, W., 8 Rumbaut, R. (1991). Ethnic minorities and mental health. Annual
Review of Sociology, 17, 351 -383.

Vogt, W. P. (1999). Dictionary of Statistics and Methodology (2nd ed). Thousand
Oaks: Sage.

Walls, C. (1992). The role of church and family support in the lives of older
African Americans. Generations: Journal of the American Society on
Aging, 16(3), 33-36.

Washington, P. (1996). The police: A reluctant social service agency in the
African American community. In H. Neighbors, 8 J. Jackson (Eds), Mental
health in Black America (pp. 177-188). Thousand Oaks: Sage.

Wells, K., Klap, R., Koike, A., 8 Sherboume, C. (2001). Ethnic disparities in
unmet need for alchoholism, drug abuse, and mental health care.
American Journal of Psychiatry, 158(12), 2027-2032.

Westney, O. (1993). Human ecology theory: Implications for education, research,
and practice. In P. Boss, W. Doherty, R. LaRossa, W. Schumm, 8 S.
Steinmetz (Eds), Sourceka of family theories and methods: A
contextual approach (pp. 448-450). New York: Plenum.

Whaley, A. (2001). Cultural mistrust and mental health services for African
Americans: A review and meta-analysis. The Counseling Psychologist,
29(4), 51 3-531 .

Wilson, G. (2000). Race, class, and support for egalitarian statism among the
African American middle class. Journal of Sociology and Social Welfare,
)O(Vll(3), 75-90.

157

Yeh, C. (2002). 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(1), 19-29.

158

   

111111111111111111111