Therapist experiences working with Asian American college students

Figures & data

Table 1. Code descriptions and frequencies (total number of domain Codes = 302)

Domain and Category Codes	Frequency (%)	Representativeness	Description
Stereotypes and discrimination	22 (7.28%)	Typical (9)	Feels subjected to and negatively impacted by stereotyped expectations and biases. Perceived ethnic/racial discrimination.
Gender and sexuality	17	Variant (8)	Influenced by body image expectations, feminine or masculine stereotypes.
Unfair treatment	1	Rare (1)	Perceives poor treatment, bias, or rejection by others due to their ethnicity.
Model Minority Stereotype (MMS)	2	Rare (2)	Pressure to conform to elevated academic performance expectations as an Asian American. Internalization of MMS, and maladaptive perfectionistic tendencies.
Prejudice or bias	2	Rare (2)	Indications of prejudice or biased feelings toward other groups.
Internalized inferiority beliefs	4	Rare (2)	Holds a negative self-concept related to their Asian background (e.g. low self-esteem related to ethnic identity).
Family stress	64 (21.19%)	General (16)	Stress originating with student’s immediate or extended family members.
Obligation	36	Typical (14)	Stress related to filial obligation, including pressure to succeed to meet the needs or expectations of family.
Estrangement	12	Variant (7)	Lack of a nurturing or meaningful relationship between parents and the student (e.g. alienation, lack of support).
Conflict	13	Variant (8)	Overt conflict typically between parents and the student with varying topics (e.g. parental authority vs. autonomy).
Family assistance	7	Variant (5)	Being burdened with familial responsibilities (e.g. problem solving, caregiving, providing instrumental help).
Acculturative stress	9(2.98%)	Variant (8)	Immigration-related stress, first-generation stressors.
Social isolation	5	Variant (4)	Social isolation and loss of social support network due to immigration.
Communication and language barriers	5	Variant (5)	Communication and language barriers in some areas of life.
Emotion regulation	41(13.58%)	Typical (13)	Problems with managing emotional experience.
Emotional expression	7	Variant (6)	Paucity or immaturity in expressing internal emotional states and communication.
Emotion identification	13	Typical (9)	Lack of insight and trouble identifying emotional experience.
Emotion socialization	13	Typical (9)	Differences in emotion perception and expression due to being reared in a culturally distinct environment. Family lacks support in emotional communication.
Extreme negative coping (acting out)	12	Variant (5)	Maladaptive ways of coping or responding to intense negative affect (e.g. self-injury, high risk sexual behavior, substance use, gambling, violent relationships).
Avoidance	7	Variant (4)	Extreme avoidance patterns and absence of goal-directed behavior to manage negative affect (e.g. social withdrawal, school avoidance, non-stop gaming).
Academic stress	38 (12.58%)	Typical (13)	Stress due to academic performance or pathways (subjective or objective failure).
Poor performance	8	Variant (5)	Objective indicators of poor performance (e.g. academic probation, risk of dismissal, displacement from a program).
Subjective distress about performance	7	Variant (4)	Student is not living up to own standards of achievement.
Dissonance about field of study	5	Variant (4)	Concerns or dissatisfaction about choice of major or current area of study, or confusion about academic direction.
Identity search	53 (17.54%)	General (16)	Struggle with achieving identity in relevant domains (e.g. search for meaning, conflict between choices without ability to integrate paths, lack of sense of self).
Developing bicultural competence	13	Typical (9)	Deficits in functioning as alternately independent (American) or interdependent (Asian) as the situation calls for, including home-school transition problems.
Professional/Academic identity	9	Variant (7)	Internal conflict a choice of major, lack of satisfaction or fulfillment, misfit with competence, or in response to intense family pressure for an area of study.
Interpersonal/Social belonging	27	Typical (10)	A sense of confusion about where the student belongs. Includes formation of peer or romantic relationships. Lacks feelings of acceptance socially.
Treatment approach or considerations	75 (24.83%)	General (17)	Characterizations of treatment techniques, orientations, elements, or processes.
Directive intervention	33	General (16)	Behavioral, cognitive behavioral, skills oriented.
Family communication	9	Variant (6)	Focus on building communication within the family.
Ethnic match favorable	13	Variant (8)	Discussions that include advantages of clinician-student match in race/ethnicity.
Psychoeducation	7	Variant (5)	Education about mental health and illness, intervention for stigma concerns, and as a part of intervention orientation.
Insight oriented intervention	32	Typical (13)	Humanistic, psychodynamic.
Ethnic match unfavorable	9	Variant (6)	Discussions that suggest that client-therapist match presents a disadvantage.
Group therapy	9	Variant (6)	Considerations about the fit of group therapy for Asian American students.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.