No Student Left Behind

The road to cultural competency in CAPS and beyond

by Wen Zhuang

Illustration by Carly Paul

published November 9, 2018

One phenomenon has seen steady rise on college campuses: the influx of international students, from an average of 600,000 in 2013 to 800,000 in 2016. Since then, however, numbers saw a 3.3 percent decline, and professionals have attributed a string of reasons to explain this occurrence: issues of affordability, uncertainty about visa policies, and of course, our irresolute, clamorous President (last year, Trump reportedly called “every Chinese student in the US a spy”). These are certainly reasons to shy away from the US. However, problems regarding the wellbeing of international students have always been constant, though historically and continuously overlooked.

After the 2016 election and the corresponding rise in stress-levels of college students across the country, especially among underrepresented and underprivileged students, pressure on campuses for better-integrated counseling and psychological services (CAPS) ran high. Although appropriate changes are happening, a demographic of students that require an alternative to Western pedagogical therapy is rarely considered in these progressive movements towards integrated and diverse CAPS offices.

International student enrollment has more than tripled in the last 50 years, with nearly five percent of all students enrolled in higher-education coming from countries outside the US. The 2017 “SEVIS by the Numbers,” a biannual report on international student data, estimated 77 percent of these students to be from Asian countries; China and India continue to send the largest number of students, at 362,368 and 206,698 respectively. Concentrated and well-funded recruitment efforts from the US and corresponding countries have fueled this rise. Seeing the monetary value of international students has encouraged college advising services in China—part of the local industry of college prep that generated $4.5 billion in revenue in 2013. Brian Ong, CEO of the largest boutique counseling service, Bangdai, is transparent about their financial stability: “Some 25 percent of the people on your rich list are sending or working on sending their kids to college in the US,” states Ong. Though this conception is largely true, socioeconomic stereotypes are another generalization that works to undermine real issues facing these student groups. Not all Asian international students are wealthy; often low-income students that don’t fit under these umbrella perceptions may feel more hesitant to seek help, especially when there’s a need to look off campus for specific providers. To ensure CAPS offices are welcoming spaces for these students, schools of higher education must contend with gaps in cultural competence.

“The problem with these schools is that they make recruiting trips to China, to Asia. They want these students: they’re excellent, they pay full tuition. Along with not being offered financial aid, they are also not offered adequate services” Dr. Aleta Johnson tells the Independent. Dr. Johnson recently left her position at Brown CAPS after being brought on 25 years ago; at that time, she was the only Asian-American therapist, coming onto staff after student protests advocating for more Asian-American representation in CAPS. “And when teachers and supervisors are culturally sensitive,” she adds, “they understand that these students are reserved often due to hierarchical academic structures in China, or Korea, and are then able to offer the right kind of support.” A lack of diverse and representative providers exacerbates this dismissal of mental health support. What is needed is a system of care that is consistent, preventative, and holistic—one that can reach further than the clinical one-hour meeting. What are the ways that young people of a similar age in China relax? In what settings do they feel comfortable? What conversation topics might make them feel more involved?




The road to therapy, for even domestic students, is laden with speed bumps. In February 2015, access was made easier: Yuri Tomikawa, a 2012 alumnus of Brown, founded, a website that connects people easily with available and compatible therapists in the Boston, New York, Rhode Island, and Connecticut areas. It is often the first website students search when they aren’t able to find the right match in their CAPS offices. Tomikawa credits how hopeless she felt while trying to find an available therapist as what brought her to start her business, and what pushed her to add more specific options in the search bar. Even with Zencare’s ambitious mission and the changes it’s made in CAPS accessibility, there is still a population largely unaccounted for: with Asian international students, proper help with issues of cultural isolation and social anxiety might start with a well-designed system, but does not end there. There is still the problem with communication: Zencare’s bilingual options offer only Mandarin Chinese, Portugese, Spanish, French, and Italian, and when selected, most of these options can only be carried out by a handful of available therapists, sometimes only one–– Yumin Tan (LICSW) is the only bilingual therapist working in Mandarin and English in the Providence area. “You will always feel more comfortable to speak and think in your native tongue,” Dr. Tan tells the Independent when asked about her usual clientele, which is largely made up of Chinese international high school and graduate students.

“However, it is not only a matter of language,” she adds, “it is mostly a matter of culture, how therapists can better understand the traditions and stigmatized culture that these students often hail from.” Traditionally, the method used in Western psychotherapy is a talk-based therapy, but the effects aren’t applicable to all: If a student is having family issues, and they come from a conservative, culturally specific Chinese household, advising them to “talk it out” and confront their family might warrant more issues for the student. Dr. Tan speaks on the importance of this distinction: “The idea of ‘speaking up’ is not the culture in the East. It's ironically this encouragement to confront your issues by ‘talking’ about it that keeps [students] from seeking help, but it is exactly this suppression that [students] feel a need to seek out help” Being sensitive to these specificities in approach not only ensures that help is given but that it’s the right kind of help. Due to mental health stigmas, Dr. Tan’s patients come largely from referrals; rarely do students approach her directly. She also notes the increase in high school students seeking help, often those in “homestays”—when an international student is paired with an American host family, usually strangers who are paired through programs similar to college recruiting programs. Usually, these homestays exponentiate feelings of isolation already felt in school. “It really makes an impact when these barriers exist for 12, 13, 16-year-olds; it becomes a part of their identity development as a whole.” While some of these high schools are beginning to incorporate ESL programs into their curriculum, not much else is available to aid both a student’s academic and personal growth.

Unfortunately, knowledge of these specific barriers to access for Asian international students are not widely discussed and conversations often surface only after tragic events, when these issues can no longer be overlooked. After the public suicide of Brown University doctoral student Hyoun Ju Sohn in 2015, the bleak realities that these international students face rang clear. Dr. Johnson remembers receiving various referrals in the months after, even Korean graduate students coming to her directly with similar fears stirred up by the incident. “Surprisingly, in the cross-experience analysis of Asian Americans and Asian international students and suicides, the biggest predictor of suicidal behavior is actually the perception of assimilation, not exactly depression. There is this sort of insidious impact that a false sense of belonging and a slow drip of micro-aggression has on [these students].” Dr. Johnson discounts presumptions like the Model Minority Myth, as it is too often used to rationalize campus suicides among international students. Instead of placing the blame on a lack of support, or even issues with assimilation, often suicides get pinned on high-pressure “tiger moms” or the failure on the part of these students to speak out about their struggles. The former showcases the dangers of certain stereotypes and the latter reveals an ignorance of pedagogies outside of accepted Western ones.




In the 2017 report from the Center for Collegiate Mental Health (CCMH), social anxiety saw an expedited rise within 2016-17. Last year, the CAPS office at RISD saw over 500 students, almost 23 percent of the student population––a record high that’s left Shauna Summers, CAPS director, proud and hopeful. However, the percentage of international students, and people of color in general, that seek CAPS has not mirrored this increase, though often these groups are directly affected by racist policies, immigration reform, and divisions in the US political climate. That same report shows that 96,397 US students sought CAPS help while students from countries like China, India, and Japan saw 1,826, 1,295, 124 respectively. And while 67.2 percent of the white student demographic have utilized campus help, only 9.3 percent of black students and 8 percent of Asians and Asian Americans have done the same. Most of the time, diversity in campus CAPS staff is the only way for underrepresented, underprivileged groups to feel safe in seeking help.

Brown and RISD have made desperate strides towards overturning systemic issues. However, playing catch-up has placed increased pressure on the few therapists of color. “People of color don't always stay in these positions because it's difficult to be a person of color in certain places. It's a lot of pressure and a lot more work.” Nikole Barnes tells the Independent. She has been the Assistant Director of RISD CAPS since June, focusing on training. Along with her full-time position, she feels it’s vital to keep her private practice open. Though sometimes she only sees five patients a year, being one of the only women of color available, Dr. Barnes feels it is her duty to cover all bases. This is the reality for many bilingual and POC therapists. Underrepresentation often forces them to spread themselves thin: “We can't always say no because there's no one else for these students to go to.” Similarly, Dr. Johnson, “only felt okay to leave Brown CAPS and return to private practice when she was no longer the only one representing for Asian and Asian Americans.”

On the topic of outreach and considering cultural differences, all doctors of color working within the institution observe a similar trend: motivations to secure knowledge and participation with CAPS on college campuses should be done so collaboratively with these students. Parents of international students, especially those hailing from a society of high-pressure academic competition, will warm up to the idea of “seeking help” when it’s done as a way to further their child’s academic success. These expectations from parents are often perceived as unreasonable but the dismissal of CAPS comes not from an educated, credible rejection, but from a ignorance towards this type of help, as it is not widely offered in most Asian countries.

Dr. Johnson kept these goals in mind when working on outreach during her time at Brown: “These students are not going to come to counseling but they will through workshops, or events that are advertised as furthering their success professionally and academically,” she says. Shifts in approach like that are ways CAPS can work to validate, not pathologize, their culture. “International students are coming from a culture that is largely homogeneous––sure, there are hierarchies with class––but they aren't used to being denigrated for having slanted eyes, or the amount of stereotyping,” adds Dr. Johnson, “and it’s not easy to adjust to that.” She noticed that often students were looking for other ways to justify their culture, often inadvertently locking themselves into homogenous groups. Xin Er Jiang, now in her last year at RISD, mentioned the pressure to get involved in relationships, both romantic and friendly. “By observing my high school peers who came to study in the US, a common cure to loneliness and cultural insecurities is getting into relationships. And most of the time, it’s only with other international students,” they told the Independent. Though these are valid ways to reduce isolation and ones that have brought levels of comfort to these students, they are limited solutions to deep-seated, systemic issues. The roots of these feelings are often ambiguous, and adjustment has to happen on so many levels. As a consequence, students like Jiang are often left to figure these uncertainties out on their own: “I don't know if RISD is causing it, or being away in a foreign country is causing it, or that's just the normal essence of human life.”




While often counseling services can feel as if they are working against the clock, it’s important that all therapists, regardless of race and culture, pursue their clinical pedagogy with a constant critical eye. Though Asian international students are disproportionately absent in CAPS discourse, cultural incompetence and the lack of representation in mental health services have proven to negatively affect students from all different countries, socioeconomic backgrounds, and cultures. Progressive interventions in campus counseling and psychological services should not come as a response to emergent circumstances, but as a pre-existing system of support, ensuring aid is available and appropriate whenever needed.


WEN ZHUANG R‘19 is still trying to “connect” with her therapist.