GLBT Vietnamese-Americans: Building a Conceptual Framework to Examine Minority Help-Seeking Behavior

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GLBT Vietnamese-Americans: Building a Conceptual Framework toExamine Minority Help-Seeking BehaviorThang D. Luua; Monit Cheunga

a University of Houston, Houston, Texas, United States

Online publication date: 09 October 2010

To cite this Article Luu, Thang D. and Cheung, Monit(2010) 'GLBT Vietnamese-Americans: Building a ConceptualFramework to Examine Minority Help-Seeking Behavior', Journal of GLBT Family Studies, 6: 4, 365 — 380To link to this Article: DOI: 10.1080/1550428X.2010.511082URL: http://dx.doi.org/10.1080/1550428X.2010.511082

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GLBT Vietnamese-Americans:Building a Conceptual Framework to Examine

Minority Help-Seeking Behavior

THANG D. LUU and MONIT CHEUNGUniversity of Houston, Houston, Texas, United States

A conceptual framework is built for teaching research and as-sessing mental health needs and help seeking of the gay, lesbian,bisexual, and transgender (GLBT) Vietnamese-American popula-tion. To be sensitive to cultural needs, mindfulness is used as atheoretical starting point for examining self-acceptance in this pop-ulation. The framework first describes how acceptance or rejectionof one’s sexual orientation/identity by self and others predicts men-tal health outcomes. Second, it analyzes how the intent to seek helpand actual help seeking is affected by internal (i.e., self-blame, self-concealment, denial) and external (i.e., environmental, accultura-tion, economic) factors. The framework provides a step-by-step pro-cess for understanding the interconnection between a theoreticalconcept and the consequences when the studied variables interact.

KEYWORDS GLBT, mindfulness, self-acceptance, sexual orienta-tion, self-blame, Asian mental health, research framework

INTRODUCTION

At the dawn of the twenty-first century, American gay, lesbian, bisexual,and transgender (GLBT) persons continue to suffer from discrimination,civil rights violations, and sometimes death because of their sexual orien-tation/identity. It is not surprising that the stigma associated with GLBTlifestyles also plays a detrimental role in mental health. A number of stud-ies have found that the GLBT community suffers higher rates of suicide,depression, and other mental health issues and are more likely to needmental health services than heterosexuals (Balsam, Beauchaine, Mickey, &

Address correspondence to Monit Cheung, Graduate College of Social Work, Universityof Houston, Houston, TX 77204. E-mail: [email protected]

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Rothblum, 2005; Cochran, Mays, Alegria, Ortega, & Takeuchi, 2007; Roberts,Grindel, Patsdaughter, Reardon, & Tarmina, 2004).

The difficulties faced by the GLBT Asian-American communities, in par-ticular Vietnamese-Americans, may be even more daunting because theyrepresent a hidden population who underutilize mental health and relatedservices (GLADD, 2009). According to Census 2000, there were 1,122,528Vietnamese Americans residing in the United States (U.S. Census Bureau[USCB], 2000), with the majority of the population being concentrated inlarger cities in the southern and western parts of the country. No officialstatistics have been reported on GLBT representation among Vietnamese-Americans because they are well-hidden and not active in voicing theirconcerns (Blanc, 2005; Laurent, 2005).

Various studies have indicated that Asians have greater negative viewsof homosexuality and greater levels of discomfort with homosexuality thanCaucasian Americans (Lippincott, Wlazelek, & Schumacher, 2000; Span &Vidal, 2003). Carrier, Nguyen, and Su (1992) found that 90% of the Viet-namese students in their study reported that they have strong feelings againstVietnamese-American men who have sex with other men. Taken together,these studies indicate that GLBT Vietnamese-Americans face tremendouschallenges and difficulties when it comes to self- and societal rejection.Furthermore, this continuing challenge makes the choice of seeking or notseeking mental health services a more difficult dilemma to resolve when helpis needed. Thus, understanding the role of self-acceptance, societal accep-tance, and internal/external factors that contribute to help-seeking attitudesand behaviors is important in fully informing these individuals about thechoices they make when it comes to meeting mental health needs.

Starting from the theory of mindfulness, we examine the steps of build-ing a framework for examining the relationship between acceptance, sup-port, and help-seeking attitudes and behaviors for mental health services inthe GLBT Vietnamese-American community. Since no literature addresseshow to build a conceptual framework, this article presents the materials witha systematic framework-building process for use in teaching family serviceresearch. Through this process, a research agenda can also be established(see Figure 1).

Step 1: Theorizing Mindfulness

Introduced more than 2,500 years ago by Siddhartha Gautama (i.e., Bud-dha), mindfulness is a perspective based on Buddha’s Satipatthana-sutta (TheSetting-Up of Mindfulness discourse) (Rahula, 1978). In this discourse, theBuddha discussed how to purify the mind and body through mindfulness andawareness exercises. Mindfulness involves the intent to accept self withoutjudgment and the actual acting of the self-perspective (Vujanovic, Young-wirth, Johnson, & Zvolensky, 2009). Mindfulness in its original form literally

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GLBT Vietnamese-Americans 367

No Yes

No Yes

INTERNAL EXTERNAL EXTERNAL

Self Self Denial Acculturatio Prior Therapy n Self Financial Experience Support Support Blame Concealment

INTENT TO SEEK HELP YES NO

ACTUALLY SEEKING

YES

HELP NO

Self-Initiation (Best-Case Scenario)

External Support (Acceptable Scenario)

Service Barriers (Contemplation Scenario)

Self and System Barriers (Worst-Case Scenario)

MINDFULNESS

ACCEPTANCE OF ONESELF

SELF BLAME

SECRET KEEPING/SELF

CONCEALMENT

MENTAL HEALTH ISSUES

ACCEPTANCE FROM OTHERS

AUTHENTIC SELF

WELLNESS

PSYCHOLOGICAL ENVIRONMENTAL ECONOMIC WELL-BEING SUPPORT SUPPORT

FIGURE 1 Mindfulness as a core in the conceptual framework.

means “to remember” or “presence of mind” (Brown, Ryan, & Creswell,2007, p. 212). Today, mindfulness is defined as “a receptive attention to andawareness of present events and experience” (Brown et al., 2007, p. 212). Inpsychotherapy, mindfulness is also used to teach participants to develop“moment-by-moment awareness, approaching ongoing experiences withan attitude of nonjudgment and acceptance” (Williams, Duggan, Crane, &Fennell, 2006, p. 201). Similar to existentialism, mindfulness builds a connec-tion between self-acceptance and the realization of environmental support.

Based on the cultural implications of mindfulness, many Asians believethat conscious awareness can engage them with reality and awaken their

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368 T. D. Luu and M. Cheung

sense of what is around them. A typical individual may hold this aware-ness briefly before automatically making an appraisal or judgment aboutthe present experience (Brown et al., 2007). Influencing behavior, judgmentmay allow people to maintain a harmonious order in their lives, but it mayalso direct them to a superficial, incomplete, or distorted picture of realitywhen the mind is not focused. In order to maintain a nonjudgmental attitude,mindfulness is a philosophy that reminds people to exercise an acceptingstate of mind before analyzing the facts being observed. In the analysis ofthe mind, Asians are seen to be more “present and nonjudgmental in inter-personal contexts. . . to maximize group harmony,” and Asian females arealso “more mindful and interdependent” in interpersonal relationships thantheir Asian male counterparts (Luk, Holman, & Kohlenberg, 2008, p. 185).Many Asian-Americans feel that being Asian means being mindful of theirculture and existence within the environment.

Mindfulness may vary in interpersonal and task-oriented contexts. Itis guided by seven core principles for cultivating an attitude of mindfulawareness that connects the self to the contextual environment (Bien, 2006;Luk et al., 2008):

1. Non-judging—Being nonjudgmental and not placing self-centered expec-tations onto others;

2. Patience—Understanding that things will unfold in time and maintaininga sense of serenity;

3. Beginner’s Mind—Seeing things as if for the first time to maintainneutrality;

4. Non-striving—Accepting things as they are from moment to moment;5. Trust—Trusting our own being and who we really are;6. Acceptance—Seeing and accepting things as they really are in the present

and not worrying about the past or future;7. Letting go—Letting go of any obstruction in our mind and coming back

to the center of our emotions to experience the meaning of existence.

With these principles, mindfulness encourages immediate focus on eventsas they occur without the influence of discriminative, categorical, or habitualthoughts (Brown et al., 2007). This focus aims to place consciousness ina readiness mode of objectivity to allow for healthier behavioral responsesto both internal reactions and external stimuli about injustice. “Being mind”(i.e., shifting the mind in which the experience is perceived) is a first steptoward acceptance by self and others (Crane & Elias, 2006).

Step 2: Connecting Theory to the Studied Variables

Mindfulness is used in this framework as a tool to motivate people to feelemotionally ready when they are present with uncomfortable feelings and

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thoughts. This readiness helps people face difficulties before they untanglethemselves from discomfort, especially in the coming-out process with theirfamily members (Fruhauf, Orel, & Jenkins, 2009; Hanh, 2001). Heppner andKernis (2007) use the model of self-identity to connect mindfulness with thebehaviors of identifying with one’s authentic self and receiving acceptancefrom others. As an important component in mindfulness, self-acceptancepromotes authenticity with a low level of ego defensiveness, which canlessen a person’s self-protective reactivity (i.e., self-blame, secret keeping,denial) and thus prevent self-turmoil.

Societal acceptance is another component in mindfulness. Various re-search studies have been conducted on attitudes toward homosexuals in theUnited States but they tend to report a more negative attitude in the Asiancommunities when compared with the dominant European-American cul-ture. Span and Vidal (2003) found that Asian students consistently showedmore negative attitudes toward homosexuality than their Caucasian coun-terparts. Lippincott and associates (2000) studied Asian international stu-dents who were more likely to have significantly higher levels of discomfortwith homosexuals as compared to American students. Meston, Trapnell, andGorzalka (1998) discovered that Asians born or those with a longer residencyin a Western country such as Canada were less likely to have negative at-titudes toward homosexuality. Contrary to these findings, a study by Lottesand Kuriloff (1992) found no significant race differences in attitudes towardhomosexuals between Whites, Blacks, and Asians in the United States. Thesefindings indicate that while more negative attitudes prevail for Asians outsidethe United States, the attitudes for those living in the United States are morepositive, which may reflect the effects of acculturation.

Aside from culture, gender plays a significant role in coloring individ-ual perceptions and attitudes toward homosexuality. Although both malesand females were found to have negative attitudes toward homosexuals,both studies in Herek (1988) and Herek and Capitanio (1995) found thatheterosexual females were not as negative toward gay men as heterosexualmales. Meston and associates (1998) also reported that although CanadianAsian males were more liberal in many behavioral and attitudinal indicators,they were more negative than their female counterparts in attitudes towardhomosexuality. In general, men and women shared similar attitudes towardlesbians (Herek & Capitanio, 1995).

There has been minimal research focused on Vietnamese Americans’attitudes and beliefs toward GLBT issues. Nevertheless, homosexuality, es-pecially lesbianism, has not been a familiar concept to most Vietnamesepeople (Colby, Cao, & Doussantousse, 2004). Although there have not beenany laws against homosexuality in Vietnam, local people still regard homo-sexual behavior as a “social evil” (Blanc, 2005). As a general perception, Viet-namese people view homosexuality as a trendy fashion—not a stable socialidentity (Blanc, 2005; Colby et al., 2004). In studies of Vietnamese-Americans’

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attitudes toward gay men, respondents felt that extreme homophobia existsin the Vietnamese-American community (Carrier et al., 1992) and sexualityissues are important contextual considerations when GLBT Vietnamese indi-viduals try to adapt in the American environment (Masequesmay, 2003). Ina study of 314 GLBT Asian people’s attitude toward openness about one’ssexual/gender identity, Kimmel and Yi (2004) found that the subjects wholived in the United States tended to be more open about their views ofhomosexuality than those who lived in Asian countries.

Self-acceptance and acceptance by others allow mindfulness to surface.Although Buddha did not explicitly connect mindfulness to homosexuality,bisexuality, or the state of one’s gender identity, he espoused an adaptationperspective for the mind that aims to lessen human suffering with a strongemphasis on acceptance (Gilpin, 2008). This perspective can be used toexamine the struggles many GLBT Vietnamese-Americans face when tryingto reconcile self-acceptance and societal expectations. Certainly, the call fornonjudgmental self-acceptance in the present moment is an ideal model toexamine how the self-discovery journey of accepting one’s sexual orientationand identity can be completed with support from others.

Step 3: Linking Important Concepts to the Problem

The behavioral manifestation of self-blame and self-concealment plays acrucial role in causing psychiatric problems. A number of studies indicatethat internalization (self-blame) is a major factor in depression and suicide(Gilbert, Irons, Olsen, Gilbert, & McEwan, 2006; Ingram, Trenary, Odom,Berry, & Nelson, 2007; Yen & Siegler, 2003). Two other studies foundthat self-concealment was a predictor of greater depressive symptomatology(Kawamura & Frost, 2004; Kelly & Yip, 2006) while, interestingly, anotherstudy found that self-concealment and social self-efficacy did not mediatethe relationship between acculturative experiences and depressive symp-tomatology (Constantine, Okazaki, & Utsey, 2004). Furthermore, Eller andcolleagues (2005) found that denial and avoidance were important copingstrategies among people with HIV. Compas and colleagues (2006) founddenial to be related to higher levels of anxiety and depression. Crane andcolleagues (2008) found that a mindfulness-based treatment modality helpedreduce self-discrepancies and increase self-regulated behavior toward re-covery from depression and reduction of suicidal behavior. Although theseconcepts about the self are emphasized in the theory of mindfulness, noneof these studies have focused on the effects of self-acceptance or rejectionon the Vietnamese population.

Step 4: Establishing a Research Agenda

Another dimension in this framework addresses how to initiate a researchproject to examine the relationship between self-directed behavior and the

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internal and external aspects of acceptance. Once a GLBT individual sensesno support in the environment, he or she will develop internal defenses thatmay decrease his or her motivation to seek help. Correspondingly, in theVietnamese culture, the effective use of one’s internal power to fight againstnon-acceptance is strongly related to the presence of mindfulness. Thus, inthis framework, both internal and external dimensions are included in theanalysis.

INTERNAL FACTORS: SELF-BLAME, SELF-CONCEALMENT, AND DENIAL

Internal factors such as self-blame, self-concealment, and denial play salientroles in moderating the propensity to seek help. Specifically, Carrier andcolleagues (1992) found that Vietnamese men who have sex with other menreported that they were very reluctant to come out or talk about their sexualorientation. Another study revealed that fewer Vietnamese-Americans thanNorth Americans communicated about diseases such as HIV and AIDS (Yi,1998). As a result of the stigmas attached to homosexuality, Yoshioka andSchustack (2001) reported that their Southeast Asian participants concealedfrom their families their HIV status and sexual orientation.

There is a strong belief that the family unit and the collective communitywill suffer great loss of face and shame from the sexual orientation and re-lated problems presented by a family member. Furthermore, Vietnamese in-dividuals who conceal their problems do not get any support to seek help. Ina qualitative study of Vietnamese attitudes toward mental illness in Vietnam,Nguyen (2003) argues that it is possible that Vietnamese individuals pre-fer to conceal mental health problems rather than risk being stigmatized.Certainly, Asians may be more self-concealing because of strong cultural at-titudes about what is or is not appropriate to discuss with outsiders (Akutsu &Chu, 2006). Another study found that Amerasian Vietnamese refugees werevery reluctant to disclose details about their lives or enter into any therapeu-tic services and were likely to withhold or distort the truth about personalproblems (McKelvey, 1994). Morrow (1987) found that the shame of mentalor emotional problems was so great that Southeast Asians had spent timetalking around the subject rather than disclosing it. Liao, Rounds, and Klein(2005), using a sample of Asian and Asian-American college students, foundthat self-concealment was more negatively related to attitudes toward coun-seling among these students than with white American students. Yoo, Goh,and Yoon (2005) also found that Korean students living in Korea who hadgreater self-concealment levels and more negative social network orienta-tion had more negative attitudes toward seeking professional help. Althoughnone of these studies focused on the GLBT Asian population, Nguyen andAnderson (2005) found that the Vietnamese-American respondents who ex-pressed greater willingness to discuss and be open about personal problems

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were more likely to seek professional services and have greater confidencein the benefits of such services.

Certainly, these studies support the inclusion of internal factors such asself-concealment, self-blame, and denial in the framework to explain Asianpeople’s reluctance in seeking help. However, as some of the discussed stud-ies suggest, it may be useful to operationalize these three concepts in rele-vant cultural terms. For example, self-concealment may be operationalizedto measure feelings associated with traditional Vietnamese beliefs involv-ing shame, suffering, and loss of face. Self-blame may be operationalizedin terms of Vietnamese values involving collective and familial dishonor,personal sacrifice, and problem internalization (i.e., taking self-blame ratherthan blaming others). Finally, denial may be operationalized in terms of pro-tection of honor, maintenance of harmony, and unacceptability of personalfailures.

EXTERNAL FACTORS: PRIOR THERAPY EXPERIENCE AND ACCULTURATION

Studies have found that prior therapy experience was proven to positivelypredict mental health service-seeking behavior (Chen, & Mak, 2008; Wilson,Rickwood, & Deane, 2007). It is commonly agreed that once a client hastried and received benefits from these services, he or she will continue withthe services. Many of these studies, however, focused the observations onhealth care, not mental health service utilization (see Chung & Lin, 1994).However, prior therapy experience may be operationalized as reaching outto find out about services and actually attending therapy sessions.

Research indicates that a higher level of acculturation to American cul-ture translates to a higher level of acceptance of help seeking of Westernhealth services among Asians (Chung & Lin, 1994; Kim & Omizo, 2003). Astudy by Ownbey and Horridge (1998) found a strong relationship betweenthe length of United States residency and acculturation, but this relationshipdoes not link to service utilization. According to Suinn (1992), acculturationcan be operationalized and measured through variables such as language,identity, friendship choice, behaviors, generation/geographic history, andattitudes. These variables serve to differentiate the attitudes and behaviorsbetween those who are more acculturated and less acculturated into Ameri-can society.

MORE EXTERNAL FACTORS: ECONOMIC OR FINANCIAL SUPPORT

External support and conditions such as ability to pay out of pocket for men-tal health services or insurance availability may also impact help-seekingattitudes and behaviors. A report by the U.S. Surgeon General indicatedthat U.S. ethnic minority clients often are unable to afford mental healthservices because of a lack of health insurance and poor financial means

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(McCarthy, 2001). Another study found that among Asians, lack of finan-cial resources prohibits seeking help for psychiatric problems (Lauber &Rossler, 2007). In addition, Wong and colleagues (2006) found that amonga group of U.S. Southeast Asian refugees, the greatest barrier to mentalhealth services was their inability to pay for the cost of services. As partof the mindfulness culture, economic stability is an important determinantfor Vietnamese-Americans when they reach out for help. Therefore, externalfactors such as self-support and financial support may affect help-seekingattitudes, so it is important to operationalize such variables in terms of eco-nomic options for payment of services. For example, external factors maybe measured through dimensions such as insurance coverage, Medicare andMedicaid options, self-pay, and availability of loans for services.

STEP 5: ANALYZING THE USE OF THE FRAMEWORK

This framework of mindfulness addresses three phenomena that are relatedto GLBT Vietnamese-Americans’ help-seeking behavior: self-blame, inter-nal and external factors, and help-seeking choices. First, the mindfulnessperspective calls for self-acceptance in a nonjudgmental manner so that en-vironmental support can be obtained. If a Vietnamese-American individualaccepts himself or herself and finds acceptance from others, this individualwill find an authentic self that integrates an ability to think, feel, and dowhat comes naturally to achieve an optimal level of body-mind-spirit con-nection. However, if the individual does not accept himself or herself andoften uses self-blame to react to criticism, he or she will use secret keepingor self-concealment as a defense mechanism. Without proper handling of theproblem, defensive behavior and long-term concealment will lead to men-tal health issues and illnesses (e.g., suicidality and depression mentioned inmindfulness-based treatment research described previously).

The second component is related to self and others—internal and ex-ternal factors. Internal factors that affect reaching out include self-blame,self-concealment, and denial. External factors include environmental supportsuch as prior therapy experience and acculturation, and economic supportsuch as ability to pay for services. With both internal and external support,a GLBT individual not only can find cultural support, but can also deal withmany barriers to accessing appropriate mental health services.

Third, help-seeking attitudes and behaviors can affect actual family in-volvement and social service utilization. How change in attitudes can affectVietnamese-Americans in change of behavioral actions can be illustrated bythe six stages of change described in the Transtheoretical Model of Change.These stages include the following:

• pre-contemplation (i.e., lack of a perceived need or intention for change),• contemplation (i.e., awareness of problem but lack of commitment for

change),

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• preparation (i.e., decision to change through small behavioral and mentalactions),

• action (i.e., overt behaviors to change),• maintenance (i.e., continuation of actions to sustain change), and• relapse (i.e., a resumption of old behaviors) (Petrocelli, 2002).

There is evidence of the utility, validity, and reliability of this model inthe process of change from intent to actual behavior (Forsberg, Halldin, &Wennberg, 2003; Haller, Miles, & Cropsey, 2004; Morera et al., 1998). Threestages of the Transtheoretical Model of Change (pre-contemplation, contem-plation, and action) may be used to understand the four possible scenarios asderived from the two mindfulness dimensions—intent and actualization (i.e.,intent to seek help and the actual help-seeking behavior). In the best-casescenario, or “self-initiation,” the GLBT individual has shown intent to seekhelp and actually has reached out for help (action stage). In the acceptablescenario, or external support, the GLBT individual does not intend to seekhelp but actually has reached out and has received mental health serviceswith the help from families or friends. In the contemplative scenario (con-templation stage), or service barriers, the GLBT person has shown intent toseek help but does not actually reach out for help because of service avail-ability and other barriers. In the worse-case scenario, or self- and systembarriers, the GLBT person does not intend to seek help and does not actu-ally seek or receive help because the mind does not shift to the help mode,in which case no assistance can be delivered to the person who needs theservice (pre-contemplation stage).

Step 6: Identifying Research Outcomes

The ultimate outcome of this framework is to obtain research data to sup-port evidence-based programs. Based on the internal/external analysis, weidentify that personal and system barriers are the main issues for GLBTVietnamese-Americans seeking help. From the personal perspective, Zhang,Snowden, and Sue (1998) found that Asian-Americans were less likely thanwhite Americans to visit mental health centers and less willing to discusstheir mental health problems. From the system perspective, another studyfound a majority of Asian-Americans terminate mental health services treat-ment prematurely to avoid the shame or stigma attached to psychologicalproblems (Shum, 1996). Bearing the image of being a model minority, Asian-Americans have been underrepresented in mental health service utilization(Kim & Omizo, 2003; Lee et al., 2009).

Added to the environmental dimension is the sociocultural perspective.Young, Bukoff, Waller, and Blount (1987) state that Southeast Asians re-ported high rates of mental problems but most of them did not use any

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psychiatric services. Another study by Holzer and colleagues (1985) foundthat the Vietnamese people do not use mental health services and avoid ser-vices where mental health providers represent a different culture. Even if theyutilize services, they do not use mental health specialists, but rather turn tophysicians of Vietnamese or Chinese ethnicity for help. Other studies focus-ing on the Vietnamese-American population and underutilization of mentalhealth services have found this group especially vulnerable to difficultiesand at higher risk for the development of serious mental disorders (Chung &Lin, 1994). One study found that common mental health problems in South-east Asian populations consisted of posttraumatic stress disorder, depression,and anxiety (Braun & Browne, 1998), but their utilization of mental healthservices was almost nonexistent (Phan, 2000). In a comparative study of Viet-namese, Polish, Romanian, Iraqi, and Hmong populations, the Vietnameseparticipants reported the fewest number of symptoms in mental health as-sessments (91% reported having three or fewer mental health symptoms),but the results indicated their reluctance to report problems rather than anactual count (Young et al., 1987). Research has reported an emphasis onvalue dimensions such as protecting family honor from shame and dealingwith personal problems in a private manner (Kim & Omizo, 2003).

Although no specific studies have yet addressed GLBT Vietnamese-Americans’ help-seeking behaviors, Phan (2000) advised that future studiesmust deal with the clients’ willingness to seek help. With this conceptualframework, internal/external support becomes an essential element to beincluded in a future research plan that connects treatment to help-seekingbehavior.

IMPLICATIONS ON RESEARCH AND EDUCATION

Mindfulness as a theoretical concept explains the barriers of stigmatization inmental health within the Vietnamese-American community. From the exter-nal perspective of this framework, GLBT is a taboo attached with a perceptionthat shames the Vietnamese-American community and makes the entire com-munity look weak. The great tragedy is that the problem is so well-hiddenthat it adds to the wider illusion that Vietnamese-Americans are an idealminority (PBS, 2009). Since Vietnamese individuals are reluctant to speakabout their own mental anguish or need for mental health services, familymembers collude in hiding the problem. Thus, many Vietnamese-Americanswho have serious mental problems resist obtaining external help for fear ofdamaging the family and community image (Lee at al., 2009). Because theissue is often swept under the rug and/or dealt with in a quiet manner, theinternal self-perspective must also be analyzed when the GLBT individual’sneeds are being examined. As more Asian-American professionals enter themental health field, their research will shed light on the hidden problem.

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In counseling and social work education, the step-by-step process ofestablishing this framework provides a basis for structurally understandingthe process of conducting research. In this framework, self-identity is anintegral part of psychological well-being and, as the current model makesclear, either or both self-rejection or external rejection can have a detrimentalimpact on psychological well-being. However, the impact may be even morenegative for GLBT Vietnamese-Americans because of the extreme level ofhomophobia and rejection of nontraditional cultural values in the commu-nity, especially as the phobia is related to one’s acceptance of self-identity.It is a vicious cycle as these individuals blame themselves, remain secretive,do not receive any support, and therefore deny themselves the option toseek mental health services.

The implications for research in family studies are clear. Currently, theresearch on mental health issues in the GLBT Vietnamese-American commu-nity is underdeveloped. Future research must address how self-acceptanceis being affected by acculturation and how self-concealment may connectto the measure of mental health needs in this community. Further examina-tion of reluctance to seek help can tie to both internal and external factorsthat influence an individual’s help-seeking decision. As a practical matter,more research will encourage practitioners to conduct needs assessments toevaluate the difficulties faced by this population.

The framework-building process for this study can be used as an exam-ple to provide a guide for researchers to integrate theories into the exami-nation of important variables. In this study, we use the mindfulness conceptto start the connection between self and others so that service barriers canbe examined from both internal and external perspectives. This frameworkidentifies the importance of cultural sensitivity when dealing with culturaltaboos of sexual orientation and identities. Research has already indicatedthat programs that adequately address the cultural needs of the Vietnamese-American community can motivate service utilization and create greater ser-vice satisfaction among Vietnamese-Americans (Akutsu, Tsuru, & Chu, 2004;Phan, 2000; Silove et al., 1997). Once the framework is tested with inter-vention programs that focus on connecting these variables, researchers andpractitioners can continue the outreach to those GLBT individuals to effectchanges that connect services with a special emphasis on the Vietnamese cul-ture. Culturally sensitive assistance that focuses on mindfulness is a positivestep toward helping a rarely addressed population in family-based services.

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