Considerable changes in the population characteristics of the United States, both in numerical and in percentage terms, reflect an unprecedented demographic complexity in the history of the nation. Thirty-one percent of the total U.S. population is composed of ethnic and racial minorities. In addition, 11% of the total U.S. population is foreign born; of these, 51.7% are from Latin America and 26.4% are from Asia. For the first time in history, the United States is experiencing a large proportion of children and young adults who are not of European ancestry and do not speak either a Germanic language (including English) or a Slavic language as their first language.
Changes in the information collected in the most recent U.S. Census, such as mixed-race status, same-sex couples, and grandparental caregiving, have provided a rich, albeit complex, demographic landscape. Some of the demographic changes influencing the research, teaching, and practice of counseling psychology are summarized in this section.
Race and Ethnicity
The ratio of persons of color to Whites increased from 1 out of every 8 persons in 1900 to approximately 1 out of every 3 in 2000. Most of the increase in racial and ethnic diversity occurred in the latter part of the 20th century, with an increase of 88% from 1980 to 2000 in the combined non-White and Latino/a population. The Asian and Pacific Islander population tripled while the White population dropped 12 percentage points between 1970 and 2000. In addition, the option to select more than one racial group in the 2000 census identified 6.8 million (2.4%) multiracial individuals. The increase in racial and ethnic diversity in the United States has been attributed mainly to unprecedented international migration rates from Latin America and Asia/Pacific Islands and higher birth rates for these groups. Latinos/as, an ethnic category that includes any race, is the fastest-growing segment of the population with an increase from 6.4% in 1980 to 12.5% of the total population in 2000.
The proportion of older people is increasing and that of younger people is decreasing, particularly for White groups. The number of people age 65 years and older increased 10 times since 1900, with a total of 35 million, or 12.4% of the population, in 2000. This number is expected to increase again substantially in the 2010s when baby boomers begin approaching conventional retirement age. The proportion of the population of children under 15 years of age has declined since 1900, dropping from 1 out of every 3 (35.5%) individuals to 1 out of every 5 (21.4%) in 2000. The increase in racial diversity in immigration has also influenced the age composition of the United States, with younger age cohorts having a greater percentage of individuals of color than older age cohorts. Latinos/as have the youngest median age and have the highest percentage of children under 15 (32%), while non-Latino Whites have the oldest median age and lowest percentage of children under 15 years of age.
Households and Family Structure
The U.S. Census 2000 reflected a growing complexity in household composition. Fifty-two percent of all households were composed of married couples while 9% of coupled households were composed of unmarried couples, a figure that increased 63% from 1990 to 2000. The number of unmarried couples is likely larger because the census restricted responses to only heads of households and their partners. African Americans and Native Americans/Alaskan Indians had the largest percentages of unmarried couples with 16.9% and 17.4%, respectively, while Asians had the lowest reported rates with 4.7%. The one-person household experienced the greatest growth and was 26% of all households in 2000. In addition, 1 out of every 9 households described as composed of unmarried partner couples were same-sex unions in the 2000 census. Approximately 1 out of 4 same-sex couples are parenting children under 18 years old.
About 5.8 million grandparents were identified as living with their grandchildren in the U.S. Census 2000, and 2.4 million were identified as the primary caregivers of these children. Grandparents residing with their grandchildren and serving as caregivers were more common with non-Whites and Latinos/as. However, Latino (35%) and Asian (20%) grandparents living in mutigenerational households are less likely to be caregivers than African Americans (52%) and Native Americans/Alaskan Natives (56%).
Mental Health Care Need and Use
Findings from different studies converge to highlight high prevalence of unmet mental health care needs.
Forty-six percent of adults in the United States are predicted to meet diagnostic criteria for a mental health disorder in their lifetime, according to findings from the National Comorbidity Survey Replication. The Survey also found that only 41% of adults in need of mental health services received treatment with rates of unmet need greater for ethnic and racial minority groups, the elderly, and the poor. Data on mental health service use for children and adolescents are even more disheartening, with 79% of those with mental health needs going unmet. Similar to the adult population, ethnic/racial minority children and adolescents have higher rates of unmet mental health needs (African Americans 76.5%, Latinos/as 88.4%, Other 89.7%) than Whites (76%).
Ethnic/racial minority status, low educational level, and low income have been found to be associated with premature termination of mental health services. For example, once services are initiated, African American families have been found to have attrition rates greater than 50%. African Americans have also been found more likely to receive low-quality psychiatric care, which may partially explain the high attrition rates. Being Latino/a, particularly of Mexican descent, has been associated with low use of mental health services. Only 15% of Mexican immigrants and 37% of U.S.-born Mexican Americans with psychiatric disorders have been found to receive care from a general practitioner, mental health professional, other professionals, or informal helpers to address their mental health needs.
In addition, findings from the McArthur Foundation National Survey of Midlife Development in the U.S. suggest that individuals with minority sexual orientation (e.g., lesbian, gay, bisexual) have higher prevalence rates of major depression, panic attacks, psychological distress, and generalized anxiety disorder than do heterosexual men and women. Lesbians, gay men, and bisexual individuals have been found to use mental health services more than their heterosexual counterparts and account for 7% of adults between the ages of 25 and 74 receiving mental health services.
Implications for Counseling Psychology
The demographic characteristics of counseling psychologists in the United States, as reflected in the membership to American Psychological Association’s Society of Counseling Psychology, suggest that approximately 11% of counseling psychologists at the doctoral level self-identify as non-White or Latino/a, falling short of reflecting Census 2000 data by two thirds. The average age of counseling psychologists (57 years) reflects the fact that 78% of members are White, which is the oldest racial group in the United States. This high number of older members also suggests that the number of younger people entering the field is relatively low and that fewer counseling psychologists will be available to address the needs of Latinos/as, Asians, and Blacks, who are the youngest groups, and of individuals with minority sexual orientations in the near future.
Recent research suggests that ethnic match between therapist/counselor and client is not a strong predictor of mental health service use or premature termination of treatment, suggesting that culturally competent and responsive care may be more predictive of use and continuation of services than the ethnic or racial status of the counselor. This emphasis on cultural competence and culturally responsive care has two major implications for both practicing and counseling psychologists in training. First, it suggests a focus on ethnic-specific or minority group-specific (e.g., individuals with minority sexual orientations) mental health needs and program development. Second, it emphasizes the increasing importance that counseling psychology training programs include in their curricula ethnic-specific engagement and treatment retention strategies and minority group-specific concerns. Moreover, the increasing ethnic and racial diversity of the United States and the greater visibility of lesbians, gay men, and bisexual individuals point to the need to recruit more young individuals to join the profession.
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