The Role of Outcome Expectations and Attitudes on Decisions to Seek Professional Help David L. Vogel Iowa State University Stephen R. Wester University of Wisconsin—Milwaukee Meifen Wei and Guy A. Boysen Iowa State University Two studies examined the predictors of seeking psychological services. Study 1 examined the role of attitudes in mediating the relationship between 11 psychological factors and intent to seek help for 3 psychological problems. The results demonstrated that (a) the psychological factors and attitudes predicted 62% of the variance in intent to seek help for interpersonal problems and 18% of the variance for drug problems and (b) attitudes toward counseling mediated most of the relationships between the different psychological factors and help-seeking intent. Study 2, in turn, demonstrated that (a) anticipated outcomes of talking with a counselor were associated with the use of psychological services and (b) anticipated risks of disclosing emotions were salient for those having experienced a distressing event. Keywords: help seeking, intentions, attitudes, anticipated risks, anticipated benefits Psychotherapy has been described as “a potentially difficult, embarrassing, and overall risky enterprise . . . [that can] induce fear and avoidance in some individuals” (Kushner & Sher, 1989, p. 256). Consistent with this statement, the extant literature consis- tently reports that people see counseling as a last resort (Hinson & Swanson, 1993), that they would prefer to handle things on their own or in conjunction with individuals close to them (Wills, 1992), and that less than one third of the people who could likely benefit from psychological treatment obtain such services (Andrews, Is- sakidis, & Carter, 2001). This presents a serious problem. It seems as if a large majority of those who could likely benefit from psychological counseling do not seek such service. Perhaps a better understanding of the reasons underlying people’s decisions to seek counseling could allow the profession to reach out to those who need services (Komiya, Good, & Sherrod, 2000). A number of psychological factors have been examined in relation to help seeking for psychological problems. For example, individuals are more likely to seek counseling when they perceive their problems as more severe than the problems of others (Good- man, Sewell, & Jampol, 1984) and when they sense that their decision to do so will reduce their feeling of distress (Mechanic, 1975). Individuals with a social network that accepts and encour- ages help seeking rather than rejects or discourages help seeking may also be necessary for the person to see seeking help as a positive choice (Friedson, 1961; Rickwood & Braithwaite, 1994). At the same time, concerns of being perceived as crazy can decrease the chances an individual will seek out services even when the potential consequences of not seeking counseling ser- vices (i.e., increased suffering) are severe (Sibicky & Dovidio, 1986). Indeed, studies have demonstrated several psychological factors that inhibit help seeking from a professional. These psy- chological factors are fear of treatment (Amato & Bradshaw, 1985; Kushner & Sher, 1989; Pipes, Schwarz, & Crouch, 1985), antici- pated costs (Vogel & Wester, 2003), desire to avoid discussing distressing information (Cepeda-Benito & Short, 1998; Cramer, 1999; Kelly & Achter, 1995; Vogel & Wester, 2003), desire to avoid experiencing painful feelings (Komiya et al., 2000), and desire to avoid the social stigma or negative judgments from others (Deane & Chamberlain, 1994). Despite the potential significance of these psychological factors, however, a direct examination of multiple psychological factors simultaneously with help seeking is needed. Researchers have tended to examine the role of these psychological factors in iso- lation from one another. As a result, we do not know the relative effect of the different factors on people’s decision to seek help. This is an important omission in the literature, as some contradic- tory results exist across studies regarding the importance of dif- ferent factors. Some studies, for example, have reported that psy- chological distress and social support do not significantly predict help-seeking intent (Kelly & Achter, 1995; Vogel & Wester, 2003), whereas others show a connection between these factors and intent to seek help (Cepeda-Benito & Short, 1998; Cramer, 1999). Similarly, other studies have demonstrated that certain factors that should decrease or inhibit help seeking, such as the desire to avoid self-disclosing painful feelings or fears about what therapy will be like, affect help-seeking decisions (Kelly & Achter, 1995; Kushner & Sher, 1989; Vogel & Wester, 2003), whereas others do not (Carlton & Deane, 2000; Deane & Todd, 1996). As a result, it is important to directly examine these psychological factors simultaneously with a more sophisticated analysis such as structural equation modeling (SEM). By doing so, researchers will be able to better understand what factors have a unique effect on David L. Vogel, Meifen Wei, and Guy A. Boysen, Department of Psychology, Iowa State University; Stephen R. Wester, Department of Psychology, University of Wisconsin—Milwaukee. Correspondence concerning this article should be addressed to David L. Vogel, Department of Psychology, Iowa State University, W149 Lagomar- cino Hall, Ames, IA 50011-3180. E-mail: dvogel@iastate.edu Journal of Counseling Psychology Copyright 2005 by the American Psychological Association 2005, Vol. 52, No. 4, 459 – 470 0022-0167/05/$12.00 DOI: 10.1037/0022-0167.52.4.459 459