Chinese International Students’ Satisfaction with University Mental Health Counselling: A Mixed-Methods Study on the Impacts of Language Barriers, Cultural Differences and the Working Alliance

Abstract

Background: Chinese international students may experience language and cultural challenges when using university counselling services. This study examined the associations between perceived language barriers, cultural differences, and counselling satisfaction and explored students’ counselling experiences using a mixed-methods approach. Methods: An explanatory sequential mixed-methods design was used. A total of 125 Chinese international students with previous university counselling experience completed an online questionnaire assessing counselling satisfaction, perceived language barriers, and cultural differences. Descriptive statistical analysis, group comparisons, correlation analysis, and multiple regression were conducted. Subsequently, 10 participants completed semi-structured interviews. Interview data were analyzed using reflexive thematic analysis, and qualitative findings were integrated with the quantitative results. Results: Perceived language barriers and cultural differences were negatively associated with counselling satisfaction in bivariate analyses. In the regression model, cultural differences showed the strongest negative association with counselling satisfaction, whereas language barriers were no longer statistically significant. The model explained 18.2% of the variance in counselling satisfaction. Qualitative findings indicated that second-language use could create cognitive and communicative difficulties but could also provide emotional distance that facilitated disclosure. Participants also emphasized empathy, cultural responsiveness, trust, goal alignment, and therapeutic collaboration. Conclusions: Cultural differences may be particularly important in understanding counselling satisfaction among Chinese international students, while the role of language appears complex rather than uniformly negative. Alliance-related experiences may help students navigate linguistic and cultural difficulties. Further research should use validated measures of working alliance and language and cultural barriers.

The authors' abstract, as published at the source. Healthcare, 2026 · DOI ↗