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Attitudes toward sport psychology consulting of adult athletes from the United States, United Kingdom, and Germany

Abstract The purpose of this study was to explore attitudes about sport psychology consulting of athletes living in the United States, United Kingdom, and Germany. The Sport Psychology Attitudes ‐ Revised form (SPA‐R; Martin, Kellmann, Lavallee, & Page, 2002) was administered to 404 athletes from the United States, 147 athletes from the United Kingdom, and 260 athletes from Germany. A 2 (Gender) x 3 (Nationality: American, British, and German) × 2 (Type of Sport: physical contact and physical non‐contact) MANCOVA was conducted with past sport psychology consulting experience as a covariate and attitudes about sport psychology as dependent variables. Follow‐up univariate and discriminant function analyses were then performed to identify the attitudes that maximized differences related to gender, nationality, and type of sport. Results revealed that attitudes about sport psychology services might be influenced by gender, nationality, and type of sport. Sport psychology practitioners must be sensitive to how personal characteristics and past experiences influence athletes’ expectations and attitudes toward sport psychology consulting to improve the services they offer.

. In addition, previous exposure to professional sport psychological help, especially previous experiences that are perceived as positive, increase the likelihood that assistance will be sought in the future (e.g., Gould, Murphy, Tammen, & May, 1991;Schell, Hunt, & Lloyd, 1984). However, few studies have been conducted to determine how these various factors may interact with or influence expectations and attitudes.
Evidence from the counseling and sport psychology areas indicates that women express more willingness to seek medical and psychological help than men (Addis & Mahalik, 2003;Fischer & Farina, 1995;Guttman, 1999;Jordan & Quinn, 1997;Martin, Akers, Jackson, Wrisberg, Nelson, Leslie, et al., 2001;Martin et al., 1997;Wrisberg & Martin, 1994). Rigid or restrictive gender roles learned during socialization may result in personal constraint, devaluation, or violation of others or self (Good & Wood, 1995). In most societies, the male body and its muscles are associated with strength and power (Robinson & Howard-Hamilton, 2000) and a portion of the male gender role is to not discuss personal problems or admit vulnerability (Jordan & Quinn, 1997). Conversely, the client role emphasizes acknowledgment of weakness or the need for improvement (Robinson & Howard-Hamilton). Thus, the male and client roles seem rather discontinuous, which probably leads males, as compared to females, to be more apprehensive about seeking assistance from professionals (Addis & Mahalik, 2003).
In addition to gender, ethnicity or cultural identity may play an influential part of a person's openness or willingness to seek psychological assistance. Although data are available on adults' expectations and attitudes about seeking help from counselors and sport psychology consultants (see Martin et al., 2001), few data exist related to athletes' nationality, ethnicity, or cultural identity and their willingness and openness to seek sport psychology help (see Kontos & Breland-Noble, 2002;Martin et al., 1997;Wrisberg & Martin, 1994). Evidence from some counseling research indicates that attitudes toward seeking help are not solely a function of gender and ethnicity, but a function of their interaction (e.g., Ponterotto, Anderson, & Grieger, 1986). Although this interaction has not been shown in attitudes toward seeking sport psychology consulting of African-American and Caucasian athletes in the United States (Martin et al., 1997;Wrisberg & Martin, 1994), it may be seen in athletes from other ethnic groups. Several barriers may interfere with appropriate help-seeking behavior in various segments of the population. These barriers include fear that confidentiality will be breached, the belief that increased emotional psychological distress will occur, and the suspicion that consulting will not be useful .
Research on the socialization into and through sport indicates that competitive sports may also influence attitudes toward seeking assistance. Individuals learn which norms operate in a given social context through (a) observing the responses of teammates in particular situations, (b) being told by coaches what is appropriate behavior, and (c) observing how role models behave (Coakley, 2001). Persons often conform to social norms and experience the benefits of group acceptance and avoid negative group reactions, even though they may risk deindividuation (Cialdini & Trost, 1999). Other persons choose not to conform to social norms thus maintaining control over their lives but risking group rejection (Cialdini & Trost, 1999).
Males competing in sports often develop the belief that to be a man and an athlete requires them to learn to accept pain, physical risk, and injury in stoic silence whereas, female athletes gradually learn to accept pain and adversity as part of athletics but do not necessarily associate this with their identities as women (Messner, 1992;Nixon, 1996). Hence, male athletes may be more resistant to sport psychology services than female athletes (see Kontos & Breland-Nobles, 2002;Martin et al., 2001;Yambor & Connelly, 1991).
Sports that involve physical contact, power, and intimidation are grounded in the values and experiences of men, which work to the disadvantage of women being evaluated in these same sports (Coakley, 2001). Those athletes participating in sports that are physically demanding and involve bodily contact, physical intimidation, and possible injury due to other competitors (e.g., physical contact sports) may be socialized to accept pain, physical risk, and injury to a greater extent than those who compete in physical non-contact sports (Coakley, 2001;Messner, 1992). Anecdotal reports in the media (e.g., Tolson, Kleiner, & Marcus, 2000) and the number of books available related to specific sports and mental training skills provide some evidence that physical non-contact sport participants (e.g., golfers, gymnasts, tennis players, volleyball players) may be more receptive to sport psychology services than are contact-sport participants (e.g., American football players, rugby players, soccer athletes, wrestlers).
Past research indicates that attitudes toward sport psychology influence athletes' intentions to practice sport psychology skills (Greaser, 1992), influence their adherence to mental skills training following psychoeducational workshops (Bull, 1995), and determine future market opportunities for sport psychology consultants (DeFrancesco & Cronin, 1988;Schell et al., 1984). As a service oriented profession, it would seem important to examine athletes' attitudes toward seeking sport psychology consultation to determine if stigma tolerance is a mediator of help-seeking behavior. It would also seem important to explore whether participants of certain sports view sport psychology consulting more favorably than others. Learning the perceptions and attitudes toward sport psychology consultation of athletes from various countries and cultural backgrounds and who participate in various sport groups could help sport psychology practitioners target and promote positive attitudes about seeking psychological help and foster a less stereotypical and myth-laden view of counseling and sport psychology consulting (Martin, Kellmann, Lavallee, & Page, 2002).
Recent attempts have been made to develop a measurement tool to assess athletes' expectations and attitudes about sport psychology consulting (Harmison, Petrie, & Martin, 2001;Martin et al., 2001;Martin et al., 2002;Martin et al., 1997;Wrisberg & Martin, 1994). Martin and colleagues (2002) used both exploratory and confirmatory factor analyses to develop the Sport Psychology Attitudes -Revised (SPA-R) form. In addition, multiple group measurement invariance testing an extension of confirmatory factor analysis was used to evaluate the factor structure of the SPA-R instrument across samples of participants who differed in gender, nationality, and age. The SPA-R instrument was found to measure the same constructs across these various samples. The logical next step would be to determine whether these groups differ in mean level on the constructs assessed by the instrument (Floyd & Widaman, 1995).
The sport psychology literature needs more information assessing how athletes think and feel about sport psychology consulting. Consequently, the purpose of the present study was to investigate attitudes toward seeking sport psychology services of male and female adult athletes who participate in physical contact and physical non-contact sports in the United States, United Kingdom, and Germany. Based on previously mentioned literature, it was anticipated that there would be a difference between those who had seen a sport psychology practitioner and those who had no previous consulting experience. Likewise, as has been identified by subsequent research, a difference between male and female athletes' attitudes toward sport psychology consulting was expected. The present investigation extends previous research (e.g., Martin et al., 1997) by exploring whether athletes from different countries have different attitudes about sport psychology consulting. In addition, we investigate whether differences are evident between athletes who participate in sports that involve physical contact as compared to those who participate in sports that physical intimidation and physical contact with other individuals rarely if ever occur.

PARTICIPANTS
The sample was 811 athletes (440 males and 371 females) ranging in age from 18 to 27 years of age (M = 20.57, SD = 2.42). A total of 877 questionnaires were distributed during team meetings and classes. The athletes volunteered to participate in the study and informed consent was received prior to completing the questionnaires. Of the 877, 811 complete useable forms were returned, representing a 92% response rate. Included in the sample were 404 athletes from the United States (226 males and 178 females), 147 athletes from the United Kingdom (85 males and 62 females), and 260 athletes from Germany (129 males and 131 females). Of the 811 individuals surveyed, 128 (16%) had seen a sport psychology practitioner at least once.
Physical contact sports were defined as those sports that involve physical and verbal intimidation and possible physical injury due to another competitor as part of the strategies or rules of the game, whereas physical non-contact sports were considered to be those sports that physical intimidation and physical contact with another individual rarely if ever occur during competition (Coakley, 2001). Of the 811 athletes (see Table 1), 360 (246 males and 114 females) participated most often in physical contact sports (i.e., American football, baseball, basketball, boxing, net ball, rugby, soccer, softball, and wrestling) whereas 451 (194 males and 257 females) reported that they participated most often in physical noncontact sports (i.e., golf, gymnastics, rowing, swimming, tennis, track and field/cross country, and volleyball).

INSTRUMENT
The Sport Psychology Attitudes -Revised form (SPA-R; Martin et al., 2002) was used to determine athletes' attitudes toward sport psychology consulting. The SPA-R is a refinement of the Attitudes Toward Seeking Sport Psychology Consultation Questionnaire (ATSSPCQ; Martin et al., 1997). The SPA-R was translated into German and then independent of the first translation, it was translated back into English to maximize content equivalence and to lessen interpretation difficulties (i.e., the back-translation method, Brislin, 1970). Slight wording changes were made to the demographic section of the German and British SPA-R forms (see Martin et al., 2002). The SPA-R is comprised of a demographic section and a section measuring attitudes toward sport psychology. The 13-item demographic section included questions about the athlete's age, gender, race, education level, primary sport participated in, number of years participating in that sport, number of sessions with a sport psychology consultant, level of consultant satisfaction, and willingness to consult in the future. The 25-item attitudinal section consists of four scales: (a) stigma tolerance, (b) confidence in sport psychology consulting, (c) personal openness, and (d) cultural preference. Respondents were asked to individually report their attitudes and beliefs about sport psychology consulting on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Test-retest procedures indicated that the SPA-R scales were .90 for stigma tolerance, .83 for confidence in sport psychology consulting, .71 for personal openness, and .70 for cultural preference. Coefficient alphas for the SPA-R scales were .84 for stigma tolerance, .82 for confidence in sport psychology consulting, .61 for personal openness, and .66 for cultural preference. Through various structural equation modeling procedures, the SPA-R was also found to have adequate stability across various samples (see Martin et al., 2002).

PROCEDURES
Institutional review board approval was obtained prior to data collection. Athletic administrators and coaches were contacted, subsequently agreed to participate in the study and to recruit student athletes involved in their programs. The SPA-R was administered to the student athletes during team sport meetings. The investigators read instructions for completing the inventory and informed athletes that their participation was voluntary. Informed consent was obtained from all athletes prior to their completion of the questionnaire. Respondents were assured of anonymity and that all data would be kept strictly confidential. Each participant was given an answer sheet and a question sheet. The instructions directed respondents to individually report their attitudes and beliefs about sport psychology consulting. The test administrators answered any questions and instructed the participants to answer each item as honestly as possible. Respondents took approximately 7 to 10 minutes to complete the questionnaire.

PRELIMINARY ANALYSIS
Because it was anticipated that prior sport psychology experience was related to attitudes about sport psychology consulting, a one-way multivariate analysis of variance (MANOVA) was conducted with prior consulting experience as the independent variable (experience vs. no experience) and the response mean scores on the four scales of the SPA-R instrument (i.e., confidence in sport psychology consulting, stigma tolerance, personal openness, and cultural preference) as the dependent variables. The MANOVA indicated significant differences in attitudes about sport psychology between those with and without prior sport psychology consulting experience, Wilks' Lambda = .93, F(4, 806) = 15.30, p = .0001, ȑ 2 = .07. Followup univariate analysis and discriminant function analyses were then performed to explore further this multivariate effect. These procedures revealed that confidence and stigma tolerance were the only dependent variables that were significant, F(1, 809) = 44.56, p = .0001, ȑ 2 = .05, r 2 = .80 and F(1, 809) = 16.06, p = .0001, ȑ 2 = .02, r 2 = .52; respectively. Specifically, the responses of athletes who had received sport psychology services (M = 5.09, SD = .97) indicated that they were more likely to be confident about seeking sport psychology services than were athletes who had no past experience working with a consultant (M = 4.46, SD = .96). Likewise, those who had never consulted a sport psychology practitioner had a greater stigma toward seeking sport psychology consulting (M = 2.68, SD = .93) than those who had already worked with a sport psychology consultant (M = 2.32, SD = .96). Because a relationship was discovered between prior consulting experience and attitudes about sport psychology, prior consulting experience was used as a covariate in the main analysis (see next section). Before performing this analysis, it was necessary to verify that the homogeneity of regression assumption had not been violated. No significant interaction (p > .05) between the independent variables and the covariate with the dependent variables was found when testing this assumption. Therefore, this assumption related to past sport psychology experience was not violated, making it possible to perform a multivariate analysis of covariance (MANCOVA) to examine whether differences exist as a function of gender, nationality, and type of sport.

MAIN ANALYSIS
A MANCOVA was conducted using the student athletes' mean scale scores as dependent variables and whether they had previously consulted a sport psychology practitioner as the covariate to determine if their attitudes and beliefs about sport psychology consulting could be differentiated by gender (male and female), nationality (American, British and German), type of sport (physical contact and physical non-contact), or any interaction of these factors. Descriptive statistics for the SPA-R scale mean scores are reported in Table 2. Gender. The results of the MANCOVA indicated a significant main effect for gender, Wilks' Lambda = .97, F(4,795) = 6.29, p = .0001, ȑ 2 = .03. Follow-up univariate and discriminant function analyses revealed that stigma tolerance, personal openness, and cultural preference were the dependent variables that were significant (see Table 3). The responses of male athletes (M = 2.79, SD = 1.01) indicated that they were more likely to stigmatize sport psychology consultants than female athletes (M = 2.43, SD = .81; see Figure 1). In addition, male athletes (M = 3.40, SD = 1.30) identify with their own culture, ethnicity or race more than female athletes (M = 2.96, SD = 1.24). Moreover, males were more likely than females to try to work things out on their own without seeking help (M = 4.48, SD = .85, M = 4.18, SD = .97; respectively). p < .05***, p < .01**, p < .001* Figure 1. Mean responses to SPA-R subscales as a function of gender.
Nationality. The MANCOVA indicated a significant main effect for nationality, Wilks' Lambda = .93, F(8,1590) = 7.70, p = .0001, ȑ 2 = .04. The follow-up analyses (see Table 3) indicated that athletes from the United States were more likely to have a stigma toward seeking sport psychology than were athletes from the United Kingdom and Germany, whereas athletes from the United Kingdom were more confident in sport psychology consultants and less likely to identify solely with their own nationality, ethnicity, or race than were the athletes from the United States and Germany (see Table 2 and Figure 2). Type of Sport (Physical Contact or Physical Non-contact). The results of the MANCOVA revealed a nonsignificant main effect for type of sport, Wilks' Lambda = .99, F(4,795) = 1.58, p = ns. Other groupings related to type of sport was analyzed using the same overall design. That is, the analysis was conducted with the sports grouped as individual versus team sports and then categorized as coactive, mixed, and interactive sports. All permeations related to type of sport produced nonsignificant results when gender and nationality were included into the design. The physical contact versus physical non-contact grouping seemed most logical in this case since we were investigating socialization into and through sport and whether participants in sports involving strength, possible body contact, and intimidation devalue help-seeking behaviors and reinforce individualistic mental toughness. When examining the descriptive statistics of each sport individually, athletes participating in wrestling and American football had the greatest stigma toward seeking assistance from sport psychology consultants.
Gender x Nationality x Type of Sport. The results of the MANCOVA revealed only one multivariate interaction, Nationality x Type of Sport, Wilks' Lambda = .98, F(8,1590) = 2.06, p = .008. The magnitude of the difference was low, ȑ 2 = .01. The univariate and discriminant function analyses (see Table 3) indicated that physical contact sport participants from the United States were more likely to have a stigma toward seeking sport psychology consultation than were the other groups (see Table 2 and Figure 3).

DISCUSSION
The number of sport psychology practitioners consulting with athletes, coaches, and teams has increased over the past two decades and more media attention has been given to the importance of mental training (see Brewer, Van Raalte, Petitpas, Bachman, & Weinhold, 1998;Martin et al., 2002). Based on previous athletes' exposure to sport psychology consulting research (Gould et al., 1991;Schell et al., 1984), it was not surprising to learn that athletes in the current study with previous consulting experience had a greater appreciation of sport psychology and mental skills and were less likely to be concerned about seeking future assistance than those who had no such consulting experience.
The findings of this investigation extend previous studies (e.g., Linder et al., 1991;Linder et al., 1989;Maniar et al., 2001;Martin et al., 2001;Martin et al., 1997;Van Raalte, Brewer, Brewer, & Linder, 1992;Van Raalte et al., 1990;Wrisberg & Martin, 1994;Yambor & Connelly, 1991) that have reported individual differences in people's attitudes about sport psychology consultation as a function of gender. In the present study, male athletes stigmatized sport psychology consultation more than did female athletes. In addition, female athletes seemed to be more accepting of ethnic backgrounds, cultures, or races other than their own and more willing to seek assistance, whereas male athletes were less likely to be open to seek assistance and less accepting of others. These findings are consistent with previous research assessing athletes' attitudes toward and expectations of sport psychology consulting (e.g., Martin et al., 1997), in which male athletes seem to identify with their own ethnicity, culture, or race more than do female athletes. Findings related to healthcare and prevention have been remarkably consistent and have shown that, as a group, men of different ages (e.g., Husaini, Moore, & Cain, 1994), nationalities (e.g., D'Arcy & Schmitz, 1979, and ethnic and racial backgrounds (Neighbors & Howard, 1987) seek professional help less frequently than do women (see Addis & Mahalik, 2003). Moller-Leimkuhler (2000) suggests that traditional social or cultural norms associated with masculinity, such as the inhibition of emotional expression, may hinder reporting and help seeking in males.
In this study, athletes from the United States, United Kingdom, and Germany exhibited slightly different attitudes toward sport psychology consulting, although these were minimal to say the least. Athletes from the United States were more likely to have a stigma toward seeking assistance from sport psychology professionals than were athletes from the United Kingdom and Germany, whereas athletes from the United Kingdom were more confident in the abilities of sport psychology consultants and less likely to identify with their own culture and ethnicity than were the athletes from the United States and Germany. Few studies exist related to athletes' nationality, ethnicity, or cultural identity and their willingness and openness to seek sport psychology help. Those that have examined these factors have produced mixed results (see Kontos & Breland-Noble, 2002;Martin et al., 1997;Wrisberg & Martin, 1994). Attitudinal differences between various cultural or social groups may be a result of different ideologies and social philosophies (Cohen, Guttmann, & Lazar, 1998) or public-targeted campaigns which highlight the need to improve attitudes and eradicate negative stereotypes surrounding seeking psychological help (Loewenthal, Macleod, Lee, Cook, & Goldblatt, 2002). In the United States, capitalist ideologies and individualistic social philosophies have shaped an ambivalent set of attitudes toward persons in need (Cohen et al.). Consequently, persons needing help are often devalued, and requesting aid is an activity frequently conducted in privacy (Cohen et al.). On the other hand, national crusades such as the Defeat Depression campaign, which ran between 1992 and 1996 in the United Kingdom, may have influenced some individuals' views about seeking professional psychological assistance (Loewenthal et al., 2002). Even prior to this campaign, research indicated that family doctors in the United Kingdom were frequently utilized and ranked with friends and neighbors as potential providers of help, whereas in the United States family doctors are far less frequently used helpers (see Barker, Pistrang, Shapiro, & Shaw, 1990). Identifying and then targeting certain populations or segments of society that tend to avoid seeking professional help could prove beneficial. Thus, sport psychology consultants need to educate athletic administrators, coaches, teachers, and parents that athletes, especially male athletes, should learn and develop appropriate help-seeking skills.
The type of sport that athletes have been socialized into and through may also play a role in whether help is sought from a sport psychology consultant. The results indicated that athletes competing in physical-contact sports in the United States might have a more negative view of sport psychology consulting than physical-contact sport participants from the other countries and the physical non-contact sport participants in all three countries. Many of the physicalcontact sport participants from the United States competed in American football. Athletes competing in physical-contact and masculine sports, especially those playing American football, may need to be provided with additional information about the benefits of mental training. This information may be viewed more positively if it comes from someone they revere such as a coach or role model from their particular sport (Barnett, 1993;Messner, 1992). Within some physical contact sport teams there are certain playing positions that require few instances where physical contact occurs such as a place kicker in football. Individuals playing these positions may utilize consultants more and view consulting differently than those playing other positions such as offensive or defensive line positions.
Sport psychology consultants may need to be aware of and sensitive to the unique characteristics of athletes, the sports in which they play, and the positions that they hold to reduce help-seeking barriers and facilitate healthy help-seeking behaviors. Generally, the findings of the present study indicate that sport psychology consultants may want to offer mental training skills to male athletes in a fashion that is different than that used to introduce the concept of mental training to female athletes, especially for those male athletes who participate in sports that emphasize physical contact and masculinity. Using phrases like "sport psychology skills" or "psychology and counseling services" may be less attractive to male athletes than phrases like "mental toughness strategies" or "performance enhancement services" (see Maniar et al., 2001). At least initially, the latter phraseology may stimulate some athletes to learn mental skills, adhere to mental training, and/or be open to seeking sport psychology services, to a greater extent than would the former phraseology.
Some limitations should be noted when interpreting the current results. The sample used was not a random representation of athletes from the United States, United Kingdom, or Germany, leading to possible threats to external validity. Instead, the athletes who participated were sampled by convenience and represented only a limited portion of the athletes in these countries. Moreover, athletes selected the sport that they primarily participated in at their respective level. However, many of the athletes competed in more than one sport and/or type of sport during their life (i.e., physical contact and physical non-contact). Therefore, it is possible that greater rigidity in gender typing of sport activities may be demonstrated by athletes participating in only physical contact or traditionally masculine sports (Messner, 1992;Sabo, 1988).

FUTURE DIRECTIONS
As the practice of sport psychology has entered an age of accountability (Anderson, Miles, Mahoney, & Robinson, 2002), a number of issues related to athletes' attitudes toward sport psychology consulting needs to be addressed in the future. In addition to continuing to evaluate gender, nationality, and type of sport as in the present study, information is needed regarding how personality type and athletic maturity influences expectations and attitudes about seeking sport psychology help. Athletes with an optimistic view and who compete at higher levels may possess more favorable attitudes toward seeking consultation than their lower level counterparts (Harmison et al., 2001). Further, there may be within-age group variation and within-ethnic/racial group variation, in addition to within-sport group preferences that exist for consulting (Kontos & Breland-Noble, 2002). Moreover, longitudinal studies investigating changes in help-seeking attitudes and behaviors need to be conducted (see Leffingwell, Rider, & Williams, 2001). Multicultural training and understanding the social contexts of a particular sport could help sport psychology practitioners improve athletes' and coaches' receptiveness to consulting (Butryn, 2002;Martens, Mobley, & Zi, 2000).