Despite the high and increasing prevalence of poverty in the United States, psychologists and allied professionals have done little to develop mental health interventions that are tailored to the specific sociocultural experiences of low-income families. In this article, we describe the sociocultural stressors that accompany the material deprivations of poverty, and the mental health difficulties to which they often give rise. Next, we outline the psychosocial and class-related issues surrounding low-income adults' access to and use of mental health services and suggest a conceptual framework to guide the modification of mental health practice to better accommodate poor peoples' complex needs. This framework describes opportunities for practice modification at three levels of intervention, beginning at the individual level of traditional individual psychotherapy and subsequently targeting increasingly broad contextual elements of poverty.

As poverty rates in the United States increase, women continue to be disproportionately represented among individuals in poverty. As a result of their poverty, low-income women experience a range of acute stressors and chronic life conditions, within a sociopolitical climate that is highly stigmatizing. Not surprisingly, low-income women experience mental health issues at substantially higher rates than their higher-income counterparts. Despite the clear need for mental health services for this population, rates of access to treatment are low and attrition rates are high. The minimal research examining treatment outcomes for low-income women reveals mixed findings. Further, there is little research on low-income women's qualitative experiences of therapy; the role of their poverty and what they perceive to be meaningful and effective. The present study attempted to fill the gap in our understanding of low-income women's psychotherapy needs and experiences, in an effort to offer new insights about directions for research, training, and practice that can improve mental health services for this highrisk population. This study employed a qualitative descriptive methodology to explore low-income women's (n=10) experiences in traditional outpatient psychotherapy, with a particular focus on how poverty shaped their experiences and what they perceived to be most effective and meaningful. Six clusters emerged from data analysis: Awareness, Instrumental support and flexibility, Building strengths, Respect and dignity, Shared power, and Authenticity. These clusters, in turn, coalesced into three overarching themes: Awareness, Practices, and Relational Quality. Awareness pertains to participants' sense that their therapist understood the nature of poverty and was sensitive to the role of poverty-related stressors in their clients' lives. Practices reflects therapists' willingness to respond directly and actively to participants' poverty-related needs, as these are inextricably intertwined with their mental health. Relational quality refers to the participants' view of how therapists approached relational dynamics; in particular, how they negotiated issues such as power and transparency. Findings are discussed in the context of feminist theory and current research. Limitations are also presented along with recommendations for future research, training, and practice. i Low-Income Women and Therapy 1 Chapter 1: Introduction Research on health disparities has demonstrated dramatically that a variety of marginalized populations in this country have relative difficulty securing effective health services in general (e.g.,

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