Recognizing social class in the psychotherapy relationship: A grounded theory exploration of low-income clients.

Abstract

The process of psychotherapy among 16 low-income clients was explored using grounded theory (Charmaz, 2006; Glaser & Strauss, 1967) in order to understand and identify their unique experiences and needs. Semistructured interviews were conducted with 12 women and 4 men who had attended at least 6 sessions of psychotherapy within 6 months of the interview. Our grounded theory that evolved depicted a tapestry of the dynamic process by which low-income clients experience social class within psychotherapy. Specific therapist behaviors that contribute to more and less positive experiences emerged from the data and pointed to the importance of acknowledging social class within the therapy room. The significance of therapists enhancing the 50-min hour via advocacy and meaningful moments within and outside of the therapy room was highlighted among all participants. Implications for practice with low-income clients and directions for future research are provided.

Influence of social class perceptions on attributions among mental health practitioners

“…These findings indicating that practitioners in this sample did not significantly differ in their perceptions of Pat even though they detected social class differences between the two versions of the vignette were somewhat unexpected based upon prior findings regarding differences in psychotherapy utilization rates, referrals, experiences, and outcomes among individuals from non-upper middle class backgrounds (e.g., Falconnier, 2009; Nadeem et al, 2008; Rabinowitz & Lukoff, 1995; Thompson et al, 2012). However, given the relative dearth of quantitative examinations of the impacts of practitioner perceptions of client social class within psychotherapy (Goodman et al, 2012; Stabb & Riemers, 2012) and the presence of some mixed findings in previous research (e.g., Garb, 1997; Smith et al, 2011), directional hypotheses may have been somewhat premature.…”

“…Lott (2002) argued that many psychologists share these prejudices and Smith (2005) posited that psychotherapists have attitudinal barriers that contribute to them engaging in classist behaviors in their clinical work. Perhaps these prejudices are also reflected in the dearth of research on attitudes toward poverty and the lack of a sophisticated understanding of attributions based on social class indicators in relationship to psychotherapy (e.g., Cozzarelli et al, 2001; Thompson, Cole, & Nitzarim, 2012; Williams, 2009). The purpose of this study was to examine the extent to which mental health practitioners’ attributions toward a hypothetical client varied based upon the social class cues used to describe the client in two versions of a clinical vignette.…”

Substance use disorders and racial/ethnic minorities matter: A meta-analytic examination of the relation between alliance and outcome.

“…There is also a need to examine how therapists culturally adapt their treatments (Benish, Quintana, & Wampold. 2012;Owen et al, 2012;Pan et al, 2011;Wong et al, 2007) and how they generate individual case formulations in complex psychosocial cases (Ridley & Kelly, 2007;Thompson et al, 2012). For example, strategies to resolve alliance ruptures (Gaztambide.…”

Social class and the therapeutic relationship: The perspective of therapists as clients. A qualitative study using a questionnaire survey

“…Liu, Pickett and Ivey () claim that all therapists are potentially classist, since verbally orientated therapy models are based on white, societal norms, with therapists being middle‐class by virtue of their profession. Moreover, since class enters every aspect of clinical work, whether explicitly or implicitly (Walkerdine, ), therapists’ and clients’ levels of social class‐consciousness can significantly impact on the therapeutic relationship (Ballinger & Wright, ; Balmforth, ; Kim & Cardemil, ; Thompson, Cole & Nitzarim, ).…”

“…The majority of studies into social class take the therapist's viewpoint (Ballinger & Wright, ; Borges, ; Kearney, ; Kim & Cardemil, ; Smith, Mao, Perkins & Ampuero, ; Walkerdine, ). Only a few studies examine clients’ (predominantly working/lower class) perspectives (Balmforth, ; Isaac, ; Thompson et al., ). With the exception of Balmforth's study () (one middle‐ and six working‐class clients), none addressed middle‐class client views with a lower‐class therapist, reflecting perhaps the imbalance in therapists being predominantly middle‐class (Brown, ).…”