‘What help can you get talking to somebody?’ Explaining class differences in the use of talking treatments

Abstract

Talking treatments are underused in England by working-class people: their higher rates of common mental disorders compared with their middle-class counterparts are not matched by an increased use of these treatments. Given that,overall, talking treatments are effective in tackling depression and anxiety,understanding their underuse is important. Based upon semi-structured interview data I argue that a framework centred on individuals' cultural dispositions towards treatment can help with this task. Following Bourdieu, such dispositions can be traced to social structural conditioning factors, together comprising the habitus. Four key dispositions emerge from the data: verbalisation and introspection, impetus for emotional health, relation to medical authority and practical orientation to the future. In turn, these dispositions are rooted in the material, health, occupational and educational characteristics of working-class circumstances. Tracing these circumstances offers suggestions for increasing the use of this service.

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

“…Northern and regional accents tended to be viewed as inferior if respondents had a higher‐classed therapist, and exacerbated feelings of shame. These accounts are consistent with the literature, illustrating how middle‐class oration can be seen as superior (Bernstein, ; Kearney, ), triggering stereotypical assumptions (Holman, ); in other words, classism.…”

“…A client and therapist's initial impressions of each other can impact the therapeutic relationship with prejudicial attitudes affecting the outcome (Balmforth, ). Regardless of obvious external aspects (including home, car, neighbourhood), class differences and similarities are apparent through more subtle factors, for example ; accent, language, appearance and manner, reinforcing both the client's and the therapist's internalised classism (Holman, ). Moreover, feelings of inequality may be intensified resulting in poor therapeutic outcomes (Chalifoux, ).…”

Exploring the relationship between social class, mental illness stigma and mental health literacy using British national survey data

“…It therefore makes sense that ‘abnormal’ deviations from the health necessary for material existence are subject to more sensitive attitudes. I have described elsewhere how impetus for physical health can help to explain working-class underuse of talking treatments (Holman, 2014).…”

Moral narratives and mental health: rethinking understandings of distress and healthcare support in contexts of austerity and welfare reform

“…Research demonstrates that rates of non-attendance within IAPT are high and have complex causes (Marshall et al, 2016). What little evidence exists around experiences of IAPT amongst people from low-income groups suggests that embedded cultural dispositions often play a key role in deterring them from attending and benefiting from these kinds of therapeutic support service (Holman, 2014). If this is the case, such findings lie at odds with the commonly accepted requirement for people to selfrefer to IAPT as a 'first step to recovery', and may also throw question on the much heralded potential of recent alternative (not yet mainstream) approaches e.g.…”