Effective Psychotherapy With Low-income Clients: The Importance of Attending to Social Class

Kim, Saeromi; Cardemil, Esteban V.

doi:10.1007/s10879-011-9194-0

Cited by 39 publications

(39 citation statements)

References 34 publications

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“…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, ).…”

Section: Introductionmentioning

confidence: 99%

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

Trott

Reeves

2018

Couns and Psychother Res

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Background This research aimed to explore clients’ perceptions of the impact of social class and whether, if so how, perceived social class disparities impact upon the therapeutic relationship. Method A total of 45 completed questionnaires, via an online survey, were returned, comprising 30 middle‐class and 15 working‐class qualified and practising therapists from their role as client. A quasi‐phenomenological approach was taken and thematic analysis used to interrogate the data. Findings Four primary themes were identified as follows: (1) Perceptions of own social class; (2) Social class as a facilitative aspect of therapy; (3) Negative impact of social class on therapy; and (4) Clients perceptions of their therapeutic relationship. The findings show that where there was social class disparity, it was the explicit recognition and acknowledgement of disparity that were shown to have a positive impact on the client; improving equality, increasing rapport and enabling greater psychological growth. Implications for practice Therapists’ lack of awareness of social class was shown to lead to inadvertent oppressive and/or classist behaviour. For a client to take full benefit from therapy, therapists must recognise the importance of social class and classism and their impact upon the therapeutic relationship, and be prepared to attend to these dynamics when appropriate. Conclusions Though many respondents thought social class was an irrelevant factor within their therapeutic relationship, this study illustrates that social class was a silent but powerful force affecting clients’ feelings of equality and the effectiveness of therapy.

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Section: Introductionmentioning

confidence: 99%

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

Trott

Reeves

2018

Couns and Psychother Res

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“…GAD is defi ned as excessive and chronic worry and although the content of the concerns may vary, it tends to be large and pervasive and can include a range of areas, such as interpersonal relationships, physical health, fi nances, and global and/ or minor issues (such as care with the home or children; APA, 2013). A real lack of fi nancial resources, living in potentially violent areas and the lack of knowledge may enhance the concerns and should be in the mind of the psychologist who will work with this potentially more vulnerable patient (Kim & Cardemil, 2012). In fact, increasing the availability and quality of mental health services provided to persons from historically disadvantaged racial and ethnic groups is a necessity and many previous authors have in-dicated that traditional mental health treatments should be modifi ed to match clients' cultural contexts (Griner & Smith, 2006).…”

Section: Discussionmentioning

confidence: 99%

“…For a patient profi le with low education, it is important to keep in mind the inevitability of the fl exibility of time and the way to implement the techniques (being even more didactic and explanatory, taking care not to be patronizing). As for patients living in vulnerable areas, understanding their context and being aware of what risks or lack of resources there are, contributes to a better therapeutic relationship and consequently to treatment adherence (Kim & Cardemil, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…Finding a fi ne balance between keeping focus and track of the session and, at the same time, understanding that sessions with these patients might be longer in duration is a pivotal skill to increase the likelihood of treatment adherence and success. As proposed by Kim and Cardemil (2012) in the study of therapeutic effi cacy for patients with low-income, clinical work for this population should include some consideration of adaptations to the structure of the therapy, aiming at increasing the acceptability and attractiveness of the intervention to low-income clients.…”

Section: Adaptation Of a Cogni Tive-behavioral Protocol For Generalizmentioning

confidence: 99%

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Adaptation of a Cognit ive-Behavioral Protocol for Generalized Anxiety Disorder Patients with Low Educational Attainment

Coutinho¹,

Dias²,

Marques³

et al. 2017

Temas Psicol.

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This article reports the experience of treating low-income patients with a primary diagnosis of generalized anxiety disorder (GAD) in a public hospital in Rio de Janeiro, Brazil. At the start of the project for outpatient treatment, which included the application of a cognitive model for GAD treatment, we observed that the majority of patients presented low educational level, which made it hard for them to understand key aspects of the cognitive-behavioral based treatment offered. Therefore, important adaptations to the treatment protocol were made necessary, including the way techniques were presented and applied, the therapeutic approach used, and even the duration of sessions. Since variations of cognitive therapy are increasingly being applied in hospital outpatient clinics in countries worldwide, the objective of this article is to present the adaptations performed and promote a discussion on the possible solutions for the diffi culties faced in applying clinical psychology practice among patients with low educational and socioeconomic levels. This is a clinical study presenting an illustrative case, where adaptations to the treatment protocol were essential for the positive outcome of the case. It is concluded that, with the 1 Mailing address: Avenida Ataulfo de Paiva, 1079, sala 509,

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“…Strengthening family resilience would give the youth a sense that their families can address their own problems (Walsh, 2002). Such family programs have been documented in literature: using the family systems approach in therapy with poor clients has been shown to work (Smith, 2005); family sessions involving psychoeducation in problem solving have effectively prevented depression among low-income mothers (Kim & Cardemil, 2012).…”

Section: The Mitigating Role That Families and Social Resources Playmentioning

confidence: 99%

Psychological Distress Among College Youth as a Function of Family SES: The Mediating Effect of Sense of Poverty and the Mitigating Role of Family Resources

Reyes

Yujuico

2014

Journal of Pacific Rim Psychology

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A lthough college provides an opportunity for socioeconomic advancement, poor college youth confront material scarcity and financial problems and are at risk for psychological distress. Yet, distress is a product not only of poverty per se but of a sense of poverty, or a subjective evaluation of one's socioeconomic conditions vis-à-vis life circumstances. Both sense of poverty and psychological distress, however, can be mitigated by collective problem-solving in the family and by the family's social resources. Analysis of data from Filipino college youth (n = 831) shows that the family's inability to meet financial obligations is not directly associated with distress, but indirectly through sense of poverty. Lack of family assets is not a predictor of psychological distress, given that the positive indirect effect through sense of poverty is counteracted by a negative direct effect. Results also show that family problem-solving lessens psychological distress and that adequate access to social resources lessens the negative effect of sense of poverty on distress.

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Effective Psychotherapy With Low-income Clients: The Importance of Attending to Social Class

Cited by 39 publications

References 34 publications

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

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

Adaptation of a Cognit ive-Behavioral Protocol for Generalized Anxiety Disorder Patients with Low Educational Attainment

Psychological Distress Among College Youth as a Function of Family SES: The Mediating Effect of Sense of Poverty and the Mitigating Role of Family Resources

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