Academic journal article American Journal of Psychotherapy

The Influence of Client Socioeconomic Status on Psychotherapists' Attributional Biases and Countertransference Reactions

Academic journal article American Journal of Psychotherapy

The Influence of Client Socioeconomic Status on Psychotherapists' Attributional Biases and Countertransference Reactions

Article excerpt

Clinical reaction related to client socioeconomic status has not been adequately researched, yet socioeconomic status can profoundly affect psychotherapist perceptions of a client's presenting concerns, symptom severity, and prognosis. Using an online national survey, this study examined the influence of client socioeconomic status on psychotherapist cognitive attributions and countertransference reactions (N = 141). Results revealed no significant differences in cognitive attributions based on socioeconomic status. However, significantly stronger countertransference reactions of being dominated by the client with a higher socioeconomic status were found. In addition, the clients with higher socioeconomic status were ascribed with mild problems compared with the client of lower socioeconomic status. Psychotherapeutic implications are discussed.

KEY WORDS: Socioeconomic status, cognitive reactions, attributional bias, countertransference


It has been noted that the cultural significance of socioeconomic status (SES) and its influence on the psychotherapy process has not been given the attention that it deserves in mental health literature (Lam & Sue, 2001; Liu, 2001). Prior research examined some forms of clinical judgment in relation to SES (Abramowitz & Dokecki, 1977), but litde empirical research has examined how SES impacts the therapeutic exchange between psychotherapist and client (Liu, Soleck, Hopps, Dunston, & Pickett, 2004). In particular, litde has been written to help psychotherapists identify and confront their personal reactions and attitudes to differences in client SES. The present study attempts to illustrate how psychotherapists respond to clients of different SES through the examination of attributional biases and countertransference reactions.

Many authors suggest that SES is part of an individual's identity (Liu, Soleck, et al., 2004): it effects how we perceive personal success (Liu, Soleck, et al., 2004; Storck, 1997); it interacts with other identity characteristics (e.g., gender, race); it affect one's overall quality of life (D'Andrea & Daniels, 2001). The economic context that people find themselves in can, therefore, affect how they view themselves and how others view them (Liu, Soleck, et al., 2004). This understanding of SES is an important consideration because it can affect the quality of a therapeutic relationship and how a psychotherapist responds to diverse clients. In fact, the differing values associated with SES can introduce both conscious and unconscious biases into a psychotherapist's clinical judgments (Sue & Sue, 2003).

Early research by Abramowitz & Dokecki (1977) found evidence of negative bias against clients of lower SES in the form of less favorable mental health diagnoses. A later review of related research (Garb, 1997) suggested that this form of bias may not occur in all clinical samples. However, in his review, Garb (1997) reported that studies that showed less evidence of clinician bias included larger sample sizes (e.g., over 200 participants). Inconsistency among studies has been attributed to factors such as differences in sample sizes and the operational definitions of SES. However, one similarity among the few studies in this area is the general method in which psychotherapist bias was measured. In most SES studies, clinical bias has been measured through a psychotherapist's clinical judgments of a client or simulated client. These clinical ratings include client diagnosis, prognosis, degree of pathology, and recommended treatment options (e.g., Bamgbose & Edwards, 1980; Di Nardo, 1975; Lee & Temerlin, 1970; Routh & King, 1972; Trackman, 1971; Umbenhauer & De Witte, 1978). Although clinical judgments are important considerations for examining psychotherapist bias, they do not capture all aspects of a psychotherapist's reactions to a client. Psychotherapist cognitive and countertransference reactions represent two important considerations not adequately studied in SES-related research. …

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