Academic journal article The Professional Counselor

The Relationship between Socioeconomic Status and Counseling Outcomes

Academic journal article The Professional Counselor

The Relationship between Socioeconomic Status and Counseling Outcomes

Article excerpt

There is a robust relationship between socioeconomic status (SES) and mental health (Goodman & Huang, 2001; Strohschein, 2005), a finding that researchers have consistently replicated (Adler, Epel, Castellazzo, & Ickovics, 2000; Kraus, Adler, & Chen, 2012; Muntaner, Eaton, Miech, & O'Campo, 2004; von Soest, Bramness, Pedersen, & Wichstrom, 2012). Furthermore, researchers have linked SES to important outcomes in a number of domains, including academic achievement and employability (Blustein et al., 2002) and health service utilization (Goodman & Huang, 2001). Pope-Davis and Coleman (2001) argued that SES is an important cultural variable that is closely aligned with race and gender. Despite the risk factor that SES poses for mental health and well-being, the current literature does not empirically represent SES as much as other cultural variables, especially with regard to counseling outcome research (Falconnier, 2009; Liu, 2011). To respond to this shortcoming, we investigated potential links between SES and counseling outcome.

SES and Mental Health

SES as a Variable of Study

In the last 20 years, two content analyses have reviewed cultural variables and SES within counseling (Liu, Soleck, Hopps, Dunston, & Pickett, 2004; Pope-Davis, Ligiero, Liang, & Codrington, 2001). Liu et al. (2004) reviewed three journals from 1981-2000 and concluded that SES was mainly studied post hoc, and used primarily to account for unexplained variance. Similarly, focusing on the Journal of Multicultural Counseling between the years of 1985 and 1999, Pope-Davis et al. (2001) analyzed the content of articles for prominent multicultural variables and found that SES was underexamined as a primary variable of study. Taken together, both content analyses pointed to an overall lack of attention to SES in mental health counseling literature.

There is agreement regarding the multicultural and social justice relevance of economic empowerment and SES in the field of counseling (Ratts, Toporek, & Lewis, 2010); however, available SES counseling literature is predominantly conceptual and not empirical. There are several possibilities for the overall lack of empirical investigations into SES and counseling outcomes. First, only recently have mental health counselors made a concerted effort to empirically demonstrate counseling outcomes (Hays, 2010). In addition, Smith, Chambers, and Bratini (2009) opined that, while research on the pathogenic impact of poverty on emotional well-being is robust and logical, the development of practitioner-based interventions has been limited. The counseling profession has not been a leader in empirically studying this complex variable, which further limits the profession's contributions to research-based interventions. Moreover, SES is complex (Liu et al, 2004); its etiology is often interconnected with mental health risk factors. One challenge of SES research, then, is effectively conceptualizing which aspect of the variable to address first. This challenge is best expressed in the old adage "Which came first, the chicken or the egg?" In other words, do lower SES levels lead to higher rates of mental health disorders or do higher rates of mental health disorders lead to lower SES levels? Eaton, Muntaner, Bovasso, and Smith (2001) identified four possible answers: (a) Lower SES raises the risk of developing a mental health disorder, (b) lower SES prolongs the duration of a mental health disorder episode, (c) mental health disorders lead to downward social mobility or (d) mental health disorders hinder attainment of upward SES status. It also is plausible that these answers are not mutually exclusive, further complicating the role of SES in mental health.

Objective Versus Subjective Indicators of SES

Another possible reason for the limited pursuit of SES research is the difficulty in operationalizing SES. As a construct, SES is multifaceted, impeding the use of discrete variables (Liu et al. …

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