With the Affordable Care Act expanding access to mental health care, APA’s Committee on Socioeconomic Status is working to ensure that
all practicing psychologists are ready to treat clients living in
poverty. The committee is developing practice guidelines to
help practitioners improve therapy with low-income clients.
Psychologists often receive little training in this aspect of
diversity, says committee member Kipp Pietrantonio, PhD,
a psychologist at the Ohio State University’s Counseling and
Consultation Service. Multicultural training doesn’t give
socioeconomic status nearly as much attention as race and
ethnicity, sexual orientation and other factors, he points out.
Without such training, he says, psychologists may
unwittingly commit micro-aggressions that make it less
likely that a client returns for a second session, especially
when combined with such barriers as lack of insurance,
transportation and child care.
“When a person from a low-income background comes
to a counseling session, they’re immediately out-classed,”
says Pietrantonio. “They see a doctoral degree on the wall,
someone dressed in white-collar clothing and an office with
nice furniture they can’t afford, all of which says to them, ‘I’m a
middle- to upper-income person here to help you.’”
Plus, says Pietrantonio, recommendations that may be
appropriate for more well-off clients may not be feasible for
people struggling to put food on their tables. Psychologists
often encourage clients to exercise more without considering
that clients living in poverty may not have access to workout
clothes, child care, a gym or even a safe area where they can run,
The new guidelines will help fill this gap in training, says
Pietrantonio. He urges anyone with ideas to email APA’s Public
Interest Directorate at firstname.lastname@example.org. “We don’t want this
to be the committee’s guidelines but a collective look,” he says.
In the meantime, there’s plenty that practitioners can do to
make psychological services more accessible to people living
in poverty in addition to offering sliding scales, seeing patients
pro bono and accepting Medicaid, says Laura Smith, PhD, an
associate professor of psychology and education at Columbia
University’s Teachers College.
For one, psychologists can examine class biases in the same
way that they develop multicultural competence in other areas.
In a qualitative study that Smith and co-authors published
in the Journal of Clinical Psychology in 2013, psychotherapists
revealed that they had previously held common stereotypes of
poor people as lazy, violent and dirty.
Psychologists may also assume that most poor people don’t
work. That’s not the case, says Smith. “A lot of people in poverty
today are working people,” she says, citing unlivable minimum
wages as a contributing factor. Mistaken assumptions can play
out clinically, she says, referring to studies that suggest that
psychologists may be less inclined to work with poor clients and
more likely to view them as having more serious disturbances
than their wealthier counterparts.
An APA committee is working to help psychologists be more
sensitive in their work with people living in poverty.
By Rebecca A. Clay
Eliminating class bias