Читать книгу Counseling the Culturally Diverse - Laura Smith L. - Страница 94

The existence of societal bias against people who are poor has been well documented (APA Task Force on Socioeconomic Status, 2007; Smith, 2013), and therapists, of course, are not immune to harboring these attitudes as well. For example, research has demonstrated that clinicians tend to perceive clients who live in poverty more unfavorably than more affluent clients (as, for example, being more dysfunctional and making poorer progress in therapy). In the area of diagnosis, it has been found that an attribution of mental illness is more likely when a person's history suggests a lower rather than a higher socioeconomic class origin (Liu et al., 2006). Many studies demonstrate that clinicians who are given identical clinical vignettes tend to make more negative prognostic statements and judgments of greater maladjustment when the individual is said to come from a poor or working‐class background rather than from the middle class (Lee & Temerlin, 1970; Smith, Mao, Perkins, & Ampuero, 2011; Stein, Green, & Stone, 1972).

In addition, the culture‐bound characteristics of mental health practice as with regard to communities of color includes dimensions that are also relevant for social class experiences; the assumptions underlying therapeutic activities are permeated by middle‐class values that do not always apply to life in poverty. For example, appointments made weeks in advance with short, weekly, 50‐minute timeframes are not consistent with the necessity of surviving chaotic circumstances and seeking immediate solutions to pressing problems. Poor people have learned from experience that endless waits are associated with publicly‐funded medical clinics, police stations, and government agencies, where one can frequently wait hours for a 10‐ to 15‐minute appointment, and arriving promptly does little good. Therapists, however, rarely understand these aspects of life in poverty and may be quick to see late arrival as a sign of resistance or indifference (Schnitzer, 1996).

Similarly, with regard to conventional psychological practice, people from poor and working‐class backgrounds may view protracted therapeutic attempts to discover underlying intrapsychic problems as inappropriate or irrelevant. The harsh environment of poverty, where the future is uncertain and immediate needs must be prioritized, can make long‐range life planning difficult and even unrealistic. Because of the high cost of treatment in private practice, a low‐income client may be the first in their family to participate in therapy, and their expectations of therapy may be very different from those of their psychotherapists. For example, low‐income clients who are concerned with survival on a day‐to‐day basis may expect primarily suggestions and problem‐solving help from the counselor (Lorion, 1974). When clients are relatively unfamiliar with the therapy process, the smooth progress of the session can be affected. Therapists may interpret these experiences as reflecting client resistance or hostility; the client can in turn feel misunderstood by the therapist, with the result being a premature termination of therapy. Considerable evidence exists to suggest that clients from more privileged socioeconomic backgrounds have significantly more interviews with their therapists, and that middle‐class patients tend to remain in treatment longer than lower‐class patients (Gottesfeld, 1995; Leong, Wagner, & Kim, 1995; Neighbors, Caldwell, Thompson, & Jackson, 1994).

Working effectively with clients who are poor requires several major preconditions (Smith, 2010). First, therapists must spend time understanding their own class‐based biases and prejudices. Confronting one's own classism can help detect the influence of commonplace social stereotypes of poor people, which can vary in association with race. For example, poor White people can be seen through the lens of “White trash” stereotypes, while poor Black women have been stigmatized with the racist stereotype of “welfare queens” (Smith & Redington, 2010). These widespread social biases can affect the diagnosis and treatment of clients who live in poverty. Second, it is essential that counselors understand how poverty affects the lives of people who lack financial resources, and behaviors that are associated with the survival of poverty should not be pathologized. Finally, poverty and the economic disparities that are the root causes of emotional distress among the poor demands that therapists apply a social justice context to their case conceptualization (Smith, 2010).

Several conclusions are suggested at this point: (a) poverty and classism present overwhelming stressors that undermine the mental and physical health of clients; (b) a failure to understand the life circumstance of clients who lack financial resources, along with unintentional class bias, may affect the ability of helping professionals to deliver appropriate mental health services; and (c) classism can make its appearance in the assessment, diagnosis, and treatment of lower‐socioeconomic‐class clients.