Considering poverty in the therapeutic process: experienced therapists’ adaptations

Despite high rates of mental health difficulties, low-income individuals are less likely to access mental health services and show fewer improvements when they do compared to middle-income clients (Falconnier, 2009 Falconnier, L. (2009). Socioeconomic status in the treatment of depression. American Journal Of Orthopsychiatry, 79(2), 148-158.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). A handful of studies have shown, however, that when interventions are altered to address poverty-related stressors, they become more effective (e.g. Miranda, Azocar, et al., 2003 Miranda, J., Azocar, F., Organista, K. C., Dwyer, E., & Areane, P. (2003). Treatment of depression among impoverished primary care patients from ethnic minority groups. Psychiatric Services, 54(2), 219–225.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Although this research is extraordinarily valuable, we know little about how mental health practitioners working in naturalistic settings think about and tailor their practices to meet the unique challenges of working with clients who are impoverished. Such grassroots, practice-based knowledge could contribute to efforts to adapt interventions. This qualitative descriptive study of experienced psychologists working with clients in poverty aimed to fill this gap. Results indicate that psychologists often develop unique practices specific to clients in poverty. These include practices for addressing power dynamics, managing boundaries, and working with the relationship between intrapsychic and contextual poverty-related stressors. Perhaps the most striking finding of this study involves how participants conceptualized and enacted boundaries in the context of work with this population. These findings are discussed in the context of feminist theoretical models and current research. Implications for research, practice, and training are highlighted.