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 Trachtman, 1971 Umbenhauer & De Witte, 1978). In most SES studies, clinical bias has been measured through a psychotherapist’s clinical judgments of a client or simulated client. However, one similarity among the few studies in this area is the general method in which psychotherapist bias was measured. Inconsistency among studies has been attributed to factors such as differences in sample sizes and the operational definitions of SES. 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). A later review of related research ( Garb, 1997) suggested that this form of bias may not occur in all clinical samples. In fact, the differing values associated with SES can introduce both conscious and unconscious biases into a psychotherapist’s clinical judgments ( Sue & Sue, 2003).Įarly research by Abramowitz & Dokecki (1977) found evidence of negative bias against clients of lower SES in the form of less favorable mental health diagnoses. 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. 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). 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 present study attempts to illustrate how psychotherapists respond to clients of different SES through the examination of attributional biases and countertransference reactions. In particular, little has been written to help psychotherapists identify and confront their personal reactions and attitudes to differences in client SES. Prior research examined some forms of clinical judgment in relation to SES ( Abramowitz & Dokecki, 1977), but little empirical research has examined how SES impacts the therapeutic exchange between psychotherapist and client ( Liu, Soleck, Hopps, Dunston, & Pickett, 2004). 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).
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