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What better to do on a rainy Sunday than watch an #APA2020 symposium on one of my absolute favorite topics?
Here are my notes & thoughts on "Addressing Classism and other Barriers to Psychotherapy for People Living in Poverty" from (1/x)
Here are my notes & thoughts on "Addressing Classism and other Barriers to Psychotherapy for People Living in Poverty" from (1/x)
Susan Woodhouse, PhD; Linda Campbell, PhD; Emily Selby-Nelson, PhD; Christianne Connelly, MA, NCC
(I don't know if the authors are on Twitter so I apologize for not tagging if they are!)
(2/x)
(I don't know if the authors are on Twitter so I apologize for not tagging if they are!)
(2/x)
"The 'problem of the poor' is often discussed in terms of resistance to tx and lack of motivation...little attention has been given to the potential for therapists' classism, stereotypical characterization, and implicit bias toward low-SES and rural clients."
THISSSS
(3/x)
THISSSS(3/x)
Dr. Campbell starts with guiding Q: what makes for a therapist who can successfully work with low-SES clients?
She also defines poverty in terms of chronicity. So this isn't about people who are poor temporarily, but who have been poor and are very likely to remain poor.
(4/x)
She also defines poverty in terms of chronicity. So this isn't about people who are poor temporarily, but who have been poor and are very likely to remain poor.
(4/x)
2 major barriers to tx: practical and attitudinal.
I *really* appreciate the point about therapists as authority figures, and how ppl living in poverty tend to have negative experiences with authority figures. We have to be sensitive to what we represent as therapists.
(5/x)
I *really* appreciate the point about therapists as authority figures, and how ppl living in poverty tend to have negative experiences with authority figures. We have to be sensitive to what we represent as therapists.
(5/x)
Whew! "Psychotherapists are middle or upper middle class by virtue of education" regardless of earlier life experience.
Tough pill to swallow. We are all susceptible to perpetuating classism.
(6/x)
Tough pill to swallow. We are all susceptible to perpetuating classism.
(6/x)
Dr. Campbell asks us to consider simple signifiers of our current SES that may be alienating to low-SES clients:
Vacation pics in the office, fancy textbooks, nice furniture, expensive clothing and jewelry, vocabulary
(7/x)
Vacation pics in the office, fancy textbooks, nice furniture, expensive clothing and jewelry, vocabulary
(7/x)
Therapists should also think about the conventional boundaries + structure of therapy and how they often DO NOT WORK for lower-SES clients.
50 min. hour, office in wealthier part of town, and the therapist "job" being unrelated to advocacy and connecting them to resources
(8/x)
50 min. hour, office in wealthier part of town, and the therapist "job" being unrelated to advocacy and connecting them to resources
(8/x)
And bigger picture issue --> cultural competence training for therapists typically does not include socioeconomic class.
My view: we don't talk about class enough and too often conflate SES with race/ethnicity. They're very related but not the same.
(9/x)
My view: we don't talk about class enough and too often conflate SES with race/ethnicity. They're very related but not the same.
(9/x)
Dr. Selby-Nelson has recommendations for practice!
1. Use class competent practice. Build awareness of your own class privilege and biases about poverty, class, and therapy. Learn about effective tx for this population.
(10/x)
1. Use class competent practice. Build awareness of your own class privilege and biases about poverty, class, and therapy. Learn about effective tx for this population.
(10/x)
2. Build advocacy guidance into practice. Help clients navigate systems and advocate for themselves effectively. Promote community engagement.
(I'll add: this means we must recognize how systems have failed our clients and believe that they don't deserve this.)
(11/x)
(I'll add: this means we must recognize how systems have failed our clients and believe that they don't deserve this.)
(11/x)
3. Use evidence-based treatment! CBT is as effective for low-SES and higher SES clients. IPT is effective for PTSD, social functioning, depression.
Overall, don't change what tx you use, but rather HOW you use it. Really important to be flexible!
(12/x)
Overall, don't change what tx you use, but rather HOW you use it. Really important to be flexible!
(12/x)
So basically, the recommendation is flexibility within fidelity as per usual. However, therapist flexibility requires specific knowledge abt classism and poverty.
Also, *I* think that this requires deeper reflection for type-A therapists with low frustration tolerance.
(13/x)
Also, *I* think that this requires deeper reflection for type-A therapists with low frustration tolerance.
(13/x)
Santiago et al. (2013) has more background lit and recommendations!
https://onlinelibrary.wiley.com/share/5V8JMPVUF9IPZYAUMPTA?target=10.1002/jclp.21951
(14/x)
https://onlinelibrary.wiley.com/share/5V8JMPVUF9IPZYAUMPTA?target=10.1002/jclp.21951
(14/x)
This entire slide!! These are practical ways that we can work more effectively with clients who are lower-SES.
The last section "Integrate advocacy into your career"... is how @therapy4theppl was born
(15/x)
The last section "Integrate advocacy into your career"... is how @therapy4theppl was born
(15/x)
Dr. Woodhouse is now talking about therapist characteristics that help them be effective when working with low-SES and rural clients.
Acknowledges so very little work done in this area.
(16/x)
Acknowledges so very little work done in this area.
(16/x)
"In 2015, Sue and Sue stated that mental health professionals may hold privileged worldviews and inadvertently work in an ineffective and oppressive manner with low-SES individuals."
Why do our training programs not talk more about this?
(17/x)
Why do our training programs not talk more about this?
(17/x)
Dr. Woodhouse and colleagues are working on a qualitative study interviewing experienced & effective therapists of rural and low-SES clients to learn what they're doing so well.
*chef's kiss*
Looking forward to this paper!!
(18/x)
*chef's kiss*
Looking forward to this paper!!
(18/x)
This symposium was excellent and I'm so glad to see this work being done. Thank you to all of the presenters!
We have such a long way to go in understanding how to make therapy more engaging and effective for people living in poverty. I guess Step 1 is acknowledging it.
(19/x)
We have such a long way to go in understanding how to make therapy more engaging and effective for people living in poverty. I guess Step 1 is acknowledging it.
(19/x)
Last note: if we zoom out and consider engagement and access for the field of psychology more broadly, making the @APA convention virtual this year was a great step forward.
#PsychClassChat
(20/20)
#PsychClassChat
(20/20)
