Social class and the therapeutic relationship: The perspective of therapists as clients. A qualitative study using a questionnaire survey

Socioeconomic status, psychotherapy duration, and return to work from disability due to common mental disorders

Objective Low socioeconomic status (SES) is a risk factor for work disability due to common mental disorders (CMDs), one possible reason being inequal use of services. Psychotherapy is an evidence-based treatment for CMDs. This study examines socioeconomic and sociodemographic differences in psychotherapy attendance and an association of psychotherapy duration with return to work (RTW).Methods The study subjects (N = 12,263) were all Finnish citizens granted a disability pension (DP) due to CMDs in 2010-2012. Numbers of psychotherapy sessions (maximum 200) were collected from the nine-year interval around the DP grant. Socioeconomic and sociodemographic differences in psychotherapy duration (dependent variable) among DP recipients were studied using multinomial logistic regression models, likewise, the association between psychotherapy duration and RTW (dependent variable) among temporary DP recipients was examined.Results Higher SES, female gender, and younger age were positively associated with attending longer psychotherapies and surpassing the early treatment termination level (>10 sessions). Attending 11-60 psychotherapy sessions was positively associated with full RTW and partial RTW, whereas longer psychotherapies were not. Early termination was positively associated with partial RTW only.Conclusion This study demonstrates varying tendencies among CMD patients from different backgrounds to attend long rehabilitative psychotherapies, which may create inequalities in RTW.

Socioeconomic status and the therapeutic alliance: An empirical investigation using structural equation modeling

OBJECTIVE

The purpose of the study was to investigate the associations between client socioeconomic status and the therapeutic alliance.

METHODS

Data on socioeconomic status and different aspects of the therapeutic alliance were obtained from participants currently or recently in psychotherapy and analyzed using structural equation modeling.

RESULTS

The results provided support for a structural equation model where socioeconomic status was positively related to the therapeutic alliance. The study also found that the associations between socioeconomic status and therapeutic alliance was significantly stronger among clients who had received psychodynamic therapy compared to those who had received cognitive behavior therapy.

CONCLUSIONS

The results are discussed in relation to research suggesting that clients of lower socioeconomic status are estranged from the psychotherapeutic context, reflecting experiences among the clients both of not being understood and as inferior in relation to their therapist, as well as possible perceptions that such client are less suitable for psychotherapy.