Low-income women’s experiences in outpatient psychotherapy: A qualitative descriptive analysis

Abstract

Although low-income women in the United States are at elevated risk for a range of mental health difficulties, they are less likely to access mental health services and more likely to drop out prematurely than higher income women. To explain this paradox, researchers tend to emphasize practical obstacles, but attend less to how low-income women themselves experience and value psychotherapy. The present study aimed to fill this gap using a qualitative descriptive methodology to explore 10 low-income women’s subjective experiences of outpatient psychotherapy. The data that emerged from the qualitative interviews can be distilled into eight clusters, grouped within three broad domains: within the domain of Awareness, participants found therapy to be meaningful and effective when the therapist: (1) was aware of the nature of poverty and poverty-related stressors, and (2) had some sort of direct exposure to poverty. Within the domain of Practices, participants described therapy as useful when the therapist: (3) demonstrated flexibility, (4) provided instrumental support, and (5) emphasized building strengths. Within the domain of Relational Quality, participants found therapy to be meaningful when the therapist: (6) really listened to the clients – without judgment, (7) attempted to share power, and (8) demonstrated authenticity. We discuss these findings in the context of current literature and feminist theory, and describe their implications for training and research.

Keywords:

• poverty
• mental health practice
• low-income women
• service delivery
• outpatient psychotherapy
• multicultural competence
• class

Acknowledgments

We are grateful to Dr Brinton Lykes, Dr Elizabeth Sparks, and Dr Laura Kanter for their invaluable contributions to this study. We are also indebted to the staff of the numerous shelters and programs who helped us recruit participants, and above all, to the women who gave us their time and their stories.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The research it describes was supported in part by The Lynch School of Education at Boston College.