Are Barriers to Psychotherapy Treatment Seeking Indicators of Social Determinants of Health?: A Critical Review of the Literature
Abstract
One of the most persistent and troubling health disparities is the underutilization of mental health services by individuals with marginalized aspects of their identity. We provide a critical review of the literature of barriers to psychotherapy initiation and the connection to social determinants of health. We propose a change from a deficit-based view of the problem to a strength-based view that include the following strategies: family therapy treatments designed to reduce barriers, telehealth as an option to address treatment barriers, changes to the recruitment of therapists-in-training, and person of the therapist development.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Even in urban areas, it can be difficult to regularly attend psychotherapy sessions because of barriers to service utilization.
“Even in urban areas, it can be difficult to regularly attend psychotherapy sessions because of other barriers to service utilization [24] such as structural barriers (e.g., commuting to the therapist’s office), availability of professionals sharing the patient’s cultural or ethnic values, or availability of psychotherapists with a specific expertise.”
People in rural areas can face significant challenges in finding and attending face-to-face psychological services.
“People in rural areas can face significant challenges in finding and attending face-to-face psychological services with mental health professionals who often practice in urban areas [5,22,23,24].”
Cites
Counseling the Culturally Different: Theory and Practice
Baptiste, D. A., Sue, D. W., & Sue, D. W. (1993) · Family Relations · doi:10.2307/585569 · Cited by 1,918 · see citing works
Help-Seeking and Access to Mental Health Care in a University Student Population
Eisenberg, D., Golberstein, E., & Gollust, S. E. (2007) · Medical Care · doi:10.1097/mlr.0b013e31803bb4c1 · Cited by 1,131 · see citing works
Disparity in Depression Treatment Among Racial and Ethnic Minority Populations in the United States
Alegría, M., Chatterji, P., Wells, K., Cao, Z., Chen, C.-N., Takeuchi, D., Jackson, J., & Meng, X.-L. (2008) · Psychiatric Services · doi:10.1176/ps.2008.59.11.1264 · Cited by 993 · see citing works
Ethnic Disparities in Unmet Need for Alcoholism, Drug Abuse, and Mental Health Care
Wells, K., Klap, R., Koike, A., & Sherbourne, C. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.12.2027 · Cited by 773 · see citing works
Advancing Health Disparities Research Within the Health Care System: A Conceptual Framework
Kilbourne, A. M., Switzer, G., Hyman, K., Crowley-Matoka, M., & Fine, M. J. (2006) · American Journal of Public Health · doi:10.2105/ajph.2005.077628 · Cited by 761 · cited 1× · see citing works
“…barriers (e.g., lack of transportation), low mental health literacy, mental health stigma (Langley et al., 2010), and negative perceptions of mental health care providers among racial and ethnic minorities (Alegría et al., 2010; Chow et al., 2003; Kilbourne et al., 2006; Nadeem et al., 2007).”
BackgroundConceptualizing and measuring historical trauma among American Indian people
Whitbeck, L. B., Adams, G. W., Hoyt, D. R., & Chen, X. (2004) · American Journal of Community Psychology · doi:10.1023/b:ajcp.0000027000.77357.31 · Cited by 751 · see citing works
Andermann, A. A. J. (2016) · Canadian Medical Association Journal · doi:10.1503/cmaj.160177 · Cited by 727 · see citing works
Family experience of barriers to treatment and premature termination from child therapy.
Kazdin, A. E., Holland, L., & Crowley, M. J. P. (1997) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.65.3.453 · Cited by 721 · see citing works
Clinical Handbook of Couple Therapy
Gurman, A. S., & Jacobson, N. S. (2002) · Medical Entomology and Zoology · Cited by 651 · see citing works
Re-visioning Family Therapy: Race, Culture, and Gender in Clinical Practice
Maccarelli, L. M., Psychology), A. D. 4. (., & Elman, N. S. (1999) · PsycEXTRA Dataset · doi:10.1037/e325522004-017 · Cited by 549 · see citing works
Family experience of barriers to treatment and premature termination from child therapy.
Kazdin, A. E., Holland, L., & Crowley, M. J. P. (1997) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.65.3.453 · Cited by 548 · see citing works
Langley, A. K., Nadeem, E., Kataoka, S. H., Stein, B. D., & Jaycox, L. H. (2010) · School Mental Health · doi:10.1007/s12310-010-9038-1 · Cited by 477 · see citing works
Racial/Ethnic Disparities in the Use of Mental Health Services in Poverty Areas
Chow, J. C., Jaffee, K. D., & Snowden, L. R. (2003) · American Journal of Public Health · doi:10.2105/ajph.93.5.792 · Cited by 445 · see citing works
Barnett, M. L., Gonzalez, A., Miranda, J., Chavira, D. A., & Lau, A. S. (2018) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-017-0815-0 · Cited by 431 · see citing works
Hogan, M. F. (2003) · Psychiatric Services · doi:10.1176/appi.ps.54.11.1467 · Cited by 426 · cited 1× · see citing works
“This call has been echoed in multiple reports (e.g. Hogan, 2003).”
BackgroundNadeem, E., Lange, J. M., Edge, D., Fongwa, M. N., Belin, T., & Miranda, J. M. (2007) · Psychiatric Services · doi:10.1176/ps.2007.58.12.1547 · Cited by 407 · see citing works
Czyz, E. K., Horwitz, A. G., Eisenberg, D., Kramer, A., & King, C. A. (2013) · Journal of American College Health · doi:10.1080/07448481.2013.820731 · Cited by 388 · see citing works
Kazdin, A. E., Holland, L., Crowley, M. J., & Breton, S. J. (1997) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.1997.tb01621.x · Cited by 373 · see citing works
Sarche, M., & Spicer, P. (2008) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1425.017 · Cited by 339 · see citing works
THE CULTURAL GENOGRAM: KEY TO TRAINING CULTURALLY COMPETENT FAMILY THERAPISTS
Hardy, K. V., & Laszloffy, T. A. (1995) · Journal of Marital and Family Therapy · doi:10.1111/j.1752-0606.1995.tb00158.x · Cited by 317 · see citing works
The Cultural Genogram Key to Training Culturally Competent Family Therapists
Hardy, K. V., & Laszloffy, T. A. (2017) · Routledge eBooks · doi:10.4324/9781315225791-8 · Cited by 262 · see citing works
Planey, A. M., Smith, S. M., Moore, S. A., & Walker, T. (2019) · Children and Youth Services Review · doi:10.1016/j.childyouth.2019.04.001 · Cited by 257 · see citing works
Villatoro, A. P., Morales, E. S., & Mays, V. M. (2014) · American Journal of Orthopsychiatry · doi:10.1037/h0099844 · Cited by 231 · see citing works
One Size Does Not Fit All: Taking Diversity, Culture and Context Seriously
Alegria, M. M., Atkins, M. S., Farmer, E. M. Z., Slaton, E., & Stelk, W. J. (2010) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-010-0283-2 · Cited by 226 · see citing works
Use of specialty mental health services by Asian Americans with psychiatric disorders.
Meyer, O. L., Zane, N. W. S., Cho, Y. I., & Takeuchi, D. T. (2009) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0017065 · Cited by 226 · see citing works
Snell-Johns, J., Mendez, J. L., & Smith, B. H. (2004) · Journal of Family Psychology · doi:10.1037/0893-3200.18.1.19 · Cited by 202 · see citing works
Mennis, J., & Stahler, G. J. (2016) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2015.12.007 · Cited by 198 · see citing works
Dinwiddie, G. Y., Gaskin, D. J., Chan, K. S., Norrington, J., & McCleary, R. M. (2012) · Social Science & Medicine · doi:10.1016/j.socscimed.2012.11.024 · Cited by 178 · see citing works
Latino healing: The integration of ethnic psychology into psychotherapy
Comas-Díaz, L. (2006) · Psychotherapy: Theory, Research, Practice, Training · doi:10.1037/0033-3204.43.4.436 · Cited by 172 · see citing works
Disparities in completion of substance abuse treatment between and within racial and ethnic groups
Guerrero, E. G., Marsh, J. C., Duan, L., Oh, C., Perron, B., & Lee, B. (2013) · Health Services Research · doi:10.1111/1475-6773.12031 · Cited by 168 · see citing works
Murry, V. M., Heflinger, C. A., Suiter, S. V., & Brody, G. H. (2011) · Journal of Youth and Adolescence · doi:10.1007/s10964-010-9627-1 · Cited by 163 · see citing works
Cultural Competence: A Literature Review and Conceptual Model for Mental Health Services
Hernandez, M., Nesman, T. M., Mowery, D., Acevedo-Polakovich, I. D., & Callejas, L. M. (2009) · Psychiatric Services · doi:10.1176/ps.2009.60.8.1046 · Cited by 162 · see citing works
Pinedo, M. (2019) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2019.05.017 · Cited by 154 · see citing works
Is couple and relationship education effective for lower income participants? A meta-analytic study.
Hawkins, A. J., & Erickson, S. E. (2014) · Journal of Family Psychology · doi:10.1037/fam0000045 · Cited by 144 · see citing works
Disparities in Unmet Need for Mental Health Services in the United States, 1997–2010
Roll, J. M., Kennedy, J. J., Tran, M., & Howell, D. N. (2013) · Psychiatric Services · doi:10.1176/appi.ps.201200071 · Cited by 138 · see citing works
Foundations of multicultural psychology: Research to inform effective practice.
Smith, T. B., & Trimble, J. E. (2016) · doi:10.1037/14733-000 · Cited by 132 · see citing works
Jackson, H., Judd, F., Komiti, A., Fraser, C., Murray, G., Robins, G., Pattison, P., & Wearing, A. (2007) · Australian Psychologist · doi:10.1080/00050060701299532 · Cited by 125 · see citing works
Alegria, M. M., Lin, J. Y.-C., Chen, C., Duan, N., Cook, B. L., & Meng, X. (2012) · Health Services Research · doi:10.1111/j.1475-6773.2012.01403.x · Cited by 122 · see citing works
Belloch, A., del Valle, G. D. V., Morillo, C., Carrió, C., & Cabedo, E. (2008) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-008-0423-0 · Cited by 121 · see citing works
Cook, B. L., Doksum, T., Chen, C., Carle, A. C., & Alegria, M. M. (2013) · Social Science & Medicine · doi:10.1016/j.socscimed.2013.02.006 · Cited by 106 · see citing works
Doss, B. D., Knopp, K., Roddy, M. K., Rothman, K., Hatch, S. G., & Rhoades, G. K. (2020) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000479 · Cited by 104 · see citing works
Assessing the Individual, Neighborhood, and Policy Predictors of Disparities in Mental Health Care
Cook, B. L., Zuvekas, S. H., Chen, J., Progovac, A. M., & Lincoln, A. K. (2016) · Medical Care Research and Review · doi:10.1177/1077558716646898 · Cited by 88 · see citing works
Cross‐cultural considerations of therapist self‐disclosure
Constantine, M. G., & Kwan, K. K. (2003) · Journal of Clinical Psychology · doi:10.1002/jclp.10160 · Cited by 74 · see citing works
Transformative Family Therapy: Just Families in a Just Society
Almeida, R. V., Vecchio, K. D., & Parker, L. (2007) · DigitalGeorgetown (Georgetown University Library) · Cited by 70 · see citing works
Racial and Ethnic Disparities in Use of Psychotherapy: Evidence From U.S. National Survey Data
Chen, J., & Rizzo, J. A. (2010) · Psychiatric Services · doi:10.1176/ps.2010.61.4.364 · Cited by 68 · see citing works
Responding to Remediation and Gatekeeping Challenges in Supervision
Russell, C. S., DuPree, W. J., Beggs, M. A., Peterson, C., & Anderson, M. P. (2007) · Journal of Marital and Family Therapy · doi:10.1111/j.1752-0606.2007.00018.x · Cited by 59 · see citing works
Kim, B. S. K., Hill, C. E., Gelso, C. J., Goates-Jones, M. K., Asay, P. A., & Harbin, J. M. (2003) · Journal of Counseling Psychology · doi:10.1037/0022-0167.50.3.324 · Cited by 48 · see citing works
Guerrero, E. G., Campos, M. D., Urada, D. I., & Yang, J. C. (2012) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/1747-597x-7-34 · Cited by 48 · see citing works
Kazdin, A. E., & McWhinney, E. (2017) · Journal of Child and Family Studies · doi:10.1007/s10826-017-0869-3 · Cited by 47 · see citing works
Community and Treatment Engagement for Depressed African American Youth: The AAKOMA FLOA Pilot
The AAKOMA Project Adult Advisory Board, & Breland-Noble, A. M. (2012) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-011-9281-0 · Cited by 45 · see citing works
Black Lives Matter: We are in the Same Storm but we are not in the Same Boat
Watson, M. F., Turner, W. L., & Hines, P. M. (2020) · Family Process · doi:10.1111/famp.12613 · Cited by 44 · see citing works
Understanding the Experience of Black Clients in Marriage and Family Therapy
Awosan, C. I., Sandberg, J. G., & Hall, C. A. (2009) · Journal of Marital and Family Therapy · doi:10.1111/j.1752-0606.2009.00166.x · Cited by 39 · see citing works
A phenomenological study of clinicians’ perspectives on barriers to rural mental health care
Jensen, E. J., Wieling, E., & Mendenhall, T. (2020) · Journal of Rural Mental Health · doi:10.1037/rmh0000125 · Cited by 36 · cited 4× · see citing works
“Stigma associated with mental health care by minority clients is of the most significant barriers to treatment identified by the literature (Borson et al., 2019; Jensen et al., 2020).”
BackgroundInfluentialSTUDENT IMPAIRMENT AND REMEDIATION IN ACCREDITED MARRIAGE AND FAMILY THERAPY PROGRAMS
Rusell, C. S., & Peterson, C. (2003) · Journal of Marital and Family Therapy · doi:10.1111/j.1752-0606.2003.tb01210.x · Cited by 31 · see citing works
Socioculturally Attuned Family Therapy
McDowell, T., Knudson‐Martin, C., & Bermúdez, J. M. (2018) · Springer eBooks · doi:10.1007/978-3-319-15877-8_1093-1 · Cited by 31 · see citing works
Cummings, J. R., Wen, H., Ritvo, A. D., & Druss, B. G. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201300443 · Cited by 30 · see citing works
Reducing Barriers to Mental Health Care: Bringing Evidence‐Based Psychotherapy Home
Soo Borson, B., Korpak, A. M., Carbajal‐Madrid, P., Likar, D., Brown, G. A., & Batra, R. (2019) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16088 · Cited by 24 · see citing works
Voices of Marriage and Family Therapists of Color
Wieling, E. A., & Rastogi, M. (2004) · Journal of Feminist Family Therapy · doi:10.1300/j086v15n01_01 · Cited by 22 · see citing works
Benefit Limits for Behavioral Health Care in Private Health Plans
Hodgkin, D., Horgan, C. M., Garnick, D. W., & Merrick, E. L. (2008) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-008-0196-5 · Cited by 22 · see citing works
Reducing Disparities: Race, Class and the Social Determinants of Health
David, R. J., & Messer, L. C. (2011) · Maternal and Child Health Journal · doi:10.1007/s10995-011-0878-6 · Cited by 17 · see citing works
Lundgren, L. M., Amaro, H. D. L. A., & Ben‐Ami, L. (2005) · Journal of Social Work Practice in the Addictions · doi:10.1300/j160v5n01_08 · Cited by 16 · see citing works
Cultural Values Matter: The Therapeutic Alliance with East Asian Americans
Hynes, K. C. (2019) · Contemporary Family Therapy · doi:10.1007/s10591-019-09506-9 · Cited by 15 · see citing works
Self-citationThe effect of distance to provider on employee response to changes in mental health benefits
Lindrooth, R. C., Sasso, A. T. L., & Lurie, I. Z. (2006) · Health Economics · doi:10.1002/hec.1118 · Cited by 14 · see citing works
Breaking Up Is Hard to Do: Dismissing Students From MFT Training Programs
Sampson, J. M., Kelly‐Trombley, H. M., Zubatsky, J. M., & Harris, S. M. (2012) · American Journal of Family Therapy · doi:10.1080/01926187.2011.628205 · Cited by 7 · see citing works
D’Aniello, C., & Hertlein, K. M. (2017) · Contemporary Family Therapy · doi:10.1007/s10591-017-9416-z · Cited by 4 · see citing works
Self-citation(2015) · Journal of Family Psychology · doi:10.1037/fam0000114 · Cited by 2 · see citing works
Kennedy, J., Tran, M., & Roll, J. M. (2011) · PsycEXTRA Dataset · doi:10.1037/e676412011-001 · Cited by 1 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Bouchard, S., Dugas, M. J., Belleville, G., Langlois, F., Gosselin, P., Robillard, G., Corno, G., & Marchand, A. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11195924 · Cited by 21 · see citing works
“Documenting how VCP may reduce barriers for accessing care also deserves to be studied more thoroughly [24].”
Darnell, D. A., Pullmann, M. D., Hull, T. D., Chen, S., & Areán, P. A. (2022) · JMIR Formative Research · doi:10.2196/36521 · Cited by 17 · see citing works
Psilocybin for Depression: From Credibility to Feasibility, What’s Missing?
Munafò, A., Arillotta, D., Mannaioni, G., Schifano, F., Bernardini, R., & Cantarella, G. (2022) · Pharmaceuticals · doi:10.3390/ph16010068 · Cited by 15 · see citing works
Gregory, V. L., Wilkerson, D., Wolfe-Taylor, S. N., Miller, B. L., & Lipsey, A. D. (2024) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990.2024.2400934 · Cited by 12 · see citing works
Durepos, P., MacLean, R., Ricketts, N., Boamah, S. A., Witherspoon, R., Gould, O., Olthuis, J. V., Totton, K., Tucker, K., Boulay, I., et al. (2024) · Aging & Mental Health · doi:10.1080/13607863.2023.2288864 · Cited by 5 · see citing works
Gordon, T. C., Hope-Bell, J., Draper‐Rodi, J., MacMillan, A., Miller, D., & Edwards, D. J. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-095933 · Cited by 5 · see citing works
Hubbard, A. K., Harris, S. M., Dick, M., & McGee, D. P. (2024) · Journal of Marital and Family Therapy · doi:10.1111/jmft.12692 · Cited by 4 · see citing works
Parents' expected barriers to psychosocial care for children with complex problems
Pannebakker, N. M., Reijneveld, S. A., Numans, M. E., & Kocken, P. (2023) · Child & Family Social Work · doi:10.1111/cfs.13093 · Cited by 3 · see citing works
Cho, H., Kim, W., Gillis, K., Harris, R. E., Park, Y., Farero, A. M., & Ma, W. (2024) · Journal of Family Violence · doi:10.1007/s10896-024-00707-x · Cited by 2 · see citing works
Sorry About the Connection: Client-Reported Telehealth Technology Competency and Difficulties
Hynes, K. C., Tambling, R. R., Kingzette, A., & Bischoff, T. (2023) · Journal of Technology in Human Services · doi:10.1080/15228835.2023.2283216 · Cited by 1 · see citing works
Self-citationTreatment Approaches and Growth Parameters in Pediatric ADHD: Examining Differences Across Race
Saleh, A., Willing, L. M., Ryee, M.-Y., Russo, K., Gestrich-Thompson, W. V., & Andrew, L. M. (2025) · Child Psychiatry & Human Development · doi:10.1007/s10578-025-01913-4
Davis, B. N., & Drislane, L. E. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1686583
VanHook, C., Lee, H. J., Ringo, I., & Jones, H. A. (2026) · Healthcare · doi:10.3390/healthcare14091212
Bridgeman, G., Gunasekera, L., & Kulkarni, J. (2026) · Australasian Psychiatry · doi:10.1177/10398562261481734
- Authors
- Tambling, R. R., Hynes, K. C., & D’Aniello, C.
- Affiliations
- University of Connecticut (US)
- Purdue University Northwest (US)
- Texas Tech University (US)
- Corresponding author
- Tambling, Rachel R.
- Venue
- The American Journal of Family Therapy
- Publisher
- Informa UK Limited
- Published
- 2021-01-08
- Volume
- 50
- Issue
- 5
- Pages
- 443-458
- ISSN
- 0192-6187 (ISSN-L)
- 1521-0383
- OpenAlex
- W3120826853
- Cited by
- 14
- References
- 66
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 3
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Family Therapy (publishedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Counseling Practices and Supervision
- Keywords
- barriers to psychotherapy, treatment seeking, social determinants of health, health disparities, marginalized communities, strengths-based approach, family therapy, telemedicine
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
