The Influence of Client Socioeconomic Status on Psychotherapists’ Attributional Biases and Countertransference Reactions
Abstract
Clinical reaction related to client socioeconomic status has not been adequately researched, yet socioeconomic status can profoundly affect psychotherapist perceptions of a client's presenting concerns, symptom severity, and prognosis. Using an online national survey, this study examined the influence of client socioeconomic status on psychotherapist cognitive attributions and countertransference reactions (N = 141). Results revealed no significant differences in cognitive attributions based on socioeconomic status. However, significantly stronger countertransference reactions of being dominated by the client with a higher socioeconomic status were found. In addition, the clients with higher socioeconomic status were ascribed with mild problems compared with the client of lower socioeconomic status. Psychotherapeutic implications are discussed.
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One included research paper on mental health found a link between SES and decision-making.
“Two of the included research papers on diabetes64 65 and one on mental health87 found a link between SES and decision-making.”
From Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review (2024) · cites this paper as [87]
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Neenan, M., & Dryden, W. (1929) · Postgraduate medical journal · doi:10.1177/104438942901000201 · Cited by 212
“Negative bias and oppression toward differing socioeconomic status (SES) populations, or classism, manifests as reduced access to services, inaccurate mental health diagnoses and assessment of prognoses, and inappropriate hospitalizations (e.g., Dougall & Schwartz, 2011; Hudson, 2005; Jurado, 2020).”
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“…and client characteristics, such as ethnicity/race, religion/spirituality, and SES, have been studied considerably and resulted in varied findings with regard to therapeutic relationships and clinical outcomes (e.g., Barnett & Johnson, 2011; Cabral & Smith, 2011; Dougall & Schwartz, 2011).”
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“In another study, counselors and counselor trainees rated case vignettes and videos of presenting problems featuring clients from either lower or higher SES (Dougall & Schwartz, 2011).”
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Thompson, M. N., Diestelmann, J., Cole, O., Keller, A., & Minami, T. (2014) · Psychotherapy Research · doi:10.1080/10503307.2013.873556 · Cited by 12
“In order to understand factors that may contribute to these findings, authors (e.g., Dougall & Schwartz, 2011) have suggested that we need to better understand therapists’ perceptions of clients’ motivation and therapists’ attributional judgments (Chen, Froehle, & Morran, 1997) about the client.”
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“We intentionally chose to use video vignettes because previous researchers (Dougall & Schwartz, 2011; Thompson et al., 2014) have posited that some previous vignette-based studies may have produced null findings because participant reactions were not strongly evoked.”
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“Limitations in personalization due to human memory constraints and cognitive biases further hinder effective treatment (Dougall & Schwartz, 2011; Markin & Kivlighan, 2007; Smith, 1980).”
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Hîrju, A. (2019) · Journal of Community Positive Practices · doi:10.35782/jcpp.2019.4.05
“Dougall and Schwartz (2011) from the University of Arkon studied the influence of the socio-economic status of the client on the attribution biases of the therapist and countertransference.”
BackgroundClements, A. (2021) · UKnowledge (University of Kentucky) · doi:10.13023/etd.2021.002
“Negative biases about socioeconomic status may prompt therapists to attribute blame for less favorable outcomes to clients rather than questioning their own therapeutic approach (Dougall & Schwartz, 2018).”
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Glover, R. L. (2017) · UKnowledge (University of Kentucky) · doi:10.13023/etd.2017.277
- Authors
- Dougall, J. L., & Schwartz, R. C.
- Affiliations
- University of Akron (US)
- Venue
- American Journal of Psychotherapy
- Published
- 2011-07
- Volume
- 65
- Issue
- 3
- Pages
- 249-265
- ISSN
- 0002-9564 (ISSN-L)
- 2575-6559
- OpenAlex
- W98414497
- Cited by
- 16
- References
- 0
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2022: 2 · 2020: 2 · 2019: 2 · 2015: 1 · 2014: 2 · 2013: 1
- FWCI
- 1.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychotherapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Counseling Practices and Supervision
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Keywords
- countertransference, attribution bias, therapeutic relationship
- MeSH terms
- Adult, Aged, Analysis of Variance, Attitude of Health Personnel, Cognition, Countertransference, Female, Humans, Judgment, Male, Middle Aged, Prejudice, Professional-Patient Relations, Surveys and Questionnaires, Social Class, Social Perception, Young Adult
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