Socioeconomic Status and Access to Psychotherapy


Nowadays, it is considered a well-established fact that one’s affiliation with a lower social stratum can indeed be seen as such that increases his or her likelihood of ending up seeking psychotherapy. Moreover, as opposed to what is the case with their wealthy counterparts, most socially underprivileged individuals appear to require much lengthier exposure to such therapies so that they may have a fair chance of recovery (Thompson et al., 2012).

It also accounts for an undeniable fact that during the recent few decades, the government has been applying a continual effort into trying to help socioeconomically disadvantaged citizens to enjoy unobstructed access to psychotherapies. This, in turn, should have resulted in diminishing the susceptibility to mental disorders on the concerned people’s part. The objective reality, however, shows that this is far from the case (Jacobson, 2016). This paper will explore such a seeming phenomenon at length and expound on what should be deemed the discursive significance of the would-be acquired analytical insights into the subject matter.


Before proceeding to tackle the issue, we need to outline the major deficiency of psychology as a whole: the apparent lack of axiomatic integrity. As Avasthi (2016) aptly observed, “Psychiatric (psychological) practice has no standard treatments because of no universally agreed ways of conceptualizing the problems that are to be treated” (p. 3). What this means is that psychology cannot be referred to in terms of “hard science” by definition.

However, because ever since the end of WW2, the number of practicing psychologists/psychiatrists in the West has been growing exponentially, something needed to be done to legitimize (scientifically) the very psychological paradigm as we know it. Hence, the traditional popularity of “behaviorism” in America as a positivist psychological theory that draws from the assumption that one’s behavior is reactive to the externally applied stimuli and that it is possible to apply a quantitative approach to measuring the effectiveness of psychotherapeutic interventions (Schlinger, 2018). In its turn, the latter supposition implies that to improve the mental condition of a patient means to reduce the severity of irrational anxieties experienced by the person (symptom-reduction model).

Even though, during the recent decades, the behaviorist method of addressing mental anxieties in patients has been increasingly falling out of favor with more and more psychologists/psychiatrists, its legacy continues to have a strong effect on the APA-approved strategies for treating such patients. In fact, this effect appears to become ever stronger as time goes on.

The validity of this suggestion can be illustrated by the adoption of “evidence-based therapy” (EBT) by most practicing psychologists in the US. As Mendelberg (2018) suggested, “In response to demands for objective, scientific evidence and expeditious efficacy, the acronym “EBT” became popularized as a general reference to cognitive-behavioral therapy used to produce therapeutic change” (p. 210). The concerned development may seem to have very little with the analyzed issue. This, however, is far from being the case.

After all, those who call for the increased “objectification” of psychotherapeutic interventions do not take into account the fact that this will necessarily lead to strengthening the “normativity” of the would-be-associated practices. Moreover, as practice indicates, the “normative” qualities of a particular psychotherapeutic strategy cannot be discussed outside the class-related implications of the currently prevalent socioeconomic discourse within the society (Helminiak, 2016).

What this means is that, regardless of how strongly “person-centered” a particular EBT may be, its practitioners will not be able to avoid discriminating against socioeconomically disadvantaged patients in one way or another. This simply could not be otherwise, as the “EBTs… rarely frame the conversation in terms of differences in the linguistic possibilities represented in each treatment and how the availability and marketing of therapeutic languages are parsed out along class lines” (Goodman, 2016, p. 78). After all, the specifics of how one perceives the surrounding social reality and its place in it never cease to be closely reflective of both: the particulars of the individual’s socioeconomic status and the intricacies of his or her brain’s morphogenetic structuring (Willemet, 2015).

In this regard, a certain analogy can be drawn between the availability of different fast food outlets even in the most impoverished parts of just about every large city in the West (“ethnic ghettoes”) and the fact that most low-income citizens in Western countries are legally eligible to receive some basic psychotherapeutic treatments. The socioeconomically disadvantaged “ghetto” residents are unlikely to die from hunger, but they are likely to develop obesity and die from being forced to eat unhealthy food all the time. Similarly, socially and economically disfranchised mental patients will never be denied basic therapy upon their request, especially if they are covered by a state-subsidized healthcare plan (Goodman, 2016). This, however, does not mean that they will be able to benefit from such a state of affairs in any tangible way.

Quite to the contrary: there is a good reason to believe that the exposure to a particular EBT, on the low-income patient’s part, will result in making it much harder for him or her to take control of its unconscious angsts. The rationale behind this suggestion has to do with the growing awareness of more and more psychotherapists around the world that to prove effective, the psychotherapeutic treatment of a patient must be “holistic,” in the cause-effect sense of this word (Dobson, 2018).

That is, instead of being solely concerned with the reduction of mental symptoms in a person, it must aim at setting him or her on the path of an overall psychosomatic betterment. And the most straightforward way of making sure that this is indeed the case is by establishing a friendly relationship between the psychotherapist and the patient, “Research has confirmed… that the patient-therapist relationship is an interpersonal process central to the cure” (Mendelberg, 2018, p. 213).

However, within the context of an EBT practitioner dealing with a low-income patient, this could hardly be the case. The reason for this is that EBTs are intentionally designed to be as “classless” as possible, whereas one’s low positioning on the socioeconomic ladder invariably affects the manner in which the person cognitively engages with the social environment, which in turn has a very strong effect on his or her sense of self-identity. In this regard, the main discursive implication is apparent: while interacting with each other during the orientation session, a psychologist and his/her socially disadvantaged patient are likely to realize that their existential values do not correlate and that they are much too different to consider becoming friends. Subsequently, this will substantially undermine the effectiveness of the would-be applied psychotherapeutic treatment.

What has been mentioned earlier suggests that the time has come to reassess the appropriateness of the behaviorist approach to treating mental patients, especially given the fact that the recent breakthroughs in the fields of sociology, neurology, and molecular biology expose the fallaciousness of many axiomatic premises that this approach is based upon. Evidently enough, there are too many phenomenological aspects to the workings of one’s psyche for the representatives of the Homo Sapiens species to be considered nothing but the two-legged versions of the famous “Pavlov’s dog” (Tang, 2018). The growing popularity of the biosocial, feminist, and neo-Marxian paradigms in psychology testifies to the validity of this suggestion better than anything else.

Before concluding this paper, the main insights into the topic should be summarized, yielded by the undertaken research. These are as follows:

  • The seemingly “positivist” sounding of the symptom-reduction models (such as EBT) to dealing with mental patients serves to conceal the fact that there is very little scientific legitimacy to these models in the first place.
  • Even though in most Western countries, one’s low socioeconomic status does not have a strongly hampering effect on the person’s access to therapy, the treatment received by low-income patients is likely to prove ineffective, to say the least.
  • The key to increasing the practical workability of psychotherapeutic interventions are the psychologist’s willingness to adopt an interdisciplinary approach to trying to attain a better understanding of the actual mechanics of one’s psycho-cognitive functioning.


To conclude, these insights work to confirm the full soundness of the suggestion that even today, a patient’s chances of receiving a high-quality therapy positively relate to the amount of money that he or she has in the bank. It is understood, naturally, that such a situation can hardly be seen as thoroughly tolerable.


Avasthi, A. (2016). Are social theories still relevant in current psychiatric practice? Indian Journal of Social Psychiatry, 32(1), 3-9.

Dobson, K. (2018). Dissemination: Science and sensibilities. Canadian Psychology/Psychologie Canadienne, 59(2), 120-125.

Goodman, D. (2016). The McDonaldization of psychotherapy: Processed foods, processed therapies, and economic class. Theory & Psychology, 26(1), 77-95.

Helminiak, D. (2016). Advocating truth but respecting diversity: Resolving the contemporary “paradox”. The Humanistic Psychologist, 44(4), 355-365.

Jacobson, N. (2016). Current evolutionary adaptiveness of psychiatric disorders: Fertility rates, parent−child relationship quality, and psychiatric disorders across the lifespan. Journal of Abnormal Psychology, 125(6), 824-839.

Mendelberg, H. (2018). Outcome research, theory, and evaluation of psychotherapy in praxis. The Psychologist-Manager Journal, 21(4), 209-228.

Schlinger, H. (2018). The heterodoxy of behavior analysis. Archives of Scientific Psychology, 6(1), 159-168.

Tang, P. (2018). What do our brains really want? The Lancet Neurology, 17(4), 308-314.

Thompson, M., Cole, O., & Nitzarim, R. (2016). Recognizing social class in the psychotherapy relationship: A grounded theory exploration of low-income clients. Journal of Counseling Psychology, 59(2), 208-221.

Willemet, R. (2015). Conceptual and methodological issues in comparative neuroscience and psychology: A reassessment. PeerJ PrePrints, 1(1), 1-34.

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PsychologyWriting. 2022. "Socioeconomic Status and Access to Psychotherapy." December 1, 2022.

1. PsychologyWriting. "Socioeconomic Status and Access to Psychotherapy." December 1, 2022.


PsychologyWriting. "Socioeconomic Status and Access to Psychotherapy." December 1, 2022.