Psychotherapy is Less Effective and Less Accessible for Those in Poverty

A special issue explores the connection between poverty, mental health, and psychotherapy.


A special issue of Counselling and Psychotherapy Research examines the role social inequality plays in the success of psychotherapy and on the mental wellbeing of individuals. The issue, edited by Jaime Delgadillo, a clinical psychologist at the University of Sheffield, aims to bring attention to this pressing issue in the field of psychology. Findings suggest that people living in poverty are more likely to develop mental health issues and less likely to make progress in psychotherapy, as compared to their more affluent counterparts. Delgadillo begins the issue questioning the role of class in the therapeutic relationship.

“Social, educational and economic disparities between therapists and clients are often evident. If psychological therapy exerts its restorative influence through communication and guided action, how can effective communication take place when therapists and clients are worlds apart?”

Source: 2015 Census Data

The existing literature demonstrates that social inequalities and poverty lead to higher rates of mental health concerns, and the incidence of depression is especially high among women impacted by poverty. Despite the increased risks, those struggling financially are often least able to access therapeutic treatment. Delgadillo writes:

“Today, people living in poverty are still more likely to experience mental health problems, and are less likely to access therapy, and when they do so they are less likely to recover from depression and anxiety problems.”

While the reduction of poverty has clear indications of improving wellbeing, few psychological interventions have specifically targetted this issue. Strides have been made in the last decade to improve access to services, such as psychotherapy, something that was long seen as a luxury for the privileged and educated. However, more is needed to address the aforementioned issues; critics argue that simply adding increasing funding to the current U.S. mental health system is not enough.

An article in this special issue examines training received by psychotherapists with regards to social class and poverty. The authors write:

“Regarding training, our results indicated that participants received very few clock hours of instruction related to social class issues. After controlling for socially desirable responding, although we detected no statistically significant bias against lower‐class clientele, we did find a measure of bias among trainees towards those from the upper class.”

A complementary study examined the effects this lack of understanding has on the success of the psychotherapy process. The study identified involuntary oppressive natures and classist behaviors from therapists toward clients which hinder the development of rapport, eventually leading to lower success rates overall.

Culturally diverse views of depression from economically disadvantaged individuals are explored in another contribution to the issue. This article highlights the range of experiences captured by the umbrella term depression. Together, these articles emphasize the need for more understanding when dealing with the unique experiences of an economically disadvantaged population. The studies in this issue argue that in order to be effective psychotherapists, those in the field must familiarize themselves with the lived realities of those living in poverty, which may be considerably different from their own.

“Social inequalities continue to be under-researched in our field; rarely acknowledged in clinical training programs or in the therapy consulting room,” Delgadillo writes. “It is like an obstacle that is hidden in plain sight; our senses perceive socioeconomic differences effortlessly, but these perceptions may not register consciously in our therapeutic reflections, formulations and actions.”

Research finds that psychotherapy improves wellbeing regardless of income and that these improvements are relative to a client’s initial levels of distress. However, low income families generally start the therapeutic process with greater levels of distress, emphasizing the need for appropriate methods from the helping professional.

Delgadillo suggests improved integration and consideration of social inequality, power dynamics, and cultural competency into training programs to improve the effectiveness of psychotherapy. Economic inequality is associated with higher incidents of mental health issues, and problems concerning access and success in treatment demand increased attention in both practice and research. Delgadillo concludes:

“The research, published in the journal Counselling and Psychotherapy Research, indicates that a chronic lack of money can be damaging to people’s health and wellbeing – something which currently isn’t widely acknowledged by policy makers and mental healthcare providers.”



Delgadillo, J. (2018). Worlds apart: Social inequalities and psychological care. Counselling and Psychotherapy Research. Worlds apart: Social inequalities and psychological care. (Link)

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Jessica Janze
MIA Research News Team: Jessica Janze is a doctoral student in the Counseling and School Psychology program at the University of Massachusetts Boston. She has a master’s degree in counseling psychology and has worked primarily with children impacted by psychological trauma. Jessica’s research interests include the impact of mindfulness in early education, emotional regulation, and the role contemplative practices play in mental health.


  1. Well if one looks into trauma – the ability to comprehend and analyze what a person is currently experiencing sometimes never can be done ie Vets in POW camps and such.Dr Henry Louis Gates program on family history highlights hidden stories of trauma- literally for safety and other reasons not able to be acknowledge.
    Back in the day in grad school threre was acknowledgement but so small. Michael Harrington’s book- “The Other America” is still seminal reading. The problem came to the fore with the downgrading and lack of funding for community centers and many folks WANTING to go into private practice. Both options proved to be toxic to ethical professionals. I totally dropped out.

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  2. social class is a major issue in psychotherapy. in my experience, if one has more resources, there’s an attempt to drag one down…for control and power and profit. the low status, of course, are easily labeled and destroyed. next!

    at a personal level, my “solution” is to make real friends. that’s difficult in modern America, but its happened, for me, and I’m thankful. i find that real friends have real conversations for no payment, no insurance required. they then expect the same of me (reciprocity), and the cycle continues.

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    • I found the same to be true, if you come from a higher social class (bankers), than the scientifically invalid DSM believers, those “mental health professionals” are particularly vicious and vindictive.

      One and a half times the max recommended dosage of one neuroleptic, plus six other drugs, for a 140 lb, non-violent mother, active volunteer, and artist working on her portfolio? Just to proactively try to prevent a non-existant malpractice suit due to a “bad fix” on a broken bone, and to cover up medical evidence of the abuse of her small child by a Bohemian Grove attending Baal worshipper and his likely pedophile Lutheran pastor “soul mate”? Really??? That’s blatant attempted murder, with obvious motives, via anticholinergic toxidrome poisoning.

      I, too, found largely ignoring the looney “mental health” practicers, and concentrating on my good friends, to be what helped me make my “great escape” as well.

      And what’s great is it’s not just us pointing out that the psychiatrists are destroying America any longer, lots of people are pointing this out on the internet now.

      It does seem, once again, the psychiatrists and their psychological and other DSM deluded “mental health” minion are in need of Neremburg trials. Because they can’t seem to stop murdering millions for profit, over and over and over again, in country after country after country, based upon their scientifically debunked theology.

      And once again, the “mental health professionals” are murdering millions for the globalist banksters, who needed bailouts in 2008. In part, because those war mongering and profiteering, globalist banksters don’t know the first rule of how to properly manage a bank – don’t give out bad loans. Although never ending wars against the concept of “terror,” as opposed to a real enemy, is a stupid idea that will bankrupt any country too, not to mention the inanity of creating the derivatives markets. I could go on and on about the fiscal stupidity and appalling nature of the globalist “Luciferian banksters.” Although this banking insider already did a great job of that.

      We can all hope that by attempting to educate the iatrogenic illness creating “mental health professionals,” who automatically assume they are more intelligent than their clients. Whose profession’s primary societal function, according to their own medical literature, is actually turning child abuse victims into the “mentally ill” with the psychiatric drugs. That there is something to the concepts of “don’t judge a book by its cover” and “all people are created as equal.”

      And they do need to end their systemic, built into the DSM, child abuse covering up, since such behavior is technically illegal. How covering up child abuse is built into today’s DSM system, resulting in that becoming the primary function of today’s “mental health” industry, is somewhat described in this article.

      Let’s hope we wake up the “mental health professionals,” since collectively and likely ignorantly, they’re in the process of recreating the worst of the psychiatric industry’s history once again.

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  3. This is a very interesting and relevant article. “Social, educational and economic disparities between therapists and clients are often evident. If psychological therapy exerts its restorative influence through communication and guided action, how can effective communication take place when therapists and clients are worlds apart. The relationship is the cornerstone to effective therapy but differences in social class, education level, wealth, as are differences in race, culture, gender, religion and other factors certainly exist. Acknowledging those differences is important. Social class is often a taboo of sorts to discuss in the United States. A therapist should examine his/her biases and prejudices about this topic as not to inflict harm upon a client through judgment. We all have blindspots so need a fearless examination of them.

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  4. 1. The normal sign, symptoms and sequalea of dis/stress are being mis-positioned and mis-labled as if they are separate “MENTAL” problems, which is medical fraud.
    2. The reason therapy is largely useless in helping poor people feel better, is because it does not and cannot address the root cause of the problem which can only be solved with access to decent food, safe social environments, affordable housing, education and jobs and healthy lifestyles that promote human health.
    3. It is ludicrous to suggest that counseling of any kind can improve people’s financial position. Poverty is political violence, and not remotely a “mental health” problem cured by talking about ones struggles to someone who is getting paid by the state to listen to them.
    4. Further the money the state pays for therapy, should by put directly into the pockets of the impoverished and used to develop affordable housing and other Social Determinants of Health (that have nothing to do with access to “health care AKA sick care and therapy.)
    5. I can’t imagine a greater waste of time, money or effort than attending on a therapist so they can write a prescription to the food bank or an exercise class.
    6. Why continue to enrich the wealthy to pointlessly minister to the poor and disenfranchised, rendering them wealthier and us more impoverished.
    7. It is a clear and obvious waste of resources to throw more money at the toxic “mental health” system, no matter what guise the “help” comes as.
    8. Psychiatry and Psychology are the WRONG organizations to address social problems. All they did so far, was twist real-world problems into pseudo-diseases and problems of the “mind”.
    9. Billions have been wasted allowing P & P to act as middle-men pocketing the money desperately needed to go directly into food security and housing and education.
    10. Stop feeding the middlemen (the problem) and start feeding the public!
    11. The abuse at its core, is primary about FOOD, (the building blocks of real health) but has been mispostioned as the dis/stress caused by lack of decent food and opportunities, repackaged and sold back to the public as “mental health” problems, so that this industry can continue to feed its self over and above the people- it NEEDS to remain impoverished- so its can stay in business and not suffer the same fate as those of us whose needs remain unmet —- BECAUSE they have fraudulently positioned the real problem as “mental health” rather than a legal rights issue of ACCESS to the resources we really need.
    12. A lot of therapy would be unnecessary if people had their basic needs met.
    13. Therapy can never hope to address the real medical needs of someone suffering from the host of real medical conditions caused by lack of access to the Social Determinants of Health.
    14. “More understanding”, is code for we are going to spend more decades wasting more billions maintaining the status quo of power.
    15. None of the services currently offered help the poor, but continue to unjustly enrich therapists at the expense of the poor.
    16. Are therapist currently so obtuse that they can’t grasp the ravages that poverty has on human beings, especially those they do see in their practice? It is shocking to consider that therapists and other professionals are so disconnected from the reality of the majority that they have to actually be TAUGHT by a public institution, that social inequity causes the human suffering.
    17. …”low income families generally start the therapeutic process with greater levels of distress, emphasizing the need for appropriate methods from the helping professional.” This is a bid for, continue to give us more of the money that is desperately needed and should be going directly into making real and meaningful changes to the social circumstances that cause human dis/stress and disease. This is a professional bid to keep the gravy train flowing into their mouths, instead of using it to feed the hungry.
    18. Food scarcity and living in a state of constant disequilibrium is a major cause of human suffering. If the poor had access to the resources that keep people safe and healthy, the need for counseling would lower dramatically.
    19. It is a disingenuous and self-serving insult to humanity to suggest:
    1) that the real physical health problems caused by poverty cause “mental health” (emotional problems that are alleviated by talking to a therapist.
    2) that public access to therapy is the answer to an empty stomach, the ravages of consuming sub-standard food on the health of the human body and that …’access and success in treatment”… could remotely solve the problem of poverty.
    20. There is also an element of victim blaming herein that subtly suggests victims subjected to the political violence of poverty would be “successful” in life, if they just had access to therapy.

    “The research, published in the journal Counselling and Psychotherapy Research, indicates that a chronic lack of money can be damaging to people’s health and wellbeing – something which currently isn’t widely acknowledged by policy makers and mental healthcare providers.”
    21. No kidding! How much of the public purse was wasted on figuring that out?
    22. Applying the chemical imbalance scam to this scenario, it is accurate to state that in the same way that a lack of serotonin does not cause the social construct “mental illness” or result in lack of “mental health”; a lack of therapy, does not cause the social construct “mental illness” or result in lack of “mental health,”
    23. Further, a chronic lack of money does not cause the social construct “mental illness” or result in lack of “mental health”, nor will these serious social problems be solved by sitting around talking about them with a therapist.

    They fooled us once people, lets not let them switch up the game in their favor and fool us again!
    ©JMGayton 6/9/18 MH, AB, CA.

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  5. This is likely because the therapists have no clue what really bad poverty is like. They are employed, after all. They have degrees. Most have a chance at making decent money, some end up with crap jobs, though.

    I have been on different ends of the economic spectrum and I find that what SomeoneElse is saying is true. I came from privilege and the therapists couldn’t relate to that. Later, I found they’d ask me stuff like, “Can’t you take a cab?” when of course the price was prohibitive.

    Therapy is mostly ineffective, simply because the therapist tends to assume the client thinks just like she does. The therapist assumes she is normal and healthy and the ideal for living. Bullshit.

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  6. Look at Wilkinson & Pickett – ‘The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyones Wellbeing’ – they argue that it is not poverty per se that is causing the stress, so much as the disparity between the wealth disparities – the same applies in very poor countries – if there is wealth disparity there is increased mental disorder etc – if there is greater equality there is greater community life, trust, willingness to help each other, and low levels of violence,
    Here is a 5 minute read

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  7. another thing is that, to avoid being drugged and pathologized by “normal” therapists, if one wants therapy one must search for an “alternative” therapist. Well, ok, we do know that this one wont drug us but she’s also trained in a school of psychology that grew out of positive psychology, the human potential movement, or a new age orientation. And Im sorry but these orientations tend to be polyanna-ish as fuck. They cant take it when you try to explain how you can’t get a better job, afford to go back to school, or just in general pay your rent or whatever… exist in a service industry job where you’re treated like crap by a boss who’s a jerk and your nerves are shot. They cant take it and get all “maybe you dont want to succeed, maybe success is what you’re really afraid of”… or “if it’s meant to be that you’ll go back to school, the money will work itself out.” Like… um… yeah , no. Things in my world, where I am living in poverty, don’t really work like that. SORRY.

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  8. Szasz says that psychoterapy is only a talk with another, maybe hostile person. It is not even a medicine. So we say that sb has got trauma, and then his feelings are not psychological AND HUMAN anymore, they are seen only as disrupted and then we think that sb should correct that person, using magic/ fetish like psychotherapy. I am sorry, we say sb has got trauma, because our small world didn’t accept things hidden behind words trauma, we want cure trauma, because everyone should be normal. NORMALCY IS antypsychological TERRORISM. This kind of feelings are not accepted, so we want to cure it, pretend to cure, because we want to get rid of them, we want to ged rid of pain, get rid of death in psyche, that’s why they invent term MENTAL HEALTH,to control phenomenology of the psyche by economics. If someone is in psychiatric hospital, he is there because they don’t want him in economic EGO APOLLONIAN state, we don’t want psyche inside authoritarian SOULESS ANTYPSYCHOLOGICAL state, so we decided to get rid of PSYCHE- only get rid of, WITHOUT EXPLANATION AND ACCEPTANCE OF THE REAL STATE, NO, WE CALL IT MENTAL ILLNESES – MENTAL ILlNESSES MEANS ALSO NOT REAL,WE TAKE BACK THE AUTONOMY OF THE STATE to get rid of it …..and pretend that there are false illnesses in place of TRUE HUMAN PSYCHE.
    There should be places for extraordinary states of mind, which are far more advanced THAN APOLLONIAN EGO =NORMALCY. We are not the ones who can judge/cure sb psyche,because we are not the owners of the psyche, we can help,to accompany….To do that, we must admit that psyche exists,THAT PSYCHE BEHIND EGO APOLLONIAN exists and IS STH GREATER NOT, SOMETHING WORSE than simple state of normalcy. There is hierarchy in psychic world, but economics and materialists destroy this logic to control and destroy PSYCHE We are not able to imagine worLd without diagnosis, because DSM is the power, psyche should be the power, that own economics laws. Apollonian ego -normalcy is not even a psyche, it’s just psychological mediocrity, without psychological consciousness. We should say it loud ====normal means easy, apollonian ego means normal======psyche means MORE THAN NORMAL,MEANS TITANS, BECAUSE THIS PEOPLE FEEL MORE THAN NORMAL EVER WILL, FOR EXAMPLE ANELLIESE MICHEL, PSYCHE OF THE TITANS ARE NOT AUTHORITARIAN property, IT BELONGS only TO PSYCHOLOGICAL WORLD, WHICH WE CALL today -SEVERE MENTALLY DISTURBED, because we do not accept, and do not know what is it, because phenomenolgy of the psyche is hidden behind the mask of false diagnosis/theology and pseudo medicine. Diagnosis is just empty nominalism and economics dehumanisation, IT HAS NOTHING TO DO WITH empathy and phenomenology.
    You must read Revisioning psychology to understand me. Stop begging for money, fight, if you can’t win, die in fight to restore the phenomenology of the psyche. We can’t be humans with F65 in place of feelings reactions. Economists and materialists should stand lower than psychological people, because they are psychologically simpler.. Because of them we can’t win,because they take back our psychological worth, using economics and bilious medical language.
    I write this because for me psyche is value. I spit on your grave, YOU economists,materialists, transcendentalists, nihilists, spiritualists, BECAUSE YOU DESTROY HUMAN PSYCHE .Read Revisioning psychology, you will understand this point of view. Do not cure psyche, build PSYCHOLOGICAL EMPIRE USING GREAT WORDS. BECAUSE OUR PSYCHOLOGICAL LIFE IS INVISIBLY DESTROYED.

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