Considering Socioeconomic Status in Treatment

By Jen L’Insalata

Socioeconomic status encompasses more then just income. It includes aspects of ownership, wealth, and class identity. Social gradients between rich and poor showcase varying degrees of well-being linked to mental and physical health outcomes, access to resources, opportunity, and education, and provide a pathway to power through the existence of a status-driven western economy (Wilkinson, & Pickett, 2017).

Individuals residing in a higher socioeconomic status have access to healthcare and education which present opportunities for global wellbeing. Education and career endeavors associated with higher income offer a sense of prestige that is often unavailable to those of lower socioeconomic standing (Wilkinson, & Pickett, 2017). Individuals in lower socioeconomic classes are often considered ‘disadvantaged’ in terms of health outcomes, access, and opportunity. The association with being ‘disadvantaged’ leads to social isolation and alienation (Smith, 2005).

Poverty is complex and can be addressed from framework spanning several disciplines including psychology. However psychological services often fall short when providing services for low income populations. Classism and negative biases often influence the service provider and distinctions between white collar and blue-collar mentalities are not acknowledged in the therapeutic setting. This further exacerbates alienation and leads to a breakdown in understanding between the therapist and the client (Smith, 2009).

Historical movements have attempted to provide access to psychological services to lower income individuals through means of community mental health programs. Clinicians trained through higher education observed that individuals from lower socioeconomic status appeared unable to “grasp” concepts addressed through therapy (Smith, 2009). Misconceptions surrounding relatability and priority further alienate the client from the therapist.

When developing psychological services for lower income populations, once can utilize Maslow’s Hierarchy of needs as a framework. Maslow suggests that in order for individuals to address higher level concerns, basic needs must be satisfied (Wedding, & Corsini, 2014). In application, psychologists must recognize that individuals at lower socioeconomic statuses often struggle to secure basic needs such as food and shelter. Thus, priorities differ from individuals who have obtained security in low level needs and are able to focus on higher level motivators such as belonging, emotional wellbeing, and self-actualization.

Strength based client centered approaches are likely benefit those at lower socioeconomic levels as the focus on a client’s strengths rather then limitations and encourage the client to take an active role in the course of their program. Strength based client focused approaches rely heavily on collaboration when treatment planning and recognizing that clients may experience challenges unforeseen to the therapist. Strength based approaches also place the client in the position as the expert shifting the power differential between client and psychologist (Snyder & Lopez, 2006).

Similarly, family systems theory incorporates both the systemic and structural framework when working with low income individuals. Family systems therapy addresses poverty as it effects the individual and conceptualizes a client’s relationship to poverty when formulating a treatment approach (Smith, 2005). The therapist becomes aware of their interactions as a component of the system structure and thus the impact on the client.


Smith, L. (2005). Psychotherapy, Classism, and the Poor: Conspicuous by Their Absence. American Psychologist, 60(7), 687–696.

Snyder C.R. & Lopez, S.J.(2006). Positive Psychology: The Scientific and Practical Explorations of Human Strengths” SAGE.

Wedding, D., & Corsini, R. J. (Eds.). (2014). Current psychotherapies (10th ed.). Belmont, CA: Brooks/Cole. ISBN: 9781285083711.

Wilkinson, R. G., & Pickett, K. E. (2017). The enemy between us: The psychological and social costs of inequality. European Journal of Social Psychology, 47(1), 11–24.

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