Skip to main content

Advertisement

SpringerLink
Log in

When Words are not Enough: Psychotherapy with Clients Who are Living Below the Poverty Level

  • Original Paper
  • Published:
Journal of Contemporary Psychotherapy Aims and scope Submit manuscript

Abstract

The present article describes six strategies found useful when working with depressed clients who are struggling with severe financial limitations. First, it is important to help clients maintain an attitude of hope for a better future, so they remain as positive yet realistic about their current options and future goals. Second, empathy is considered to be a central component in all psychotherapy sessions, helping therapists to understand their clients’ life experiences and ongoing struggles. Third, clients can learn to develop more adaptive perspectives about life, family, and friends, trying to focus on the positive events they have experienced and the supportive bonds they have developed. Fourth, clients can develop new specific coping skills that may help them to manage the problems they encounter. Fifth, many clients can better utilize the social support that is often available, starting to ask family members and friends for assistance and support when help is needed. Sixth, an interdisciplinary treatment team is often optimal when the treatment plan integrates the potential benefits derived from psychotherapy, medications, and social service agencies. An effective psychotherapist respects the limits of psychology while consulting with colleagues from other health care professions. These six strategies can help guide therapists when working with clients who are struggling with persistent depression in the face of adversity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Almeida, O., Pirkis, J., Kerse, N., Sim, M., Flicker, L., Snowdon, J., et al. (2012). Socioeconomic disadvantage increases risk of prevalent and persistent depression in later life. Journal of Affective Disorders, 138, 322–331.

    Article  PubMed  Google Scholar 

  • Arean, P., Gum, A., McCulloch, C., Bostrom, A., Gallagher-Thompson, D., & Thompson, L. (2005). Treatment of depression in low-income older adults. Psychology and Aging, 20(4), 601–609.

    Article  PubMed  Google Scholar 

  • Arean, P., Macklin, S., Vargas-Dwyer, E., Raue, P., Sirey, J., Kanellopolos, D., & Alexopoulos, G. (2010). Treating depression in disabled, low-income elderly: A conceptual model and recommendations for care. International Journal of Geriatric Psychiatry, 25(8), 765–769.

    Article  PubMed  PubMed Central  Google Scholar 

  • Beck, J. (2011). Cognitive therapy: Basics and beyond (2nd ed.). New York: Guilford.

    Google Scholar 

  • Beck, A. T., Steer, R., Kovacs, M., & Garrison, B. (1985). Hopelessness and eventual suicide: A ten-year prospective study of patients hospitalized with suicidal ideation. American Journal of Psychiatry, 142, 559–563.

    Article  CAS  PubMed  Google Scholar 

  • Beeber, L., Cooper, C., Van Noy, B., Schwartz, T., Blanchard, H., Canuso, R., et al. (2007). Flying under the radar: Engagement and retention of depressed low-income mothers in a mental health intervention. Advances in Nursing Science, 30(3), 221–234.

    Article  PubMed  Google Scholar 

  • Bell, A., & D’Zurilla, T. (2009). Problem-solving therapy for depression. Clinical Psychology Review, 29(4), 348–353.

    Article  PubMed  Google Scholar 

  • Breggin, P. (2015). Rational principles of psychopharmacology for therapists, healthcare providers, and clients. Journal of Contemporary Psychotherapy,. doi:10.1007/s10879-015-9307-2.

    Google Scholar 

  • Butler, A. (2014). Poverty and adolescent depressive symptoms. American Journal of Orthopsychiatry, 84(1), 82–94.

    Article  PubMed  Google Scholar 

  • Butterworth, P., Rodgers, B., & Windsor, T. (2009). Financial hardship, socio-economic position and depression. Social Science and Medicine, 69, 229–237.

    Article  PubMed  Google Scholar 

  • Cagney, K., Browning, C., Iveniuk, J., & English, N. (2014). The onset of depression during the Great Recession. American Journal of Public Health, 104, 498–505.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cheavens, J., Feldman, D., Woodward, J., & Snyder, C. R. (2006). Hope in cognitive psychotherapies: On working with client strengths. Journal of Cognitive Psychotherapy, 20(2), 135–145.

    Article  Google Scholar 

  • Constantino, M., Marnell, M., Arnow, B., Haile, A., Kanther-Sista, S., Wolman, K., & Zappart, L. (2008). Integrative cognitive therapy for depression: A randomized pilot comparison. Psychotherapy: Theory, Research, Practice, and Training, 45(2), 122–134.

    Article  Google Scholar 

  • Dass-Brailsford, P. (2012). Culturally sensitive therapy with low-income ethnic minority clients. Journal of Contemporary Psychotherapy, 42(1), 37–44.

    Article  Google Scholar 

  • deMaat, S., Dekker, J., Schoevers, R., & Jonghe, F. (2007). Relative efficacy of psychotherapy and combined therapy in the treatment of depression. European Psychiatry, 22, 1–8.

    Article  Google Scholar 

  • Ekers, D., Richards, D., & Gilbody, S. (2008). A meta-analysis of randomized trials of behavioural treatment of depression. Psychological Medicine, 38, 611–623.

    Article  CAS  PubMed  Google Scholar 

  • Ennis, N., Hobfall, S., & Schroder, K. (2000). Money doesn’t talk, it swears: How economic stress and resistance resources impact inner-city women’s depressive mood. American Journal of Community Psychology, 28(2), 149–173.

    Article  CAS  PubMed  Google Scholar 

  • Evans, G., & English, K. (2002). The environment of poverty: Multiple stressor exposure, psychophysiological stress, and socio-emotional adjustment. Child Development, 73(4), 1238–1248.

    Article  PubMed  Google Scholar 

  • Friedman, M., Cardemil, E., Golian, J., Uebelacker, L., & Miller, I. (2003). The GIFT program for major depression. Cognitive and Behavioral Practice, 10, 157–168.

    Article  Google Scholar 

  • Gavin, A., Walton, E., Chae, D., Alegria, E., Jackson, S., & Takeuchi, D. (2010). The associations between socio-economic status and major depressive disorder among Blacks, Latinos, Asians, and non-Hispanic Whites. Psychological Medicine, 40, 51–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Grote, N., Swartz, H., Geible, S., Zuckoff, A., Houck, P., & Frank, E. (2009). A randomized controlled trial of culturally relevant, brief interpersonal psychotherapy for perinatal depression. Psychiatric Services, 60(3), 313–321.

    Article  PubMed  PubMed Central  Google Scholar 

  • Grote, N., Swartz, H., & Zuckoff, A. (2008). Enhancing interpersonal psychotherapy for mothers and expectant mothers on low incomes: Adaptations and additions. Journal of Contemporary Psychotherapy, 38(1), 23–33.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gum, A., Arean, P., & Bostrom, A. (2007). Low-income depressed older adults with psychiatric comorbidity. International Journal of Geriatric Psychiatry, 22, 124–130.

    Article  PubMed  Google Scholar 

  • Hanandita, W., & Tampubolon, G. (2014). Does poverty reduce mental health? Social Science and Medicine, 113, 59–67.

    Article  PubMed  Google Scholar 

  • Jacobson, N. S., Martell, C. R., & Dimidjian, S. (2001). Behavioral activation treatment for depression: Returning to contextual coots. Clinical Psychology: Science and Practice, 8, 255–270.

    Google Scholar 

  • Kim, S., & Cardemil, E. (2012). Effective psychotherapy with low-income clients: The importance of attending to social class. Journal of Contemporary Psychotherapy, 42(1), 27–35.

    Article  PubMed  PubMed Central  Google Scholar 

  • Krupnick, J., & Melnikoff, E. (2012). Psychotherapy with low-income clients: Lessons learned from treatment studies. Journal of Contemporary Psychotherapy, 42(1), 7–15.

    Article  Google Scholar 

  • Krupnick, J., Sotsky, S., Simmens, S., Moyer, J., Elkin, I., Watkins, J., & Pilkonis, P. (1996). The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome. Journal of Consulting and Clinical Psychology, 64(3), 532–539.

    Article  CAS  PubMed  Google Scholar 

  • Ledley, D., Marx, B., & Heimberg, R. (2010). Making cognitive-behavioral therapy work: Clinical process for new practitioners (2nd ed.). New York: Guilford.

    Google Scholar 

  • Lorant, V., Croux, C., Weich, S., Deliege, D., Mackenbach, J., & Ansseau, M. (2007). Depression and socio-economic risk factors. British Journal of Psychiatry, 190, 293–298.

    Article  PubMed  Google Scholar 

  • Madianos, M., Economou, M., Alexiou, T., & Stefanis, C. (2011). Depression and economic hardship across Greece in 2008 and 2009. Social Psychiatry and Psychiatric Epidemiology, 46, 943–952.

    Article  PubMed  Google Scholar 

  • Martell, C., Addis, M., & Jacobson, N. (2001). Depression in context: Strategies for guided action. New York: Norton.

    Google Scholar 

  • Miranda, J., Azocar, F., Organista, K., Dwyer, E., & Areane, P. (2003a). Treatment of depression among impoverished primary care patients from ethnic minority groups. Psychiatric Services, 54(2), 219–225.

    Article  PubMed  Google Scholar 

  • Miranda, J., Chung, J., Green, B., Krupnick, J., Siddique, J., Revicki, D., et al. (2003b). Treating depression in predominantly low-income young minority women. Journal of the American Medical Association, 290(1), 57–65.

    Article  PubMed  Google Scholar 

  • Moynihan, R., & Cassels, A. (2005). Selling sickness. New York: Perseus.

    Google Scholar 

  • Najman, J., Hayatbakhsh, M., Clavarino, A., Bor, W., O’Callaghan, M., & Williams, G. (2010). Family poverty over the early life course and recurrent adolescent and young adult anxiety and depression. American Journal of Public Health, 100, 1719–1723.

    Article  PubMed  PubMed Central  Google Scholar 

  • Nezu, A., & Nezu, C. (2001). Problem solving therapy. Journal of Psychotherapy Integration, 11(2), 187–205.

    Article  Google Scholar 

  • Norstrom, T. (1995). The impact of alcohol, divorce, and unemployment on suicide. Social Forces, 74(1), 293–314.

    Article  Google Scholar 

  • Overholser, J. C. (1995a). Cognitive-behavioral treatment of depression: Part II. Techniques for improving social functioning. Journal of Contemporary Psychotherapy, 25, 205–222.

    Article  Google Scholar 

  • Overholser, J. C. (1995b). Cognitive-behavioral treatment of depression: Part III. Reducing cognitive biases. Journal of Contemporary Psychotherapy, 25, 311–329.

    Article  Google Scholar 

  • Overholser, J. C. (1996a). Cognitive-behavioral treatment of depression: Part IV. Improving problem-solving skills. Journal of Contemporary Psychotherapy, 26, 43–57.

    Article  Google Scholar 

  • Overholser, J. C. (1996b). Cognitive-behavioral treatment of depression: Part VII. Coping with precipitating events. Journal of Contemporary Psychotherapy, 26, 337–360.

    Article  Google Scholar 

  • Overholser, J. C. (2003). Cognitive-behavioral treatment of depression: A three-stage model to guide treatment planning. Cognitive and Behavioral Practice, 10, 231–239.

    Article  Google Scholar 

  • Overholser, J. C. (2005). Contemporary psychotherapy: Promoting personal responsibility for therapeutic change. Journal of Contemporary Psychotherapy, 35(4), 369–376.

    Article  Google Scholar 

  • Overholser, J. C. (2007). The central role of the therapeutic alliance: A simulated interview with Carl Rogers. Journal of Contemporary Psychotherapy, 37, 71–78.

    Article  Google Scholar 

  • Overholser, J. C. (2012a). Treating depression during a recession: Psychotherapy with indigent clients. Journal of Contemporary Psychotherapy, 42(1), 1–6.

    Article  Google Scholar 

  • Overholser, J. C. (2012b). Emotional effects of financial misfortune in low-economic populations. Directions in Psychiatry, 32, 115–123.

    Google Scholar 

  • Overholser, J. C. (2015). Positive psychotherapy according to the Socratic method. Journal of Contemporary Psychotherapy, 45(2), 137–142.

    Article  Google Scholar 

  • Overholser, J. C., & Braden, A. (2011). Recovery from a suicidal crisis: Where there’s hope, there’s life. In K. McKay & J. Schlimme (Eds.), Making sense of suicide (pp. 95–104). Oxford, UK: Interdisciplinary Press. ISBN 978-1-84888-068-9.

    Google Scholar 

  • Overholser, J. C., & Schubert, D. (1996). Cognitive-behavioral treatment of depression: Part VI. Integrating the use of antidepressant medications. Journal of Contemporary Psychotherapy, 26, 235–250.

    Article  Google Scholar 

  • Overholser, J. C., & Silverman, E. (1998). Cognitive-behavioral treatment of depression: Part VIII. Developing and utilizing the therapeutic relationship. Journal of Contemporary Psychotherapy, 28, 199–214.

    Article  Google Scholar 

  • Rahman, A., Sikander, S., Malik, A., Ahmed, I., Tomenson, B., & Creed, F. (2012). Effective treatment of perinatal depression for women in debt and lacking financial empowerment in a low-income country. British Journal of Psychiatry, 201, 451–457.

    Article  PubMed  PubMed Central  Google Scholar 

  • Santiago, C., Kaltman, S., & Miranda, J. (2013). Poverty and mental health: How do low-income adults and children fare in psychotherapy? Journal of Clinical Psychology, 69(2), 115–126.

    Article  PubMed  Google Scholar 

  • Santiago, C., Wadsworth, M., & Stump, J. (2011). Socioeconomic status, neighborhood disadvantage, and poverty-related stress. Journal of Economic Psychology, 32, 218–230.

    Article  Google Scholar 

  • Simmons, L., Braun, B., Charnigo, R., Havens, J., & Wright, D. (2008). Depression and poverty among rural women. Journal of Rural Health, 24(3), 292–298.

    Article  PubMed  Google Scholar 

  • Smith, L. (2005). Psychotherapy, classism, and the poor. American Psychologist, 60(7), 687–696.

    Article  PubMed  Google Scholar 

  • Summerfield, D. (2008). How scientifically valid is the knowledge base of global mental health? British Medical Journal, 336(7651), 992–994.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wadsworth, M. (2012). Working with low-income families: Lessons learned from basic and applied research on coping with poverty-related stress. Journal of Contemporary Psychotherapy, 42(1), 17–25.

    Article  Google Scholar 

  • Waters, L. (2000). Coping with unemployment. International Journal of Management Reviews, 2(2), 169–182.

    Article  Google Scholar 

  • Yamamoto, J., Acosta, F., & Evans, L. (1982). The poor and working-class patient. In F. Acosta, J. Yamamoto, & L. Evans (Eds.), Effective psychotherapy for low-income and minority patients (pp. 31–50). New York: Plenum Press.

    Chapter  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, Case Western Reserve University, Cleveland, OH, 44106-7123, USA

    James C. Overholser

Authors
  1. James C. Overholser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James C. Overholser.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Overholser, J.C. When Words are not Enough: Psychotherapy with Clients Who are Living Below the Poverty Level. J Contemp Psychother 46, 89–96 (2016). https://doi.org/10.1007/s10879-015-9313-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10879-015-9313-4

Keywords

Search

Navigation