Working with Low-income Families: Lessons Learned from Basic and Applied Research on Coping with Poverty-related Stress

Abstract

Poverty and low socioeconomic status create tremendous amounts of physical and psychosocial stress that compromise health and well-being. This paper explores how the stressors created, exacerbated, and maintained by living in poverty lead to compromised mental health, and at the same time present significant challenges to participating in and benefitting from traditional psychotherapy. This paper summarizes the strong research evidence supporting the causal role of poverty-related stress in contributing to mental (and physical) health problems, discusses the physiology that underlies this process and how it affects clients’ ability to make use of psychotherapy, and presents recommendations for incorporating a multi-faceted approach to coping in clinical work with low-income clients and families. Addressing the pernicious effects of economic stress with a multi-step approach to effective coping can serve to prepare low-income clients to better engage in and get the most out of psychotherapy.

This is a preview of subscription content, access via your institution.

References

  1. Almeida, D., Neupert, S., Banks, S., & Serido, J. (2005). Do daily stress processes account for socioeconomic health disparities? Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 60, 34–39.

    Article  Google Scholar 

  2. Belle, D., & Doucet, J. (2003). Poverty, inequality, and discrimination as sources of depression among U.S. women. Psychology of Women Quarterly, 27, 101–113.

    Article  Google Scholar 

  3. Bento, S., Goodin, B., Fabian, L., Page, G., Quinn, N., & McGuire, L. (2010). Perceived control moderates the influence of active coping on salivary cortisol response to acute pain among women but not men. Psychoneuroendocrinology, 35, 944–948.

    PubMed  Article  CAS  Google Scholar 

  4. Bergin, A. E., Masters, K. S., & Richards, P. S. (1987). Religiousness and mental health reconsidered: A study of an intrinsically religious sample. Journal of Counseling Psychology, 34, 197–204.

    Article  Google Scholar 

  5. Chen, E., Martin, A. D., & Matthews, K. A. (2006). Socioeconomic status and health: Do gradients differ within childhood and adolescence? Social Science and Medicine, 62, 2161–2170.

    PubMed  Article  Google Scholar 

  6. Chen, E., Matthews, K. A., & Boyce, W. T. (2002). Socioeconomic differences in children’s health: How and why do these relationships change with age? Psychological Bulletin, 128, 295–329.

    PubMed  Article  Google Scholar 

  7. Compas, B. E., Connor-Smith, J. K., Saltzman, H., Thomsen, A. H., & Wadsworth, M. E. (2001). Coping with stress during childhood and adolescence: Problems, progress, and potential in theory and research. Psychological Bulletin, 127, 87–127.

    PubMed  Article  CAS  Google Scholar 

  8. Conger, R. D., & Elder, G. H., Jr. (1994). Families in troubled times: Adapting to change in rural America. Hawthorne, NY: Aldine de Gruyter.

    Google Scholar 

  9. Conger, R. D., Rueter, M. A., & Elder, G. H., Jr. (1999). Couple resilience to economic pressure. Journal of Personality and Social Psychology, 76, 54–71.

    PubMed  Article  CAS  Google Scholar 

  10. Connor-Smith, J. K., Compas, B. E., Wadsworth, M. E., Thomsen, A. H., & Saltzman, H. (2000). Responses to stress in adolescence: Measurement of coping and involuntary stress responses. Journal of Consulting and Clinical Psychology, 68, 976–992.

    PubMed  Article  CAS  Google Scholar 

  11. Cosgrove, L., & Flynn, C. (2005). Marginalized mothers: Parenting without a home. Analysis of Social Issues and Public Policy, 5, 127–143.

    Article  Google Scholar 

  12. Ennis, N. E., Hobfoll, S. E., & Schröder, K. E. E. (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, 149–173.

    PubMed  Article  CAS  Google Scholar 

  13. Etter, E.M., Wadsworth, M.E., Rindlaub, L., Rienks, S., & Markman, H. (2011). Strong Families, Resilient Children: Preventing Psychopathology in Children in Poverty (under review).

  14. Evans, G. W. (2004). The environment of child poverty. American Psychologist, 59, 77–92.

    PubMed  Article  Google Scholar 

  15. Folkman, S., & Lazarus, R. (1985). If it changes it must be a process: Study of emotion and coping during three stages of a college examination. Journal of Personality and Social Psychology, 48, 150–170. doi:10.1037/0022-3514.48.1.150.

    PubMed  Article  CAS  Google Scholar 

  16. Gallup, G., Jr. (1994). The Gallop poll: Public opinion 1993. Wilmington, DE: Scholarly Resources.

    Google Scholar 

  17. Grimes, M., & McElwain, A. (2008). Marriage and family therapy with low-income clients: Professional, ethical, and clinical issues. Contemporary Family Therapy: An International Journal, 30, 220–232. doi:10.1007/s10591-008-9071-5.

    Article  Google Scholar 

  18. Guest, K. C., & Biasini, F. J. (2001). Middle childhood, poverty, and adjustment: Does social support have an impact? Psychology in the Schools, 38, 549–560.

    Article  Google Scholar 

  19. Gurin, G., Veroff, J., & Feld, S. (1960). Americans view their mental health: A nationwide interview survey. Oxford, England: Basic Books.

    Google Scholar 

  20. Heim, C., & Nemeroff, C. B. (2001). The role of childhood trauma in the neurobiology of mood and anxiety disorders: Preclinical and clinical studies. Biological Psychiatry, 49, 1023–1039.

    PubMed  Article  CAS  Google Scholar 

  21. Henly, J. R., Danziger, S. K., & Offer, S. (2005). The contribution of social support to the material well-being of low-income families. Journal of Marriage and Family, 67, 122–140.

    Article  Google Scholar 

  22. Kahn, J. R., & Pearlin, L. I. (2006). Financial strain over the life course and health among older adults. Journal of Health and Social Behavior, 47, 17–31.

    PubMed  Article  Google Scholar 

  23. Kelly, A. E., & Kahn, J. H. (1994). Effects of suppression of personal intrusive thoughts. Journal of Personality and Social Psychology, 66, 998–1006.

    Article  Google Scholar 

  24. Klebanov, P. K., Brooks-Gunn, J., & Duncan, G. J. (1994). Does neighborhood and family poverty affect mothers’ parenting, mental health, and social support? Journal of Marriage & the Family, 56, 441–455.

    Article  Google Scholar 

  25. Leadbeater, B. J., & Linares, O. (1992). Depressive symptoms in Black and Puerto Rican adolescent mothers in the first 3 years postpartum. Development and Psychopathology, 4, 451–468.

    Article  Google Scholar 

  26. Masten, A. S., Best, K. M., & Garmezy, N. (1990). Resilience and development: Contributions from the study of children who overcome adversity. Development and Psychopathology, 24, 425–444.

    Article  Google Scholar 

  27. McEwen, B. S. (1998). Stress, adaptation, and disease: Allostasis and allostatic load. New York, NY: New York Academy of Sciences.

    Google Scholar 

  28. McLoyd, V. C. (1990). The impact of economic hardship on Black families and children: Psychological distress, parenting, and socioemotional development. Child Development, 61, 311–346.

    PubMed  Article  CAS  Google Scholar 

  29. McLoyd, V. C., & Wilson, L. (1994). The strain of living poor: Parenting, social support, and child mental health. In A. C. Huston (Ed.), Children in poverty: Child development and public policy. Cambridge, UK: Cambridge University Press.

    Google Scholar 

  30. Noh, S., & Kaspar, V. (2003). Perceived discrimination and depression: Moderating effects of coping, acculturation, and ethnic support. American Journal of Public Health, 93, 232–238.

    PubMed  Article  Google Scholar 

  31. O’Brian, M., Margolin, G., & John, R. S. (1995). Relation among marital conflict, child coping, and child adjustment. Journal of Clinical Child Psychology, 24, 346–361.

    Article  Google Scholar 

  32. Pargament, K. I. (1997). The psychology of religion and coping: Theory, research, practice. New York, NY: Guilford Press.

    Google Scholar 

  33. Pargament, K. I., Cole, B., Vandecreek, L., Belavich, T., Brant, C., & Perez, L. (1999). The vigil: Religion and the search for control in the hospital waiting room. Journal of Health Psychology, 4, 327–341.

    PubMed  Article  CAS  Google Scholar 

  34. Pearlin, L. I., & Radabaugh, C. W. (1976). Economic strains and the coping functions of alcohol. American Journal of Sociology, 82, 652–663.

    Article  CAS  Google Scholar 

  35. Raikes, H. A., & Thompson, R. A. (2005). Efficacy and social support as predictors of parenting stress among families in poverty. Infant Mental Health Journal, 26, 177–190.

    Article  Google Scholar 

  36. Raviv, T., & Wadsworth, M. E. (2010). The Efficacy of a Pilot Prevention Program for Children and Caregivers Coping with Economic Strain. Cognitive Therapy & Research, 34, 216–228.

    Article  Google Scholar 

  37. Rayburn, N. R., Wenzel, S. L., Elliott, M. N., Hambarsoomians, K., Marshall, G. N., & Tucker, J. S. (2005). Trauma, depression, coping, and mental health service seeking among impoverished women. Journal of Consulting and Clinical Psychology, 73, 667–677.

    PubMed  Article  Google Scholar 

  38. Repetti, R. L., Taylor, S. E., & Seeman, T. E. (2002). Risky families: Family social environments and the mental and physical health of offspring. Psychological Bulletin, 128, 330–366.

    PubMed  Article  Google Scholar 

  39. Sandler, I. N., Tein, J.-Y., & West, S. G. (1994). Coping, stress, and the psychological symptoms of children of divorce: A cross-sectional and longitudinal study. Child Development, 65, 1744–1763.

    PubMed  Article  CAS  Google Scholar 

  40. Santiago, C.D., Etter, E.M., Wadsworth, M.E. & Raviv, T. (2011) Predictors of Responses to Stress Among Families Coping with Poverty-related Stress. Anxiety, Stress, & Coping (in press).

  41. Santiago, C. D., & Wadsworth, M. E. (2009). Coping with family conflict: What’s helpful and what’s not for low-income adolescents. Journal of Child and Family Studies, 18, 192–202.

    Article  Google Scholar 

  42. Sapolsky, R. M. (2004). Social Status and Health in Humans and Other Animals. Annual Review of Anthropology, 33, 393–418.

    Article  Google Scholar 

  43. Sapolsky, R. M. (2005). Sick of poverty. Scientific American, 293, 94–99.

    Article  Google Scholar 

  44. Scott, L. D., & House, L. E. (2005). Relationship of distress and perceived control to coping with perceived racial discrimination among Black youth. Journal of Black Psychology, 31, 254–272.

    Article  Google Scholar 

  45. Shonkoff, J. P., Boyce, W. T., & McEwen, B. S. (2009). Neuroscience, molecular biology, and the childhood roots of health disparities: Building a new framework for health promotion and disease prevention. JAMA: The Journal of the American Medical Association, 301, 2252–2259.

    Article  CAS  Google Scholar 

  46. Smith, L. (2009). Enhancing training and practice in the context of poverty. Training and Education in Professional Psychology, 3, 84–93. doi:10.1037/a0014459.

    Article  Google Scholar 

  47. U.S. Census Bureau (2009) Tables of NAS-based poverty estimates:2009. Retrieved Jan. 12, 2011 from http://www.census.gov/hhes/povmeas/data/nas/tables/2009/index.html.

  48. Vinokur, A. D., Price, R. H., & Schul, Y. (2002). Impact of the JOBS intervention on unemployed workers varying in risk for depression. In T. A. Revenson, A. R. D’Augelli, S. E. French, D. L. Hughes, & D. Livert (Eds.), A quarter century of community psychology: Readings from the American Journal of Community Psychology (pp. 477–511). New York: Kluwer.

    Google Scholar 

  49. Wadsworth, M. E., & Berger, L. E. (2006). Adolescents coping with poverty-related family stress: Prospective predictors of coping and psychological symptoms. Journal of Youth and Adolescence, 35, 57–70.

    Article  Google Scholar 

  50. Wadsworth, M. E., & Compas, B. E. (2002). Coping with economic strain and family conflict: The adolescent perspective. Journal of Research on Adolescence, 12, 243–274.

    Article  Google Scholar 

  51. Wadsworth, M. E., & Santiago, C. D. (2008). Risk and resiliency processes in ethnically diverse families in poverty. Journal of Family Psychology, 23, 399–410.

    Article  Google Scholar 

  52. Wadsworth, M. E., Raviv, T., Compas, B. E., & Connor-Smith, J. K. (2005). Parent and adolescent responses to poverty-related stress: Tests of mediated and moderated coping models. Journal of Child and Family Studies, 14, 283–298.

    Article  Google Scholar 

  53. Wadsworth, M.E., Raviv, T., Santiago, C.D., & Etter, E. M. (2011a). Testing the Adaptation to Poverty-related Stress Model: Predicting Psychopathology Symptoms in Families Facing Economic Hardship. Journal of Clinical Child and Adolescent Psychology (in press).

  54. Wadsworth, M.E., Santiago, C.D., Einhorn, L., Moran, E.G., Rienks, S., & Markman, H.J. (2011b). Preliminary Efficacy of an Intervention to Reduce Psychosocial Stress and Improve Coping in Low-Income Families. American Journal of Community Psychology (in press).

  55. Waldegrave, C. (2005). ‘Just Therapy’ with families on low income. Child Welfare, 84, 265–276.

    PubMed  Google Scholar 

  56. Wegner, D. M. (1994). Ironic processes of mental control. Psychological Review, 101, 34–52.

    PubMed  Article  CAS  Google Scholar 

  57. Yoo, H. C., & Lee, R. M. (2005). Ethnic identity and approach-type coping as moderators of the racial discrimination/well-being relation in Asian Americans. Journal of Counseling Psychology, 52, 497–506.

    Article  Google Scholar 

Download references

Acknowledgment

Portions of this research were funded by grant no. 90OJ2021 from the Administration for Children and Families, awarded to Martha Wadsworth and Howard Markman.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Martha E. Wadsworth.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wadsworth, M.E. Working with Low-income Families: Lessons Learned from Basic and Applied Research on Coping with Poverty-related Stress. J Contemp Psychother 42, 17–25 (2012). https://doi.org/10.1007/s10879-011-9192-2

Download citation

Keywords

  • Low-income
  • Socioeconomic status
  • Poverty
  • Psychotherapy
  • Coping
  • Stress