Abstract
Psychotherapy with low-income patients presents a variety of challenges for the clinician. This paper discusses some of those challenges, including the barriers that poor individuals face in obtaining treatment, as well as issues of stigma, mistrust of authority, and potential cultural differences and differing expectations between mental health providers from higher socioeconomic backgrounds and lower-income individuals in need of care. We review some of the findings reported in treatment studies with low-income, frequently minority, samples that shed light on the types of adaptations to treatment that have proven successful. Finally, we discuss some of the clinical research that has been conducted with low-income, predominantly minority women through the department of psychiatry at Georgetown University over the past several years, concluding with some of the lessons we have learned in developing and conducting psychotherapeutic treatments with this population.
Similar content being viewed by others
References
Arean, P. A., Gum, A., McCulloch, C. E., Bostrom, A., & Gallagher-Thompson, D. (2005). Treatment of depression in low-income older adults. Psychology and Aging, 20(4), 601–609.
Beeber, L. S., Cooper, C., Van Noy, B. E., Schwartz, T. A., Blanchard, H. C., Canuso, C., 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.
Blake, D. D., Weathers, F. W., Nagy, L. N., Kaloupek, D., Klauminzer, G., Charney, D., et al. (1990). A clinician rating scale for assessing current and lifetime PTSD: The CAPS-1. The Behavior Therapist, 18, 187–188.
Blazer, D. G., Kessler, R. C., McGonagle, K. A., & Swartz, M. S. (1994). The prevalence and distribution of major depression in a national community sample: The National Comorbidity Survey. American Journal of Psychiatry, 171, 979–986.
Breslau, N. J., Kendler, K. S., Su, M., Gaxiola-Aguilar, S., & Kessler, R. C. (2005). Lifetime risk and persistence of psychiatric disorders across ethnic groups in the United States. Psychological Medicine, 35, 317–327.
Brown, J., Cohen, P., Johnson, J. G., & Smailes, E. M. (1999). Childhood abuse and neglect: Specificity of effects on adolescent and young adult depression and suicidality. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1490–1496.
Brown, G. W., & Moran, P. M. (1997). Single mothers, poverty, and depression. Psychological Medicine, 27, 21–33.
Buckner, J. C., Bassuk, E. L., & Zima, B. T. (1993). Mental health issues affecting homeless women: Implications for intervention. American Journal of Orthopsychiatry, 63(3), 385–399.
Choi, N. G. (2009). The integration of social and psychologic services to improve low-income homebound older adults’ access to depression treatment. Family Community Health, 32(1S), S27–S35.
Cooper-Patrick, L., Gallo, J. J., Powe, N. R., Steinwachs, D. M., Eaton, W. W., & Ford, D. E. (1999). Mental health service utilization by African Americans and Whites: The Baltimore Epidemiologic Catchment Area follow-up. Medical Care, 37, 1034–1045.
Diala, C., Muntaner, C., Walrath, C., Nickerson, K., LaVeist, T., & Leaf, P. (2001). Racial/ethnic differences in attitudes toward seeking professional mental health services. American Journal of Public Health, 91, 805–807.
Dohrenwend, B. S., & Dohrenwend, B. P. (Eds.). (1974). Stressful life events: Their nature and effects. New York: Wiley.
Dwight-Johnson, M., Sherbourne, C. D., Liao, D., & Wells, K. B. (2000). Treatment preferences among primary care patients. Journal of General Internal Medicine, 15, 527–534.
Grote, N. K., Swartz, H. A., Geibal, S. L., Zuckoff, A., Houck, P. R., & Frank, E. (2009). A randomized controlled trial of culturally relevant, brief interpersonal psychotherapy for perinatal depression. Psychiatric Services, 60(3), 313–321.
Holzer, C. E., Shea, B. M., Swanson, J. W., Leaf, P. J., Myers, J. K., George, L., et al. (1986). The increased risk for specific psychiatric disorders among persons of low socioeconomic status. American Journal of Sociology, 6, 259–271.
Horowitz, L. M., Rosenberg, S. E., Baer, B. A., Ureno, G., & Villasenor, V. S. (1988). Inventory of interpersonal problems: Psychometric properties and clinical applications. Journal of Consulting and Clinical Psychology, 56, 885–892.
Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Archives of General Psychiatry, 51, 8–19.
Krupnick, J. L., Green, B. L., Stockton, P., Miranda, J., Krause, E., & Mete, M. (2008). Group interpersonal psychotherapy for low-income women with posttraumatic stress disorder. Psychotherapy Research, 18(5), 497–507.
LaVeist, T. A., Diala, C., & Jarrete, N. C. (2000). Social status and perceived discrimination: Who experiences discrimination in the health care system, how, and why? In C. Hogue, M. Hargraves, & K. Scott-Collins (Eds.), Minority Health in America (pp. 194–208). Baltimore, MD: Johns Hopkins University Press.
Lieberman, A. G., Weston, D. R., & Pawl, J. H. (1991). Preventive intervention and outcome with anxiously attached dyads. Child Development, 62, 199–209.
Markowitz, J. C., Patel, S. R., Balan, I. C., Bell, M. A., Blanco, C., Yellow Horse Brave Heart, M., et al. (2009). Toward an adaptation of interpersonal psychotherapy for Hispanic patients with DSM-IV major depressive disorder. Journal of Clinical Psychiatry, 70(2), 214–222.
Mcleod, J. D., & Kessler, R. C. (1990). Socioeconomic status differences in vulnerability to undesirable life events. Journal of Health and Social Behavior, 31, 162–172.
Miranda, J., Chung, J. Y., Green, B. L., Krupnick, J., Siddique, J., Revicki, D. A., et al. (2003). Treating depression in predominantly low-income young minority women: A randomized controlled trial. Journal of the American Medical Association, 290(1), 57–65.
Miranda, J., & Green, B. L. (1999). The need for mental health services research focusing on poor young women. Journal of Mental Health Policy & Economics, 2, 73–80.
Mojtabai, R. (2007). Americans’ attitudes toward mental health treatment seeking: 1990–2003. Psychiatric Services, 58, 642–651.
Mukherjee, S., Sullivan, G., Perry, D., Verdugo, B., Means-Christensen, A., Schraufnagel, T., et al. (2006). Adherence to treatment among economically disadvantaged patients with panic disorder. Psychiatric Services, 57(12), 1745–1750.
Munoz, R. F., Ying, Y. W., Bernal, G., Perez-Stable, E. J., Sorensen, J. L., Hargreaves, W. A., et al. (1995). Prevention of depression with primary care patients: A randomized controlled trial. American Journal of Community Psychology, 23, 199–222.
Ng, C. H. (1997). The stigma of mental illness in Asian cultures. Australian and New Zealand Journal of Psychiatry, 31, 382–390.
Szapocznik, J., Kurtines, W., Santisteban, D. A., Pantin, H., Scopette, M., Mancilla, Y., et al. (1997). The evolution of structural ecosystemic theory for working with Latino families. In J. G. Garcia & M. C. Zea (Eds.), Psychological interventions and research with Latino populations (pp. 166–190). Boston: Allyn & Bacon.
U.S. Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity—a supplement to mental health: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.
Zhang, A. Y., Snowden, L. R., & Sue, S. (1998). Differences between Asian and White Americans’ help-seeking and utilization patterns in the Los Angeles area. Journal of Community Psychology, 26, 317–326.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Krupnick, J.L., Melnikoff, S.E. Psychotherapy with Low-Income Patients: Lessons Learned from Treatment Studies. J Contemp Psychother 42, 7–15 (2012). https://doi.org/10.1007/s10879-011-9182-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10879-011-9182-4