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'Rarely Discussed but Always Present': Exploring Therapists' Accounts of Social Class in Therapy Charlotte Mcevoy

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‘Rarely discussed but always present’: Exploring therapists’ accounts of social class in therapy Charlotte McEvoy Submitted in partial fulfilment of the requirements of the University of the West of England, Bristol for the Degree of Professional Doctorate in Counselling Psychology Faculty of Health and Applied Sciences, University of the West of England November 2019 Word count 40,043 (excluding references and appendices) 1 2 Contents Acknowledgements………………………………………………………………………………………6 Abstract…………………………………………………………………………………………………….......7 Introduction……………………………………………………………………………………………….…8 An anecdote from practice…………………………………………………………………………..8 Theorising class in the social sciences…………………………………………………………9 Defining social class in sociology………………………………………………………...11 Official definitions of class……………………………………………………………….…12 The ‘cultural turn’ in defining class……………………………………………………..14 Feminist critiques of structural theories of class………………………………….18 Social class and socio-economic status in the UK…………………………………19 Class, mental health and therapy…………………………………………………………….…20 The relationship between social class and socio-economic status and health and wellbeing…………………………………………………………………….…….20 Class is neglected in counselling psychology in the UK………………………....23 Research on clients’ experiences of class differences in therapy…………………………………………………………………………………………….. 25 Therapists’ perspectives, and classism in psychology, counselling and psychotherapy……………………………………………………………………………………26 What can we learn from discussions of race and racism in therapy?.........29 Psychology’s contributions to understanding social class…………………….31 Psychological theories of social class…………………………………………………..33 The current study……………………………………………………………………………………..39 Research aims…………………………………………………………………………………………..39 Methodology……………………………………………………………………………………………….41 Theoretical assumptions…………………………………………………………………………...41 Qualitative survey……………………………………………………………………………………..42 Participants and recruitment……………………………………………………………………..44 Survey design and data collection………………………………………………………………46 Ethics……………………………………………………………………………………………………….50 3 Reflexivity…………………………………………………………………………………………………….50 Analysis…………………………………………………………………………………………………….51 Analysis……………………………………………………………………………………………………….55 Overview of themes……………………………………………………………………………………55 Theme 1: The ‘location’ of social class/ who ‘holds’ a classed identity…………..55 1.1 Social class is ‘held’ by the working classes…………………………………….56 1.2 Displaying awareness of class privilege and class status…………………62 Theme 2: The relationship between social class and mental health………………66 2.1 Individualising and psychologising mental health…………………………..67 2.2 Contextualising mental health……………………………………………………….71 Theme 3: Class self-positioning – disavowal of middle class status……………….75 3.1 My working class heritage……………………………………………………………..75 3.2 Mitigation of privilege…………………………………………………………………...79 3.3 Distancing the self from the ‘clueless middle-class therapist’…………..84 Theme 4: Class differences can/cannot be transcended by the therapeutic relationship………………………………………………………………………………………………88 4.1 Class differences can and must be overcome in therapy………………….89 4.2 Class differences cannot be escaped in therapy………………………………96 Discussion…………………………………………………………………………………………………104 Summary and contextualisation of findings………………………………………………104 Liberal humanist discourses vs. social inequalities discourses…………………...104 Parallels with research on white privilege…………………………………………………106 Interpretative repertoires of class blindness……………………………………………..107 Broad implications for middle class professionals……………………………………..110 Implications for formulating mental health problems………………………………..112 Implications for training…………………………………………………………………………..114 Challenges to the development of class-consciousness in therapeutic training…………………………………………………………………………………117 Implications for therapeutic practice………………………………………………………...119 Implications beyond psychotherapeutic training and practice……………………120 4 The use of qualitative surveys in counselling psychology research……………..123 Recommendations for future research………………………………………………………127 Conclusion………………………..………………………..………………………..…………………..129 References………………………..………………………..………………………..…………………….131 Appendices………………………………………………………………………………………………..150 Appendix 1: Participant information sheet……………………………………………......151 Appendix 2: Survey questions………………………………………………………….............153 Appendix 3: Demographic questions…………………………………………………………154 Appendix 4: Journal article……………………………………………………………...………..155 5 Acknowledgements I would first like to thank all the participants who took part in this research. I know how busy things can get so I am grateful that you took the time out to complete my survey and give me an insight into your work with clients. I would also like to thank my supervision team. First I would like to thank Dr. Victoria Clarke for her enthusiasm and commitment to this project, her feedback and analytic insights have been invaluable and this project would not be what it is without her. I would also like to thank Dr. Zoe Thomas for her support and encouragement and feedback in the final stages of this project. I would also like to thank my friends and family for (seemingly) never tiring of me talk about this project and reminding me of why I am doing this when it felt hardest. Thank you to Hannah and Emily in particular for being my occasional, spontaneous editors. And a special thanks to everyone who was on hand with childcare. Last and certainly not least I would like to thank two important people in my life, Josh and Ezra. Josh, you have been an absolute rock, as usual. You have been there emotionally and physically, helping in any way you can and I would not have been able to do this project without you. Don’t worry, I don’t expect you to read it! Ezra, this project is for you. I hope that one day you will be proud. Thank you for being so wonderful and I am really looking forward to of all of the adventures ahead us. 6 ‘Rarely discussed but always present’: Exploring therapists’ accounts of social class in therapy Abstract This research examines therapists’ accounts of how social class operates within therapy and its impact on the therapeutic relationship. The topic of class in therapy has rarely been addressed in the counselling psychology literature, with only a few papers published on this topic (e.g. Balmforth, 2009; Chalifoux, 1996; Kaiser & Prieto, 2018; Thompson, Cole & Nitzarim, 2012; Trott & Reeves, 2018). This study aims to address this omission by exploring the accounts of eighty- seven practicing psychologists, counsellors and psychotherapists, from trainees to experienced practitioners, who completed an online qualitative survey about social class in therapy. Thematic discourse analysis (Taylor & Ussher, 2001) was used to analyse therapists’ accounts of their own social class status and class as a form of difference more broadly, their accounts of working therapeutically with class differences and their sense-making around the relationship between class and mental health. I identified oppositional sense-making in the data, where one (smaller) group of therapists located individuals’ mental health difficulties within their socio-political context and described class differences in therapy as something that cannot be transcended by the therapeutic relationship. Another (larger) group of therapists drew upon ‘oppression blind’ (Ferber, 2012) discourses that removed clients from their socio-political context and dismissed social class as an important factor in therapy. When it came to their own class background, most participants used rhetorical strategies to disavow a middle class status and distance themselves from middle class privilege. Implications for practice and recommendations for future research are discussed. 7 Introduction An anecdote from practice Before discussing the academic rationale for my research, I’m going to discuss an anecdote from my practice – one that prompted me to undertake this research. I want to centre my own reflections around my class positioning as I will argue that reflecting on our class positioning and class privilege is integral to improving our class consciousness and working competently with class differences in the therapeutic relationship. This research was prompted by an engagement ring from the supermarket Asda. In the early stages of my training as a counselling psychologist, I was working in a counselling service in a doctors’ surgery in a socially deprived area of Bristol. I had a female client who I had been working with for several months. I felt we had a strong therapeutic relationship and I admired her resilience and capability as a single working mother. In one of our sessions she told me about how an ex- partner had proposed to her over the phone whilst he was intoxicated. When she brought it up the next day she realised he had forgotten all about it. He then somewhat reluctantly bought her an engagement ring whilst they were out food shopping in Asda. As I empathised with her feelings of disappointment at having to remind him of his proposal and her sadness at his neglect of their relationship, I also made a mistake that could have been very damaging to our work. This mistake was in assuming that part of the problem for her was where the ring came from. Upon reflection, I realised that this assumption came directly out of the middle class worldview that was implicitly dominating my thinking. My client had no
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