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Classism in the Therapeutic Alliance : Implications for Clinical Social Work Practice

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Classism in the Therapeutic Alliance : Implications for Clinical Social Work Practice Smith ScholarWorks Theses, Dissertations, and Projects 2017 Classism in the therapeutic alliance : implications for clinical social work practice Taylor Millard Smith College Follow this and additional works at: https://scholarworks.smith.edu/theses Part of the Social Work Commons Recommended Citation Millard, Taylor, "Classism in the therapeutic alliance : implications for clinical social work practice" (2017). Masters Thesis, Smith College, Northampton, MA. https://scholarworks.smith.edu/theses/1906 This Masters Thesis has been accepted for inclusion in Theses, Dissertations, and Projects by an authorized administrator of Smith ScholarWorks. For more information, please contact [email protected]. Taylor B. Millard Classism in the Therapeutic Alliance: Implications for Clinical Social Work Practice ABSTRACT This qualitative study was an exploration of the impact of classism in the therapeutic alliance, specifically from a power, privilege, and oppression framework, and with attention to participants’ salient intersecting identities. Twelve clinicians, who identified with working class backgrounds and who had engaged in therapy as both clinicians and clients, engaged in semistructured qualitative interviews. The findings indicated that classism was salient to participants’ intersectional subjectivities and to their experiences in the field. Significantly, participants all named experiences in which a systemic lack of attention to classism and/or social class identities led them to feel alienated and silenced as students, professionals, and clients. Participants linked their own classist experiences with stronger motivations to remain class- conscious as therapists and to address class differences openly in order to strengthen their therapeutic alliances. Implications for future research, social work education, and clinical social work practice are discussed. CLASSISM IN THE THERAPEUTIC ALLIANCE: IMPLICATIONS FOR CLINICAL SOCIAL WORK PRACTICE A project based upon an independent investigation, submitted in partial fulfillment of the requirements for the Master of Social Work. Taylor B. Millard Smith College School for Social Work Northampton, Massachusetts 01063 2017 ACKNOWLEDGEMENTS This thesis could not have been possible without the love, support, and wisdom from a few very important people. First, I dedicate this thesis to my mother, Kimberly Millard, who is one of the most intelligent, compassionate, and hardworking women I have ever met. Mama, you always supported all of our educational dreams and I know that you wanted us to have the opportunities that you did not have. This could not have been done without your love and support. I dedicate this to my father, Brook Millard, who left this world far too soon, who was my biggest advocate and champion, and who continues to inspire me every single day with his memory, the internalization of his support, and his various words of wisdom (i.e., “People are weird”) that helped me remain centered throughout this program. I dedicate this to my partner, Kevin Thomas, who has been my biggest cheerleader throughout this wild Smith SSW graduate school experience. My dear, you have listened to me vent, held me when I cried, celebrated when I laughed, kept the Cholula stocked, and even selflessly sacrificed half of the kitchen table (i.e., my thesis work space) these past two years. If that’s not love, I don’t know what is. I dedicate this to my sisters, Lauren Millard and Ivory Woolhiser. Thank you, Lauren, for showing me that graduate school is possible, for listening and holding space during my emotional breakdowns the past 27 months, and for validating my own intrapsychic conflicts around reconciling my feelings of gratitude and pain throughout Smith SSW. Thank you, Ivory, for always inspiring me with your authentic and creative navigation of this world and for bringing me back down to earth. I dedicate this to my dogs, Sammy and Asher, who “helped” me write my thesis by cuddling, staring at me expectantly, and pawing at my keyboard to remind me to take breaks. I dedicate this to all of the participants whose experiences and wisdom inform the narrative, meaning, and findings in this study. To each and every participant who may read this: you took so much time and care in responding to this study and in sharing such vulnerable experiences with me. In all cases, I felt humbled to bear witness to your strengths and struggles as students and clinicians who identity with working class and poor backgrounds. Your voices are critical to improving this field, and I hope this thesis is one small step in helping folks like us be better seen and heard in the future. This could not have been accomplished without you, and I thank you. I dedicate this to all working class and poor folks who are impacted by classism, including my fellow students in the CLASS Schism group at Smith SSW, budding clinicians who have been similarly silenced and marginalized in higher education, and to all of those folks—including clients and non-clients in my communities—who are yearning to be seen and heard. More than anyone, this is for you. Finally, I would like to thank my thesis advisor, Susanne Bennett, for her ongoing feedback and support throughout this process; for encouraging me to apply for the Alumni Thesis Award; and for having such a strong vote of confidence in my work and in the importance of this topic for our field. ii TABLE OF CONTENTS ACKNOWLEDGEMENTS ..................................................................................................... ii TABLE OF CONTENTS ......................................................................................................... iii CHAPTER I. INTRODUCTION ........................................................................................................... 1 II. LITERATURE REVIEW ................................................................................................ 6 III. METHODOLOGY .......................................................................................................... 37 IV. FINDINGS ...................................................................................................................... 50 V. DISCUSSION .................................................................................................................. 91 REFERENCES ........................................................................................................................ 116 APPENDICES Appendix A: HSR Approval Letter…………………………………………………………...123 Appendix B: Recruitment Flyer .............................................................................................. .124 Appendix C: Informed Consent……………………………………………………………… 125 Appendix D: Qualitative Interview Guide……………………………………….…………... 128 iii CHAPTER I Introduction The study of classism in clinical social work practice is a relevant and much-needed area of research in the mental health field; to date, researchers cite that classism has been a neglected aspect of psychology research and clinical training, in spite of its importance in clinical social work and counseling practice (Appio, 2013; Cook, 2014; Liu, Pickett, & Ivey, 2007; Liu, Ali, Soleck, Hopps, Dunston, & Pickett, 2004a; Lott, 2002; Ryan, 2006; Smith, 2005). Significantly, Lott (2002) points out that because social class permeates across all other aspects of identity, it is inevitable that clinicians will work with clients who identify as working class or poor; yet, despite the inevitability of the work, a lack of attention has been given to insuring that clinicians are able to attend to class differences in practice. Thus, the following qualitative study aimed to address the current literature gap by exploring the following question: How do perceptions of classism impact experiences of the therapeutic alliance for clinicians who both self-identify with a working class background and who have engaged in psychotherapy as a clinician and client? Not only have classism and social class identity development been largely ignored in the literature and in clinical training, working class and poor clients’ voices have been missing from the literature to date (Appio, 2013; Cook, 2014; Smith, 2005; Lott, 2004). In other words, even when class is explored in psychological research, middle class and upper class individuals are centered in research and educational narratives. Thus, the absence of classism and the absence of working class and lower income clients’ voices in the current research, educational, and clinical 1 narratives are, in themselves, expressions of a “blind spot” (Liu et al., 2007, p. 194) in the clinical field’s current conceptualization of multicultural competence. Overall, the proposed study was necessary not only because the topic of classism has been underrepresented and largely silenced in the social work field of research and education, but also because, in spite of the lack of attention given to classism, social class is a core aspect of clients’ identities. It has the potential to significantly impact experiences of therapy (Thompson, Cole, & Nitzarim, 2012), including therapeutic outcomes (Liu et al., 2007) and retention rates (Ryan, 2006) for working class and poor clients. Theoretical Framework Based on my exploration of the relevant literature to date, my research utilized a power, oppression, and privilege framework (specifically, theories of systemic oppression and institutionalized oppression). The concepts of social class stratification, psychodynamic conceptualizations of the
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