Smith ScholarWorks Theses, Dissertations, and Projects 2010 The Matthew effect and treatment selection for urban poor clients : social pain, countertransference or competition? : a project based upon an independent investigation Launa Kay Bodde Smith College Follow this and additional works at: https://scholarworks.smith.edu/theses Part of the Social and Behavioral Sciences Commons Recommended Citation Bodde, Launa Kay, "The Matthew effect and treatment selection for urban poor clients : social pain, countertransference or competition? : a project based upon an independent investigation" (2010). Masters Thesis, Smith College, Northampton, MA. https://scholarworks.smith.edu/theses/1115 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]. Launa Bodde The Matthew Effect and Treatment Selection for Urban Poor Clients: Social pain, countertransference or competition? ABSTRACT This study is a theoretical look at the intersection of neurobiology and analytic theory as it impacts clinician's decisions about treatment selection. Historically, it has been proven that clients who are poor do not receive the same level of care, attention and service as clients from "upper classes." These poorer clients do not have the same ability to compete for resources, therefore the rich get richer while the poor get poorer. This phenomena has been coined the Matthew Effect. This study is an attempt to find new and different ways of explaining the Matthew Effect phenomenon. What exactly are the forces behind the gap in services across social class stratifications? One possibility set forth by this writing is that neurobiology as described by Social Pain Theory and countertransference intersect and overlap leading to implicit bias and nonconscious reactions that determine a clinician's decision-making process. THE MATTHEW EFFECT AND TREATMENT SELECTION FOR URBAN POOR CLIENTS: SOCIAL PAIN, COUNTERTRANSFERENCE OR COMPETITION? A project based upon an independent investigation, submitted in partial fulfillment of the requirements for the degree of Master of Social Work. Launa Bodde Smith College School for Social Work Northampton Massachusetts, 01063 2010 ACKNOWLEDGEMENTS This work is dedicated to my son, Christopher Kai. He has sacrificed more than a child should. He gave up proximity and time without complaint. He has always been a remarkable child but now become a remarkable young adult. Christopher, I could not be more proud of you nor love you more. You are a true bright light. Next I need to thank Bala for seeing me through the year of this writing but more importantly keeping me grounded in an adventurous and passionate relationship and reminding me always of the important things in life. Yes, there is life outside of my head. You are my perfect partner. Konstantina and Stelios, I do not need to speak the words. Of all my chosen family, you know me most intimately, who I am and desire to be. I love you both and can never thank you for being my family when no one else would have me. I could not publish this paper without thanking the library staff at the Neilsen Library, particularly Irene Branson. No request was too big or small, and she was seemingly tireless in helping me track down some awfully obscure references. I owe a huge thank you to Barb Lui for advising me through the writing process, as well as respecting my independence and need to experiment. Being a thesis advisor is a thankless job, so please accept this as my thank you for your work and time. A special thank you to Joann Corbin for offering up time, wisdom and experience and sharing so openly and passionately and inspiring me to take on research as a career in and of itself. For the sake of brevity but with no less respect, I would like to thank all the faculty at Smith I had the pleasure of learning with. I will carry each of your voices with me. You have contributed to my unique vision of freedom that this work demands. Last and certainly not least, I think always of the clients I worked with over the past two years and the clients to be in the future. It is my deepest hope this work will be the beginning of more research and development, and that it will allow all clients the best support and compassion our profession can provide. We are not above or below but in this thing together. Our paths to freedom are inexorably intertwined. Thank you all for teaching me more about myself than I imagined possible. This profession is a gift because of the relationships it offers. May we never lose sight of that. ii TABLE OF CONTENTS ACKNOWLEDGEMENTS.......................................................................................... ii TABLE OF CONTENTS.............................................................................................. iii CHAPTER I INTRODUCTION................................................................................................ 1 II METHODOLOGY............................................................................................... 11 III THE MATTHEW EFFECT ................................................................................. 18 IV SOCIAL PAIN THEORY .................................................................................... 28 V COUNTERTRANSFERENCE ............................................................................ 36 VI DISCUSSION....................................................................................................... 47 REFERENCES ............................................................................................................. 56 iii CHAPTER 1 INTRODUCTION “Only a fearless person can work towards self development and can also help in social and political development. Therefore one should fearlessly perform all his duties.” ~~ Yajur Veda Self, social, and political development -- these are large concepts for any single person to contemplate. However, as clinical social workers, we are called upon by the duties and ethics of our profession to do just that. No easy task. The concepts we wrestle with are large and unwieldy, no doubt. When it comes to integrating all three, we encounter another monster altogether. As the Veda speaks, it takes a certain amount of fearlessness to tackle this particular monster. Not that this writer feels particularly fearless, but this thesis will attempt to integrate thinking across these spheres of development but not without risk of becoming unwieldy and large itself. For the sake of brevity and with a mission of becoming a starting point for future research, this thesis will tackle the topic of treatment selection for the urban poor based upon a theory known as the Matthew Effect, a sociological phenomena that we will utilize to help us understand how neurobiology and relationship can impact the decision- making process for clinicians. This thesis will attempt to narrow down the focus of the writing to the clinical while holding in frame the larger context of the social and political. The Matthew Effects tells us, in simple terms, the rich get richer while the poor get poorer. This may seem like folk wisdom or maybe even common sense depending on 1 one’s sociological and political orientation. However, it is a theory that has been studied and quantified and even applied to clinical therapeutic work. Its common wisdom extends beyond anecdote to a researched but perhaps not widely known phenomenon. The Matthew Effect is not particularly concerned with the causes of the gap between the rich and the poor, only that they exist and continue to widen over time. It tells us those best able to compete for resources will receive them. Those that don’t have the capacity, skill or access will not receive what they need. Though the Matthew Effect is not explanatory, it does provide an interesting sociological lens through which to view the treatment selection process for the urban poor. The Matthew Effect, however interesting, does little for us with respect to understanding the root causes of the gap between those who have and those who don’t. It also does little to help us find paths to interventions, as we are called to do in the social work profession. It is the intent of this thesis to link two disparate theories, social pain theory and countertransference, to the Matthew Effect in a way that allows us to better understand the treatment selection process for urban poor clients from a useful clinical perspective. It is this writer’s hope the result will be new thinking about treatment selection and assist social work clinicians in developing new interventions with this population -- interventions that provide the best level of care possible. Mental Health Care and Clients Who are Poor History of the poor in psychotherapy Analytically-informed psychotherapy has a long history of serving and “not serving” the poor. To trace the history as far back as Freud and the free clinics, one can begin to see early forces at work in defining class issues within the confines of the 2 therapeutic relationship. Freud himself, in the volumes of published cases, did not record working with a single, lower-class patient (Brody, 1976). Freud was, however, a powerful force in creating free clinics and advocating for free mental health care for everyone, regardless of race, class or status. The founder of psychodynamic thinking was his own paradox. The 1950s and 1960s saw a surge of interest in class positioning as a determinant