Traditional, mainstream psychotherapy is largely “middle class” in nature and practice. It’s basic worldview involves conceptions of mental health that promote middle class themes and values. Rationality. Scientific analysis. Work ethic. Control of emotions. Strategic planning. Go-getting. Language expression. Success philosophy. Competition. Foresight. High social status.
A striking failure in modern-day psychotherapy is the absence of adequate treatment approaches and academic/professional trainings that are apparently useful to lower- and working-class patients. I believe a big part of the cause lies in that contemporary mental health prototype and the middle-class prototype have become operationally equivalent.
Several weeks ago, I was the featured expert of GMA 7’s newest TV mental health weekly program entitled “Out of Control.” The TV crew brought me to a squatter community to shoot a brief therapy segment with a 60-year-old woman suffering from onychophagia (chronic nail biting). This was one of those times when I needed to adjust from my “middle classness” to fit a “lower-class” ethic.
Necessary therapeutic adjustments are important in “psychotherapy for the poor.” For example, my language as a “middle class” therapist may have considerable personally disorganizing effect upon the “lower-class” patient. If careless, the “message” I’d set forth could be most unrealistic or prejudicial to the “lower-class” patient when conducted in a manner consistent with “middle-class” culture. I felt happy about the successful result of my recent “psychotherapy for the poor” episode at GMA 7 because it showed the appropriateness and adaptiveness that context-sensitive therapy can apply for the realities found in a lower-class environment.