Date of Award


Degree Name

Doctor of Philosophy



First Advisor


Second Advisor



This qualitative study was designed to produce a theoretical model to illustrate disadvantaged clients' social class-related experiences in therapy. Clients' perceptions of therapist behaviors that positively and negatively influenced the quality of their therapy were also explored. Individual interviews were conducted with 18 adult clients (13 females, 5 males; age range: 18 to 64 years) at urban and rural community agencies primarily serving individuals who are considered economically disadvantaged. Participant-clients' disadvantaged status was based on their income below the cutoff for Medicaid eligibility in the state of Illinois and need for reduced fees or reliance on Medicaid coverage to pay for therapy services. Participants reported diverse ethnic backgrounds, including European American (n = 8), Hispanic American (n = 5), African American (n = 3), Jewish American (n = 1), and biracial (European and Native American; n = 1). Most participants reported a yearly household income less than $10,000 (n = 11), and that they were either unemployed or not in the labor force due to disability (n = 16). They reported varied religious/spiritual affiliations, educational levels, and socioeconomic backgrounds. The grounded theory method (Glaser & Strauss, 1967; Strauss & Corbin, 1998; Charmaz, 2000) was utilized to collect and analyze the data. The emergent theory, categories, and direct quotes from the participants are presented in order to illustrate clients' social class-related experiences in therapy. Results are consistent with existing empirical and theoretical literature on social class and therapy, and identify ways that disadvantaged social class affects individuals' therapy experiences. Implications for clinicians working with this population and public policies are discussed.




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