Some relationships between social class and the practice of dynamic psychotherapy.

Abstract

From both a practical and a theoretical point of view, the psychiatric literature has, in the past few years, been increasingly concerned with the practice of dynamic psychotherapy in outpatient clinics. This concern has been sparked by several considerations. In the first place, from an economic standpoint psychotherapy as now practiced will permit only limited care of a selected number of applicants. Roughly calculated, the number of therapists needed to follow our present orientation is estimated at around 40,000 and it is not expected that we could provide anywhere near this figure in the near future. In the second place, as a professional group, we seem to share the rather pleasant delusion that those who support the mental hygiene clinic movement should eventually find the finances to provide enough therapists to meet the current demands. This is despite the fact that we have no sure evidence that the results from psychotherapy are better than other modes of treatment, or possibly no treatment at all. This becomes even more disconcerting when we consider that evidence is beginning to accumulate that present methods of clinic treatment may be suitable for only a limited group of people within our society. There are indications that our practice of psychotherapy is biased in favor of the so-called upper classes of our culture, and that our prized patients are those who share the same values and traits that we as a professional group cherish. The authors have been particularly interested in this problem, i.e., the role of social status in the practice of psychotherapy. Hollingshead and Redlich( 1), from their broad survey, indicate that the upper classes preferentially receive more intensive