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Social Class and Suitability for Psychodynamic Psychotherapy: A Causal Model

A causal model is postulated to mediate the connection between patients' social class and therapists' evaluations of patients' suitability for psychodynamic psychotherapy. The model postulates that patients' social class gives rise to the learning of intellectual skills and cognitive styles, which lead to ways of interacting verbally with others, which in turn result in therapists' evaluations of patients' suitability. Thirty psychiatric outpatients were assessed for their intellectual skills and cognitive styles, and for their verbal interactions with their therapists during the first therapy session. One mediations] pathway was discovered as postulated by the model. This pathway was found to mediate the connection between patients' social class and their subsequent attendance in psychotherapy as well. Two unexpected pathways were found to mediate therapists' judgments of suitability, one of which also mediated patients' attendance in psychotherapy. These unexpected pathways are of particular interest for the clues they offer to the ways in which psychodynamic psychotherapy may be possible and rewarding with lower-class patients