TPC-Journal-V4-Issue4

The Professional Counselor \Volume 4, Issue 4 392 Again, counselors rated lower-SES clients as having more severe problems than higher-SES clients. These results reflect other research investigating perceptions and attitudes about lower-SES populations. Historically, clinicians have tended to view poorer clients as lacking in effort (Feagin, 1975; Kluegel & Smith, 1986) and motivation (Seccombe, James, & Walters, 1998), and as being apathetic and passive (Leeder, 1996). Although these studies provide some useful information regarding the present line of inquiry, studies related to clinical outcome and SES as a main variable of study are sparse (Liu, 2011). There is a need to better refine and understand the relationship between SES and mental health. Present Study To address the dearth of counseling outcome studies examining SES, the primary purpose of the present study was to prospectively explore the relationship between SES indicators and counseling outcome. In light of the aforementioned SES literature (e.g., Braveman et al., 2005; Adler et al., 2000), we conceptualized SES as including a combination of objective data and subjective self-perceptions regarding class. Thus, in operationalizing SES as a variable of study, we collected commonly researched objective indices—namely educational attainment, household income and health insurance status, as well as subjective data including client perceptions of financial security and class level. In the present study, we also examined potential links between SES and three psychological variables thought to facilitate positive change through counseling: client motivation, treatment expectancy and social support. Also of interest was the degree to which the expectation of positive outcome through therapy was linked to SES and counseling outcome. If lower-SES clients indeed fit the perception of increased apathy, we conjectured that these clients would report lower levels of expectation for improvement. Lastly, social support was relevant to this study because it can minimize the impact of lower SES on mental health (Beatty et al., 2011). For example, in a recent study of homeless individuals, social support mediated everyday stressors (Irwin, LaGory, Richey, & Fitzpatrick, 2008). Additionally, Beatty et al. (2011) showed that lower childhood SES was related to less perceived social support. In summary, lower SES level is potentially related to reduced client motivation, treatment expectancy and social support. Thus, we tested two main hypotheses. First, we hypothesized that lower SES levels were linked to lower levels of client motivation, treatment expectancy and subjective social support. Second, we hypothesized that objective SES variables (e.g., education level, income, health insurance status) and subjective SES variables (e.g., perceived financial security, perceived SES) predicted counseling outcome. Because results have been inconclusive about the primacy of objective versus subjective SES variables, as well as the most predictive combination of SES variables, we entered both sets of predictors into one block of a regression analysis to explore which variables uniquely accounted for variance in outcome. Finally, we tested whether psychological variables (e.g., client motivation, treatment expectancy, social support) explained outcome variance beyond that accounted for by SES variables. Method Participants and Procedure Study participants were adult clients starting counseling at an on-campus university training center. The center, located in a Midwestern suburban area, serves both university students and individuals from surrounding communities at no cost, and is staffed by students enrolled in a CACREP-accredited counseling program. Between January and April 2010, front desk staff at the training center provided new adult clients with the consent form and study measures, which included the Outcome Questionnaire-45.2 (OQ; Lambert et al., 2003),