TPC-Journal-V4-Issue4

The Professional Counselor \Volume 4, Issue 4 400 Implications and Future Research The results of the present study are consistent with the work of researchers who have argued that SES variables have complex relationships with one another and with mental health (Liu, 2011). When measured together, subjective and objective SES measures impacted clinical outcomes. As individual variables, however, only educational level and health insurance status predicted improved outcome. Indices of SES have not evolved to the point that they can be measured with discrete variables. Counseling SES research would benefit from further development of SES indices, as well as comprehensive studies using measures as a whole within broader contextual issues to fully understand the utility in mental health counseling research. Results also show that clients who had access to health insurance experienced greater amelioration of symptoms even though counseling services in the present study were provided at no cost. This result was unexpected and must be studied further. Future research might examine whether access to insurance satisfies a basic need of security, which, in turn, improves counseling outcomes. Increasingly, states are incorporating mental health parity (Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, 2008); therefore, studies must review the long-term effects associated with clinical outcomes and cost-effectiveness. Regarding short-term findings, Lang (2013) found that suicide rates were significantly reduced when states required parity between physical and mental health benefits. Also, studies controlling for counselor and client differences are needed. For example, an experimental design might examine counselor countertransference regarding lower-SES clients. Results might show how much counselor perceptions could be altered on the one hand, and biased on the other. This study also indicates a further need for counselors to understand the contextual influences of SES with regard to counseling outcome. It is important for counselors to embody the full characteristics of their professional identity—including that of mental health advocate—to address SES issues involving both misconceptions and gaps in SES research. Conclusion The present study contributes to the body of knowledge regarding the effect of client SES on counseling outcome. Results show that higher education and access to health insurance—even at a free counseling clinic— may improve counseling outcome. For all clients, possession of health insurance augmented the amount of improvement. Although these findings should be regarded as tentative, SES appears to be an important client variable affecting the success of counseling and meriting further research. The results also underscore the need for a comprehensive SES measure to gain a more complete picture of how SES influences counseling outcome. Finally, we found no links between lower SES levels and motivation, treatment expectancy and perceived social support. An important implication for the practicing counselor is to value the nuances of SES as potential influences on client outcome. Counselors would benefit from exploring potential SES stressors with clients and accessible resources to minimize mental health stressors and improve counseling outcomes. Conflict of Interest and Funding Disclosure The authors reported no conflict of interest or funding contributions for the development of this manuscript. References Adler, N. E., Epel, E. S., Castellazzo, G., & Ickovics, J. R. (2000). Relationship of subjective and objective social status with psychological and physiological functioning: Preliminary data in healthy white women. Health Psychology , 19 , 586–592. doi:10.1037/0278-6133.19.6.586