‘It overshadowed everything’: Understanding working-class clients' experiences of social class differences within the therapeutic relationship

Abstract

Background: Little is known about the experiences of working-class clients in psychological therapy. This qualitative study explores how social class differences are experienced within the therapeutic relationship by six clients from a working-class background. Materials & Methods: Semi-structured interviews were conducted with women in Britain who self-identified as working-class and had engaged in therapy with clinicians whom they perceived to be from a higher class background than themselves. Interpretative phenomenological analysis was used to analyse the data. Findings: The study identified three superordinate themes: a meeting of two worlds, class in the implicit relationship and managing difference. The findings indicate that class differences have a significant impact on both the therapeutic relationship and on participants' view of themselves. Discussion: For some, addressing social class differences helped to alleviate internalised classism and address the impact of structural oppression. However, when clients felt judged, misunderstood or perceived a lack of empathy, they began to disengage and hide parts of their experiences related to social class. As such, the findings have significant implications for how class differences within the therapeutic relationship might be addressed in psychological therapy.