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January 1978

Are There Social Class Differences in Patients' Treatment Conceptions?Myths and Facts

Author Affiliations

From the Department of Psychiatry, Massachusetts General Hospital, and the Departments of Psychology (Dr Eisenthal) and Psychiatry (Dr Lazare), Harvard Medical School, Boston.

Arch Gen Psychiatry. 1978;35(1):61-69. doi:10.1001/archpsyc.1978.01770250063006

• Traditionally, lower-class individuals who have sought psychiatric help have been hampered in their efforts by classrelated inequities in the delivery of psychiatric services. A common explanation for this phenomenon has been that the treatment conceptions of lower-class individuals are "inappropriate." This report presents theoretical and research evidence challenging this notion. A review of the literature from 1954 through 1974 yielded no good evidence that lower-class patients need, expect, or want treatments incongruent with those of upper-middle-class therapists. An experimental study of the requests for help made by 278 walk-in clinic patients confirmed this observation. Patient requests, as measured by an 84-item, self-rated questionnaire, were largely independent of social class. It was concluded that social class differences in treatment disposition and outcome cannot be attributed to social class differences in patients' treatment conceptions. The possibility that methodological and sociological factors can account for the discrepancies between the findings of this study and past studies is discussed. Strategies for minimizing treatment biases against lower-class patients and for maximizing treatment effectiveness with higher-class patients are also suggested.

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