Socioeconomic status and the therapeutic alliance: An empirical investigation using structural equation modeling

J Clin Psychol. 2022 Jun;78(6):1058-1073. doi: 10.1002/jclp.23290. Epub 2021 Dec 12.


Objective: The purpose of the study was to investigate the associations between client socioeconomic status and the therapeutic alliance.

Methods: Data on socioeconomic status and different aspects of the therapeutic alliance were obtained from participants currently or recently in psychotherapy and analyzed using structural equation modeling.

Results: The results provided support for a structural equation model where socioeconomic status was positively related to the therapeutic alliance. The study also found that the associations between socioeconomic status and therapeutic alliance was significantly stronger among clients who had received psychodynamic therapy compared to those who had received cognitive behavior therapy.

Conclusions: The results are discussed in relation to research suggesting that clients of lower socioeconomic status are estranged from the psychotherapeutic context, reflecting experiences among the clients both of not being understood and as inferior in relation to their therapist, as well as possible perceptions that such client are less suitable for psychotherapy.

Keywords: cognitive behavior therapy; psychodynamic therapy; psychotherapy; socioeconomic status; therapeutic alliance.

MeSH terms

  • Humans
  • Latent Class Analysis
  • Professional-Patient Relations
  • Psychotherapy / methods
  • Social Class
  • Therapeutic Alliance*