Thesis advisor: Lisa A. Goodman / As poverty rates in the United States increase, women continue to be disproportionately represented among individuals in poverty. As a result of their poverty, low-income women experience a range of acute stressors and chronic life conditions, within a sociopolitical climate that is highly stigmatizing. Not surprisingly, low-income women experience mental health issues at substantially higher rates than their higher-income counterparts. Despite the clear need for mental health services for this population, rates of access to treatment are low and attrition rates are high. The minimal research examining treatment outcomes for low-income women reveals mixed findings. Further, there is little research on low-income women's qualitative experiences of therapy; the role of their poverty and what they perceive to be meaningful and effective. The present study attempted to fill the gap in our understanding of low-income women's psychotherapy needs and experiences, in an effort to offer new insights about directions for research, training, and practice that can improve mental health services for this high-risk population. This study employed a qualitative descriptive methodology to explore low-income women's (n=10) experiences in traditional outpatient psychotherapy, with a particular focus on how poverty shaped their experiences and what they perceived to be most effective and meaningful. Six clusters emerged from data analysis: Awareness, Instrumental support and flexibility, Building strengths, Respect and dignity, Shared power, and Authenticity. These clusters, in turn, coalesced into three overarching themes: Awareness, Practices, and Relational Quality. Awareness pertains to participants' sense that their therapist understood the nature of poverty and was sensitive to the role of poverty-related stressors in their clients' lives. Practices reflects therapists' willingness to respond directly and actively to participants' poverty-related needs, as these are inextricably intertwined with their mental health. Relational quality refers to the participants' view of how therapists approached relational dynamics; in particular, how they negotiated issues such as power and transparency. Findings are discussed in the context of feminist theory and current research. Limitations are also presented along with recommendations for future research, training, and practice. / Thesis (PhD) — Boston College, 2014. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental, and Educational Psychology.

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Thesis advisor: Lisa A. Goodman / Those in poverty face myriad stressors, traumatic events, and ongoing hardships; and not surprisingly, struggle with a range of mental health issues. Yet, they are less likely to access mental health services than their middle-income counterparts, and when they do, they are more likely to drop out of treatment prematurely. Although researchers have found that when interventions are tailored to address poverty-related stressors outcomes are dramatically improved, the perspectives of those providing such treatment is rarely described. This qualitative descriptive study of twelve experienced psychologists working with clients in poverty aimed to fill this gap. The study explored the extent to which psychologists develop unique practices for working with low-income clients, as well as the personal and contextual factors that support or hinder these efforts. Findings can be distilled into three categories: Practices unique to working with low-income clients include strategies for addressing power dynamics, managing boundaries, and addressing external stressors as part of the therapeutic process. Therapist attributes key to working with low-income clients include possessing a values-based commitment to working with marginalized groups; possessing experience with, knowledge of, and empathy for the realities of living in poverty; possessing a high degree of self-awareness related to poverty; and possessing a willingness to be deeply affected by the work and cope with negative feelings. Contextual obstacles to working with low-income clients include agency-level and social service system-level challenges. Perhaps the most striking finding was participants' understanding of how conceptualizations of appropriate boundaries need to change in the context of work with this population. Many participants described, for example, giving food to their clients when they were hungry or giving them small amounts of money to help them take care of their most basic needs. The discussion section explores these findings in the context of ecological and feminist theoretical models and current research and describes the implications of the results for research, training, and practice. / Thesis (PhD) — Boston College, 2014. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.

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Content removed due to copyright restrictions: Paper titled, "Practitioner characteristics with comparison of counselling and psychotherapy practices between New Zealand and Singapore mental health practitioners" was presented and published in the proceedings of The Inaugural International Asian Health Conference, at the University of Auckland, 4-5 November 2004. 2. Workshop cum paper titled, " A modified cognitive behavioural therapy model for working with Chinese people" was also presented and published in the above Conference. 3. Abstract on paper titled, "Integrating homework assignments based on culture: Working with Chinese patients" was accepted in April 2006 for publication in the Cognitive and Behavioral Practice. 4. Paper titled, "Cultural considerations in using cognitive behaviour therapy with Chinese people: A case study of an elderly Chinese woman with generalised anxiety disorder", was published in November 2006 in the New Zealand Journal oj Counselling, Volume 35(3), 1 53- 1 62, and presented at the 29th National Conference of the Australian Association for Cognitive Behaviour Therapy, 1 8- 20 October 2006, under the title "Cultural considerations for Chinese people: Implications for CBT". 5. Abstract on paper titled, "Cognitive behaviour therapy in New Zealand and S ingapore : From a doctoral study and personal experience" was presented and published (in a book of abstracts) at the 1 st Asian Cognitive Behaviour Therapy (CBT) Conference: Evidence-based Assessment, Theory and Treatment, at The Chinese University of Hong Kong, 28-30 May 2006. 6. Paper titled, "CounsellinglPsychotherapy with Chinese Singaporean clients" was published in 2006 in the Asian Journal oj Counselling, Volume 1 3(2), 27 1 -293 . / This study compared the characteristics, self-reported practices and experiential skills of mental health practitioners (MHPs) in New Zealand and Singapore with the aim of benefiting both nations in managing the mentally ill. A mixed-research design was used consisting of a mail questionnaire survey and a structured interview. For each country, mail questionnaires were sent to 300 MHPs, namely, counsellors, psychiatrists, psychologists, psychotherapists, and social workers, while structured interviews were held with 12 MHPs. Potential participants were drawn from available electronic or printed publications on counselling and psychotherapy services in both countries. Those drawn from individual listings of MHPs were systematically sampled, whereas those drawn from organisational listings of MHPs were sampled by way of estimation. Despite the relatively low response rates of 20% to 27% from the participants of the mail questionnaire, the major findings were supported and augmented by those from the structured interviews in the combined analysis of results. Results were categorised into personal, professional and practice characteristics of MHPs. Personal characteristics included demographic characteristics. Professional characteristics included training characteristics, primary job affiliation and use of Western therapy models and interventions. Practice characteristics were sub-divided into five categories: practice setting; diagnostic system and assessment procedures; client and caseload; gender/ethnic match; and experiential skills. Similarities in personal and demographic characteristics between MHPs of both New Zealand and Singapore were found with respect to gender, ethnicity, and language ability. Differences in these characteristics were found with respect to age range and religious affiliation. Similarities in professional characteristics between MHPs of both countries were found with respect to country of therapy training, qualification in therapy, number of years of supervised training received, and use of Western therapy models and interventions. Differences in these characteristics were found with respect to primary job affiliation, availability of clinical psychology programmes, years of experience in therapy, and registration of practice. Similarities in practice characteristics between MHPs of both countries were found with respect to relevance of therapy models, focus of practice, diagnostic system and use of assessment procedures, clients seen, clients' presenting problems, and gender/ethnic match. Differences in these characteristics were found with respect to preferences of therapy models, and average number of sessions per client. Similarities in experiential skills between MHPs of both countries were found with respect to handling of self-disclosure, religious or spiritual issues, and traditional healers. Implications for Chinese clients and cognitive behaviour therapy were discussed, as well as limitations of the study.

Content removed due to copyright restrictions: Paper titled, "Practitioner characteristics with comparison of counselling and psychotherapy practices between New Zealand and Singapore mental health practitioners" was presented and published in the proceedings of The Inaugural International Asian Health Conference, at the University of Auckland, 4-5 November 2004. 2. Workshop cum paper titled, " A modified cognitive behavioural therapy model for working with Chinese people" was also presented and published in the above Conference. 3. Abstract on paper titled, "Integrating homework assignments based on culture: Working with Chinese patients" was accepted in April 2006 for publication in the Cognitive and Behavioral Practice. 4. Paper titled, "Cultural considerations in using cognitive behaviour therapy with Chinese people: A case study of an elderly Chinese woman with generalised anxiety disorder", was published in November 2006 in the New Zealand Journal oj Counselling, Volume 35(3), 1 53- 1 62, and presented at the 29th National Conference of the Australian Association for Cognitive Behaviour Therapy, 1 8- 20 October 2006, under the title "Cultural considerations for Chinese people: Implications for CBT". 5. Abstract on paper titled, "Cognitive behaviour therapy in New Zealand and S ingapore : From a doctoral study and personal experience" was presented and published (in a book of abstracts) at the 1 st Asian Cognitive Behaviour Therapy (CBT) Conference: Evidence-based Assessment, Theory and Treatment, at The Chinese University of Hong Kong, 28-30 May 2006. 6. Paper titled, "CounsellinglPsychotherapy with Chinese Singaporean clients" was published in 2006 in the Asian Journal oj Counselling, Volume 1 3(2), 27 1 -293 . / This study compared the characteristics, self-reported practices and experiential skills of mental health practitioners (MHPs) in New Zealand and Singapore with the aim of benefiting both nations in managing the mentally ill. A mixed-research design was used consisting of a mail questionnaire survey and a structured interview. For each country, mail questionnaires were sent to 300 MHPs, namely, counsellors, psychiatrists, psychologists, psychotherapists, and social workers, while structured interviews were held with 12 MHPs. Potential participants were drawn from available electronic or printed publications on counselling and psychotherapy services in both countries. Those drawn from individual listings of MHPs were systematically sampled, whereas those drawn from organisational listings of MHPs were sampled by way of estimation. Despite the relatively low response rates of 20% to 27% from the participants of the mail questionnaire, the major findings were supported and augmented by those from the structured interviews in the combined analysis of results. Results were categorised into personal, professional and practice characteristics of MHPs. Personal characteristics included demographic characteristics. Professional characteristics included training characteristics, primary job affiliation and use of Western therapy models and interventions. Practice characteristics were sub-divided into five categories: practice setting; diagnostic system and assessment procedures; client and caseload; gender/ethnic match; and experiential skills. Similarities in personal and demographic characteristics between MHPs of both New Zealand and Singapore were found with respect to gender, ethnicity, and language ability. Differences in these characteristics were found with respect to age range and religious affiliation. Similarities in professional characteristics between MHPs of both countries were found with respect to country of therapy training, qualification in therapy, number of years of supervised training received, and use of Western therapy models and interventions. Differences in these characteristics were found with respect to primary job affiliation, availability of clinical psychology programmes, years of experience in therapy, and registration of practice. Similarities in practice characteristics between MHPs of both countries were found with respect to relevance of therapy models, focus of practice, diagnostic system and use of assessment procedures, clients seen, clients' presenting problems, and gender/ethnic match. Differences in these characteristics were found with respect to preferences of therapy models, and average number of sessions per client. Similarities in experiential skills between MHPs of both countries were found with respect to handling of self-disclosure, religious or spiritual issues, and traditional healers. Implications for Chinese clients and cognitive behaviour therapy were discussed, as well as limitations of the study.