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Class and Classism in Family TherapyPraxis: A Feminist, Neo-Marxist ApproachKyle Zrenchik a & Teresa McDowell aa Department of Counseling Psychology , Lewis & Clark College ,Portland , Oregon , USAPublished online: 30 Apr 2012.

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Journal of Feminist Family Therapy, 24:101–120, 2012Copyright © Taylor & Francis Group, LLCISSN: 0895-2833 print/1540-4099 onlineDOI: 10.1080/08952833.2012.648118

Class and Classism in Family Therapy Praxis:A Feminist, Neo-Marxist Approach

KYLE ZRENCHIK and TERESA MCDOWELLDepartment of Counseling Psychology, Lewis & Clark College,

Portland, Oregon, USA

The field of family therapy has experienced tremendously posi-tive influences by critical theoreticians, expanding the praxis toinclude multicultural perspectives as well as reflecting upon howrace, sex, and other identities influence both clients and practi-tioners. However, we have found there to be a significant lack ofsimilar interest in how social class and classism influence fam-ily therapy. This is particularly distressing, as we argue, becauseof the overwhelming influence one’s social class and experiencewith classism has on his/her sense of self, his/her past and presentexperiences with his/her communities, and his/her individual andfamily well-being. Further, unchecked classist ideologies can nega-tively impact families via the practitioner. As we contend, throughutilizing a feminist, neo-Marxist ontology to critically reflect howclass and classism affect families and family practitioners, a goodsense rhetoric and ideology can be created to inspire deep systemicchange.

KEYWORDS classism, neo-Marxism, family therapy, socialjustice, Karl Marx, social class, socio-economic status, criticalconsciousness

“Conservatives say if you don’t give the rich more money, they will losetheir incentive to invest. As for the poor, they tell us they’ve lost all incentivebecause we’ve given them too much money.”—George Carlin

Received June 14, 2011; accepted August 18, 2011.Address correspondence to Teresa McDowell, Department of Counseling Psychology,

Lewis & Clark College, 0615 SW Palatine Hill Rd, MSC 86, Portland, OR 97219. E-mail:teresamc@lclark.edu

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Social class and classism are largely overlooked in family therapy(Kosutic & McDowell, 2008) and counseling literature (Liu et al., 2004; Smith,2005; Furnham, 2003). This reflects the taboo against talking about socialclass in the broader society of the United States. According to Yeskel (2007),“we pretend it [social class] doesn’t exist and if it doesn’t exist how canwe talk about it?” (p. 12). When social class is highlighted in the helpingfields, it is often from a liberal perspective that assumes those “less fortu-nate” can and should be empowered in order to “move up” in society, thuslaying both the burden of, and blame for, poverty on the most economicallyoppressed and marginalized. In other words, the problem is assigned to thepoor and working class rather than to those benefiting from the povertyof others. This extends beyond national borders to global economic sys-tems. Similar to race, ethnicity, religion, sex, gender, sexual orientation, age,and ability, social class is integral to the interconnection of identity, lifeexperience, and world view. While there have been many advancementsin multicultural appreciation, classism and class biases are disproportion-ally under-evaluated, and “therapists know little more about the therapeuticexperiences of poor people today than they did decades ago” (Smith, 2005,p. 687). Some scholars have argued that therapists’ unreasonable expecta-tions, demands, and shaming of their underprivileged clients are commonlyperpetuated yet rarely acknowledged (Siassi & Messer, 1976; Smith, 2005;Smith, Foley, & Chaney, 2008; Liu et al., 2004). Classism is not simply anaive prejudice that can be overcome by developing empathy and respectfor the poor, but a tangible result of social and economic inequity. Further,it is our view that classism is the umbrella under which all other forms ofoppression are connected.

At the crux of this article is the argument that in order to be competent,family therapists must develop critical class consciousness and take actionfrom a class conscious standpoint in the therapeutic process. We agree withYeskel (2007), who argued, “I don’t think we will be successful in any of ourwork against racism, sexism, heterosexism, etc., until we begin to take onthe issue of classism” (p. 15). Understanding the effects of classism on indi-viduals and families helps clinicians better understand, properly diagnose,and develop effective treatment plans for all clients (Liu et al., 2004). At best,therapists are often unaware of their own classist values (Chalifoux, 1996),and therefore may be unable to fully connect with low status clients (Javier &Herron, 2002). At worst, our own class privileges, by definition of our socialand professional role (Harley, Jolvette, McCormick, & Tice, 2002), can inad-vertently harm those we attempt to help. In this article, we offer a feministneo-Marxist view of social class that we believe will further social classawareness among family therapists and therapists-in-training. Raising aware-ness is vital to challenging classism and developing self-of-the-therapist.We believe examining social class from feminist neo-Marxist perspectives can

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help practitioners, researchers, and educators resist inadvertently colludingwith hegemonic forces (i.e., systems of power exerted by dominant groupsover others in society), impacting clients living within capitalism.

In the sections that follow, we review the impact of social class onfamily life, and offer a primer on the philosophical foundations of criticalsocial theorist Karl Marx, as well as related works of Gramci, Habermas,Bourdeaux, and others in the critical and feminist traditions. We offer a briefoverview of social class and classism from a neo-Marxist perspective that wehope will “unmask or demystify the discourse of power” (McKerrow, 1989,p. 91), and challenge all of us to increase our class awareness relative tounderstanding and working with families. In alignment with a critical advo-cate’s telos, we end by offering several areas for those interested in exploringfeminist neo-Marxist approaches to consider, including (a) raising social classawareness and self-of-the-therapist, (b) doing clinical work in capitalist, care-for-profit contexts, and (c) considering the impact of class(ism) knowledgeand awareness on the practice of family therapy.

REALITY CHECK-TO-CHECK

There is a general misconception that the majority of families in the U.S. aremiddle-class, when in fact 60% to 70% are working-class (U.S. Departmentof Labor, 2001). Thirty-two million people in the United States live inpoverty. That is roughly 12% of the population. The top 1% of U.S. citi-zens own more wealth, land, and resources than the bottom 95% combined(Collins & Yeskel, 2005). In addition, 1.7 million hourly-paid workers (56%of all wage earners) make minimum wage or less (U.S. Bureau of Labor andStatistics, 2006), and the average credit card debt is over $15,000 (Woolsey &Schulz, 2010). Approximately one-fourth of all U.S. workers are working-poor, meaning they work full-time for poverty-level wages (U.S. Departmentof Labor Statistics, 2007). Conversely, CEO’s have increased the pay gapbetween an average paid employee and the top executives from 28 to 1 in1970, to a current 369 to 1 (Henry, 2006).

According to the U.S. 2000 Census (Liu et al., 2004), the average annualhousehold income for White families was $46,000, followed by Latino fami-lies ($33,000), and Black families ($29,000). Asian/Pacific Islanders reportedaverage household incomes of $53,000, but also reported more wage earn-ers per household. The median family income was $51,000. Over half ofthose in the United States live “paycheck to paycheck” (Metlife, 2003).Recent economic downturns have exacerbated the situation, as evidencedby one in every 200 families facing foreclosure (Federal Deposit InsuranceCorporation, 2010), and 1.5 million declaring bankruptcy between 2009 and2010 (Administrative Office of the U.S. Courts, 2010).

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THE EFFECTS OF SOCIAL CLASS ON WELL-BEING

There is ample evidence that social class affects physical, mental, and rela-tional health. For example, those who are poor or working class havehigher rates of depression and anxiety (Liu et al., 2004), childhood mor-tality (Singh & Yu, 1996), cardiovascular disease (Kaplan & Keil, 1993),hunger (U.S. Department of Agriculture, 2006), neurotic disorders (Lewiset al., 2003), and time spent in youth justice systems (Holley & Van Vleet,2006). Poor communities often endure more severe environmental dangers,including the worst air quality (Wheeler & Ben–Shlomo, 2005).

As health researchers seek to detail the health and wellness disparagesbetween classes and the very real health costs of poverty both to the individ-ual and the greater community, consistently evidence suggests a correlationbetween classism, corporate-controlled health care, and classist legislationto the health of the individual and family (Veenstra, 2006). Furthermore, the46.3 million people in the United States without health insurance or whocannot afford co-payments go without needed care (Cohen, Martinez, &Ward, 2010). These dynamics create and maintain privilege for a very specificpopulation at the cost of the vast majority.

These conditions are a direct result of social placement and dispro-portionate rationing of resources. Money, land, and other resources are notlimitless, but finite. To conserve access to resources, systems are createdto maintain privilege and disenfranchise the poor. For example, the poorare less likely to go to college (Ali & Saunders, 2006), are largely absentfrom political office, and left out of producing formal, reified knowledge(Zandy, 1996). People from wealthier backgrounds have higher self-conceptsand career adaptability (Bluestein, Coutinho, Murphy, Backus, & Catraio,2010), and as a result are more likely to gain access to resources andcomfort.

Classism not only affects the distribution of resources and wealth, butalso the distribution of respect and admiration. This is exemplified by per-ceptions of the homeless as being subhuman or worthless (Fiske, 2007) andlabels such as “criminal,” “dirty,” “addict,” and “immoral” being more com-monly assigned to people of lower socioeconomic status (SES) (Cozzarelli,Wilkinson, & Tagler, 2001). Even when we acknowledge the poor as human(Smith, 2005), we engage in a dialect of those who “deserve” to be poorand those who do not deserve to be poor, distributing aid only to the latter(Streensland, 2008). Attempts to secure social capital may then create com-petition rather than community among the underprivileged, further disablingthe poor from taking unified social action. Classism is widely internalized,leading both the rich and the poor to view those with more money as moreworthy. This is particularly hegemonic when those whose labor is beingexploited believe those who benefit from this exploitation to be of greatervalue.

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CAPITALISM AND THE FAMILY

Families are significantly impacted by social, economic, and political sys-tems in all societies. The impact of capitalism on families in the U.S.is no exception. Burroughs and Rindfleisch (2002) contended that cap-italistic materialism has proliferated acts in direct antithesis to familyand individual well-being. Child rearing, vacationing, access to education,community/school involvement, parental time at home, homeownership,leisure sports/activities, access to help during disasters, and even fam-ily communal dining are all positive correlations to family and individualhappiness (Dietz & Haurin, 2003; Ali & Saunders, 2006; Jurkiewicz, 2009;MacFarlane, Crawford, Ball, Savige, & Worsley, 2007; Marshall et al., 2007;Springer, 2010; Wellstone, 1997). These are becoming luxuries in capitalistsocieties, and foreign experiences to the working poor. Liu, Pickett Jr., & Ivey(2007) categorized the arenas of privilege given to certain populations to beprivileges of housing and neighborhood, economic liberty, socio-structuralsupport, power, familiarity with behavioral norms, self-satisfaction, leaving aheritage, and the privilege of leisure. Markoff and Gilliland (1993) found thatcouples who experience stressful jobs, lack of sleep, and active legal pro-ceedings (all of which people of low SES are likely to encounter) are morelikely to experience sexual impotence, unsatisfactory sexual relationshipswith their partner, and overall lower marital satisfaction. Classist segregationsof schools and communities have a very real and generational negative effecton all people (Kozol, 1991). Where once a significant number of (mostlyWhite) families in the United States could survive on a single income, cap-italist exploitation of labor and promotion of consumerism has led to mostfamilies needing at least two incomes. Time that was once spent with thefamily is now taken up with outside work. While the feminist movementsought for a woman’s right to work and to exit a marriage as opposed tobecoming a voiceless commodity of a husband, from a capitalist’s view-point, the influx of cheap labor made extracting surplus-value labor eveneasier (Ebert, 1998).

Capitalist frameworks influence parenting in many ways, including thepromotion of individual competition to secure future economic success.This is demonstrated in part by the frequent over-involvement of childrenin multiple activities, particularly in middle class families, to enhance theirdevelopment and competitive edge (e.g., early school attendance, excessivehomework, and private lessons). Levine (2006) argued that pressure fromwealthy parents plays a significant role in children adopting classist, cap-italistic mindsets, making them more likely to become disconnected withparents and community. Pressure to succeed may also lead to adoptinginternalized, unsatisfactory ontologies and self-images. Further, as capitalismstrives for the privatizing of all resources and services, families put theirhealth and care, elder relatives, retirement funds and trusts, national defense

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(in part), incarceration and criminal rehabilitation (in part), environmentalstewardship, and vital research in the hands of corporations, which mayyield dangerous consequences to family well-being.

ENLIGHTENMENT AND THE RISE OF THE INTELLECTUAL

Luckas (1923/1968), coming from a Marxist dialectical approach, argued thatunfair social structures are not just a result of the bourgeoisie manipulatingthe means of production, but also of the manipulation of the consciousnessof the oppressed. He argued that the bourgeoisie create social ideologiessuch as ‘the Protestant work ethic’, ‘manifest destiny’, and similar rhetoric.This directs responsibility of low social status and inadequate accessto resources on to the victims of exploitation. This hegemony (i.e., theexercises of the dominant group to maintain privilege over others), throughvarious rhetoric and rhetorical strategies, creates a class consciousness thatsuppose the poor are such because of their inherent worthlessness (e.g.,laziness and irresponsibility). Those who do not attain economic successand social influence have merely not worked hard enough, leaving theworking poor with nothing to sell but themselves (their labor), while thewealthy exploit their labor so they no longer have to work themselves(Marx, 1999). Those who have limitless access to resources are arbitrarilyconsidered ‘entitled’ to this unfairly distributed wealth. Marx called this afalse consciousness (1999). False consciousness is necessary to maintainingclassism (Luckas, 1923/1968).

It is not the lack of character or worthiness of individuals that keepspeople poor. It is the deliberate acts and policies of the wealthy classesthat keeps privilege and adequate resources from the rest of us andstigmatizes us for needing anything, while welfare to the rich is cloakedin respectability and disguised as for the public welfare and the public’ssake (Garrity, 2005, p. 23).

As Marx argued, “the maintenance and reproduction of the workingclass is, and ever must be, a necessary condition” to maintain the social statusquo and our classism-dependent capitalism (1999, p. 332). However, Marxistphilosophy provides a means of emancipation from oppressive dialectics.Gramsci (1929–1935/1973), who followed a Marxist approach, recognizedthe inherent intelligence of all people and their objective value because oftheir intelligence. One can turn to a classic feminist example that servedfaculty to the feminist movement. A woman’s domestic labor in her homeor the home of a wealthier [read White] woman was/is commonly devaluedwhen juxtaposed to a man’s work outside the home. Interestingly, women’sintelligence, and labor which employed that intelligence, literally kept/keepsothers alive and prospering. Privileged knowledge (e.g., banking,

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engineering, research, medicine, and philosophy) was primarily limited onlyto White men and thus an extension of White supremacy and patriarchy.

Gramsci argued that for the oppressed to shed themselves of their falseconsciousness (or common sense, to use Gramsci’s term) and adopt, whatGramsci called a good sense, a consciousness that benefits all people, theymust fully comprehend their oppression. That is not to suggest that peopledo not know when they are being oppressed, silenced, and marginalized,but that putting words and connecting experiences in ways that help themunderstand the dynamics of power are important aspects of liberation. Thisis what Paulo Freire (1970) referred to as conscientization, or raising ofconsciousness of one’s oppression through problem posing and reflectionfor the purpose of taking action toward a more just society. Liberation isnot externally-imported, but must be internally, intra-communally created.Communities and allies join in the cause of social justice. The members ofthe community who learn how to transverse the space between what is andwhat can/should be, the organic intellectuals (Gramsci, 1929–1935/1973),can help liberate communities and inspire community members to aspireto better circumstances. These organic intellectuals serve their communitiesand the whole of society by creating a more equitable society. They riseup, spread the word, and speak the means of liberation in the language,symbology, and metaphor of their community. Organic intellectuals leadtheir communities, and its allies, toward good sense. An example of thistype of collective action was witnessed by the entire world as Egyptian youthwent to the streets in January of 2011 with demands for social, political, andeconomic change. The resignation of Hosni Mubarak on February 11th wasinspired by thousands acknowledging what they experienced throughouttheir lives but could not talk openly about, given the unbridled power of thegovernment. Organic intellectuals led the way to widespread “good sense”and strategic action for social change.

NEO-MARXISMS

At its core, Marxism constitutes a major shift in philosophy regarding power,society, and ideology formation. Marx demanded that serious attention beplaced on the phenomena of social class. He argued that Western Europeand North America replaced feudal-type oppressive structures with less obvi-ous, faceless capitalist structures, which ultimately result in the same (ormore severe) devastation. Since his writings in the mid to late 19th cen-tury, Western thinkers have expanded this into new realms. Postmodernphilosophers (e.g. Foucault and Habermas), and many contemporary fem-inist scholars have instigated widespread shifts in thought. Scholars indisciplines outside of philosophy or economics have adopted neo-Marxistframeworks that blend tenets of Marxism into contemporary approaches.

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Women’s rights and concern for the family can be traced to the begin-ning of Marxist discourse and activism (Waters, 1972). Later neo-Marxistfeminists pointed to the connection between social class and oppressive roleorientation/gender performance, women’s rights, and colonization. Attemptsto place women and families within frameworks of production have led toreductionist views of families as simple economic units and women as agentsof biological reproduction (for the purpose of production), low-cost capital-ist labor, and domestic servitude (Barrett, 1988). Explaining the oppressionof women as solely a function of male dominance in the “interior” of thefamily (even if linked to a generalized view of patriarchy as existing beyondthe family) fails to situate family relationships within broader social, eco-nomic, and political contexts (Barrett, 1988). Neo-Marxist feminist thoughthas become well-appreciated in the advancement of sex/gender liberation.A wave of feminist scholars with neo-Marxist influences rejected the meth-ods and effectiveness of many current feminists, arguing that they werebecoming too impractical and naive. For example, Blood, Tuttle, and Lakey(1992) emphasized the role material oppression and classism has on thevery existence of patriarchy. hooks (1994) argued that the increasing patternof feminist scholars publishing in hyper-academic language and debatingmetaphor and symbolism does nothing for poor women.

Discovering and remediating wage inequality cannot be conflated withthe theoretical (Jacobs, 1995). Real economic inequality exists outside of lan-guage. And while economic inequality does manifest itself in our language(e.g., “broke,” “needy,” “lower”), to solely alter our language is akin to apply-ing a fresh coat of paint to a burned-down house. Further, putting effort intocreating a more politically correct vernacular is a top-down approach toliberation, benefitting more those that have the privileges, leading to lan-guage and syntax being a core concern, almost frivolous in comparison.Debate is often a luxury afforded to the well-to-do. Poor women of color,for example, thus find themselves bearing the weight of sexism, racism,and classism, while their semi-liberated feminist allies debate (Hill–Collins,2000). Certainly, debate and critique is not useless. It is, in fact, part of howchange occurs, but only in conjunction with action. To focus on the textualinstead of the actual, as a neo-Marxist feminist would argue, is to benefitthe bourgeoisie woman. It is to revive White feminism, and not advance allfeminisms. As long as material oppression—in the form of wage inequali-ties and a capitalist economic model which can only exist as long as thereare both homeless and very wealthy—continues to be unchallenged, artic-ulations of material oppression (e.g., classism, racism, sexism, and ableism)will exist.

INTERCONNECTIONS OF IDENTITY AND SOCIAL CLASS

Social class is both interconnected and foundational to all other systems ofoppression, and therefore core to individual and family well-being. Feminists

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(Shields, 2008; Valentine, 2007) have argued for analysis of the intercon-nection (or intersection) of identity, privilege, and oppression within andacross social contexts. Sexual orientation, abilities, ethnicities, age, immigra-tion status, nation of origin, religious orientation, sex, and gender identityinterconnect to create and maintain social inequality and social class. Justas “woman and heterosexual”, “woman and immigrant”, and “woman anddisabled” are different ways women experience womanhood, so too mustwe acknowledge the role class plays in all of our lives.

Our social identities afford us varying degrees of social and culturalcapital, which in turn afford us varying degrees of access to privilege withinthe social class system. Bourdieu (1986) defined social capital as the totalresources linked to relationships with others which provide the “backing” ofbelonging to a group that has an accumulation of collectively-owned capital.In order to secure and accumulate resources, it is necessary to have access tosocial and institutional systems through which class-based resources can begarnered. Cultural capital (Bourdieu, 1986) refers to behaviors, attitudes, lan-guage, beliefs, customs, and other practices associated with cultural groupsin power. For example, as a White, middle class, straight female, I (Teresa)am able to culturally accommodate the most dominant groups in society.It is in the best interest of those in dominant groups who have the greatestaccess to economic resources and social influence to promote their group’sforms of cultural capital. Thus, some cultural practices are seen as betterthan others. Identifying or being labeled as someone who should not partic-ipate in a privileged culture serves to limit access to cultural capital, in turnincreasing the value; a supply-demand model of social status. We offer asan example the discovery of Ted Haggard’s same-sex attractions, which costhim the social capital and cultural capital he used as a weapon against thevery type of people he wished he could openly be.

THERAPY AND CLASSISM

As therapists, we must be aware of the role of classism and internalizedclassism in our work so we are better able to resist inadvertently encouragingcomplacency to subjugation in favor of fully supporting purposeful libera-tion (Dolan–Del Vecchio & Lockard, 2004). As a discipline, we must actively“avoid the reinscription of economic power that results when the dominantalso becomes the method for the elimination of oppression/colonialism”(Cannella & Manuelito, 2008, p. 50). This includes acknowledging our owneconomic gain as professionals treating low status clients. Well-meaningtherapists who adopt the myth of meritocracy (i.e., the belief that anyonein a democratic, capitalist society can become financially successful throughhard work and ingenuity) focus on personal agency as the key to changein class status. It is important not to downplay agency and accountability.However, holding those at the bottom as solely responsible for their plight

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serves to maintain the status quo of unfair distribution of rewards inherentin the design of capitalism.

Furthermore, the majority of research is biased toward normalizingEuropean American middle- and upper-class experience (Bulboltz, Miller, &Williams, 1999). The counseling professions have been immeasurablyinfluenced by the lives and behaviors of the privileged few. Thus, clientsfrom all backgrounds end up participating, or refusing to participate, intherapeutic processes that were not necessarily designed with their bestinterests in mind. Therapists may be unaware that it is not just the tangibleeffects of classism that affect low status clients, but also phenomena likedislocation from community, language barriers, lack of opportunity for self-discovery, and increased demand for obtaining employment (Zandy, 1996).Unfortunately, therapists can mistake experiences of low status clientsas evidence of mental-emotional disorders by applying White, young,heterosexual, financially secure normalcy when working with all clients.

In the following sections, we explore the relevance of feminist, neo-Marxist social class awareness on self-of-the-therapist and the strugglesinherent to working to dismantle classism within capitalist contexts. Finally,we offer examples of the impact of feminist, neo-Marxist analysis on familytherapy praxis as a way of introducing possibilities for clinicians interestedin integrating this approach into their work.

CLASS-AWARENESS AND SELF-OF-THE-THERAPIST

Our class awareness is deeply influenced by our lived experience. Therapistsfrom lower social class backgrounds and those who cross social classes intheir daily lives are likely to be more aware of the experience of lowerand working class families. Those from higher social classes and/or thosewho limit their relationships to others in the same social class may haveless cross-class competence. Therapists must always critically reflect on theirown classism in interactions with clients of all social classes. Acting with classconsciousness includes assessing if office space is appealing or intimidatingto members of particular social classes and recognizing/intervening when acolleague’s opinions reflect a classist ideology. Even things like hiring admin-istrative staff and requiring they pass a credit check reflects an attitude thatthe poor are untrustworthy. Hosting professional conventions in expensivehotels and cities which leave (under)graduates, struggling new professionals,and therapists who serve the poor either paying disproportionately or beingleft out altogether is another example. Every family therapist who has everattended a public school, received publically-funded grants or loans, or beeneducated by professors who have, can directly trace the opportunity for theiroccupation to poor and working class clients who are responsible for a dis-proportionate share of taxation (Institute on Taxation and Economic Policy,

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Class and Classism in Family Therapy Praxis 111

2009). In the following paragraphs we share our own class experiences toboth situate ourselves in this discussion of social class and offer examplesof how therapists and therapists-in-training might be encouraged to analyzetheir own social class identities relative to self-of-the-therapist development.

Kyle: Self-of-the-Therapist and Social Class

I was raised in a blue-collar city, in a blue-collar family. Labor was highlyvalued, and used as a primary measure of one’s worth. Because I was raisedby a single mother who often worked overtime in order to make almostenough money to stay one payment above foreclosure, I had to learn at avery early age to be self-reliant and responsible for most things beyond basicnecessities. While this offered me the opportunity to become more agentic,many common childhood activities became extremely difficult or impossible.Because my mother’s schedule revolved around her work, I relied on otherparents and teachers for what my family could not provide. I rememberhaving panic attacks at eight years of age because of fears of not beingable to pay for college, which I saw as my only way out of the cycle ofpoverty. In high school is when I truly learned the stark difference betweensocial classes. Through competing on the speech team, we would often visitinvitationals hosted at wealthy schools where I could bear first-hand witnessto the opportunities and resources that were exclusive to wealthy children.Going to college, and even getting graduate degrees made me an oddityin my family. At times I was looked down upon because I was not seenas producing labor, and my accomplishments were unrelatable. Conversely,attending the blue-collar state school that I did, as it was all I could afford,was seen as, as one of my graduate professors put it, going to the “retardedstep-cousin” of colleges in my home state (he, of course, went to the wealthystate school five miles away). Because of my class-transgression, I have beenable to see the effects of class very clearly. Returning to my home town andkeeping in touch with childhood friends is too difficult for me, as it highlightsquite vividly privileges I have and the privileges they do not.

Sadly, it is hard for me to recognize the problems of the wealthy asbeing legitimate because of their seemingly infinitesimal comparative strug-gles. This is incredibly biased of me. Further, I have great anxiety regardingbecoming a “rich man’s therapist”, in large part because of our insurance-industrial complex. While I in no way want to become co-opted into theculture of the bourgeoisie, I struggle with the resources and opportunitiesI am willing to give up in order to do so.

Teresa: Self-of-the-Therapist and Social Class

I grew up in an upwardly mobile, entrepreneurial, capitalist family. My lifewas shaped daily by the ideology of capitalism and the realities of being

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a child of a business owner rather that the child of a worker. While myfather worked sixty plus hours a week, he was able to come and go ashe pleased, set the pace and agenda for a large industrial company, andcommand respect from the community. Those in his employ were assignedspecific tasks to accomplish, which often required them to stay in a limitedamount of space for a pre-determined amount of time. As a result of thiscapitalist enterprise, I was awarded status in the community even as a youngchild. As an adult, I carried my class (as well as race, nation of origin, educa-tional, language, abilities, and heterosexual) privilege and classism with melong after the family business failed and my family of origin went bankrupt,I married a construction worker and was situationally poor. The long termexperience of financial struggle and living with a partner who worked sixtyplus hours a week to make an income that made it difficult to provide for ourchildren, offered me the opportunity to view class experiences with a dif-ferent lens. My experience of gender oppression and sexism remained, yetplayed out differently across classes. In my family of origin, sexism and gen-der oppression were continuously expressed by my father (and the broadercommunity/society). While the family depended on his White male privi-lege for economic security and upper-middle class status, we also sufferedhis physical and emotional abuse, fueled in part by the stress of upwardmobility and protected by his success.

WORKING IN CAPITALIST HEALTH CARE SYSTEMS

While clinicians may have the best intentions, without a critical reflection onthe interface of capitalism and health care delivery systems, they may inad-vertently cause harm by supporting structures based on classist ideologies.Hillerbrand (1988) found that people of lower SES were more often diag-nosed, and were seen as making less therapeutic progress, as well as havingmore vocational problems, whereas wealthier persons were seen as makingfar better progress, and more likely to have educational problems. Familytherapists may mistake experiences of low status clients as mental-emotionaldisorders by applying a privileged-construction of normalcy when workingwith all clients. Within this framework, deviance is assigned to individualsand families, leaving classist models of health care delivery unexamined.

Example: Complicating “Private” Practice

As a private practitioner for many years I, Teresa, was in the position ofbeing both a business owner and therapist. My business income dependedon health insurance provided by capitalist organizations and the state whichsupports those institutions. The health care companies themselves werecare for profit capitalist ventures that expected my services to meet specific

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criteria of production (e.g., symptom removal within a limited number of ses-sions, client satisfaction, and risk reduction). I also contracted with employeeassistance programs which provide services to workers aimed at maximizingtheir production. While I did not make money directly from hiring othersfor a share of profit, my financial success depended on the well-workingsof a capitalist society. My practice also relied on my reputation and thewillingness of the most powerful in the community (e.g. doctors, judges,and business owners) to refer people to me, often with goals that reflectedan agenda of social control. Cooperating with this network and having thecultural capital to succeed in it (e.g., White, middle-class privilege, privateschool education, and entrepreneurial upbringing) steadily increased mysocial and economic capital. I am also female with children for whom I tookprimary care, placing me in a more vulnerable position in my private/publiclife. For the first part of my career, I assumed a classist position of wantingto “help” families in financial need. Simply adding opportunities to do thisto my work was not difficult. I did notice, however, that my anxiety andeffort increased when working with upper-class families who were “powerbrokers” in the community. Therapy tended to go well with either group,but why was I so much more comfortable with those beneath me in thesocial order? It became increasingly difficult to ignore my own classism.When I joined a private practice, I began to observe a widespread ten-dency to show greater or lesser respect for clients based on social class.The intersection with social class, and dependence of social class on, gen-der, race, immigration status, abilities, looks, etc., played out in a plethora ofways, including: how clients were discussed relative to presenting problems,whether or not multiple no shows were allowed to reschedule, the privacyprovided to clients as therapists walked them to and from the therapy room,the level of state intrusion and control in their lives, how being late for anappointment was handled and so on. What was beyond site? What differ-ences were occurring based on social class in the interaction in the therapyroom?

CLASS(ISM) KNOWLEDGE AND PRAXIS

Understanding how social class impacts the daily lives of all clients, includ-ing restrictions and opportunities, beliefs, values, and attitudes, is crucialto multicultural competence. As Liu et al. (2004) pointed out, counselorsoften assume all people agree to what defines and characterizes each socialclass. Further, counselors may assume all members of each social classshare homogenous ideologies and behavior patterns. Additionally, thera-pists may assume that everyone desires “upward mobility” between classes.Assuming personal characteristics, family culture, or relational dynamics asthe cause of economic struggle leads to the belief that treating these issues

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in therapy will “fix” what is preventing clients from “pulling themselves upby the bootstraps.” Knowledge of the “real world” of income, education,neighborhood, and occupation helps combat unfair and arbitrary diagnosisand interventions. Baker (1996) offered an example of the harm unexam-ined classism can cause, citing a therapist who diagnosed a woman withparanoid delusions and had her hospitalized and medicated because shesaid she always felt followed. It was later discovered that the woman wasactually being followed by trackers hired by her employer after she fileda claim against her workplace. As Baker contended, we are privileged inthis profession to not have to ask for bathroom breaks, get permission tomake quick phone calls home, or risk being fired when temporarily outsick. Therapists can inadvertently develop therapeutic approaches and inter-ventions designed and disguised in their own privilege, failing to be fullybeneficial to all clients.

Without understanding the effects of class and classism, practitionersmay find themselves unable to comprehend unfamiliar behavior or under-stand constraints and barriers to change, rendering them unable to effectivelyassist those who may need it the most (Javier & Herron, 2002). This includesunderstanding those at the fringes of a capitalist society, those in the under-class who work for cash, engage in illegal activities to make a living, orwhose meager incomes are provided through social welfare. Those in theunderclass experience the deepest forms of classism as they are portrayedas immoral, unwilling to contribute to society, or not belonging in this coun-try. Their intelligence, which may keep them and their families alive, is notaffirmed as evidence of their capacity for resilience. Though the capitalistsystem requires an underclass, the individuals and families that fall into theunderclass are the ones seen as useless or even criminal. Many in these cir-cumstances have disavowed the beliefs, values, and attitudes of those whoare at least relatively successful within the capitalist system and have learnedto resist classism and class oppression.

Providing a framework for critical consciousness-raising provides morethan just a greater comprehension for clients of their circumstance and expe-riences. It allows them to become agents of their own wellness. Further,akin to the guidelines of the Cultural Context Model (Almeida, Dolan–DelVecchio, & Parker, 2007), shifting the pathology from the family to the socialstructure, when appropriate, will help families and individuals in more fullycomprehending the causes of their identified problem. For example, imaginea two-parent, three child family struggling to cope with one parent’s recentinjury and mounting medical debt. Helping the family develop resiliencein the face of tremendous obstacles is an important contribution that canbe developed with a family therapist. Locating the problem in the broaderframework of capitalism and classism that conflates self-worth with laborproduction and denies equal, affordable healthcare, however, allows the

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family and therapist to contextually situate the problem and develop moreeffective strategies.

Example: Challenging the Lasting Effects of Classism

I (Teresa) worked with a White woman who was struggling with a decisionto stay with a wealthy White partner after leaving in-patient treatment forsubstance addiction. The violent and controlling nature of the relationshipplaced her at risk for relapse. Leaving the relationship meant losing classprivilege. While my goal was to help this client figure out what was best forher and make her own decision, I found myself leaning toward expectingher to be willing to give up class privilege for sobriety. As we began dis-cussing what it would be like for her to have less, she described a childhoodfilled with poverty-based shame, being ridiculed by other children for theclothes she wore, not being able to have friends over to her broken-downhome, and so on. She internalized a sense of being (worth)less because shehad less. Unearthing internalized classism was a central part of our worktogether to come to a decision informed by critical class consciousness ratherthan dominant discourses on poverty and shame. These conversations raisedmy class consciousness as well, helping me remove layers of White middle-class feminism to reveal layers of classism and classist assumptions aboutsituational poverty. Working together challenged both of us relative to thelasting effects of classism.

Another Example: Consumerism Consuming Families

I (Teresa) worked with a young, upper-middle class, straight White fam-ily [read socially advantaged] in a city suburb. The husband and wife werein constant conflict over expenditures on the new home they bought butcould barely afford. Arguments included the wife insisting on landscapingand new floors, the husband being angry about spending a thousand dollarson a garden party, the couple not having adequate time together due in partto the husband’s long commute into the city to work long hours, and theirmutual expectations that their three children would be involved in com-munity sports, music lessons, summer camps, and so on. Homework andgrades were major areas of tension between parents and children. I foundmyself struggling to take these problems seriously and at some level resent-ing their class advantage. As therapy progressed, it became clear that thesocial network they developed in their suburban location included unspo-ken competition between families. There were many salient indicators ofclass competition, including which area of the housing development one’shouse was in, the appearance of one’s yard, and the furniture inside one’shouse. It appeared families were dedicated to their children’s well-being

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and raising their children to compete and succeed was seen as unavoidable.It was as if without a head start, their children would be behind in life.While this family was economically successful and could be seen as oppres-sors of the poor via their class status, together we came to understand thatthey were also victims of classism. In therapy we worked on internalizedclassism and understanding the impact on their family of living, even suc-ceeding, in a capitalist system. As they became more conscious of thesebroader social and economic systems on their relationships, the couple wasable to think through decisions together in ways that challenged internaland external classism.

CONCLUSION

The omnipresence of material oppression in our capitalist society is soobvious that it is practically invisible. Community gentrification, class strati-fication, unequal access to resources and opportunities, and a symbolic andlinguistic ‘master’s house’ (Lourde, 2003), necessitated by our own economicsystem, has left the majority of those in the United States unaware of thedaily costs we all pay in a capitalist society that depends on consumerismfor economic, political, and social stability.

Many traditional systemic theoretical frameworks do not value, encour-age, or make space for interventions that serve to liberate. Systemic andsocial constructionist frameworks often fall short of promoting equity.Progress families make can be inadvertently measured by their ability tocope, conform, and adapt within an oppressive hegemony, instead of awholly respectful society. Family therapists can play an important role inbettering society. Our work with families challenges us to continually ana-lyze the complex relational, social, psychological, economic, biological, andpolitical forces that intersect within and beyond individuals and families.We bear daily witness to the material and relational effects of capitalism onfamily life and are offered a plethora of examples of how interconnectionsof identities within and across families contribute to, and mitigate the impactof, materialism and social class.

Raising these issues is not synonymous with solving them. Some thingswe are certain of: family therapists must develop class consciousness, andwrestle with classism inherent in self-of-the-therapist work in capitalist, class-based societies. Other things we are less certain of, including how we bestmove from analysis/consciousness-raising relative to class and classism inthe therapy room to broad social change. We hope this article furthers adiscussion of class and classism and encourages critical theories, includingneo-Marxist frameworks, to be considered and integrated into our collectivework with individuals, couples, families, communities, and our society.

Families of the World, Unite!

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