The Impact of Poverty: Relationship Quality, Individual Symptoms, Fee for Services, and Attrition

Abstract

Psychotherapy research has acknowledged the importance of examining dropout in therapy. However, researchers consistently neglect to look to the effect of fee-forservices on therapy attrition. Addressing this gap in the literature, the current study tests the effect that therapy fees and income-level have on attrition and dropout through the lens of Maslow’s Hierarchy of Needs. Drawing upon measures of income-status and fee paid, relationship quality, individual symptoms, adverse childhood experiences, this study examines the relationship between fee as a percentage of income and dropout in therapy for clients attending a southeastern university training clinic. Results provided support for hypotheses. Fee as a percentage of income was positively related to therapy dropout and negatively related to total sessions attended. Income was also related to higher relational distress and adverse experiences in specific contexts. Explanations of findings and future directions are provided.