Data Type: Journal Article

Status homophily, social context, and participation in psychotherapy

Kandel , Denise Bystryn. (1966). Status homophily, social context, and participation in psychotherapy. American Journal of Sociology, Vol. 71, No. 6 pp. 640-650.

This article examines the observed tendency of psychotherapists to favor patients
based on their social relationship or similarity to them—whether it is social class, community group or even ethnicity. This tendency is described as “status homophily,” which means the favoring or pampering exhibited by one individual towards another based on their shared social, ethnic and/or class status. The author seeks to uncover whether or not status homophily indeed occurs within the setting of professional psychotherapeutic practices between psychotherapists and their patients.

The author refers to studies which have monitored the lengths of psychotherapy sessions. The sessions in these studies are conducted by therapists of a high social class, while their patients are typically of the lower and middle classes. One key finding of this piece is that it demonstrates how in cases where therapists do not have the option to select patients, but rather have patients assigned to them, the duration of the therapy session is much shorter for lower-class patients than it is for middle or higher-class patients. With this evidence, the author asserts that the concept of status homophily can and should be applied to investigations of physician-patient interactions in psychotherapy. During the study, status homophily played a definite role in determining the type of patient admitted for psychotherapy by various therapists. The author claims to have observed a negative bias towards patients of the lower classes in samples based on an entire community, a single outpatient clinic, and a private voluntary hospital. The article argues that the observed and recorded rates of homophily within psychotherapy practices result from one of, or a combination of, three reasons: 1) “mutual sympathy arising between physicians and patients of similar
social statuses, or, on the contrary, antipathy between those of dissimilar statuses,” 2) “inability and/or reluctance of the physician to view lower-class patients as good or desirable therapy candidates,” 3) “low psychological-mindedness and verbal skills or interests of the lower-class patient, making him unable to accept or participate in psychotherapy” (648). This is meaningful because it demonstrates the feasibility of the value or credibility of psychotherapy sessions becoming ‘corrupted’ or impaired when a psychotherapist demonstrates status homophily towards a patient in an either favorable or unfavorable manner. The article highlights the high risk of damage that can be caused to a patient if their psychotherapist does not treat them, in both therapy and as a human being, fairly.

The article is relevant to all studies examining the actual practice of psychotherapy and/or the relationships established between therapists and their patients. The finding of the piece—that status homophily plays a major role in the majority of psychotherapeutic practices—is crucial to the understanding and study of psychotherapy and the (social) relationships between patients and therapists. For example, the concept of status homophily could be relevant to observe in studies dealing especially with an inquiry into psychotherapy with a specified social class or minority group at its focus, e.g. queer-identified individuals in psychotherapy and/or the relationship between straight therapists and their LGBTQ clients.

Categories: Medical Sociology, Social Construction
Publication Date: 1966