Article Review on Managing Boundaries and Multiple relationships/ Professional Competence and training in counseling

Cultural Competence and Poverty: Exploring Play Therapists’ Attitudes

Lauren Chase and Kristie Opiola Department of Counseling, University of North Carolina at Charlotte

This article reports the findings of a survey that investigated attitudes toward poverty among play therapists (N � 390) and its relation to demographic information. Multi- variate analyses of variance (MANOVA) were used to measure the relationship between play therapists’ demographics and their attitudes toward poverty, specifically their structural, personal deficiency, and stigma scores. Results indicated that both region and age resulted in differing views on poverty. Participants living in the Northeast held stronger structural views of poverty than participants in the South. Similarly, participants in the 50–59 and 60 plus age groups disagreed to strongly disagree with a personal explanation toward poverty than participants in the 30–39 age group. The importance of play therapists’ examining their attitudes toward poverty and the direct impact on their work is discussed. Finally, implications of the results, including overall findings, are explained.

Keywords: play therapy, attitudes of poverty, cultural competence

Culturally competent training is an element of credentialing requirements that ensures men- tal health providers offer adequate and respon- sive care to diverse populations. Although the mental health field has embedded cultural com- petence in their standards and guidelines, there are discrepancies in the way the profession as- sesses and measures competence (Sue et al., 1996). Researchers have investigated attitudes toward poverty in the helping professions (Levin & Schwartz-Tayri, 2017; Noone et al., 2012; van Heerde & Hudson, 2010; & Wit- tenauer et al., 2015), but no study has focused on play therapists’ attitudes toward poverty. The purpose of this study is to fill a gap in the literature regarding play therapist’s attitudes to- ward poverty because awareness and knowl- edge are key elements to implement culturally responsive services and skills with diverse chil- dren in a variety of settings.

Cultural Competence

Cultural competence is an important compo- nent of professional practice, and practitioners are expected to develop skills and understand- ing pertaining to diverse clientele. Researchers define cultural competence as the set of beliefs, knowledge, and skills mental health providers possess in order to deliver effective interven- tions and services to members of various cul- tures (Gilbert et al., 2007; Sue, 2006). The New Freedom Commission on Mental Health (2003) recognized disparities in mental health delivery and viewed the lack of cultural competence for minority populations as a persistent problem. Culturally competent health care is essential to providing effective care to all populations. To aid practitioners in their ability to increase their cultural competence, leading professional men- tal health associations have published profes- sional cultural competency standards and ethi- cal codes (American Counseling Association [ACA], 2014; American Psychological Associ- ation [APA], 2017a, 2017b; National Associa- tion of Social Workers [NASW], 2015; Ratts et al., 2015) to promote and guide clinical prac- tice.

Lauren Chase X https://orcid.org/0000-0001-9811-0520 Correspondence concerning this article should be ad-

dressed to Lauren Chase, Department of Counseling, Uni- versity of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, United States. Email: [email protected]

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International Journal of Play Therapy © 2021 Association for Play Therapy 2021, Vol. 30, No. 1, 50–60 ISSN: 1555-6824 https://doi.org/10.1037/pla0000144

50

Cultural competence is fundamental to effec- tively building relationships with clients and helping them achieve their mental health goals (Capell et al., 2007). Sue et al. (1996) identified three key components of cultural competence: cultural awareness, cultural knowledge, and cultural skill. Cultural awareness is founda- tional and necessary for individuals to develop culturally competent attitudes, knowledge, and skills (Gilbert et al., 2007). Furthermore, cultur- ally aware clinicians are individuals who are sensitive to their personal values and biases and acknowledge how their values and biases may influence their view of the client, client’s prob- lem, and counseling relationship (Sue, 2006; Sue & Sue, 2016). Sue and Sue (2016) further urged culturally competent mental health to know beliefs, attitudes, principles, and world- views common to the particular culture of peo- ple they serve. Additionally, culturally skilled clinicians benefit from reading relevant diverse cultural research, pursue educational opportuni- ties on diverse cultural skills, and involve them- selves with diverse cultures outside of counsel- ing relationships (Sue et al., 1992; Sue & Sue, 2016).

Sue and Sue (2016) advocated mental health providers to assess their own cultural beliefs, cultural values, and behaviors to increase their self-awareness and cultural understanding to decrease barriers in client-provider relation- ships and increase comfort in working with diverse clients. Mental health professionals gain personal awareness when they are curious, re- flective, vulnerable, and observant (Gilbert et al., 2007). A lack of cultural awareness and competence can have negative consequences for the profession, as well as the clients. Siegel et al. (2005) cautioned professionals that a lack of cultural competence on their part may lead to incorrect assessments and diagnoses and can cause minority and marginalized populations, such as clients with low socioeconomic status and living in poverty, to underutilize services and prematurely terminate care.

Poverty

Cultural competence includes working with clients of diverse backgrounds, such as clients in poverty. The culture of poverty can be a controversial topic because some practitioners believe people in poverty play a role in perpet-

uating causes of poverty and sustain the cycle across generations (Cummins, 2018; Garrett, 2018). The culture of poverty is important in understanding the concept of poverty because human action is constrained and enabled by how people define their actions. As the root of poverty culture is a multifaceted concept and is challenging to define, poverty culture dynamics help researchers examine the cycle of poverty and social inequality. Researchers and public agencies often highlight personal and environ- mental factors that contribute to the definition of poverty, with a lack of income and resources being the most defining factors (Ciment, 2013; U.S. Census Bureau, 2018; World Bank Insti- tute, 2005). People living in poverty often lack material essentials, such as shelter, water, cloth- ing, and food, which can impact one’s overall well-being (Haughton & Khandker, 2009; Wolff, 2019). The lack of essential material and inability to establish daily living patterns and activities lead individuals in poverty to feel confined by their financial situation (Gordon & Townsend, 2000). When society values finan- cial wealth, people who meet the standard of poverty may feel lesser than those with financial stability; therefore, a lack of autonomy, educa- tion, and self-worth are obstacles keeping many in poverty.

Poverty rates can be surprisingly high in de- veloped countries. The United States (US) is one of the wealthiest nations in the world but has one of the highest rates of poverty, with one in eight Americans living in poverty (Poverty Programs, 2017). While poverty affects people of all ages and demographics, minority individ- uals disproportionately exceed the national av- erage (Koball & Jiang, 2018). Those at greatest risk of living in poverty are families headed by single mothers with children (U.S. Census Bu- reau, 2018).

Growing up in poverty is a contributing fac- tor to illness, disability, and adverse mental health outcomes, which can have devastating effects on children that can extend into adult- hood (Moore et al., 2009). It appears the longer a child lives in poverty, the more devastating the impact (Wickham et al., 2014). Cooper and Stewart (2013) completed a systemic review of the literature on household income and health outcomes and found family income makes a significant impact on all areas of children’s de- velopment and their level of academic achieve-

51CULTURAL COMPETENCE AND POVERTY

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ment. They posited children living in poverty have lower cognitive ability, lower social en- gagement, greater behavioral problems, and poorer health outcomes. Furthermore, poverty impacts children’s participation in common childhood activities, such as access to extracur- ricular activities and peer social activities (Turner, 2011). In addition, family poverty im- pacts living and community environments, so- cial supports, and parental mental health, which can impact the level of stress children experi- ence (Farthing, 2014; National Scientific Coun- cil on the Developing Child, 2015; Turner & Rawlings, 2005). High levels of stress can have detrimental impacts on children’s holistic de- velopment (National Scientific Council on the Developing Child, 2015) and increases the risk of children developing mental health and be- havioral problems (Van Allen & Sterling, 2011).

Poverty Attitudes

Attitude is an important predictor of how a mental health professional behaves toward cli- ents and effectively treat clients (Sturm, 2008). Researchers have concluded that attitudes are related to behavior, especially when the atti- tudes are held with a high degree of assurity, are constant, available, and formed by direct expe- riences (Appelbaum et al., 2006; Kraus, 1995; Morrow & Deidan, 1992; Shapiro, 2004). There are competing explanations for the rationality for one’s attitudes toward poverty (Brady, 2019; Hunt & Bullock, 2016; Jordan, 2004) with two overarching themes: structural cause of poverty or personal causes of poverty (Beeghley, 1988; Feagin, 1975; Howard et al., 2017).

Structural causes of poverty include the be- lief that poverty is caused by low government investment in education, health, and employ- ment opportunities (Beeghley, 1988; Davids & Gouws, 2013; Feagin, 1975; Goldsmith & Blakely, 2010; Royce, 2018; Weiss-Gal et al., 2009). Structural causes focus on how society limits one’s opportunities through low wages, lack of education, and lack of affordable health care (Wittenauer et al., 2015). Society is blamed as a cause in the structural view (Noone et al., 2012), and a person is not responsible or in control of the cause of poverty. In contrast, personal causes of poverty are viewed as exhib- iting low motivation, possessing passive or lazy

characteristics, or growing up in a “poverty culture” (Levin & Schwartz-Tayri, 2017; Mead, 2011; Royce, 2018). Personal causes focus on the person’s inability to pull themselves out of poverty and attribute causes to negative money management or health behaviors. According to Bray and Schommer-Aikins (2015), personal causes of poverty imply that people are respon- sible and have sufficient chances to succeed if they work hard; therefore, people are viewed as being in control of their own destiny.

Mental health providers’ attitudes toward poverty have not been thoroughly examined in the research. Previous research has focused on a single region of the country or a specific popu- lation. Three specific studies explored helping professionals’ view of poverty: human service practitioners (Anderson, 2018), school counsel- ors (Ricks, 2014), and social workers (Weiss- Gal et al., 2009). Weiss-Gal et al. (2009) studied the views of social workers and service users in the midwestern United States, and they con- cluded participants held comparable levels of understanding for motivational and psycholog- ical causes. Furthermore, they found service users credited more significance to social/ structural causes and fatalistic causes compared to the social workers in the study. Additionally, Ricks (2014) examined school counselors’ atti- tudes toward poverty and found school counsel- ors living in the southeastern United States held individualistic attitudes toward poverty and at- tributed poverty to fatalistic causes. Further- more, Anderson (2018) interviewed human ser- vice practitioners from the southern United States on their view of poverty, and he found human service practitioners held both structural and individualistic views of poverty. Overall, the exploration of poverty attitudes in mental health providers is sparse and more studies are needed to improve cultural competence.

Play Therapy

Play therapists represent diverse professional licensures, including counseling, social work, psychology, and marriage and family therapy (Siu, 2010). The Association for Play Therapy (APT) addresses the importance of diversity in their mission statement, credentialing guide- lines and documents but lacks specific cultural competency guidelines. Currently APT (2019) refers to multicultural competence as the pro-

52 CHASE AND OPIOLA

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cess of play therapists becoming aware of one’s own culture and biases. For play therapists, instruction occurs in a variety of settings, such as university classrooms, professional confer- ences, and regional trainings. The variety of educational backgrounds, clinical training, and supervised experience acquired by Registered Play Therapist/Supervisors (RPT/S) and School Based-Registered Play Therapists (SB-RPT) generates unique perspectives to play therapy and creates service delivery options to clients from diverse backgrounds, such as poverty.

Play therapists striving to increase multicultural competence can work with children in poverty more effectively by becoming aware of their own biases toward poverty and learning culturally re- sponsive skills to respond to needs of children in poverty. By exploring biases and beliefs about clients from low socioeconomic status and pov- erty, play therapists can obtain knowledge to de- velop active cultural competence (Gil, 2005). Play therapists obtain knowledge when they gain infor- mation about their attitudes toward poverty to provide more responsive services. Therefore, to provide high quality services, play therapists need to explore their beliefs to best attend to the needs of children and their families who are experienc- ing poverty. In addition, the field of play therapy can benefit from exploring play therapists’ atti- tudes on poverty as a means of identifying areas where further instruction and exposure are needed.

Specifically, the researchers were interested in exploring participant’s overall attitudes toward poverty and the relationship between participant’s demographic information and their scores on the Attitudes Toward Poverty-Short Form (ATP-SF). The demographic characteristics were age, gen- der, race, region, highest educational degree, pro- fessional discipline, and years of experience. The research questions were (a) What are play thera- pists’ attitudes toward poverty? (b) Are there dif- ferences in ATP subscales (personal deficiency, stigma, structural perspective, and total) based on play therapist demographic characteristics?

Method

Procedure

Participants were recruited from the APT mail- ing list, Counselor Education and Supervision Network (CESNET) listserv, and invited mem- bers of four play therapy-related Facebook groups.

Participants in the APT mailing list were recruited via email invitation to the online SurveyShare questionnaire. Participants in the play therapy- related Facebook groups and CESNET Listserv were invited to participate from the first author posting in respective groups and Listserv. Upon entry to the survey, respondents first read the informed consent form approved by the universi- ty’s institutional review board. Participants either accepted or rejected participation in the study. If respondents accepted, they were directed to the survey items. Participants completed the ATP-SF and a demographic survey, and they could access the survey only by using the unique email invita- tion sent to them. Participants utilized email ad- dresses to sign into SurveyShare, which allowed the researchers to control for one code per person.

Participants

Initially, over 5,000 invitations to participate were sent over one month, and 391 survey pack- ets were received. After removing one incom- plete survey, the final sample size for data anal- ysis was 390. The sample size for the present study was deemed sufficient, based on exceed- ing Cohen’s (1988) and Tabachnick and Fi- dell’s (2013) recommendations for the minimal sample sizes needed to achieve adequate power (.80) at a significance level of p � .05 (i.e., 120 and 113, respectively). Specific to cultural de- mographics, participants’ ages ranged from 23 to 78 years (M � 46.13, SD � 11.94). In addition, 367 participants identified as female (94.1%), 18 as male (4.6%), and five identified as other (1.3%). Ethnoculturally, 321 partici- pants identified as White (82.3%), 18 as African American (4.6%), 25 as Hispanic/Latinx (6.4%), and 26 as other cultures (6.7%).

Participants identified as play therapists or play therapy trainees from multiple disciplines: mental health (n � 181, 46.4%), social workers (n � 95, 24.4%), marriage and family therapists (n � 46, 11.8%), and other (e.g., psychologist, international professionals; n � 68, 17.5%). In terms of regions of the country, the profession- als lived in the following regions: Northeast (n � 42, 10.8%), Midwest (n � 85, 21.8%), South (n � 154, 39.5%), West (n � 88, 22.6%), or internationally (n � 21, 5.4%). Play thera- pists’ experience levels included: 0–2 years (n � 48, 12.3%), 3–5 years (n � 79, 20.3%),

53CULTURAL COMPETENCE AND POVERTY

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6–9 years (n � 80, 20.5%), 10–13 years (n � 51, 13.1%), and 14 plus years (n � 132, 33.8%).

Instrument

The Attitudes Toward Poverty Scale-Short Form (ATP-SF; Yun & Weaver, 2010) is a self-report instrument based on the Attitudes Toward Poverty Scale (ATP; Atherton et al., 1993). The ATP-SF is a multidimensional scale measuring attitudes toward poverty, leaning to- ward a structural cause or individual deficit cause. Each item is based on a 5-point Likert scale (1 � strongly disagree to 5 � strongly agree). An example of a structural cause-item on the ATP-SF is, “People are poor due to circumstances beyond their control.” An indi- vidual deficit-item is, “Poor people are dishon- est,” and a stigma-item is “Welfare makes peo- ple lazy.” High scores indicate a belief that structural determinants are the primary causes of poverty while low scores indicate a personal explanation of poverty (Atherton et al., 1993). The Total score can range from 21 to 105.

The ATP-SF includes three subfactors: Struc- tural Perspective, Personal Deficiency, and Stigma. Structural causes of poverty include the belief that poverty is caused by low government investment in education, health, and employ- ment opportunities (Beeghley, 1988; Feagin, 1975; Weiss-Gal et al., 2009). The Structural Perspective subscale ranges from 6 to 30. Per- sonal causes focus on the person’s inability to pull themselves out of poverty by managing money poorly or poor health behaviors. The Personal Deficiency subscale ranges from 7 to 35. Stereotyping people in poverty adds to the stigma of poverty. The subscale of Stigma is important because members of marginalized groups, such as those in poverty, are at a higher likelihood of being stigmatized (Major & O’Brien, 2005). Members of groups with less power often evoke negative responses from those with more power for those in power to keep their position (Jost & Banaji, 1994). The Stigma subscale ranges from 8 to 40. The ATP-SF has a high level of internal consistency with � � .87. All of the subscales of the ATP-SF exceeded the minimum acceptable level for internal consistency with all scales being between .50 and .70.

Data Analysis

To examine the impact of play therapists’ demographics on their attitudes toward poverty, a series of multivariate analyses of variances (MANOVAs) were conducted. The independent variables were (a) race, (b) age, (c) marital status, (d) gender, (e) region, (f) setting, (g) occupation, (h) years practicing play therapy, and (i) RPT status, and the dependent variables were (a) Personal Deficiency, (b) Stigma, (c) Structural Perspective, and (d) Total Score. Be- fore conducting the MANOVAs, the data were screened for missing data, outliers, noncol- linearity, equality of variance/covariance matri- ces, and normality. Additionally, to examine play therapist’s overall attitudes toward pov- erty, researchers used average scores on the ATP-SF Total, and Structural Perspective, Per- sonal Deficiency, and Stigma subscales.

Results

The researchers strived to explore diverse demographics. Due to the lack of diversity in the sample, specifically regarding gender, race, marital status, setting, occupation, RPT status, and socioeconomic status, the researchers were unable to explore potential differences. A large majority of participants were white masters’ level, middle-class women. The average of the Total score was 86.40 (SD � 10.63). The aver- age Structural Perspective scale was 23.52 (SD � 3.94). The average of the Personal De- ficiency scale was 30.32 (SD � 3.55). The average of the Stigma scale found was 32.44 (SD � 5.53). Table 1 presents the mean scores and standard deviations for the demographic information for the ATP-SF Deficiency, Stigma, Structural Perspective, and Total scores.

Differences by Region and Age

A MANOVA was conducted to explore the impact of geographic regions on attitudes to- ward poverty. Participants were divided into five regions (Northwest, Midwest, South, West, and International). Using Pillai’s criterion, the combined dependent variables were statistically affected by the region, F(12, 1155) � 2.71, p � .001. There was a statistically significant differ- ence at the p � .05 level in Structural score

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based on region (F(4, 385) � 2.184, p � .026), but not in discipline and years of experience. Post hoc comparison using Scheffé test indi- cated that the South was significantly lower (M � 23.21, SD � 3.87) than the Northeast (M � 25.33, SD � 3.43) in regard to Structural Perspective score (p � .046). Researchers did not have statistically significant findings among participants’ scores in the Midwest, West, and International.

A MANOVA was conducted to explore the impact of age on Total score and subscales of Stigma, Structural Perspective, and Deficiency. Using the Pillai’s criterion, the combined de- pendent variables were statistically affected by age (F(12, 1143) � 2.419, p � .004). There was a statistically significant difference at the Defi- ciency score based on age [F(4, 60.24) � 4.995, p � .001]. Post hoc comparison using the Scheffé test indicated that the 30–39 group (M � 29.42, SD � 3.60) was statistically sig- nificant from the 60 � group (M � 31.48, SD � 3.19) in regard to Deficiency (p � .011). The 30–39 group is statistically significant from the 50–59 group (M � 31.02, SD � 31.9) in regard to Deficiency (p � .045). Participants in the

30–39 group scored significantly lower on the Deficiency subscale than the 50–59 and 60 � groups. Researchers did not have statistically significant findings among participants who were 20–29 and 40–49. Table 2 presents par- ticipants’ differences in their attitudes toward poverty by region and age.

Discussion

This study aims to help play therapists explore their attitudes toward poverty and the conscious and unconscious patterns of beliefs, or stereo- types, toward clients who are poor. The findings from this study begin the exploration of play ther- apists’ attitudes toward poverty and open the door for discussion about the impact attitudes have on mental health care delivery. Aiming at an explo- ration of these attitudes in our scholarship, we found, on average, play therapists disagreed or strongly disagreed with individualistic explana- tions for poverty, as demonstrated by their mean ATP-SF Total score (M � 86.40, SD � 10.63), but more telling are the average subscale scores.

The subscale scores range from 23.64 to 32.44. The average of the Stigma scale was the highest,

Table 1 Attitude Toward Poverty Total and Subscale Scores for Demographic Information

Average deficiency score (SD)

Average stigma score (SD)

Average structural score (SD)

Total score (SD)

Age 20–29 29.05 (3.30) 30.73 (6.47) 24.37 (3.43) 84.18 (11.51) 30–39 29.42 (3.60) 32.28 (5.59) 23.37 (4.16) 85.20 (10.84) 40–49 30.31 (3.70) 32.49 (5.49) 23.33 (3.74) 86.21 (10.43) 50–59 31.02 (3.19) 32.88 (5.39) 23.74 (4.03) 87.78 (10.54) 60 � 31.48 (3.19) 32.83 (5.21) 23.57 (4.04) 88.03 (10.00)

Region Northeast 30.67 (3.97) 32.95 (5.78) 25.33 (3.43) 88.98 (11.30) Midwest 30.25 (3.10) 33.71 (4.17) 23.65 (3.28) 87.71 (8.30) South 30.38 (3.58) 31.62 (5.84) 23.21 (8.87) 85.28 (11.14) West 30.18 (3.65) 32.72 (5.75) 23.10 (4.74) 86.23 (11.21) International 30.10 (4.10) 31.14 (5.87) 23.52 (3.44) 84.90 (10.86)

Table 2 MANOVA Differences in Attitudes Toward Poverty-SF of Demographic Variables

Pillai’s trace F Hypothesis df Error df Sig. Partial eta squared

Region 0.082 2.72 12 1155 0.001� 0.027 Age 0.074 2.42 12 1143 0.004� 0.025

� significant � .005.

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32.44 (SD � 5.53), and indicates play therapists tend not to believe in stereotypes or myths about individuals in poverty. Examples of stigma state- ments were “poor people think they deserve to be supported” and “Welfare mothers have babies to get more money” (Yun & Weaver, 2010). The average score for the Personal Deficiency scale was 30.32 (SD � 3.55) and indicates participants did not agree or strongly disagreed with state- ments blaming individuals for being poor. Partic- ipants did not feel a person’s individual deficit is the primary cause of poverty and did not hold individuals personally responsible for their pov- erty. Personal deficiency statements include “poor people are dishonest” and “poor people act differ- ently.” The average score for Structural Perspec- tive scale was the lowest, 23.64 (SD � 3.71), and indicates play therapy participants more often dis- agreed with statements that individuals are re- sponsible for their financial problems and believe policies or resources are needed to help those who are poor. Examples of structural attitudes include “poor people are discriminated against” and “peo- ple are poor due to circumstances beyond their control.” In comparison to other helping profes- sionals, play therapists appear to have a more favorable attitudes toward poverty than nurses (e.g., Wittenauer et al., 2015) or school counselors (e.g., Ricks, 2014) on the Total, Stigma, Personal Deficiency, and Structural Perspective scales.

As a profession, participants’ scores in relation to region and age indicated that there were varying views on the cause of poverty. When exploring regions in the United States, there were differ- ences in how strongly participants believed struc- tural causes influenced their attitudes and expla- nations toward poverty. Participants living in the Northeast leaned more strongly toward a struc- tural determinant of poverty than participants in the South. This finding may be due to variances in poverty rates between the South and Northeast. The South has the highest poverty rates in the United States, 13.6%, while the Northeast ranks the lowest, 10.3%. Nine of the 10 states with the highest poverty rates in 2017 were Mississippi, Louisiana, West Virginia, Kentucky, Alabama, Arkansas, Oklahoma, South Carolina, and Ten- nessee (Moore, 2018). Additionally, poverty rates in the South have been continuously high for decades (Jung et al., 2015), and the metro- nonmetro poverty rate gap in the South has his- torically been the largest (Farrigan, 2020). From 2014–2018, the South’s nonmetro poverty rate

was 20.5%, nearly 6% higher than in the region’s metro areas. In contrast, the Northeast has some of the lowest poverty rates, under 10.5%, in New Hampshire, Massachusetts, Connecticut, Rhode Island, and New Jersey (U.S. Census, 2018). Ad- ditionally, regional poverty rates for nonmetro and metro areas in the Northeast were more alike from 2014 to 2018 (Farrigan, 2020). Results might in- dicate that play therapists’ poverty attitudes are potentially impacted by poverty rates in their re- gion of the country. Play therapists may benefit from understanding the impact of socioeconomic and regional differences to work best with eco- nomically disadvantaged clients.

Age was the second factor that resulted in vary- ing views on poverty. Specifically, participants who in the 50–59 and 60 plus age groups more strongly disagreed with a personal explanation toward poverty than participants in the 30–39 age group. Life experience and exposure to varying environmental influences may play an important factor in poverty attitudes between the 30–39 years old and 50–59 and 60 plus groups. Partici- pants who are 50–59 and 60 plus were born in the “Baby Boomers” generation. This period was a time of prosperity and optimism potentially lead- ing participants to hold a more positive view of people experiencing poverty (Watts, 2010). Peo- ple in the Baby Boomer generation may believe that individuals who are poor are not the cause of their poverty and need assistance to work their way out of poverty. Baby Boomers’ experiences are different than participants in their 30s, “Mil- lennials.” Millennials experienced the largest eco- nomic decline since the great depression, the end of the Cold War, and deindustrialization which encouraged people to become reliant on higher education (Brooks, 2008). Millennials reliance on higher education and the belief that education will offer them greater prosperity has caused many to accrue debt with reduced job opportunities and Millennials living at or below the poverty line. Their strong belief in education as a path out of poverty may explain their slightly lower personal explanation of poverty. Generational patterns and exposures may help explain the differences in play therapists’ attitudes toward poverty. As we gain a better understanding of play therapist’s attitudes toward poverty, this may allow us to better pin- point opportunities to empower and partner with individuals and communities to seek solutions that will improve the health of those living in poverty.

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Looking at poverty attitudes is important be- cause the way play therapists and mental health professionals view poverty potentially affects the way they work with people in poverty (Anderson, 2018; Clark et al., 2017; Krumer-Nevo & Lev- Wiesel, 2005). Play therapists who view poverty from a systemic perspective may treat clients with more respect and compassion. For instance, a play therapist who holds a structural view of poverty may provide traveling services to a homeless shel- ter to support the potentially transient nature of some families in poverty. In addition, play thera- pists with a positive understanding of poverty may create structures and policies that support the basic and expanded needs of clients in poverty, such as offering snacks during playtime or providing mul- tidisciplinary resources in the community. Addi- tionally, play therapists who hold a systemic view of poverty may feel comfortable advocating for their clients through social justice advocacy. Play therapists can systemically advocate for their cli- ents by offering availability of resources, increas- ing involvement in governmental policies and laws, and promoting positive relationships among clients and resources (Crethar et al., 2008; Crethar & Winterowd, 2012). Furthermore, play therapists can be active through social justice advocacy by going to client’s environments, such as their schools and neighborhoods (Ceballos & Bratton, 2010; Sheely-Moore & Bratton, 2010), increasing their self-awareness of their work with oppressed children (Baggerly, 2006), and being aware of oppression when looking at their client’s emotions (O’Connor, 2005). The reasons discussed above are just a few examples of how varied views of poverty may impact the depth and extent play therapists’ support clients in poverty. Play thera- pists may benefit from professional development that explores and challenges their attitudes toward poverty on an ongoing basis.

Limitations and Future Directions

The limitations found in this study help inform and shape the implications for future studies. A limitation of the study was the use of a single measure to evaluate the play therapists’ attitudes toward poverty. Attitudes and poverty are com- plex concepts that might benefit from being looked at through multiple lenses. A future study including multiple measures of attitudes toward poverty and people who are poor would be bene- ficial and give more breadth and depth to under-

standing play therapist’s attitudes toward poverty. Additionally, qualitative data would allow respon- dents to elaborate on their ideas and experiences.

The authors recruited from two consortiums (APT and CESNET) and several play therapy- related Facebook groups, which may have limited the participation pool. We sought APT members, as APT is the flagship professional organization in the US for play therapists. Unfortunately, not all play therapists are members of APT. Although we expanded the search to sites that may reach other potential participants (CESNET and Facebook), recruitment through other mental health organiza- tions, such as ACA, NASW, and APA, may bridge gaps of play therapists who are not mem- bers of APT. A narrow pool of applicants may limit participation and bias the results. Future re- searchers could recruit through multiple profes- sional organizations to increase the diversity of potential participants.

A few participants in this study had a strong reaction to the ATP-SF. Participants voluntarily emailed the researchers their thoughts and ex- periences taking the survey. Some participants had a negative reaction to the ATP-SF, such as a dislike for the wording of the measure, and they reported that the ATP-SF made false as- sumptions and generalizations. The purpose of this research was to evaluate the quantitative responses to the survey, and participants’ strong reactions indicate a qualitative study may be needed as well.

Conclusion

The current study is the first study exploring play therapists’ attitudes toward poverty. Overall, the authors found that region and age play a factor in how play therapists view poverty. The findings affirm the importance of continued professional development around cultural competence when working with diverse populations. Play therapist’s awareness and knowledge impacts the way they work with diverse clients, particularly clients in poverty. Based on findings from this study, we believe it is important for play therapists to exam- ine their own views and explore factors that im- pact their views of others to ensure they are pro- viding culturally informed practices and ultimately respond with more sensitivity for those struggling in poverty.

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Received February 4, 2020 Revision received June 26, 2020

Accepted October 5, 2020 �

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