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

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Article Review Instructions

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You will write three article reviews and if you choose, one extra credit article review. You will select the article yourself by searching the UWA Library Databases. The article you choose should be a research article (has a hypothesis that is empirically tested). Pick an article relevant to a topic covered in the weekly readings. Each review is worth 20 points. The review should be 1-2 single-spaced pages in a 12-point font. It is in your best interest to submit your review before it is due so you may check your originality report and correct any spelling and grammatical errors identified by the software program.

The purpose of the review is to provide students knowledge of how research is conducted and reported. The main part of your review needs to include the following information. Please comment on these aspects of the article as part of your review. Provide only the briefest summary of content. What I am most interested in is your critique and connection to weekly readings.

Reference. Listed at the top of the paper in APA style.

Introduction. Read the introduction carefully. The introduction should contain:

· A thorough literature review that establishes the nature of the problem to be addressed in the present study (the literature review is specific to the problem)

· The literature review is current (generally, articles within the past 5 years)

· A logical sequence from what we know (the literature review) to what we don’t know (the unanswered questions raised by the review and what this study intended to answer

· The purpose of the present study

· The specific hypotheses/research questions to be addressed.

State the overall purpose of the paper. What was the main theme of the paper?
What new ideas or information were communicated in the paper?
Why was it important to publish these ideas?

Methods. The methods section has three subsections. The methods sections should contain:

· The participants and the population they are intended to represent (are they described as well in terms of relevant demographic characteristics such as age, gender, ethnicity, education level, income level, etc?).

· The number of participants and how the participants were selected for the study

· A description of the tools/measures used and research design employed.

· A detailed description of the procedures of the study including participant instructions and whether incentives were given.

Results. The results section should contain a very thorough summary of results of all analyses. This section should include:

· Specific demographic characteristics of the sample

· A thorough narrative description of the results of all statistical tests that addressed specific hypotheses

· If there are tables and figures, are they also described in the text?

· If there are tables and figures, can they be interpreted “stand alone” (this means that they contain sufficient information in the title and footnotes so that a reader can understand what is being presented without having to go back to the text)?

Discussion. The discussion is where the author “wraps up the research”. This section should include:

· A simple and easy to understand summary of what was found

· Where the hypotheses supported or refuted?

· A discussion of how the author’s findings compares to those found in prior research

· The limitations of the study

· The implications of the findings to basic and applied researchers and to practitioners

Critique.

In your opinion, what were the strengths and weaknesses of the paper or document? Be sure to think about your impressions and the reasons for them. Listing what the author wrote as limitations is not the same thing as forming your own opinions and justifying them to the reader.

· Were the findings important to a reader?

· Were the conclusions valid? Do you agree with the conclusions?

· If the material was technical, was the technical material innovative?

Conclusion.

Once you provide the main critique of the article, you should include a final paragraph that gives me your overall impression of the study. Was the study worthwhile? Was it well-written and clear to those who may not have as much background in the content area? What was the overall contribution of this study to our child development knowledge base?

APA Format Review

If you are unfamiliar or a bit “rusty” on your APA format, you may want to use the tutorial available through the APA website which is listed on your syllabus.

Grading Criteria

I will grade your paper based upon:

· How well you followed directions (as indicated in this page)

· How thoroughly you used examples to support the critique

· How accurately you used APA format

· your organization, grammar, and spelling

· Integration of assigned weekly readings

Article Review Instructions

You will write three article reviews and if you choose, one extra credit article review. You will select the article yourself by searching the UWA Library Databases. The article you choose should be a research article (has a hypothesis that is empirically tested). Pick an article relevant to a topic covered in the weekly readings. Each review is worth 20 points. The review should be 1-2 single-spaced pages in a 12-point font. It is in your best interest to submit your review before it is due so you may check your originality report and correct any spelling and grammatical errors identified by the software program.
The purpose of the review is to provide students knowledge of how research is conducted and reported. The main part of your review needs to include the following information. Please comment on these aspects of the article as part of your review. Provide only the briefest summary of content. What I am most interested in is your critique and connection to weekly readings.
Reference. Listed at the top of the paper in APA style.
Introduction. Read the introduction carefully. The introduction should contain:
· A thorough literature review that establishes the nature of the problem to be addressed in the present study (the literature review is specific to the problem)
· The literature review is current (generally, articles within the past 5 years)
· A logical sequence from what we know (the literature review) to what we don’t know (the unanswered questions raised by the review and what this study intended to answer
· The purpose of the present study
· The specific hypotheses/research questions to be addressed.
· State the overall purpose of the paper. What was the main theme of the paper?
· What new ideas or information were communicated in the paper?
· Why was it important to publish these ideas?
Methods. The methods section has three subsections. The methods sections should contain:
· The participants and the population they are intended to represent (are they described as well in terms of relevant demographic characteristics such as age, gender, ethnicity, education level, income level, etc?).
· The number of participants and how the participants were selected for the study
· A description of the tools/measures used and research design employed.
· A detailed description of the procedures of the study including participant instructions and whether incentives were given.
Results. The results section should contain a very thorough summary of results of all analyses. This section should include:
· Specific demographic characteristics of the sample
· A thorough narrative description of the results of all statistical tests that addressed specific hypotheses
· If there are tables and figures, are they also described in the text?
· If there are tables and figures, can they be interpreted “stand alone” (this means that they contain sufficient information in the title and footnotes so that a reader can understand what is being presented without having to go back to the text)?
Discussion. The discussion is where the author “wraps up the research”. This section should include:
· A simple and easy to understand summary of what was found
· Where the hypotheses supported or refuted?
· A discussion of how the author’s findings compares to those found in prior research
· The limitations of the study
· The implications of the findings to basic and applied researchers and to practitioners

Critique.
In your opinion, what were the strengths and weaknesses of the paper or document? Be sure to think about your impressions and the reasons for them. Listing what the author wrote as limitations is not the same thing as forming your own opinions and justifying them to the reader.
· Were the findings important to a reader?
· Were the conclusions valid? Do you agree with the conclusions?
· If the material was technical, was the technical material innovative?

Conclusion.
Once you provide the main critique of the article, you should include a final paragraph that gives me your overall impression of the study. Was the study worthwhile? Was it well-written and clear to those who may not have as much background in the content area? What was the overall contribution of this study to our child development knowledge base?

APA Format Review

If you are unfamiliar or a bit “rusty” on your APA format, you may want to use the tutorial available through the APA website which is listed on your syllabus.

Grading Criteria

I will grade your paper based upon:
1. How well you followed directions (as indicated in this page)
1. How thoroughly you used examples to support the critique
1. How accurately you used APA format
1. your organization, grammar, and spelling
1. Integration of assigned weekly readings

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 povert

Participants living in the
Northeast held stronger structural views of poverty than participants in the South.
Similarly, participants in the

–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 povert

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:
lchase6@uncc.edu

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International Journal of

Play Therapy

https://orcid.org/0000-0001-9811-0520

mailto:lchase6@uncc.edu

https://doi.org/10.1037/pla0000144

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

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

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

54 CHASE AND OPIOLA

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.

55CULTURAL COMPETENCE AND POVERTY

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.

56 CHASE AND OPIOLA

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.

57CULTURAL COMPETENCE AND POVERTY

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Received February 4, 2020
Revision received June 26, 2020

Accepted October 5, 2020 �

60 CHASE AND OPIOLA

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Cultural Competence and Poverty: Exploring Play Therapists’ Attitudes

Cultural Competence
Poverty
Poverty Attitudes
Play Therapy
Method
Procedure
Participants
Instrument
Data Analysis
Results
Differences by Region and Age
Discussion
Limitations and Future Directions
Conclusion
References

Cultural Competence and Poverty:
Exploring Play Therapists’ Attitudes

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

Participants living in the
Northeast held stronger structural views of poverty than participants in the South.
Similarly, participants in the

–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

Cultural Competence

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:
lchase6@uncc.edu

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Play Therapy

https://orcid.org/0000-0001-9811-0520

mailto:lchase6@uncc.edu

https://doi.org/10.1037/pla0000144

Poverty

51CULTURAL COMPETENCE AND POVERTY

T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
P
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ch
ol
og
ic
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A
ss
oc
ia
ti
on
or
on
e
of
it
s
al
li
ed
pu
bl
is
he
rs
.
T
hi
s
ar
ti
cl
e
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.

Poverty Attitudes

Play Therapy

52 CHASE AND OPIOLA

T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
or
on
e
of
it
s
al
li
ed
pu
bl
is
he
rs
.
T
hi
s
ar
ti
cl
e
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.

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

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

T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
or
on
e
of
it
s
al
li
ed
pu
bl
is
he
rs
.
T
hi
s
ar
ti
cl
e
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.

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

Instrument

Data Analysis

Results

Differences by Region and Age

54 CHASE AND OPIOLA

T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
or
on
e
of
it
s
al
li
ed
pu
bl
is
he
rs
.
T
hi
s
ar
ti
cl
e
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.

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

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)

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.

55CULTURAL COMPETENCE AND POVERTY

T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
or
on
e
of
it
s
al
li
ed
pu
bl
is
he
rs
.
T
hi
s
ar
ti
cl
e
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.

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.

56 CHASE AND OPIOLA

T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
or
on
e
of
it
s
al
li
ed
pu
bl
is
he
rs
.
T
hi
s
ar
ti
cl
e
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.

Limitations and Future Directions

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

Conclusion

57CULTURAL COMPETENCE AND POVERTY

T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
or
on
e
of
it
s
al
li
ed
pu
bl
is
he
rs
.
T
hi
s
ar
ti
cl
e
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.

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