NDSU Department of Child Development and Family Science
North Dakota Department of Human Services
December 1999
Margaret Fitzgerald, Ph.D.
Assistant Professor
Dept. of Child Development and Family Science
North Dakota State University, 283G EML, Fargo, ND 58105
Phone 701-231-8280; Fax 701-231-7174; email - mfitzger@badlands.nodak.edu
Jean Soderquist, Ph.D.
Assistant Professor, Director
Marriage and Family Therapy Program
Dept. of Child Development and Family Science
North Dakota State University
Sharon Larkin
Credit Counseling Centers, Inc.
Farmington Hills, MI
Clients coming in for their initial intake session with a financial counselor at one of three sites in North Dakota completed a survey about emotional issues related to their financial situation. Results indicate that 40% to 50% of the respondents report experiencing symptoms related to anxiety or depression. Implications for the financial counselors who work with these clients are discussed, with emphasis placed on the importance of making referrals to family therapists.
Money is often a factor by which personal and relationship success or failure is evaluated. Financial management and mismanagement are consistently found to be major sources of disagreement in families. The relationship between money and stress is documented (Blumstein & Schwartz, 1983, Voydanoff, 1990), and there is evidence that money is a source of anxiety and discomfort across the life span (Olson, McCubbin, Barnes, Larsen, Muxen & Wilson, 1989). North Dakota families are currently facing anxiety-producing financial challenges due to such things as the changing farm economy and oil industry, the number of small towns struggling to maintain their economic viability, and changes related to welfare reform.
Financial matters are associated with family discord (Hogan & Bauer, 1988), and financial problems can lead to divorce (Burkett, 1989). Financial problems can also be a symptom of other family problems (Ulrichson & Hira, 1985). Family financial difficulties and relationship problems are assumed to be interrelated, yet there is little research focusing specifically on the emotions that affect and are affected by financial difficulties. This lack of valid research has left both family therapists and financial counselors with little reliable information upon which to base treatment planning when dealing with the interaction of these two areas. The purpose of this study was to examine, from the subjects' perspectives, financial difficulties and emotional issues in order to develop suggestions to help financial counselors and family therapists better meet the needs of their clients, the majority of whom are North Dakota residents.
Family therapists
Marriage and family therapists (MFTs) are highly trained mental health professionals who bring a family-oriented perspective to mental health care. They evaluate and treat mental and emotional disorders and other mental health and behavioral problems within the context of the family. MFTs will typically ask questions about family roles, patterns, rules, goals, and stages of development, then work with the individual, couple, or other subsystems of the family to change interaction patterns so that the problem can be resolved. Some mental health workers trained in other disciplines such as social work, professional counseling, and psychology may also work with families. For the purpose of this paper, all professional clinicians who work with families will be included in further references to MFTs or family therapists.
There are several possible ways that a family with financial difficulties might become involved with a family therapist. Emotional, behavioral, or relationship problems might have been identified in a couple, an individual family member, or in the family as a group. At least initially, these problems might seem to have little or nothing to do with financial problems. It is even possible that efforts by the family to resolve a relationship problem will lead to overspending, thereby creating a financial difficulty that didn't exist previously. For example, a couple who is trying to deal with marital discord may spend excessively on a vacation in an effort to revive positive feelings toward one another. Similarly, following a divorce, the non-custodial parent may spend beyond his or her means to compensate for perceived losses in the relationship with the child. When these efforts fail to solve the problem or even compound it, the individual involved may seek family counseling, identifying the relationship problem as the primary issue. In the course of treatment the relationship between financial and emotional difficulties may become evident.
Stresses inherent in financial problems can contribute to or make worse any other problems the family members may be having. An already strained marriage could quickly become hostile and belligerent in the face of mounting debts. A severely depressed individual might decide against, or prematurely discontinue, needed therapy or medication in an effort to avoid a financial shortage. In other situations, the problems themselves may be contributing to the financial strains. Excessive gambling and alcohol or drug use can be stressful to the family both emotionally and financially with the initial costs of participation. This may be added to possible court fines and/or job loss resulting from the behaviors. Even the cost of court-ordered or voluntary treatment may become a financial problem for an already over-extended budget.
Financial counselors
Financial counselors are individuals who work with clients confronting financial challenges; they are concerned with improving the financial strength of their clients. Most counselors work with clients on income and credit management activities to help them identify avenues to increase income, decrease expenses, control credit and liquidate debt, develop saving and spending plans, and implement action for consumer recourse or problem resolution. Counselors may negotiate with creditors, landlords, judges, hospitals or employers on behalf of their clients. The financial counselor may provide services such as assistance in identifying the sources of financial problems, exploring financial alternatives and consequences, and assisting with budgeting and debt liquidation.
According to Mason and Poduska (1986), the clients of financial counselors often have inadequate income, excessive debt, excessive living expenses, inadequate budgeting skills, and problems that require immediate action. Success in the counseling process is measured by growth in the client's self-esteem and the ability to cope with financial problems. While some may use the terms "financial counselor" and "financial planner" interchangeably, financial counselors generally work with different kinds of issues than do financial planners. Financial planners concentrate on the management of current or future assets for their clients. They may help the client reduce excessive tax liabilities, assess risk tolerance, develop estate plans, and achieve a satisfactory growth rate for monetary assets.
There are many factors that can contribute to financial problems within the family. These include the overuse of consumer credit, expenses related to separation and divorce, unemployment, uninsured medical expenses, unrealistic financial expectations, being the victim of a financial scam, having a low or irregular income, or lacking skills in financial management. The goal of financial counseling is often to reduce or eliminate current financial problems or threats to financial stability and motivate the client to change self-defeating behaviors. Financial counselors may help clients deal effectively with attitude changes, inadequate communication skills, and poor consumption habits. Concentrated effort is made to resolve the immediate crises and work toward a permanent improvement in financial well-being. These efforts serve to help clients gain control over their financial affairs, overcome their sense of personal disgrace, and sometimes overcome the public embarrassment that often accompanies the failure to meet financial obligations.
Data collection
Data for this study were collected over a several month period from late 1996 to early 1997 from individuals attending their initial intake session with a financial counselor at one of three sites of a nonprofit consumer credit counseling service in North Dakota. The sample is, therefore, composed of individuals who have identified themselves as needing assistance in managing their financial affairs.
Respondents were instructed to arrive 20 minutes early for their scheduled appointment if they were willing to complete a voluntary survey on money and emotions. The response rate for the study is 258 out of 776 clients seen during the period (33%). This rate is not surprising considering that already stressed clients were asked to arrive early for their first appointment in order to participate in the study, which was optional.
It is possible that those clients who were experiencing stress, depression or anxiety self-selected into the sample by choosing to participate once they knew the area being studied. They may have wanted to express what they were feeling, even though, or perhaps because, their identity was anonymous.
Despite the limitations this self-selection may impose on the sample, there is value to the research in that it is one of the few studies that has been done on the emotional experiences of clients in financial counseling, and exploratory work often begins using a convenience sample. It is important for practitioners to acknowledge the incidence of emotional problems among their clients in order to help the clients overcome the challenges they are facing. Counselors in North Dakota need to be aware that even in a small group of clients that may or may not represent their caseload as a whole, the potential for emotional problems may be high.
Instruments
The survey instrument was developed by a mental health professional based, in part, on criteria for emotional/mood disorders from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (APA, 1994), with additional input from financial counselors. The instrument consisted of 92 closed-ended questions dealing with issues such as depression and anxiety; family of origin; eating, drinking, and gambling behavior; relationship problems; motivation for spending; and general demographic information. In this paper, findings related to anxiety and depression are reviewed. Respondents were also asked five open-ended questions related to feelings about money. Responses to one open-ended question will be discussed in this article.
The responses to the open-ended questions were coded into categories following grounded
theory methods (Strauss & Corbin, 1998) in which hypotheses are developed and verified
through the process of analysis. Grounded theory methodology was chosen because of its
utility in generating hypotheses from narrative data. A relationship between financial
difficulties and emotional distress was expected; therefore, this study was designed to
explore the specific emotions involved. The frequency of responses in each category was
then assessed to identify themes or commonalties in the
response-sets. In accordance with the procedures of the grounded theories methodology,
hypotheses and theories thus identified will be described in the results section of the
paper. Only responses to questions dealing with depression and anxiety and the influence
of money on these emotions will be reviewed in this paper.
Profile of the sample
As can be seen on Table 1, the majority of respondents (78%) are between the ages of 20 and 39. Sixty-six percent are female. Over half are renters rather than home owners, and the majority are married or living with a partner. Fifty-two percent have children living in their home. Forty-six percent (46%) make less than $20,000 a year and 50% state that they "never" maintain a balance in a savings account. The vast majority (89%) is dissatisfied with the balance in their checking account.
Table 1. Respondent profile.
-----------------------------------------------------------
Percentage of
Respondents
-----------------------------------------------------------
(n=258)
-----------------------------------------------------------
Aged 20-39 78%
-----------------------------------------------------------
Rent rather than own residence 66%
-----------------------------------------------------------
Female 66%
-----------------------------------------------------------
Married or cohabit 56%
-----------------------------------------------------------
Have children living in their home 52%
-----------------------------------------------------------
Report making $20,000 or less a year 46%
-----------------------------------------------------------
Never maintain a balance in their saving account 50%
-----------------------------------------------------------
Dissatisfied with the balance in their 89%
checking account
-----------------------------------------------------------
Have been treated for psychological or 26%
emotional issues
-----------------------------------------------------------
Having problems with the way they 45%
spend money often or always
-----------------------------------------------------------
People with a partner report that they disagree 25%
about how to spend money often or always
-----------------------------------------------------------
People with a partner report that their 33%
partner does not know how to manage money
-----------------------------------------------------------
Money has caused problems in the 27%
relationship with a partner
-----------------------------------------------------------
Emotional distress
Table 2 shows the frequency of responses to some of the specific questions that address depression and anxiety. Twenty-six percent of the respondents report that they have been treated for psychological or emotional issues in the past (Table 1), which may or may not have been related to financial problems, but 58% reported currently being depressed about financial difficulties "often" or "always" (Table 2). Forty-one percent report that they lose sleep worrying about money "often" or "always" and 48% report that they "cannot stop worrying about money problems." Nearly half of the respondents (45%) report that they have problems with the way they spend money "often" or "always."
Table 2. Responses to selected indicators of depression or anxiety.
-----------------------------------------------------------
Responded
"Often or Always"
-----------------------------------------------------------
(n=258)
-----------------------------------------------------------
I am depressed about my financial difficulties 58%
-----------------------------------------------------------
I lose sleep worrying about money 41%
-----------------------------------------------------------
I can't stop worrying about my money 48%
problems
-----------------------------------------------------------
I feel fatigued or tired most of the time 36%
-----------------------------------------------------------
I am not interested or excited about things 26%
the way I used to be
-----------------------------------------------------------
Responses to the open-ended question, Please describe the emotional difficulties you
experience because of your financial difficulties, provide insights into the types of
emotional distress that the clients of financial counselors may be experiencing. Of the
258 people who completed all or part of the questionnaire, 57 gave no response to this
question. Of the remaining 201 respondents, 18 (9%) reported that they experienced no
emotional difficulties because of their financial situations. The remaining 91% (183
individuals) identified the emotional difficulties they were experiencing. Up to four
different responses were coded for this question. The responses were categorized into the
areas as shown in Table 3. A team of two researchers and two graduate students developed
the coding scheme for this question to attain agreement and consistency. The financial
counseling agency representatives checked the categorization for face validity.
Table 3. Responses to questions on emotional problems experienced in relation to
financial difficulties.
-----------------------------------------------------------
Number of
Coded Responses
to each Theme
-----------------------------------------------------------
Experiencing no emotional problems 18
in relation to financial difficulties
-----------------------------------------------------------
Experiencing worry or anxiety over 70
money problems
-----------------------------------------------------------
Reported symptoms of depression such as 60
sadness, loss of pleasure, feeling worthless
or being unable to deal with daily demands
-----------------------------------------------------------
Reported feeling stressed or pressured 43
-----------------------------------------------------------
Reported physical symptoms of stress 39
such as stomach pain, headaches,
fatigue or sleep-related problems
-----------------------------------------------------------
Addressed feeling guilty about their 31
financial problems
-----------------------------------------------------------
* 201 of the 258 respondents gave at least one response to this question.
The most frequently occurring response to the question about emotional difficulties
related to financial problems was "experiencing worry or anxiety" over money
problems. Seventy responses were given using these or closely related words to describe
emotions. Examples of these comments are as follows:
"[I have] anxiety attacks at night and it is hard to sleep."
"I ignore my finances, therefore they pile up and cause me a great deal of anxiety and stress."
"I experience some anxiety related to creditors calling."
"I am constantly worried about how the bills are going to get paid. Thus, I try to work numerous hours, and then cannot remain focused on other things. There is no personal time when finances are a problem."
"I get anxious, stressed out - willing to give up."
"[I] worry about retirement [and] having to pay credit card debt on Social Security."
The second most frequently noted responses were symptoms of depression such as sadness, loss of pleasure, feeling worthless, or being unable to deal with daily demands. Sixty responses were in coded into this area. Client responses included the following:
"I was suicidal over money problems. I was hospitalized for depression."
"Depression, [I] feel like I am in debt forever. [I have] difficulty sleeping at times [and] awake early in the morning worrying about money."
"Depression led to overspending. Now the financial difficulties add to the depression."
"Aggravates the depressive episodes I already have. Fear about having to do without basics like food."
"I'm depressed more. [I] don't feel like doing much. [I] don't like getting up in the morning."
"I get extremely depressed after spending money on gambling. I have to lie to my spouse about where the money goes."
Forty-three responses were given in the area of feeling stressed or pressured. Sample responses include:
"I have stress. I feel stress at all times. I stay up at night and worry about getting out of debt."
"I am very stressed, I snap at my husband, I have lost sleep trying to find a way to get `out of the hole'."
"Stress is involved with this problem. I have a different [out]look on everything."
"Stress, worry - I want to be accountable to my creditors."
"Stress of unexpected large expenses interfering with budgeted payments."
Thirty-nine responses dealt specifically with the physical symptoms of stress such as stomach pain, headaches, fatigue, or sleep-related problems. Responses include:
"Mental and physical tiredness which I seem unable to recover from. (Headaches - occasionally causing blurred vision and eye soreness in right eye). Relationship problems - generally displayed in deceit, not fights."
"Loss of sleep is about all - emotionally I'm strong…"
"[I] lay awake at night and worry about my kids not having enough."
Lastly, thirty-one of the responses addressed feeling guilty about the financial problems. These include:
"Mainly guilt. I charged a lot of items and hid the statements from my [spouse]."
"Guilt because I can't always give my kids everything they deserve. Fear I'll be thought irresponsible by my parents or partner, depression and self-anger because I think I'm irresponsible, [I] worry that something really bad will happen and I'll be powerless to do anything."
To summarize, the two most frequently given responses dealt with either heightened emotion such as stress and worry in response to financial difficulties, or with the symptoms of depression that relate to the blunting of emotions. As can be seen from the above quotes, many emotional reactions may be occurring simultaneously within a person who is experiencing financial difficulties.
Discussion
From a practitioner's standpoint, helping clients deal with the emotional issues that accompany their financial problems may require either of at least two very different emphases. Emphasis would depend on whether the clients must identify ways to reduce stress and deal with anxiety (heightened emotion), or whether they need to find ways to deal with the loss of enjoyment that they are experiencing in relation to sadness, and possibly depression (blunted emotion).
In the demographic analysis of this North Dakota sample, it was apparent that many (46%) of the respondents had very low incomes and fairly high debt levels in relation to their incomes. From a financial perspective, financial counseling with these clients may be more successful if feasible ways of increasing income are addressed, along with budgeting and credit management. At the same time, from an emotional perspective, helping clients realize that they are doing the best they can given the circumstances may help lessen the emotional burden and guilt they are experiencing.
Theoretically, it makes sense that if the areas of finance and emotion are as interrelated as this preliminary research indicates that they are, financial counselors and family therapists would provide better services to their clients if they were to work together on cases that involve both issues. In this article, the focus has been on data from clients in financial counseling. It is likely that the clients of family therapists, those clients who first self-identify as having emotional or relational problems, may also experience financial problems. At some point during psychotherapy it may become obvious that financial treatment would be advisable, and the family therapist could appropriately refer the family to a financial counselor. Families who have initially recognized financial difficulties as a major source of problems might first seek help from a financial counselor. In the course of financial reorganization, the personal and interpersonal effects of the stresses may become increasingly more obvious. At that point, the financial counselor might make a referral to a family therapist to treat current symptoms and to prevent additional family problems.
It is important for financial counselors and family therapists to know when and how to integrate treatment between their disciplines. To facilitate the referral process between these two professions for the benefit of the clients, the following suggestions are offered based, in part, on the findings of this study:
First, expansion of training and awareness across both professions is necessary. Financial counselors should not be expected to become mental health professionals, as this is not their area of expertise; however, some training in how to identify symptoms of depression and anxiety, including access to screening instruments, would strengthen the financial counselors' ability to provide holistic services to their clients and to make appropriate referrals when the emotional difficulties are beyond the scope of their training. Likewise, family therapists need to be aware that financial concerns may be an underlying factor in emotional difficulties and would need to be dealt with as part of a complete treatment plan. MFTs also need to be able to recognize when financial problems have reached a stage where they can most effectively be addressed through a trained financial counselor. Recent suggestions have been made that MFTs should receive additional training in financial counseling (Poduska & Allred, 1990: Hammond, 1998). Adding substantially to training requirements in either discipline could detract from the focus and expertise of that discipline. Perhaps a better solution would be to indoctrinate students to the possibility of referral to those already trained with expertise in the other field. Moreover, as family therapy and financial counseling professionals receive in-service training, the sponsoring agencies in North Dakota could insure that this cross-training is given to those already practicing.
Second, identifying the sequencing of financial and emotional problems, if possible, may help identify who should be the primary professional to assist in the intervention, with referral to the other profession as needed. For example, if emotional problems seem to trigger spending sprees, the family therapist would become the primary interventionist. If, however, mounting credit card balances are making the client too anxious or depressed to effectively find solutions to the problems, the financial counselor would first try to deal with the credit issues as a means of alleviating the financial crisis and the accompanying stress.
Third, helping the client deal with emotional issues which are accompanied by financial
problems may
require different emphases, depending on whether the client is dealing with anxiety and
heightened emotion or dealing with sadness and depression. This is true even if the
emotions haven't begun to have a serious negative impact on relationships and if the
financial stresses haven't reached crisis proportions. Clients who are overly anxious may
be too unfocused to carry out financial remediation plans. Similarly, depressed clients
may temporarily have too little energy to be completely involved in their own behalf.
Symptoms such as these may be seen in clients who are struggling with cash-flow issues in
a farming operation long before they are faced with actual decisions to find off-farm
employment or to sell the business.
Lastly, in this sample, over half the clients reported having very limited financial resources. Identifying feasible ways of increasing income may be one of the most successful strategies in working with clients regardless of whether their problems are primarily emotional or financial. One group of North Dakota residents who fit into this category would be those who are transitioning from welfare to work. The recent establishment of a lifetime limit (five years of financial assistance) requires that each client must have alternative financial resources in place long before the limit is reached. This may require that plans for additional education or training must begin early in the counseling process.
There are a variety of financial and family therapy opportunities throughout the state of North Dakota. These would include financial counseling through Employee Assistance Programs and the Village Financial Resource Center, which offers counseling at a number of offices across the state or by telephone. There are also a number of qualified family therapists in settings including Lutheran Social Services, Catholic Family Services, university family therapy centers (such as the North Dakota State University Family Therapy Center), community mental health agencies, or private therapy offices in most cities. Fees range from non-profit or sliding-fee-scale to substantial charges. With some pre-session inquiry into fees and qualifications of the professionals, resources can be found which will be most beneficial and not add to the clients' financial difficulties.
By understanding the complex, but relatively common, relationship between finances and emotional well-being, and by creatively working together as professionals in the best interest of each client, financial counselors and MFTs can improve delivery of services in increasingly cost effective ways. Both professions can benefit as they achieve greater success without weakening their expertise with additional cross training. However, the greatest benefits in the long run will go to the clients who receive assistance with multiple aspects of their problems rather than being further subjected to the fragmentation of services which has been created by specializations.
References
Blumstein, P. W., & Schwartz, P. (1983). American couples. New York: Morrow.
Burkett, L. (1989). Debt-free living: How to get out of debt (and stay out). Chicago: Moody Press, 1989.
Hammond, C.H. (1998). Family finances: Still the missing link in MFT training. Poster presentation AAMFT Oct 1998, Dallas, TX
Hogan, M.J., & Bauer, J.W. (1988). Problems in family financial management. In C.S. Chilman, F.M. Cox, & E.W. Nunnally (Eds.). Employment and Economic Problems: Families in Trouble Series (Vol. 1, pp. 137-154). New York: Sage.
Mason, J., & Poduska, B. (1986). Financial planner or financial counselor: The differences are significant. Journal of Consumer Affairs, 20(1), 142-147.
Olson, D. H., McCubbin, H. I., Barnes, H., Larsen, Al, Muxen, M., & Wilson, M. (1989). Families: What makes them work (2nd Ed.). Los Angeles, CA: Sage.
Poduska, B.E., & Allred, G.H. (1990). Family finances: The missing link in MFT training. The American Journal of Family Therapy, 18(2), 161-168.
Strauss, A. & Corbin, (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory (2nd ed.). Thousand Oaks, CA: Sage.
Ulrichson, A.M., & Hira, T.K. (1989). The impact of financial problems on family relationships. Family Perspective. 19(3), 177-187.
Voydanoff, P. (1991). Economic distress and family relations: A review of the eighties. In A. Booth (Ed.), Contemporary families: Looking forward, looking back (pp. 429-445). Minneapolis: National Council on Family Relations.
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