rural teletherapy

Boundary Challenges for Therapists Serving Rural Communities

What are Boundary Challenges?

When you stop to think about it, it is surprising how often therapists are confronted with boundary issues in the rural communities they serve. And while one might think that this is only true for mental health therapists, the truth is that these challenges exist for occupational and speech therapists as well.

In rural communities across the country, many unanticipated interactions between therapists and their clients are unlikely to pose any significant threat. Take, for example, when therapists and clients encounter one another in the local grocery store. While this brief, unexpected meeting may be awkward, it won't negatively impact the therapy nor the client-therapist relationship.

But at other times, those encounters can be problematic both in the short and long term. So, the question is, "How does a therapist set clear, appropriate boundaries that will maximize the therapy without sacrificing a healthy therapist-client relationship?" The answer lies in understanding that boundaries are invisible lines of demarcation. While creating a sense of separateness, this separateness is an essential requirement of maximizing the therapy, empowering the client, and actually bringing the therapist and client closer together.

Are Boundary Challenges Unique to Rural Areas?

Therapists who provide their services in rural communities aren't the only ones who face the challenges of setting boundaries. As it happens, therapists who work with members of their religious or faith communities face similar problems as well. What happens when the client and therapist attend the same religious services week after week?

What’s more, any therapist could be faced with the dilemma of becoming friends or getting involved in a business deal with a former client. And what about attending social engagements where a current client will be present as well?

However, there are specific boundary issues that exist in rural communities which are unique and demand both sensitivity and skill to navigate successfully if both the client and therapist are to escape unscathed. In a small community, therapists live with the constant awareness and concern that they will be "bumping" into their clients or the client's parents regularly. Or that they will be engaged in an activity together totally unrelated to the therapy being provided.

Liabilities of Dual Relationships

Dual relationships are sometimes unavoidable in rural communities. Sometimes it’s nothing more than the lack of people around that fosters overlapping relationships in any number of ways. This could be the overlap of therapeutic and social relationships, business relationships or even other professional relationships.

Once the higher likelihood that a dual relationship will occur is recognized, it behooves the thinking therapist to anticipate one of these intersections and begin preparing for it. Where appropriate, therapists should speak with their clients or their clients' parents to plan as to how they deal for these potentially awkward situations.

On the other hand, if the therapist allows the practically inevitable to occur without a discussion beforehand, the client may be confused by the therapist's inconsistency.   Today the therapist is so friendly, and tomorrow she comes off as a cold professional keeping her distance.

Client Confidentiality

Perhaps the most crucial reason for the therapist to establish healthy boundaries is to protect the confidentiality of the client. While privacy is essential in any therapeutic relationship, due to the unique dynamics in a rural community, the importance and consequent challenge for the therapist is that much greater.

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Assume you, the therapist, are dining in a local restaurant, and your young client approaches you. Others in the restaurant will interpret the approach itself as an indication that the child is one of your clients. Engaging the child will confirm it, while being standoffish may seriously impair your therapeutic relationship. Checkmate!

In a similar vein, given the size of the rural community, it is likely that some of your clients know each other. This means that even an unintended slip of sharing confidential information regarding one client with another could be damaging. While just an innocent mistake, if the client thinks that his trust has been betrayed, the therapeutic relationship with the client will be imperiled.

What Is The Answer?

In some cases, therapists and their clients can brainstorm together and come up with straightforward ways to solve these potentially thorny boundary issues. Take, for example, if the therapist's client works for the only plumber in town. An easy solution would be to have the client to ask his boss to send someone else to fix the therapist's clogged drain.

Suppose one of the local organizations is sponsoring a trip that needs chaperones. If the young client is attending, it would be advisable for the therapist to refrain from chaperoning the trip, to avoid a potentially uncomfortable boundary conflict.

On the other hand, there are boundary issues, be they actual or potential, that are much more challenging to manage. Take, for example, when the client's father owns the company where the therapist's wife works. This may pose an unavoidable conflict that is going to require loads of respect, sensitivity, and wisdom.

In such a circumstance, where the connection cannot be avoided or severed, it behooves the therapist to broach the boundary issues with the client or the client's parents as early in their relationship as possible. They need to discuss reasonable ways of handling potentially awkward circumstances comfortably and respectfully.

The short answer is that there is no single answer as to the appropriate response to these and other boundary questions. It is very important for therapists, especially in rural communities, to be aware of potential boundary issues. It is only then that they can craft strategies or consult with others who may be helpful in solving these issues.

Be Prepared To Maximize Your Opportunity

The opportunity to serve rural communities is exciting, fulfilling and,  at times, challenging. The same small and tightly-knit community that is at the core of some of these more difficult boundary issues is the reason that many therapists find their work so fulfilling and meaningful. Don't be intimidated by these boundary challenges. They can and will be solved!

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