Understanding Rural Communities

Providing counseling in a rural community requires an understanding of the rural community culture.  While most rural cultures share some general similarities, every rural area seems to be unique. In general, therapists are trained to deliver therapy in an urban setting, and many of these counselors experience culture shock when they deliver therapy to rural residents.

Experts claim that it isn’t only about providing therapy in rural areas, but rather it’s about delivering “rural therapy”. Rural therapists often require different treatment suggestions and face different considerations than those in urban environments. This mindset can be crucial in making the difference between the therapist succeeding or failing. 

To begin with, it is critical that therapists delivering therapy in rural communities be familiar with and honor their clients’ cultural values and beliefs, many of which revolve around family. Family needs to be included in discussions regarding life decisions, such as attending college. Sometimes parents are worried about who will take care of them if their sons or daughters leave the rural community to attend college and decide not to return. 

Be a Generalist

Often rural areas are short on therapists in general and on specialists in particular. It is, therefore, incumbent upon the counselor to become knowledgeable and skilled in a wide variety of areas.  To be effective, therapists need to maintain a hunger to learn and remain current regarding innovative treatments that have proven effective.  

The therapist is akin to a “country doctor” in many ways and must be prepared for everything. This more personal persona of the therapist can often enhance the client’s trust in that therapist. On the other hand, this leaves many a rural therapist questioning whether such a broad mandate is pulling him beyond the scope of practice where he feels competent. 

Network with Other Professionals

It’s essential for rural therapists to establish an excellent referral list and network of therapists to refer to when the case is beyond the comfort level. It is necessary to get out there to meet and become familiar with therapists with whom to collaborate. Even when that number is small, rural therapists must develop a professional relationship and learn their areas of expertise.  

Often rural therapists are charged with using their creativity to compensate for the shortage of resources, particularly in the realms of supervision and support. One way is to leverage the intimate closeness of the rural community to form collaborative networks with educators and clergy. Establishing working mutually beneficial relationships with other mental health professionals is a must.

Alternatively, it is advisable to network with peers and maximize the opportunities to connect with colleagues through online directories, conferences, and professional associations. As the world moves online, this is working to the rural therapist’s advantage as his networking deficit is beginning to erode. 

Boundary Issues 

Therapists in practically every setting at some time or another need to confront boundary issues. Boundary issues can take many forms such as whether to develop a friendship with a former client, attend social events at the invitation of the client or even hire a former client to perform a service where that former client has displayed expertise. 

And yet, particular boundary issues that confront a therapist within rural communities can be somewhat unique and thus demand from the therapist delicate and skillful management if the confidential covenant between the client and therapist is to be maintained. 

Knowing just about everyone in town goes with the territory of living in a rural community. Such closeness, of course, is what makes living in a Rural America so unique and special. Consequently, it comes as absolutely no surprise to the rural therapist that clients may very well be those with whom he knows socially or through business.  

This raises one of the most delicate areas that any therapist needs to deal with, that of having a dual relationship, and the ethical questions that are associated with it. While certainly not preferable, sometimes these dual relationships in rural communities just cannot be avoided and must be engaged to preserve the therapeutic relationship. 

There is certainly nothing unusual about a therapist living in a rural community to have his transmission fixed by the only transmission specialist in town who happens to be his client as well. Or the one local plumber is coming out to the therapist’s home to fix the pipe that just burst only to meet that therapist for a session later in the week. 

Given the fact that these dual relationships are so likely, it would behoove the therapist to anticipate that the professional and personal lives will intersect and therefore adequately prepare beforehand.  

One way to prepare that has been suggested is for the therapist to take the bull by the horns and address the situation head-on by assuring the client early on that confidentiality is secured and that the client’s issues won’t be discussed outside the sessions. In any event, it is the therapist’s responsibility at some point to initiate the discussion so that together the therapist and client will find a way to minimize the awkwardness while simultaneously protecting the client’s privacy and dignity as much as possible. 

Community Connection

There are many reasons that people choose to make their home in a rural community, but foremost for many of them is the sense of connection they enjoy with others in that community. Such a precious bond is far more elusive if not impossible in larger urban areas.  

Aside from finding more physical space and natural beauty, not to mention solitude, many love the rural communities they call home because of their deep and abiding connections to both family peers.  It all comes together to produce a sense of solidarity and security in the environment that, for many, is priceless. Knowing and being able to count on your neighbors is something few in densely populated urban areas ever experience. 

These interpersonal bonds and its consequent strength can often be felt in the therapeutic realm as well. Because there is a deeper connection to people, usually the client has more of an innate trust in the therapist and feels comfortable depending on her. What’s more, the therapist isn’t just a service provider but “part of my community.”