Challenges and benefits of ethical small-community practice.

Abstract

Ethical dilemmas and boundary challenges are parts of daily life for psychologists who live and practice within small communities. Although rural psychologists are most readily identified as "small-community psychologists," there are a number of other settings that can be considered small communities-colleges, communities of color/ethnicity/culture, lesbian/gay/bisexual/transgender (LGBT), military, faith-based, feminist, criminal justice and corrections, suburban, disability, deaf/hearing impaired, chemical dependency, school districts, sport psychology, graduate training programs, and therapists who see other therapists as clients. Psychologists in these small communities strive to balance a traditional individualist perspective with a need to participate in and contribute to the overall wellness of the community in which they live and work. The 3 invited commentaries provide additional depth through their perspectives on rural, LGBT, and Latina/o community practice. Their insights model thoughtful and contemporary practice that challenges, enriches, and educates the larger field of ethical psychological practice.

On the frontier: Exploring rural psychologist practice in integrated behavioral health care.

“…Expanding traditional notions of rural ethics (Schank & Skovholt, 2006) These findings aligned with ethical issues for rural psychologists identified in the literature (Schank et al, 2010;Schank & Skovholt, 1997;Schank & Skovholt, 2006) and extended applications to IBHC settings. For example, Schank and Skovholt (2006) noted, "small community psychologists are likely to have out of session contact with clients" (p. 56).…”

“…In the current research, psychologists discussed broadening the perspectives of the medical team and bridging new and insightful perspectives through inperson communication and team collaboration With respect to existing ethical tensions found in rural practice, the IBHC setting added additional complexity. For example, in addition to the issues raised in existing literature (Campbell et al, 2003;Schank, 1998;Schank, Helbok, Haldeman, & Gallardo, 2010;Sulkowski, 2017), managing dual relationships for rural psychologists in IBHC settings was extended to include grappling with whether to treat colleagues (e.g., doctors and nurses) in the setting. Moreover, extending the work of Schank et al (2010) and Sulkowski (2017) on stretching of competence, along with being a flexible generalist, psychologists in this study discussed the need to be vigilant in consultation with doctors wanting to discuss medication recommendations or other issues outside the psychologist's scope of practice.…”

“…Immense geographic isolation is a tangible marker for the barriers to behavioral health care. Intangible markers for rural populations include lack of adequate access to psychiatric services and social welfare support, cultural values that impact utilization of behavioral health services due to stigmatization, confidentiality concerns within small communities, and issues related to socioeconomic status and access to health insurance (Harowski et al, 2006;Mackie, 2015;Wagenfeld, 1997;Schank et al, 2010;Helbok, Haldeman, & Gallardo, 2010).…”

Evaluating the effectiveness and cost-effectiveness of British Sign Language Improving Access to Psychological Therapies: an exploratory study

“…It was not unusual for a client to know the therapist, for example through shared school experiences, volunteer and committee work within the Deaf community, or more remotely as a well-known figure in the local/regional/national Deaf community. Although such experiences of multiple roles and knowledge of an individual in a variety of contexts is very common in the Deaf community, as it is in many other small communities of practice, [123][124][125] for some clients it was a barrier to engagement in therapy and an alternative therapist might be requested. …”

Social Justice Advocacy in Rural Communities

“…Although our focus is on rural areas, the literature is clear that there are other types of small communities that share some similar characteristics (see, e.g., Schank & Skovholt, 2006). Therefore, the general issues we raise may be relevant to psychologists who work with specific groups or in special settings (e.g., the military; lesbian, gay, bisexual, and transgender communities; and ethnic groups residing in a particular region; Schank, Helbok, Haldeman, & Gallardo, 2010).…”