National survey of ethical practices across rural and urban communities.

Abstract

This study examines ethical dilemmas and problems that are encountered by psychologists across rural and urban communities. A survey instrument was created on the basis of previous surveys of ethical practices. A national sample of 1,000 psychologists stratified into urban and nonurban practitioners was surveyed; 447 usable surveys were returned. Data analysis revealed significant differences between small town/rural and urban/suburban groups for several ethical categories. Notably, small town/rural psychologists are more likely to encounter several types of multiple relationships than their urban counterparts. Small town/rural practitioners are also more likely to be highly visible, or well-known, in their communities. Qualitatively, respondents described their struggles with dual relationships, and several offered suggestions to cope with boundary issues. These findings suggest the need to study the practice of psychology in rural communities in more depth, to study the impact of rural characteristics on clients and practitioners, and to create a conceptual model of best practices for rural practitioners.

Ethical challenges of practicing in rural areas

“…Rural areas tend to have scarcer economic and healthcare resources for people whose mental health care needs are the same or even greater than the needs of urban residents (Barbopoulos & Clark, 2003;Helbok et al, 2006;Stamm, 2003). The paucity of mental health professionals can lead to complications in assessment and therapy and ethical challenges related to competence, multiple relationships, confidentiality, and related matters.…”

The Provision of Neuropsychological Services in Rural/Regional Settings: Professional and Ethical Issues

“…Not only does the neuropsychologist have external knowledge of former, current, or prospective clients, but clients also have knowledge of the neuropsychologist, characterizing a lack of anonymity in rural settings (Barbopoulos & Clarke, 2003;Campbell & Gordon, 2003;Helbok, 2003;Helbok, Marinelli, & Walls, 2006;Simon & Williams, 1999). Moreover, due to the multiple overlapping relationships in rural settings, community members are much more open to scrutiny and ''gossip'' (Gates & Speare, 1990;Green & Mason, 2002;Jennings, 1992;Schank, 1998).…”

A qualitative study of rural mental health practitioners regarding the potential professional consequences of social justice advocacy.

“…Many mral areas have few, if any, mental health providers (Helbok, Marinelli, & Walls, 2006;Schank & Skovholt, 2006) and, as a result, mental health professionals in these areas may encounter issues related to clinical competence because they may need to stretch their experiise in order to serve clients (Helbok et al, 2006). Further, the lack of providers, combined with the significant issues faced by rural residents, can lead to a sense that there is not enough time in the day or week to meet the clinical needs of community members, let alone be involved in time-consuming (and nonreimbursable) advocacy efforts on behalf of individual clients or the larger community.…”