National survey of psychological practices across rural and urban communities

Abstract

The purpose of this study was to examine potential differences in the practice of psychology across urban and rural communities. The review of the rural literature suggests that psychologists in rural areas are likely to encounter numerous ethical dilemmas and problems that are related specifically to the characteristics of such communities. To date, however, much of this literature has been based on theory and the individual experiences of practitioners. This study sought to quantify any differences in the practice of psychology across communities for such ethical issues as multiple relationships, competency, burnout, confidentiality, and visibility in the community. A survey instrument was created based on previous surveys of ethical practices. A national sample of 1000 psychologists, stratified into urban and non-urban practitioners, was obtained from the American Psychological Association. After several mailings 447 usable surveys were returned. Data analysis revealed significant differences between urban/suburban and small town/rural groups, particularly for the dependent variables of multiple relationships and visibility. Significant differences were found across gender such that male psychologists are more likely than female psychologists to engage in a range of multiple relationship behaviors, and female psychologists are significantly more likely to make use of support from supervisors, colleagues, family and friends. Psychologists in private practice are significantly more likely than those in institutional settings to engage in multiple relationships, to find their work satisfying and rewarding, and to have control over their work environment; whereas practitioners in institutional settings are more likely to have support from colleagues and supervisors, and to work when too distressed to be effective. Psychologists with more experience are significantly more likely to engage in multiple relationship behaviors than those with less experience. Psychologists with a psychodynamic orientation are more likely to make use of supervision and to discuss case work with colleagues than other orientations. The most common concern listed, across community type and gender, is a lack of alternative referral sources. Results from this survey are compared to previous surveys of ethical practices. Qualitative results are categorized and discussed. Suggestions are made for future research based on these findings.

Trust and Culture in Rural Research Design

“…[22] As a result, non-community members are viewed with suspicion and distrusted making research in rural communities more difficult for outside institutions. [22] In 1991, Murray and Keller suggested that the urban model of mental health service delivery was inappropriate to meet the needs of rural communities [21] and we are suggesting the urban model for research studies follows suit.…”

“…However, the common model for research studies developed largely in urban-based areas with access to many resources. [21] In addition to resources, there may be public familiarity with the researchers, which may translate to trust. For many rural areas this approach would mean the only time participants are exposed to researchers are within the confines of the research study.…”

“…The community structure and relationships in rural communities have deep cultural, familial, historical, and political roots that can influence the research study. [21] For instance, in Southern West Virginia, politeness is often held in high regard. Participants may be reluctant to tell a researcher "no" even if the participant is uncomfortable for fear of seeming impolite.…”