Small but Mighty: Perspectives of Rural Mental Health Counselors

Limited research is available on the experiences of rural mental health counselors. The following is a phenomenological study grounded in critical theory. Four practicing licensed professional counselors currently working in rural settings in the Midwest region of the United States were interviewed to elicit stories regarding rural counseling, supervision and professional development experiences. The participants' responses included the following themes: (a) need for flexibility, (b) resource availability, (c) isolation, (d) ethical dilemmas and (e) finding meaning in one's work. The results contribute to a small but growing body of research about rural counselors, who are often misunderstood in the context of mental health.Keywords: rural counseling, rural mental health, ethical dilemmas, phenomenological, professional developmentNo common culture for the rural United States is absolute. Rural communities range according to geographic location, diversity of inhabitants, social and economic factors, problems and resources available (Bushy & Carty, 1994). As such, counselors-in-training often lack critical background information to competently and ethically serve traditionally underserved clientele (Smalley et al., 2010); in addition, counselors often lack the professionalism necessary for dealing with the profusion of unique issues in rural settings. Authors have documented studies related to rural school counseling, rural marriage and family therapy, rural mental health practitioners, rural clinical psychology, and rural healthcare and education (Bambling et al., 2007; Boyd et al, 2007; Curtin & Hargrove, 2010; Curtis, Waters, & Brindis, 2011; Ellis, Konrad, Thomas, & Morrissey, 2009; Endacott et al, 2006; Hartley, Loux, Gale, Lambert, & Yousefian, 2010; Lockhart, 2006; McCord et al., 2011; Morris, 2006; Murry, Heflinger, Suiter, & Brody, 2011; Owens, Richerson, Murphy, Jageleweski, & Rossi, 2007; Smalley et al., 2010). There is a noticeable gap in the literature, however, related to rural mental health counseling experiences.The many definitions of rural reflect the complexity and dynamism of this elusive concept. In one scenario, population density may be the focus of the definition, whereas in other cases, geographic isolation may take precedence. For example, the U.S. Census Bureau (2013) uses the urban-rural classification system to distinguish between two types of urban areas: (a) urban communities of 50,000 or more people and (b) urban clusters of between 2,500 and 50,000 people. Rural thereby encompasses all population, housing and territory not included within an urban area (U.S. Census Bureau, 2013). However, the U.S. Department of Agriculture uses a regional-economic concept as defined by the Office of Management and Budget, which distinguishes metropolitan areas as broad labor-market areas that include (a) central counties with one or more urbanized areas (densely populated areas with more than 50,000 people), and (b) outlying counties that are economically tied to the core counties as evidenced by labor-force commuting (U.S. Department of Agriculture, 2013). Nonmetropolitan areas are therefore those outside these metropolitan areas (U.S. Department of Agriculture, 2013). For the purposes of this article, rural is defined according to the Office of Management and Budget geographic isolation definition, with rural counties constituting those with fewer than 50,000 people as well as counties not economically tied to densely populated counties.Bushy and Carty (1994) authored one of two articles specifically devoted to rural mental health counseling. The authors provided a solid foundation of rural mental health considerations, outlining the availability, accessibility and acceptability of services. The authors also described rural culture and its intersection with mental health, stating that utilization patterns are typically characterized by informal support systems versus social services. …