To Humbly Go Where No Psychologist Has Gone Before: Insider-Outsider Relationships in Rural Practice

  • Author / Creator
    Friesen, Laura Suzanne
  • Canada’s rural population is an important part of the country’s national identity. And yet, this is a dwindling population which has become a rather marginalized group with unique challenges and needs. In terms of mental health, rural individuals face complex and multifaceted barriers to accessing and accepting professional psychological services. In addition to issues of availability (i.e., distance, cost, trained professionals, etc.), rural individuals also face decisions of whether to accept available services as legitimate and trustworthy forms of help. Psychologists living and working in or commuting to rural communities find it especially difficult to be accepted when they are considered outsiders to the rural community. Among other possible issues, lack of trust can negatively impact the development of helpful therapeutic relationships which in turn, influence therapeutic outcomes. What is key is the development of therapeutic relationships and yet there is a dearth of literature in this regard specific to rural professional psychological practice. With concern about good therapeutic relationships in rural areas, this project evolved with a desire to unpack beneficial processes for psychological services in rural communities. To learn more about this, I conducted an interpretive inquiry to explore the storied and complex understandings of how rurally located psychologists considered to be outsiders and insider rural clients experience the development of helpful therapeutic relationships that can lead to successful outcomes. Across both groups, the therapeutic relationship was enhanced with rural clients when the psychologist: acted as an ethnographer; earned trust with openness honesty, and authenticity; created comfort, caring, and common ground with clients; collaborated and empowered clients; became a stable base; and managed both connection and distance. Findings from the rural client group underscored the impact of a long journey in search of mental healthcare, leading to disillusionment and reduction in hope before they even met their psychologist. The rural psychologists in turn, emphasized pressure to meet community and client needs and the necessity of self-care and networking to enhance their ability to engage in complex relational work. Recommended activities for rural psychologists included the following: Address the client’s past help-seeking experiences, past harm or iatrogenic effects, and possible disillusionment; take an ethnographic approach to learning about the client and their community; create common ground and comfort; take an egalitarian approach with authentic caring; empower through collaboration; balance safe connection and distance; and become a visible stable base for clients. The findings of this research have the potential to contribute to training, policy development, advocacy efforts for equitable services, and culturally competent and ethical psychological practice with rural clients. The implications are relevant for both rural and urban-based practitioners, given the explosion of telepsychology in recent times. Indeed, participants discussed telepsychology as this study occurred during the Covid-19 pandemic. As a result, these findings provide a strong foundation for future research in areas such as telepsychology with rural clients. A unique and contributory product of this research is a new culturally-grounded model, designed to guide outsiders to ethically develop stronger therapeutic relationships with rural clients, whether in-person or through telepsychology.

  • Subjects / Keywords
  • Graduation date
    Fall 2023
  • Type of Item
  • Degree
    Doctor of Philosophy
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.