Skip to main content
SpringerLink
Log in

Professional Ethics in Rural Practice: Relational Territory

  • Reference work entry
  • First Online:
Handbook of Rural, Remote, and very Remote Mental Health

Abstract

Some of the best lessons for rural and remote practicing psychologists arise from context-specific critical incidents. It is important to identify areas of professional ethics to best respond to the rural and remote practice context both for practice but also to inform training and professional development in rural and remote practice. Key general considerations include overlapping relationships and objectivity, community pressure and integrity, generalist practice and competency, interdisciplinary collaboration and confidentiality, and professional development and support. Specific considerations are born of characteristics of the community of practice interacting with the generalist nature of practice. That gives rise to necessary practice adaptations specific to the size and remoteness of the community. It is that element of rural practice that make adaptations necessary that could be used as a rationale or excuse for idiosyncratic variations to practice that are not justifiable and further increase ethical dilemmas. This risk is enhanced with insufficient awareness. In this chapter, some such adaptations are explored. Central to all are “boundary setting” and “consultation” as mechanisms for resolving dilemmas.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 449.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 549.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Adams SJ, Xu S, Dong F, Fortney J, Rost K. Differential effectiveness of depression disease management for rural and urban primary care patients. J Rural Health. 2006;22:343–50.

    Article  PubMed  Google Scholar 

  • Austin W. Engagement in contemporary practice: a relational ethics perspective. Texto Contexto. 2006;15:135–41.

    Article  Google Scholar 

  • Austin W. The ethics of everyday practice: healthcare environments as moral communities. Adv Nurs Sci. 2007;20:81–8.

    Article  Google Scholar 

  • Austin W, Bergum V, Nuttgens S, Peternelj-Taylor C. A re-visioning of boundaries in professional helping relationships: exploring other metaphors. Ethics Behav. 2005;16:77–94.

    Article  Google Scholar 

  • Austin W, Park C, Goble E. From interdisciplinary to transdisciplinary research: a case study. Qual Health Res. 2008;18:557–64.

    Article  PubMed  Google Scholar 

  • Australian Psychological Society. Code of ethics. Melbourne: Australian Psychological Society; 2004a.

    Google Scholar 

  • Australian Psychological Society. Guidelines for psychological practice in rural and remote settings. Melbourne: Australian Psychological Society; 2004b.

    Google Scholar 

  • Australian Psychological Society. Mentoring program for rural and remote psychologists. InPsych, April. Melbourne: Australian Psychological Society; 2005.

    Google Scholar 

  • Barbopoulos A, Clark JM. Practising psychology in rural settings: issues and guidelines. Can Psychol. 2003;44:410–24.

    Article  Google Scholar 

  • Bauman Z. What prospects of morality in times of uncertainty? Theory Cult Soc. 1998;15:11–22.

    Article  Google Scholar 

  • Behnke SH. Multiple relationships and APA’s new ethics code: values and applications. Monit Psychol. 2004;35:66–7.

    Google Scholar 

  • Behnke SH. Exploring ethics in rural settings: through the lens of culture. Monit Psychol. 2008a;39:44–5.

    Google Scholar 

  • Behnke SH. Multiple relationships: a vignette. Monit Psychol. 2008b;39:62.

    Google Scholar 

  • Benson E. Beyond ‘urbancentrism’. Monit Psychol. 2003;34(6):54.

    Google Scholar 

  • Bishop ML. Will advertising improve the organizational image or rural mental health service providers? J Rural Community Psychol. 2005;E8(2):117–136.

    Google Scholar 

  • Bock S, Campbell CD. Crisis intervention in rural communities: a cultural catch-22. J Rural Community Psychol. 2005;E8(1):79–88.

    Google Scholar 

  • Campbell CD, Gordon MC. Acknowledging the inevitable: understanding multiple relationships in rural practice. Prof Psychol Res Pract. 2003;34:430–4.

    Article  Google Scholar 

  • Canadian Psychological Association. Canadian code of ethics for psychologists. 4th ed. Ottawa: Canadian Psychological Association; 2017.

    Google Scholar 

  • Charlebois J. Counsellors’ professional and personal perspectives on working and living in a remote northern community. Unpublished master’s thesis, Acadia University, Wolfville; 2006.

    Google Scholar 

  • Clarke I. Learning from critical incidents. Adv Psychiat Treatment. 2008;14:460–468.

    Google Scholar 

  • Coakes SJ. Defining the nature of participation in rural Australian communities: a qualitative approach. J Community Psychol. 2002;30:635–46.

    Article  Google Scholar 

  • Cope J, Watts G. Learning by doing: an exploration of experience, critical incidents and reflection in entrepreneurial learning. Int J Entrep Behav Res. 2000;6:104–24.

    Article  Google Scholar 

  • Cottone RR. Displacing the psychology of the individual in ethical decision-making: the social constructivism model. Can J Couns. 2004;38:5–13.

    Google Scholar 

  • Crossley M, Morgan D, Lanting S, Bello-Haas VD, Kirk A. Interdisciplinary research and interprofessional collaborative care in a memory clinic for rural and northern residents of western Canada: unique training ground for clinical psychology graduate students. Aust Psychol. 2008;43:231–8.

    Article  Google Scholar 

  • DeStefano TJ, Clark H, Potter T. The impact of organizational factors on burnout among rural mental health staff. J Rural Community Psychol. 2005;E8(1):131–136.

    Google Scholar 

  • Dimogiannis T. Comparison of the work of psychologists in rural and urban settings: implications for professional training. Unpublished master’s thesis, Deakin University, Geelong; 2000.

    Google Scholar 

  • Donoghue A, Hodgins G, Judd F, Scopelliti J, Grigg M, Komiti A, Murray G. Training case managers to deliver focused psychological strategies. Int J Ment Health Nurs. 2004;13:33–8.

    Article  PubMed  Google Scholar 

  • Dyck KG, Cornock BL, Gibson G, Carlson AA. Training clinical psychologists for rural and northern practice: transforming challenge into opportunity. Aust Psychol. 2008;43:239–48.

    Article  Google Scholar 

  • Eley RM, Hindmarsh N, Buikstra E. Informing rural and remote students about careers in health: the effect of Health Careers Workshops on course selection. Aust J Rural Health. 2007;15:59–64.

    Article  PubMed  Google Scholar 

  • Endacott R, Wood A, Judd F, Hulbert C, Thomas B, Grigg M. Impact and management of dual relationships in metropolitan, regional and rural mental health practice. Aust N Z J Psychiatry. 2006;40:987–94.

    Article  PubMed  Google Scholar 

  • Essinger S. The application of the 2002 American Psychological Association’s ethics code and its standards of conduct for the psychologist practicing in a rural community as compared to the psychologist practicing in an urban community. Dissertation, Capella University; 2006.

    Google Scholar 

  • Fair TD. The practice of psychology in a rural area. J Psychol Christ. 2004;23:54–7.

    Google Scholar 

  • Fisher MA. Protecting confidentiality rights: the need for an ethical practice model. Am Psychol. 2008;63:1–13.

    Article  PubMed  Google Scholar 

  • Gale JA, Deprez RD. A public health approach to the challenges of rural mental health service integration. In: Stamm BH, editor. Rural behavioral health care: an interdisciplinary guide. Washington, DC: American Psychological Association; 2003. p. 95–108.

    Chapter  Google Scholar 

  • Gardiner M, Sexton R, Durbridge M, Garrard K. The role of psychological well-being in retaining rural general practitioners. Aust J Rural Health. 2005;13:149–55.

    Article  PubMed  Google Scholar 

  • Green R, Mason R. Managing confidentiality in rural welfare practice in Australia. Rural Soc Work. 2002;7:34–43.

    Google Scholar 

  • Greenhill JA, Mildenhall D, Rosenthal D. Ten ideas for building a strong Australian rural health system. Rural Remote Health. 2009;9:1206.

    CAS  PubMed  Google Scholar 

  • Gripton J, Valentich M. Dealing with non-sexual professional-client dual/multiple relationships in rural communities. Rural Soc Work. 2004;9:216–25.

    Google Scholar 

  • Harowski K, Turner AL, LeVine E, Schank JA, Leichter J. From our community to yours: rural best perspectives on psychology practice, training, and advocacy. Prof Psychol Res Pract. 2006;37:158–64.

    Article  Google Scholar 

  • Haydar SH. Dual relationships and the psychologist’s inner circle: ethical decision making concerning multiple relationships with family and friends. Diss Abstr Int. 2007;67(9-B):5405.

    Google Scholar 

  • Hays KF. Being fit: the ethics of practice diversification in performance psychology. Prof Psychol Res Pract. 2006;37:223–32.

    Article  Google Scholar 

  • Helbok CM. The practice of psychology in rural communities: potential ethical dilemmas. Ethics Behav. 2003;13:367–84.

    Article  PubMed  Google Scholar 

  • Helbok CM, Marinelli RP, Walls RT. National survey of ethical practices across rural and urban communities. Prof Psychol Res Pract. 2006;37:36–44.

    Article  Google Scholar 

  • Hourihan F, Kelly B. National health policy: what does this mean for rural mental health research? Aust J Rural Health. 2006;14(2):49–50.

    Article  PubMed  Google Scholar 

  • Jackson H, Judd F, Komiti A, Fraser C, Murray G, Robins G, Pattison P, Wearing A. Mental health problems in rural contexts: what are the barriers to seeking help from professional providers? Aust Psychol. 2007;42:147–60.

    Article  Google Scholar 

  • Jameson JP, Blank MB. Rural services: defining problems and developing solutions. Clin Psychol Sci Pract. 2007;14:283–98.

    Article  Google Scholar 

  • Johnson WB, Ralph J, Johnson SJ. Managing multiple roles in embedded environments: the case of aircraft carrier psychology. Prof Psychol Res Pract. 2005;36:73–81.

    Article  Google Scholar 

  • Johnson ME, Brems C, Warner TD, Roberts LW. The need for continuing education in ethics as reported by rural and urban mental health care providers. Prof Psychol Res Pract. 2006;37:183–9.

    Article  Google Scholar 

  • Jones CM. From novice to expert: issues of concern in the training of psychologists. Aust Psychol. 2008;43:38–54.

    Article  Google Scholar 

  • Kee JA, Johnson D, Hunt P. Burnout and social support in rural mental health counselors. J Rural Community Psychol. 2002;E5(1):119–125.

    Google Scholar 

  • Kemp Brill MK. Rural ethics for rural psychologists. Dissertation, Tennessee State University, Tennessee; 2003.

    Google Scholar 

  • Kersting K. Professional pioneering on the frontier. Monit Psychol. 2003;34(6):68.

    Google Scholar 

  • Lamb DH, Catanzaro SJ, Moorman AS. A preliminary look at how psychologists identify, evaluate, and proceed when faced with possible multiple relationship dilemmas. Prof Psychol Res Pract. 2004;35:248–54.

    Article  Google Scholar 

  • Linzmayer C. Integrated human services in rural areas: a social work approach. Rural Soc Work. 2003;8:25–37.

    Google Scholar 

  • McDonald TW, Harris SM, Leesurier EA. Mental health care issues in a predominantly rural and frontier state: results and implications from a comprehensive survey. J Rural Community Psychol. 2005;E8(1):99–108.

    Google Scholar 

  • McIlwraith RD, Dyck KG. Strengthening rural care – the contribution of the science and practice of psychology. ISBN#: 1-896538797. Ottawa: Canadian Psychological Association; 2002.

    Google Scholar 

  • McIlwraith RD, Dyck KG, Holms VL, Carlson TE, Prober NG. Manitoba’s rural and northern community-based training program for psychology interns and residents. Prof Psychol Res Pract. 2005;36:164–72.

    Article  Google Scholar 

  • Meyer D, Hamel-Lambert J, Tice C, Safran S, Bolon D, Rose-Grippa K. Recruiting and retaining mental health professionals to rural communities: an interdisciplinary course in Appalachia. J Rural Health. 2005;21:86–91.

    Article  PubMed  Google Scholar 

  • Moleski SM, Kiselica MS. Dual relationships: a continuum ranging from the destructive to the therapeutic. J Couns Dev. 2005;83:3–11.

    Article  Google Scholar 

  • Morrissey S, Reddy P. Maintaining ethical practice and ethical mindedness. In: Morrissey S, Reddy P, editors. Ethics and professional practice for psychologists. Melbourne: Thomson; 2006. p. 163–70.

    Google Scholar 

  • Morrissey S, Symons M. Teaching ethics for professional practice. In: Morrissey S, Reddy P, editors. Ethics and professional practice for psychologists. Melbourne: Thomson; 2006. p. 50–62.

    Google Scholar 

  • Nelson W, Lushkov G, Pomerantz A, Weeks WB. Rural health care ethics: is there a literature? Am J Bioeth. 2007a;6:44–50.

    Article  Google Scholar 

  • Nelson W, Pomerantz A, Howard K, Bushy A. A proposed rural healthcare ethics agenda. J Med Ethics. 2007b;33:136–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Nigro T, Uhlemann M. Dual relationship in counselling: a survey of British Columbian counsellors. Can J Couns. 2004;38:36–53.

    Google Scholar 

  • O’Kane A, Tsey K. Towards a need based mental health resource allocation and service development in rural and remote Australia. Australas Psychiatry. 2004;12:390–5.

    Article  PubMed  Google Scholar 

  • Perkins D, Larsen K, Lyle D, Burns P. Securing and retaining a mental health workforce in Far Western New South Wales. Aust J Rural Health. 2007;15:94–8.

    Article  PubMed  Google Scholar 

  • Peterson ZD. More than a mirror: the ethics of therapist self-disclosure. Psychother Theory Res Pract Train. 2002;39:21–31.

    Article  Google Scholar 

  • Preskill H. The use of critical incidents to foster reflection and learning. Hum Resour Dev Q. 2006;7:335–47.

    Article  Google Scholar 

  • Reber AS, Reber E. The Penguin dictionary of psychology. 3rd ed. London: Penguin Books; 2001.

    Google Scholar 

  • Ridgeway RB. Ethics dilemmas in forensic psychology: a comparison of practitioner choices in rural and urban settings. Diss Abstr Int. 2005;66(8-B):4499.

    Google Scholar 

  • Roberts LW, Battaglia J, Epstein RS. Frontier ethics: mental health care needs and ethical dilemmas in rural communities. Psychiatr Serv. 1999;50:497–503.

    Article  CAS  PubMed  Google Scholar 

  • Roberts LW, Warner TD, Hammond KG. Ethical challenges of mental health clinicians in rural and frontier areas. Psychiatr Serv. 2005;56:358–9.

    Article  PubMed  Google Scholar 

  • Roufeil L, Lipzker A. Psychology services in rural and remote Australia. InPsych. 2007;29(5):8–11.

    Google Scholar 

  • Sawyer D, Gale J, Lambert D. Rural and frontier mental and behavioural health care: barriers, effective policy strategies, best practices. Waite Park: National Association for Rural Mental Health; 2006.

    Google Scholar 

  • Schank JA, Skovholt TM. Dual-relationship dilemmas of rural and small-community psychologists. Prof Psychol Res Pract. 1997;28:44–9.

    Article  Google Scholar 

  • Schank JA, Skovholt TM. Ethical practice in small communities: challenges and rewards for psychologists. Washington, DC: American Psychological Association; 2006.

    Book  Google Scholar 

  • Schopp LH, Demiris G, Glueckauf RL. Rural backwaters or front-runners? Rural telehealth in the vanguard of psychology practice. Prof Psychol Res Pract. 2006;37:165–73.

    Article  Google Scholar 

  • Scopelliti J, Judd F, Grigg M, Hodgins G, Fraser C, Hulbert C, Endacott R, Wood A. Dual relationships in mental health practice: Issues for clinicians in rural settings. Austral New Zeal J Psychiat. 2004;38:953–959.

    Google Scholar 

  • Sinclair C, Pettifor J, editors. Companion manual to the Canadian code of ethics for psychologists. 3rd ed. Ottawa: The Canadian Psychological Association; 2001.

    Google Scholar 

  • Smith AJ. Rural mental health counseling: one example of practicing what the research preaches. J Rural Community Psychol. 2003;E6(2):13–31.

    Google Scholar 

  • Staal MA, King RE. Managing a multiple relationship environment: the ethics of military psychology. Prof Psychol Res Pract. 2000;31:698.

    Article  Google Scholar 

  • Stamm BH, Lambert D, Piland NF, Speck NC. A rural perspective on health care for the whole person. Prof Psychol Res Pract. 2007;38:298–304.

    Article  Google Scholar 

  • Thorngren JM. Rural mental health: a qualitative inquiry. J Rural Community Psychol. 2003;E6(2):158–168.

    Google Scholar 

  • Truscott D, Crook KH. Ethics for the practice of psychology in Canada. Edmonton: University of Alberta Press; 2004.

    Google Scholar 

  • Turchik JA, Karpenko V, Hammers D, McNamara JR. Practical and ethical assessment issues in rural, impoverished, and managed care settings. Prof Psychol Res Pract. 2007;38:158–68.

    Article  Google Scholar 

  • Van Vliet KJ. Interdisciplinarity and counselling psychology research: challenges and opportunities. Paper presented at the annual conference of the Canadian Psychological Association, Montreal; 2009, June.

    Google Scholar 

  • Weigel DJ, Baker BG. Unique issues in rural couple and family counselling. Fam J. 2002;10:61–9.

    Article  Google Scholar 

  • Wihak C, Merali N. Adaptations of professional ethics among counselors living and working in a remote native Canadian community. J Multicult Couns Dev. 2007;35:169–81.

    Article  Google Scholar 

  • Womontree M. Ethical concerns common to small community and rural mental health practice. Unpublished doctoral dissertation, The Adler School of Professional Psychology, Chicago, Illinois, United States of America; 2004.

    Google Scholar 

  • Wood JAV, Miller TW, Hargrove DS. Clinical supervision in rural settings: a telehealth model. Prof Psychol Res Pract. 2005;36:173–9.

    Article  Google Scholar 

  • Yonge O, Grundy Q. Managing dual role relationships in rural settings. CAP Monit. 2006;24:2–4.

    Google Scholar 

  • Younggren JN, Gottlieb MC. Managing risk when contemplating multiple relationships. Prof Psychol Res Pract. 2004;35:255–60.

    Article  Google Scholar 

  • Zur O. Therapeutic boundaries and dual relationships in rural practice: ethical, clinical and standard of care considerations. J Rural Community Psychol. 2006;E9:1–36.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. PAA Psychologists’ Association of Alberta, Edmonton, AB, Canada

    Judi L. Malone

Authors
  1. Judi L. Malone
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Judi L. Malone .

Editor information

Editors and Affiliations

  1. Institute of Global Health Equity Research, University of Global Health Equity, Kigali, Rwanda

    Timothy A. Carey

  2. Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia

    Judith Gullifer

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Singapore Pte Ltd.

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Malone, J.L. (2021). Professional Ethics in Rural Practice: Relational Territory. In: Carey, T.A., Gullifer, J. (eds) Handbook of Rural, Remote, and very Remote Mental Health. Springer, Singapore. https://doi.org/10.1007/978-981-15-6631-8_7

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-6631-8_7

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-6630-1

  • Online ISBN: 978-981-15-6631-8

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation