Challenges for Developing Therapist - Practicing in Rural Areas

Dual Relationships? Double Relationships? Boundaries? Competency? Ethical Dilemmas? It’s hard to know the black and white line of these things, when you are practicing in rural MN.

When I go to the local coffee shop to grab a cup of coffee, odds are that my barista is a current client, previous client, a friend, or a family member of a current/previous client. When I go to a restaurant to eat with my family or friend’s odds are the hostess, bartender or waitress is one of these as well. If that person was a hostile client or didn’t like your services, odds are you are not going to want to drink that coffee or eat that food. When I go to Walmart, Target or the local grocery store, odds are you will run into a client or two. As many of us know, our clients are not shy; they will approach to say hi and chit chat about what is going on in their life since they last saw you. Sometimes you don’t want your male client staring at that box of tampons sitting right on top of your cart, but that’s life as a practitioner in rural MN. This is a normal phenomenon that happens on a regularly basis, not something that happens once a year.

Where does the community go for help? It’s not practical or feasible for low income, poverty ridden families to take an entire day off of work every week to be able to travel outside of their community to see a provider that doesn’t know their family name or a family friend. Further, many individuals in rural MN struggling with mental health, do not have the luxury of a vehicle or public transportation so they are dependent on volunteer drivers, their own two feet, the city bus (if the community has one), or friends/family to bring them to appointments. I have client’s that travel 50 miles one way for an appointment because there are no providers closer to them for services. I have client’s that walk 5 miles one way to get to an appointment because they have no other form of transportation. Although some are allowed volunteer drivers through their insurance, many turn this away for the simple fact of a dual relationship. I understand! Who wants the person that gives them communion at church to be the person driving them to their chemical dependency treatment? They are already ashamed enough of themselves, they don’t want to put themselves in the place of public shaming.

Dual relationships are impossible to avoid at times in rural MN. After all, where does the Pastor go when he is struggling with marital issues? He calls you. Where does the Doctor go when their teenager’s behaviors have become out of control? They call you. Where does the Dentist go when they are struggling with grief and loss? They call you. How about when your local co-rec volleyball or softball league needs a sub player for the week and one of your teammates finds someone that is a previous or current client? You smile and play the game. Or when the opposing team has a current or previous client playing with them and you accidently spike the ball in their face or pitch a ball into their leg? It puts a whole different dynamic on just living your life when you are rural practitioner. When you go to the gym, and you are mid-sweat only to look to your left and see one of your client’s that pushes boundaries sits down on the machine next to you and starts chatting about therapy related stuff. When you go to your cousin’s wedding, and several clients are sitting in the room…of course they see you. This might put a damper on your own personal enjoyment of what is meant to be a beautiful event. When you go to your friend’s baby shower and another client is there that you never knew was friends with your friend. This might put a damper on this intimate moment. This is the kind of stuff that happens on a regular basis in a rural practitioner’s life that grad school never teaches them how to deal with.

Tips to deal with dual relationship:

1. Don't acknowledge them unless they acknowledge you

2. Don't introduce them to whoever you are with

3. Give a smile or a say hi and keep moving

4. Remember it's as uncomfortable for them as you

5. Share your tips with me and I'll add them here!