Having grown up in small north-central Iowa town (population 2400), I can totally identify with the Nickel premise that extra-therapeutic contact “is not only unavoidable at times, but, under certain conditions, even uniquely beneficial.” (Nickel, 2004, p. 17) Smaller communities are indeed more interdependent, inevitably leading to situations where there are simultaneous overlapping relationships. In a town the size of Eagle Grove it is a foregone conclusion that if you work with anyone in the community, you know most if not all of the significant others in that person’s life. We used to joke that it was “unusual if a neighbor didn’t take note of what color underwear you were wearing today.” The reality is that the closest hospital, or referral source for mental health treatment, would be 30 miles away. That’s an insurmountable distance for some people who need access to local mental health facilities.
I wholeheartedly agree with the statement that “rural culture often upholds the prevailing notions that outsiders are not to be trusted, and that a community should care for its own. (Nickel, 2004, p. 19) I submit that it would be extremely difficult to a therapist to be successful in the absence of such multiple relationships, because it is those relationships that foster the foundation of the working relationship needed to make lasting progress in a mental health setting. In any case, there are systemic risk assessments that should likely be engaged in. “Age, diagnosis, life experiences such as abuse, and culture are key elements that need to be considered in establishing boundaries.” (Corey, Schneider-Corey, & Callanan, 2007, p. 282)
Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.
Nickel, M. (2004). Professional boundaries: The dilemma of dual & multiple relationships in rural clinical practice. Counseling and Clinical Psychology Journal, 1(1), 17-22. Retrieved from http://web.ebscohost.com.ezproxy.bellevue.edu/ehost/pdfviewer/pdfviewer?vid=2&hid=17&sid=1c482e9f-e9cf-44cc-a08d-39a86f74b8f3@sessionmgr10