Professional Practice out of the Urban Context: Defining Canadian Rural Psychology
Malone, Judi L., Canadian Psychology
There is an often unacknowledged difference between urban and rural practice in psychology which lacks clarity, in part, because of the lack of a common definition of rurality. Rural psychology in Canada presents complex and nuanced aspects of professional practice. The professional and social milieus of rural communities position the practising psychologist within a context that may differ vastly from urban settings. The rural context highlights the need to define this specific practice setting. This paper proposes a tentative definition of rural Canadian professional practice in psychology. This is meant to elucidate the distinct practice, training, and ethical considerations that may be the realities of the psychologists who are in professional practice in rural Canada. Rural professional practice is unique and Canadian training programs are urban-based. Training of future psychologists needs to acknowledge the unique features of rural practice to meet our obligations to students specifically and to rural Canadians generally. This is enhanced with a shared definition of rural professional practice in psychology.
Keywords: professional practice, rurality, professional ethics, Canadian psychology
Communities and peoples differ across contexts and small communities are a vibrant part of the fabric of Canadian society. Small communities can be defined by culture, professional experience, geographical separation, and of course, rurality. In most small communities, providers of psychological services will experience overlapping relationships and difficulties in separating formal and informal community participation (Schank & Skovholt, 2006). Psychology in Canada tends to reflect urban-centricpolicies typical in North America which may not be responsive to the rural context (Jameson & Blank, 2007; Misener et al., 2008). This has implications for the availability of rural-specific formal training, research, and literature. Psychologists need to acknowledge the unique features of rural practice to meet our obligations in training psychologists and for psychology to contribute to rural Canadians generally. This is enhanced with a shared definition of rural professional practice in psychology.
There is a need to define rural practice in its complexity. The literature does not coalesce around a standard definition of rural practice in psychology. Definitions that do exist focus on population and distance. In empirical studies operational definitions ranged from communities of 2500 to under 20000 people or by distance such as 50 kilometres from an urban centre (Bazana, 1999; du Plessis, Beshiri, Bollman, & Clemenson, 2001; Ministry of Rural Affairs, 2000). The defining characteristics of rurality became an issue in a study of medical students in the United Kingdom. In that study, "What is rural?" became an unintended theme of the research (Deaville et al., 2009). Indeed, the authors concluded that degree of rurality, or what is rural, "will mean different things to different people, depending on their background" (Deaville et al., 2009, p. 1165).
A better articulated definition of rural professional practice in psychology is needed but will be difficult to achieve. My collaborations with rural psychologists from across the country have highlighted the variability in rural cultures and communities. How can we compare such diverse rural communities and come up with a suitable definition of rural practice? Can there really be engaged discussion on professional ethics in such a poorly defined context? Although the issues identified for small communities are not exclusive to rural communities, this paper will focus on the needs, practice considerations, and sensitivities specific to rural Canadian communities as these impact professional practice. This is particularly prudent as about 20% of the Canadian population is rural (Barbopoulos & Clark, 2003; Harowski, Turner, LeVine, Schank, & Leichter, 2006). The purpose of this paper is to propose a more uniform definition of what rural Canadian psychological practice is, illuminating practice, training, and ethical considerations.
This paper begins by highlighting issues specific to rural communities and people, explore the implications for psychology in rural practice in Canada, then proposes a definition based on commonalities for psychology in rural Canadian practice. This is done by drawing on themes in relation to existing literature, personal experience in rural professional practice and in national collaborations on ethics, and my own research on professional ethics in rural practice (Malone, 2010). The resulting definition explores the phenomenon in a way that represents one of many possible perspectives. The literature helps begin to frame this discussion but collectively Canadian psychology can develop a holistic profession-centred definition to better understand and foster rural professional practice.
Rural Communities & Peoples
There is so much diversity among rural settings and people that characterising these communities is difficult. This means studying a group with great heterogeneity. The "geographic diversity in Canada accounts somewhat for these distinctions, as evidenced by coastal towns and fishing villages of the east and west coasts, rural farming and lumbering communities, rolling prairie lands, and northern isolated communities set on the tundra and Cambrian shield" (Moffit et al., 2009, p. 1156). That said, distinct concerns and characteristics of rural people have been proposed. Research has shown that the prevailing idea of idyllic stress-free rural life is an urban myth (Barbopoulos & Clark, 2003; Pong, 2007; Zapf, 2001). In fact, Jameson and Blank (2007) have suggested that rural people be considered a vulnerable group of people. International and national changes in economies, politics, and ecology have created disadvantages for rural people (Cheers, 2001; Pong, 2007), increasing their needs and decreasing their ability to serve their community members (Jameson & Blank, 2007). Recent research by Sanderson (2004), for example, found that rural Canadian farmers appeared to be losing hope in farming. Key forces in shaping rural communities have been geographic isolation, social and economic factors, rapid changes to rural areas, and the culture of rural people. Isolation creates significant service disparity for rural communities (Barbopoulos & Clark, 2003; Harowski et al., 2006), yet being isolated does not protect rural communities from the impact of national and world events (Cheers, 2001). Rural communities experience more economic hardship and report higher levels of unemployment or underemployment than their urban counterparts (Barbopoulos & Clark, 2003; Jameson & Blank, 2007). There is more poverty among rural people than inner-city residents, especially for women and children (Harowski et al., 2006). Poverty has been shown to increase the likelihood of mental distress for rural people (Pong, 2007; Stamm, Lambert, Piland, & Speck, 2007). Certainly, this appears to imply that there are distinct concerns for rural people. However, in many of the studies reviewed it was difficult to tell how rural and urban groups were matched and how variables were controlled. Many of the articles appeared to be well informed opinion of cultural analysis. Others appeared to compare rural and urban characteristics.
In considering common characteristics, it has been implied that rural communities and their psychological service needs have been changing (Barbopoulos & Clark, 2003). In addition to their geographical diversity, rural populations are becoming more diverse. Numbers of aging rural residents are growing, younger rural residents are migrating to urban centres (Barbopoulos & Clark, 2003; Jameson & Blank, 2007; Harowski et al., 2006), and there are increasing numbers of immigrants and refugees to rural areas (Hargrove, 2007; Harowski et al., 2006). In some areas, community dynamics are being further altered by an influx of employment-mobile urban families seeking rural lifestyles (Hargrove, 2007). Given this diversity, the notion of a homogeneous "rural culture" has been questioned. Yet, the literature consistently suggests that psychologists be sensitive to traits considered common in rural populations. These include stoicism, conservatism, interconnection with others, and being from marginalized groups (Barbopoulos & Clark, 2003; Harowski et al., 2006; Jameson & Blank, 2007; Judd et al., 2006). The risk in this "sensitivity" is that rural people are aggregated into one group and defined only by their difference from urban populations. This could foster stereotypes that do not consider variability.
One example is the stigma concerning mental disorders in Canada (Cohen, 2009). This is presumed to be worse in rural areas due to socially influenced or collective attitudes toward mental illness in rural communities (Jackson et al., 2007). Some literature has suggested that rural residents report higher levels of pride, independence, and stoic behaviour (Harowski et al., 2006; Judd et al., 2006; Sanderson, 2004; Stamm et al., 2007). However, no causal empirical evidence was found to suggest that this translates directly into mental health stigma. Research has shown that rural people tend to be less aware of mental health issues and seek help less often (Jackson et al., 2007; Stamm et al, 2007). What accounts for this paucity in mental health awareness and helpseeking is not readily apparent.
One explanation is the perception that these communities are "closer knit" and, therefore, are less responsive to labeling mental health issues and see individual concerns as community considerations. If this is true, then perhaps there are social functions to the stigma against help-seeking in rural areas that foster a greater emphasis on family, individualism, and fatalism (Barbopoulos & Clark, 2003; Harowski et al., 2006; Jackson et al., 2007; Jameson & Blank, 2007). Further, rural communities have a vibrancy that contributes to the safety net of rural people. This helps people to connect and endure in trying times, giving people hope, and building successful communities (Harowski et al., 2006; Schank & Skovholt, 2006; Vella-Brodrick, Judd, Scannett, & Burney, 2006). Perceptions of rural health needs may underestimate the beneficial impact of informal community services, greater community involvement, and the capacity that derives from collective values (Sanderson, 2004; Vella-Brodrick et al., 2006).
There are other features of rural communities that may negatively impact mental health. Enhanced social connectedness may foster a "goldfish bowl phenomenon" as community members expect to know more about each other which decreases privacy and increases community pressure (Barbopoulos & Clark, 2003; Harowski et al., 2006). There can be a sense of isolation created by limited access to services and resources, social relationships, and increased difficulties in accessing services and necessities (Barbopoulos & Clark, 2003). Characteristics are difficult to empirically validate but two characteristics of rural communities were studied more thoroughly. In a comparative study in Australia, remoteness of communities was associated with increased reports of psychological distress (Vella-Brodrick et al., 2006). The second consideration from Canada was that Aboriginal people have very high rates of serious mental health concerns and the proportion of Aboriginal peoples living in rural areas is greater than for Canadians in general (approximately 40% vs. 20%; Peters, 2001). Aboriginal Canadians are culturally marginalized and profoundly socially disadvantaged which makes them more sensitive to economic problems and the inadequate and inequitable mental health services in rural areas (Barbopoulos & Clark, 2003; Romanow & Marchildon, 2003). For these reasons, rural practitioners should be prepared to work with Aboriginal clients. Overall, there are distinct mental health issues in rural areas but an inconclusive understanding of the characteristics of rural communities and people.
Psychological Practice in Rural Canada
What is rural Canadian professional practice in psychology? There are many considerations. Do we consider the residence of the psychologist or only where they practice? Some Canadian psychologists live and work in urban centres but occasionally commute to rural communities for work. Some may have worked in rural communities in the past. And, what of the researchers interested in rural practice? Breadth in perspective means considering a variety of national settings and a range of communities of practice in defining rural practice. There is the standard Statistics Canada definition, the flexible benchmark, of communities of less than 10 000 people that are also outside of the commuting zone of an urban centre (du Plessis et al., 2001). There are also rural Canadian psychologists who self-identify as "rural". These professionals may be intimately familiar with the distinct variables of the communities but may not meet that specific criterion. What about semiurban communities (of less than 40 000 people) that are geographically isolated and have service limitations more consistent with smaller rural communities? The communities and peoples of Canada vary greatly across the provinces and territories and rural psychologists may work with multiple communities of varying sizes and localities.
Perhaps rural professional practice is not clearly understood because of the urban-centric nature of psychology and many other professions in Canada (Misener et al., 2008). Despite one fifth of our population living in rural areas, Canada is considered to be an urbanized country (Barbopoulos & Clark, 2003; Harowski et al., 2006). Most Canadian psychology students receive no formal training or exposure to rural practice considerations (Barbopoulos & Clark, 2003; Mcllwraith, Dyck, Holms, Carlson, & Prober, 2005) and "current training models in graduate psychology are out of touch with the practice demands of rural psychologists" (Harowski et al., 2006, p. 1 58). Institutions have an obligation to train students well (Jones, 2008), and because one fifth of the Canadian population is rural, that includes training students to work effectively in rural communities.
Practice characteristics contextualize the psychologists' experience of professional ethic and foster the conditions which may make certain ethical issues more prevalent, complicated, or even less easily resolved. There is a need to better understand rural professional practice in order to understand professional ethics in that setting. Although the underlying ethical issues may be similar between rural and urban settings they may well manifest in different ways in rural communities. While ethical issues may be fundamentally common, they take on different complexions and complexities in rural settings which beget a better understanding of rural professional practice in psychology.
There are several adaptations of professional practice norms that may be necessary to accommodate geographic barriers and resource limitations in rural practice. Some adaptations may be required to mediate geographic barriers. One example is providing telephone services as a regular means of dealing with geographic distances. Telephone services may mean increased access but may also mean decreased nonverbal communication and increased levels of anonymity (Suzuki, Ahluwalia, Kwong, & Mattis, 2007). Another way to mediate geographic barriers is travel. Rural psychologists may be required to travel to fulfill their professional role raising questions in relation to transporting and storing files.
Another adaptation related to travel is practice in non-normative practice settings. Travel may mean that the rural Canadian psychologist works in borrowed office space with a community agency or within a community medical clinic. There may be benefits to shared office spaces for increasing communication or being more accessible to the community. There are also salient risks of shared office space, namely confidentiality, and securing client files and psychological materials. Another variation to typical professional practice may be to provide services in the client's home. This setting has potential boundary risks for both clients and psychologists and may be perceived as inappropriate. However, appropriate service delivery in such settings may provide valuable naturally occurring clinical information and increase client comfort levels, both of which may provide enhanced assessment and service delivery. Additionally, videotaping these sessions with consent or having a team approach to such visits further minimizes the chance of client exploitation or perception of same for the psychologist (Malone, 2010).
Another adaptation to urban-centric practice norms is when service delivery is tailored to the needs of rural consumers. Rural Canadian psychologists need an awareness of the impact of rural norms for conducting assessments and may find a need for rurally relevant assessment protocols. And, what of practice conditions that do not have any established protocols? There are Canadian federal contracts to provide short-term intensive psychological services for clients with significant geographical barriers to service access. These kinds of practice scenarios both force and require variations to normative standards for assessment and treatment in rural practice. Consequently, the rural practitioner may need to adopt innovative practices that are not supported by the conservative evidence-based literature. This can raise a variety of ethical issues.
Finally, social justice is a salient consideration in the provision of ethical services to rural people and communities. There may be a need to advocate for socially appropriate services and to assess the systemic interventions in place to deliver appropriate services in rural areas. This may include the need to advocate for rural communities and peoples or advocacy efforts directed at poverty in rural areas. The rural practitioner may need to be aware of systemic processes in rural communities, the impact of poverty, and how their professional role can impact these social conditions.
There was little formal literature that reflected adaptations of professional practice norms to accommodate rural practice considerations such as mediating geographic barriers, practising in nonnormative settings, or tailor urban-centric practice norms to rural needs. This appears to be an area where more study is required and this lack of discussion in the literature creates a certain vulnerability and professional isolation for rural psychologists. Required practice accommodations without norms may leave rural psychologists vulnerable because of the atypical nature of such practices.
The fourth adaptation or consideration, social justice, was represented in the literature and is more frequently being considered in Canadian psychology (Cohen, 2009; Pope & Arthur, 2009). Social justice may be particularly relevant in rural Canada because of the poorer socioeconomic conditions of rural Canadians (Pong, 2007; Romanow & Marchildon, 2003) which speaks to the nature of the practice in these settings. Indeed, "social care is embedded in place, by which we mean the social relations that determine who provides what are closely connected with the physically bounded settings of meaning and interaction in which these activities and relations occur" (Hanlon, Halseth, Clasby, & Pow, 2007, p. 466). If this is true, then rural practice itself may foster such views or, alternatively, attract the kind of psychologist who has social advocacy as an area of focus. Recent research has indicated that rural practitioners are likely to participate hi social advocacy for their communities (Boydell, Stasiulis, Barwick, Greenberg, & Pong, 2008; Larson & Jones, 2009). There is more need for such advocacy for the economically disadvantaged (Pope & Arthur, 2009, p. 62) which, unfortunately, means many of Canada's rural people.
Articulating a Shared Definition
What is rural? Answering that question is a daunting task. Having attended national and international conferences and presentations focusing on rural health and research I have been struck by how this very substantive question is rarely explored. The multidimensional concept of rurality has not yet been adequately defined to the requirements of all users and may never be (Muula, 2007; Stamm et al., 2007). Armstrong (2008) makes the point that "only when definitions are clear can the role of rurality in relation to mental health and well-being truly be understood and lead to meaningful community-based intervention" (p.7). Rural areas tend to be defined as areas that are not urban (Stamm et al., 2007), by population size (Zapf, 2001), or by remoteness (Muula, 2007) and many authors have called for more adequate descriptors (Armstrong, 2008; du Plessis et al, 2001; Harowski et al., 2006; Jameson & Blank, 2007; Judd, 2006). The difficulty in conceptualising rural lies in part in the increasing diversity and ongoing economic and social changes in rural areas (Barbopoulos & Clark, 2003; Jameson & Blank, 2007; Harowski et al, 2006). What is needed is an adequate definition that captures the diverse characteristics of rurality specific to professional practice in psychology. This would foster research and program development, ensure that the needs of rural people are not missed or marginalized, and validate research in rural practice. Research has suggested that such a definition should incorporate key characteristics such as: access to health care, services, and amenities (Muula, 2007; Stamm et al., 2007; Zapf, 2001), the distinct rural lifestyle or culture (Armstrong, 2008; du Píessis et al., 2001; Harowski et al., 2006), geographic disparity from urban centres (du Plessis et al., 2001; Harowski et al, 2006), and any distinct socioeconomic concerns (Jameson & Blank, 2007; Judd, 2006).
Multiple considerations such as these imply that a common definition would indeed be difficult to achieve. Perhaps this is why there are no consistent government or agency definitions in Canada (du Plessis et al, 2001). The Ministry of Rural Affairs' (2000) definition includes locations where more than half of the people live in communities with a population density less than 150 people per square kilometre. For medical issues, the Canadian government uses the General Practice Rural Index which indexes rurality according to: remoteness from the closest advanced referral centre, remoteness from the closest basic referral centres, drawing population or size of service area, number of general physicians and specialists, and presence of an acute care hospital. This definition is not as useful outside of a medical application due to its specificity (Muula, 2007). The CPA supported defining rural communities as those with less than 25 000 people that are at least 50 kilometres from a larger urban area (Bazana, 1999). The commuting distance in this definition is a concern as 50 kilometres can easily be a commuting zone or even suburb of an urban area. Finally, Statistics Canada has recommended that the definition of rural depends on the characteristics one is examining, such as economic or social variables, but advises using defined benchmarks. The suggested benchmarks are those living in communities of less than 10 000 people that are also outside of the commuting zone of an urban centre (du Plessis et al., 2001). They do not define what a commuting zone might be.
What about a professional perspective? Psychology is well positioned to consider professional practice needs for a range of allied health practitioners in rural practice. If we, as a profession, further clarify what is psychology in rural practice this may provide important benchmarks valuable beyond our own professional use. Variables such as population size, isolation, economic activity, and social systems are important determinants of rurality (Stamm et al., 2007; Zapf, 2001) overall and in consideration of our profession. Given the complexities of understanding these communities, we should also consider what psychologists themselves may consider rurality. Rural psychologists may self-identify as "rural" or they may meet any of the criteria that exist in the various definitions of Canadian rurality.
In this paper I take the view that it is useful to articulate a definition of rural professional practice in psychology that draws attention to the links between practice parameters and professional ethics. Any definition of rural is more than a static description and should consider a series of content domains that describe dimensions of rurality. Any description of rural professional practice in psychology for Canada should consider the potential demographics of rural Canadian psychologists, the need to articulate a definition, and what may be common features of rural practice.
What are the demographics of rural Canadian psychologists in professional practice? That is difficult to articulate without a definition and also required for us to articulate a definition. Given the paucity of literature, we may assume mat there is a tendency to be in generalist practice, a need to work with diverse age groups, and the requirement to find ways to bridge geographical barriers to service provision and practice in ways that reflected the limited resources common in rural areas (Barbopoulos & Clark, 2003; Schopp, Demiris, & Glueckauf, 2006). There is a concern about including criteria sufficiently stringent to determine rurality, particularly in consideration of size and location variables. And what about distinguishing between psychologists who live in a rural setting and those who commute from an urban location to a rural community? Rural psychologists who live in their community of practice work in embedded environments (Haydar, 2007; Scopelleti, et al., 2004). There are social and contextual differences between rural and urban Canada and how residential location may impact professional experience. The rurally based psychologist is often expected to Uve up to assumptions made through active informal communication networks and needs to gain the trust of community members and leaders by being in a professional role at all times within the community (Helbok, 2003; Schank & Skovholt, 2006; Scopelliti et al., 2004). There is also a balancing act between client and community needs that likely heightens the cultural and contextual dimensions inherent in rural practice (Roberts, Warner, & Hammond, 2005).
Given the importance of context and practice characteristics for understanding professional ethics, the following is a proposed a definition of rural Canadian professional practice in psychology. To conceptualise this in an accessible way, the model used is one commonly understood and used by many Canadian psychologists - the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). The DSM-IV structure is useful as it provides definitional clarity. DSM-IV descriptions list alternative terms in parentheses and includes specifiers. This structure implies that key features or criteria co-occur and manifest in various ways. This allows for variation of criteria to meet the conditions of the definition (APA, 1994). A proposed definition within that model is presented in Table 1 and was grounded in the literature and experience in rural professional practice of psychology in Canada.
The first two criteria in the required subset (a) define the community size and remoteness. The third criterion in subset (a), resources, represents a common feature of rurality in the literature (Muula, 2007; Stamm et al., 2007; Zapf, 2001). Statistics Canada provides regional socioeconomic context ratings in publications such as their Rural and Small Town Canada Analysis Bulletin. An example is the article, "Mapping the Socioeconomic Diversity of Rural Canada" available in that publication (Alasia, 2004). The second requirement, (b), reflects the experience of this author and the assertion from the literature that generalist practice is common in rural practice (Harowski et al., 2006; Helbok, 2003). The third requirement, (c), reflects some of the adaptations that are more likely in rural professional practice. The final requirement, (d), highlights how ethical dilemmas may manifest differently in rural settings because of those preceding conditions used to define rural Canadian professional practice in psychology.
This paper is meant as a study of professional practice in psychology specific to rural Canada. Although the proposed definition of Canadian rural psychology in this paper is not definitive it should and can be a springboard for further discussion and consideration that might set the stage for an in-depth interpretive examination of this issue.
Attempting to foster a comprehensive definition has limitations. I acknowledge that I am not a passive observer and cannot present an objective reality of rural professional practice. As a rural psychologist, this author is an active agent seeking a greater understanding of this setting by examining some of the pieces of this puzzle. Multiple perspectives and collaboration with researchers with differing expertise is how we will truly define rural professional practice in Canadian psychology and assist us in better representing the lived experiences of rural Canadian psychologists. This will undoubtedly add to the knowledge field, nationally and internationally, fostering a greater understanding of rural practice and professional ethics in that context. Current research and practice exists without agreed definitions of rurality or rural professional practice in psychology. This is particularly relevant in Canada where 20% of the population is rural. Canadian literature on rural practice is limited and Canadian psychology is urbanized. A better understanding of the experiences of professional psychologists in rural practice may well be quintessentially Canadian and, as such, useful for training and development of Canadian psychologists. This needs to begin with a definition to posit a possible framework for understanding the key factors that underlie rural practice. These factors are highlighted in Table 1 -Defining Rural Canadian Psychology. Rather than just representing a definition, it is a useful framework for conceptualising professional ethics in rural Canadian psychology. This shared definition implies that it is characteristics of the community interacting with the generalist nature of practice and adaptations to the size and remoteness of the community that gives rise to ethical dilemmas.
Jean Pettifor (2004) said that "there are many paths to follow in the creation of knowledge" (p. 1 1 ). This paper creates a foundation for further study with impetus for research to define rural professional practice in psychology. An adequate definition would capture the diverse characteristics of rurality and foster research and program development by providing a shared understanding of what is rural for psychologists. Qualitative studies could gather understanding about the meaning of rurality to develop potential definitions. Quantitative studies could test these theories, comparing definitions and measuring the responsiveness of psychologists to these definitions. What was presented here was a way to begin that process.
Rural professional practice is unique and Canadian training programs are urban-based. Training of future psychologists needs to acknowledge the unique features of rural practice to meet our obligations to students specifically and to rural Canadians generally. This is enhanced with a shared definition of rural professional practice in psychology.
Il existe une différence souvent non reconnue entre l'exercice de la psychologie en milieu urbain et en milieu rural, laquelle manque de clarté, en partie, en raison de l'absence d'une définition commune de « ruralité ». La psychologie en milieu rural au Canada présente des aspects à la fois complexes et nuancés de l'exercice professionnel. Les milieux professionnels et sociaux des communautés rurales positionnent le psychologue praticien dans un contexte qui peut grandement différer de celui d'un milieu urbain, et il importe de le définir. Le présent article propose une définition possible de l'exercice de la psychologie en milieu rural au Canada. L'objectif visé est de cerner les particularités dans les pratiques, la formation et les considérations éthiques qui peuvent constituer les réalités des psychologues exerçant dans les milieux ruraux du Canada. L'exercice en milieu rural est distinct, et les programmes de formation au Canada se fondent sur la pratique en milieu urbain. La formation des futurs psychologues doit tenir compte des particularités de l'exercice en milieu rural si nous voulons satisfaire à nos obligations envers les étudiants et l'ensemble des communautés rurales du Canada. Une définition commune de l'exercice de la psychologie en milieu rural contribuera à l'atteinte de cet objectif.
Mots-clés : exercice de la profession, ruralité, déontologie, psychologie au Canada.
Alasia, A. (2004). Mapping the socio-economic diversity of rural Canada. In Rural and Small Town Canada Analysis Bulletin, 5 (Catalogue No. 21-006-XIE2003002, pp. 1-36). Ottawa, Ontario: Statistics Canada.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.
Armstrong, L. L. (2008). Speaking a common language: A framework for a youth-friendly definition of rurality in Canadian mental health literature. The View from Here: Perspectives on Northern and Rural Psychology, 3, 7.
Barbopoulos, A., & Clark, J. M. (2003). Practising psychology in rural settings: Issues and guidelines. Canadian Psychology, 44, 410-424.
Bazana, G. (1999). Geographical locations survey of registered psychologists in Canada (Research Monograph). Ottawa, Ontario, Canada: Canadian Psychological Association.
Boydell, K. M., Stasiulis, E., Barwick, M., Greenberg, N., & Pong, R. W. (2008). Challenges of knowledge translation in rural communities: The case of rural children's mental health. Canadian Journal of Community Mental Health, 27, 49-63.
Cheers, B. (2001). Globalisation and rural communities. Rural Social Work, 6, 28-140.
Cohen, K. R. (2009, Summer). Advocacy-? gap and opportunity for the science and practice of psychology. Psynopsis, 31, 3.
Deaville, J. A., Wynn-Jones, J., Hays, R. B., Coventry, P. J., McKinley, R. K., & Randall-Smith, J. (2009). Perceptions of UK medical students on rural clinical placements. Rural and Remote Health, 9, 1 165.
du Plessis, V., Beshiri, R., Bollman, R. D., & Clemenson, H. (2001). Definitions of rural. In Rural and Small Town Canada Analysis Bulletin, 3 (Catalogue No. 21-006-XIE, pp. 2-17). Ottawa, Ontario: Statistics Canada.
Hanlon, N., Halseth, G., Clasby, R., & Pow, V. (2007). The place embeddedness of social care: Restructuring work and welfare in Mackenzie, BC. Health & Place, 13, 466-481.
Hargrove, D. S. (2007). Keeping a rural psychology presence alive. Clinical Psychology Science & Practice, 14, 304-305.
Harowski, K., Turner, A. L., LeVine, E., Schank, J. A., & Leichter, J. (2006). From our community to yours: Rural best perspectives on psychology practice, training, and advocacy. Professional PsychologyResearch & Practice, 37, 158-164.
Haydar, S. H. (2007). Dual relationships and the psychologist's inner circle: Ethical decisionmaking concerning multiple relationships with family and friends. Dissertation Abstracts International, 67, 5405.
Helbok, C. M. (2003). The practice of psychology in rural communities: Potential ethical dilemmas. Ethics & Behavior, 13, 367-384.
Jackson, H., Judd, F., Romiti, ?., Fraser, C., Murray, G., Robins, G., ... Wearing, A. (2007). Mental health problems in rural contexts: What are the barriers to seeking help from professional providers? Australian Psychologist, 42, 147-160.
Jameson, J. P., & Blank, M. B. (2007). Rural services: Defining problems and developing solutions. Clinical Psychology: Science & Practice, 14, 283-298.
Jones, C. M. (2008). From novice to expert: Issues of concern in the training of psychologists. Australian Psychologist, 43, 38-54.
Judd, F., Jackson, H., Romiti, ?., Murray, G., Fraser, C., Grieve, ?., & Gómez, R. (2006). Help-seeking by rural residents for mental health problems: The importance of agrarian values. Australian and New Zealand Journal of Psychiatry, 40, 769-776.
Judd, F. K. (2006). Progressing the agenda for rural mental health research. Rural and Remote Health, 6, 615.
Larson, A., & Jones, P. (2009). Rural health in a urne of cataclysm. Rural and Remote Health, 9, 1200.
Malone, J. L. (2010). Professional ethics in rural Canadian psychology: Understanding the experiences of practising psychologists. (Unpublished doctoral dissertation). Charles Sturt University, Bathurst, New South Wales, Australia.
Mcllwraith, R. D., Dyck, R. G., Holms, V. L., Carlson, T. E., & Prober, N. G. (2005). Manitoba's rural and northern community-based training program for psychology interns and residents. Professional PsychologyResearch & Practice, 36, 164-172.
Ministry of Rural Affairs. (2000). Working together in rural Canada: Annual report to parliament. Retrieved September 02, 2007, from http:// www.rural.gc.caeannualreport/2000/report_e.html
Misener, R. M., MacLeod, M. L. P., Banks, R., Morton, A. M., Vogt, C., efe Bentham, D. (2008). "There's rural, and then there's rural": Advice from nurses providing primary healthcare in northern remote communities. Nursing Leadership (CJNL), 21, 54-63.
Moffitt, P. M., Mordoch, E., Wells, C., Misener, R. M., McDonagh, M. K., & Edge, D. S. (2009). From sea to shining sea: Making collaborative rural research work. Rural and Remote Health, 9, 1 156.
Muula, A. S. (2007). How do we define "rurality" in the teaching on medical demography? Rural and Remote Health, 7, 653. Retrieved July 15, 2008 from http://www.rrh.org.au
Peters, E. (2001) Geographies of Aboriginal people in Canada. Canadian Geographer, 45,138-144.
Pettifor, J. (2004). Personal reflections on 60 years of psychology: Many roads to truth. Canadian Psychology, 45, 11-15.
Pong, R. W. (2007). Rural Poverty and Health: What do we know? Presentation to the Standing Senate Committee on Agriculture and Forestry. Sudbury, ON: Laurentian University Centre for Rural and Northern Health Research.
Pope, J. F., & Arthur, N. (2009). Socioeconomic status and class: A challenge for the practice of psychology in Canada. Canadian Psychology, 50, 55-65.
Roberts, L. W., Warner, T. D., & Hammond, K. G. (2005). Ethical challenges of mental health clinicians in rural and frontier areas. Psychiatric Services, 56, 358-359.
Romanow, R. J., & Marchildon, G. P. (2003). Psychological services and the future of health care in Canada. Canadian Psychology, 44, 283-295.
Sanderson, B. J. M. (2004). Experiencing farming in stressful times: A naturalistic inquiry. (Unpublished master's thesis). University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Schank, J. A., & Skovholt, T. M. (2006). Ethical Practice in Small Communities: Challenges and Rewards for Psychologists. Washington, DC: American Psychological Association.
Schopp, L. H., Demiris, G., & Glueckauf, R. L. (2006). Rural backwaters or front-runners? Rural telehealth in the vanguard of psychology practice. Professional Psychology- Research & Practice, 37, 165-173.
Scopelliti, J., Judd, F., Grigg, M., Hodgins, G., Fraser, C., Hulbert, C., ... Wood, A. (2004). Dual relationships in mental health practice: Issues for clinicians in rural settings. Australian and New Zealand Journal of Psychiatry, 38, 953-959.
Stamm, B. H., Lambert, D., Piland, N. F., & Speck, N. C. (2007). A rural perspective on health care for the whole person. Professional Psychology-Research & Practice, 38, 298-304.
Suzuki, L. A., Ahluwalia, M. K., Kwong Arora, A., & Mattis, J. S. (2007). The pond you fish in determines the fish you catch: Exploring strategies for qualitative data collection. The Counseling Psychologist, 35, 295327.
Vella-Brodrick, D. A., Judd, F. K., Scannett, E. D., & Bumey, S. (2006). Relative contributions of rurality and community connectedness to subjective well-being in Victorian coastal regions. International Journal of Rural Psychology, January.
Zapf, M. K. (2001). Notions of rurality. Rural Social Work, 6, 12-27.
Received September 26, 2010
Revision received April 25, 2011
Accepted April 25, 2011
Judi L. Malone
Athabasca University and Charles Sturt University
Correspondence concerning this article should be addressed to Judi L. Malone, P.O. Box 556, St. Paul, Alberta, TOA 3AO. E-mail: judim® athabascau.ca…
Questia, a part of Gale, Cengage Learning. www.questia.com
Publication information: Article title: Professional Practice out of the Urban Context: Defining Canadian Rural Psychology. Contributors: Malone, Judi L. - Author. Journal title: Canadian Psychology. Volume: 52. Issue: 4 Publication date: November 2011. Page number: 289+. © Canadian Psychological Association Aug 1996. Provided by ProQuest LLC. All Rights Reserved.