TPC-Journal-V2-Issue1

22 The Ethical Frontier: Ethical Considerations for Frontier Counselors Keith A. Cates Christopher Gunderson Michael A. Keim Counselors working in frontier communities may encounter unique challenges and experiences not regularly found in larger contexts. This paper explores the aspects of counseling significant to rural and frontier settings. It discusses the traditional attitudes of rural and frontier populations, the counselor’s place in these communities, boundaries of competence, and ethical concerns that are significant to these areas of counseling, such as confidentiality. It also offers potential ways to address related ethical issues. The cultural milieu in small communities, subcultural self- identification, frontier attitudes and beliefs, and multiple relationships are explored. Keywords: rural, ethics, frontier, multiple relationships, confidentiality, boundaries of competence The Professional Counselor Volume 2, Issue 1 | Pages 22–32 © 2012 NBCC and Affiliates www.nbcc.org http://tpcjournal.nbcc.org doi:10.15241/kac.2.1.22 Working in small and rural communities presents counselors with challenges and experiences not necessarily or often encountered in larger population centers. The geographic constraints of the area itself, the culture and behavior of the client population, as well as the attitudes and skills of the counselor, can combine to create significant difficulties in providing ethically competent mental health care. Even the term rural is difficult to define when attempting to describe the 16% (Nusca, 2011) of the total U.S. population and the 20% (Trading Economics, 2011) of the Canadian population that live in “rural” settings. Rural in this usage is generally defined in regards to low population density, population size and distance from larger population centers. Although governmental agencies vary in their exact definition and identification of rural locations and populations in the United States, urban is generally defined as an area having more than 100 people per square mile, rural areas generally comprise open country and settlements with fewer than 2,500 residents and are defined as having between 99 and 6 people per square mile, and frontier is an area having less than 6 people per square mile (Bushy & Carty, 1994; Helbok, 2003). Much of Alaska, the central United States, and central Canada are primarily designated as frontier areas. “Rural” and “frontier” become increasingly difficult to define when viewed through the perceptions of those living in these areas. Individual life experiences and interpretations blend with considerations of distance between families and communities, self-sufficiency, access to resources, and support to and from the community to create a style of living centered on individual capacity and self-reliance, as well as increased community interdependence (Brownlee, 1996; Erickson, 2001). Small and rural community living, however, does tend to have some similarities across geographic areas including scarce resources, higher poverty rates, lack of access to employment opportunities, lack of higher formal education, higher illiteracy rates, limited health services, limited insurance coverage, higher rates of disability, greater environmental hazards, increased overall age-adjusted mortality, and fewer mental health resources (Helbok, 2003; Murray & Keller, 1991; Roberts, Battaglia, & Epstein, 1999; Wagenfeld, 1988; Wilcoxon, 1989). In addition to the concerns associated with rural living, frontier areas have to contend with even fewer mental health care resources due to populations spread over a large geographic area, reduced numbers of mental health care providers, limited access to crisis services, mental health services and general medical care, inaccessibility to remote geographic areas, and the increased hardship of living in isolated locations (Bushy & Carty, 1994; Roberts et al., 1999). Alaska is illustrative of the difficulties of providing for mental health care needs and access to experienced practitioners in rural and frontier communities. Alaska is the largest state (656,424 square miles) with the lowest population density in the United States with 1.2 persons per square mile. Much of that population is concentrated in two metropolitan statistical areas that account for approximately 66% of the state’s total estimated population (U.S. Census Bureau, 2012). In 2007, it had the highest suicide rate in the nation, with 21.8 suicides per 100,000 residents as compared to 11.5 suicides per Keith A. Cates, NCC, is an Assistant Professor in the Department of Counseling and Special Education at the University of Alaska-Anchorage. Christopher Gunderson is the Director of Training and Development at Denali Family Services, Anchorage, Alaska. Michael A. Keim is an Assistant Professor in the College of Education at the University of West Georgia, Carrollton, GA, USA. Correspondence can be addressed to Keith A. Cates, University of Alaska–Anchorage, 3211 Providence Dr., UAA-COE-CASE, PSB 206K, Anchorage, AK 99508-4614, kcates@uaa.alaska.edu.