267 The Professional Counselor | Volume 14, Issue 3 • Client autonomy: Autonomy is a fundamental ethical principle, and counselors must recognize the systemic relationship between clients’ life experiences and the support they can offer. Building a strong therapeutic alliance and emphasizing foundational counseling skills and relational dimensions can help establish a sense of safety and comfort in the therapeutic relationship. • Support and counseling groups: We recommend providing support and counseling groups for postpartum mothers, as participants in this study responded positively to the group format. These groups can provide safe spaces for mothers to share their experiences and connect with one another. Counselors specializing in this area should facilitate the development of these groups to leverage the therapeutic benefits of group counseling. • Telemental health infrastructure: The challenges related to the availability and accessibility of counseling services in rural areas have been well-documented. A commonly proposed solution is telemental health counseling, which enables facilitating support groups, conducting individual counseling, and working with postpartum mothers in remote communities. Professional counselors must advocate for improving physical infrastructure in rural areas in order to enhance telemental health services, including better internet access to facilitate the provision of these services. • Continuing education and training: When providing telemental health counseling in rural areas, it is important to consider cultural competencies and approach differences with humility. Counselors not located in the same geographical areas as their clients may need more clarification on the specific context of their rural clients. Continuing education and training opportunities should be provided to counselors in rural communities, and they should be encouraged to share their work at state- and national-level conferences. • Integrated primary and mental health care: Advocacy for counselors includes encouraging the integration of primary and mental health care services. This integration is critical in rural areas where the accessibility and availability of primary and mental health care is limited. Therefore, we suggest that counselors reach out to physical health professionals in their communities in order to find ways to integrate services and to address the physical and mental aspects of wellness for clients in rural areas. Limitations and Future Research A robust research methodology is incomplete without recognizing limitations, and we identify minor limits in recruitment, sampling, and interviewing. We intentionally selected a focus group format to create a sense of community and facilitate memory recall. Due to the rural environment, participants often had preexisting relationships. We speculated that the relationships among participants could affect their interactions, leading to either selective sharing or a sense of comfort with disclosure. We felt that the latter context was present, as the participants supported one another in vulnerable moments with empathy and self-disclosure. Before collecting data, we identified an ideal group size of four to six participants; nevertheless, the four groups had significant variation as they had two, three, three, and eight participants. We held a fifth focus group, but because there was only one attendee, the data was not used for this study, as we felt the difference in setting was too great from the intended study. We also selected focus group times to accommodate mothers of young children (i.e., not offered during nap times or mealtimes). However, morning meeting times could have prevented mothers who worked during the day or outside of the home from attending. We also felt engagement in the community could have facilitated trust and recruitment, yet we did not have a preexisting connection to the communities. We considered that individual interviews could better accommodate participants’ schedules.
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