1. Rural American Culture
Understanding Rural American Culture and Applying it to Counseling

2. APA’s Goals for Cultural Competence Directed Toward Rural Areas
identifying social, economic, political and religious influences affecting rural communities
understanding the importance of ethnic and cultural influences in rural communities and the importance of the oral tradition
understanding the impact of the interaction between social institutions and ethnicity on the delivery of mental health services
recognizing the impact of the provider's own culture, sensitivity and awareness as it affects his or her ability to deliver mental health care and
understanding alternative treatment sources in the ethnic minority culture.

3. Defining Rural Rural By Numbers Geography
US Office of Management and Budget:
Six Levels of Urbanization
Large Metro
Large Fringe Metro
Small Metro
Large Rural
Small Rural
Micropolitan
Geography
Myth – All farms and Agriculture
Diverse!

5. Commonalities Poverty Education Health Isolation
In 1996, 23 percent of rural workers were employed in the service sector and were nearly twice as likely to earn the minimum wage as their urban peers (U.S. Congress, 2002).
Education
Fifteen percent of rural adults have a college education, as compared with 28 percent of urban adults. Rural adults are also more likely to have not graduated from high school. (U.S. Congress, 2002).
Health
Rural Americans are more likely to smoke, have poor diets, not exercise, and be overweight (Hartley, 2004).
suicide rate among rural males is higher than among their urban counterparts in all four regions of the US
Isolation
Study: out of 1,253 rural counties with populations of 2,500 to 20,000, nearly three-fourths of the counties lacked a psychiatrist and 95 percent of them lacked a child psychologist.

6. Generalizing Rural Culture
We must ask….What influence does: greater poverty, older populations, access difficulties, lack of privacy, and isolation have on rural culure?
(Wagonfeld, 2003):
Self-reliance
Conservatism
Distrust of outsiders
Religion
Work orientation
Emphasis on family
Individualism
Fatalism

7. Isolation and Conventional Attitudes and Behavior
Isolation  depend on self  values of independence and self-reliance  more careful and considered in decisions.
Isolation “Goldfish Bowl Effect”  Lack of privacy and anonymity.
Isolation  keep problems in the family  traditional gender and multigenerational care roles
Isolation  fewer social and activity options increased teen sex and drug use.

8. Thorngren – Qualitative Study
Relationships with others
Closer bond with others
Importance of helping neighbors
Lifestyle
More planning
”You are never done”
Characteristics
Ambition
Strong Work Ethic

9. Counseling Rural Clients
Determine Level of Acculturation
Presentation and Body Language
Terminology

10. Counseling Rural Clients
Developing a relationship
Talk about the weather
Self Disclosure
Confidentiality
“Goldfish Bowl Effect”
Techniques
Avoid Abstract
Behavioral Methods/Psychoeducation
Mutual Problem Solving

11. Counseling Rural Clients Cont.
Emotions
Validate reasons for not expressing
Teach emotional vocabulary
Depression/Self-esteem
Conceptualization
Self-Abnegation