I'd like to return this week to the article I referenced last time, in which ACA author Jonathan Rollins highlights some of the challenges of counseling in rural areas. You can find his original article here: http://ct.counseling.org/2010/04/learning-the-ropes-of-rural-counseling/
In my last post, I added to Rollins's ideas about “being on stage all the time,” a very real phenomenon as the new counselor in a small town. This week, I'd like to elaborate on what Rollins calls the need for rural counselors to be “ready for anything,” or, in other words, to be a generalist practitioner. For certain, one needs to manage many roles on any given day. As much as there may be a shortage of resources in rural areas, there follows a shortage of mental health practitioners; therapists, psychiatrists, and case and social service workers in general.
On any given day I may do therapy, case management, vocational guidance counseling and suicide risk assessment. I may be more of a social worker, connecting clients with resources. And sometimes, I find myself in the community - school, hospital ER, detention center - working to build connections with those agencies, because to me, this is essential in preventing people from falling through the cracks – something all too familiar to most of us. And even in a small town, where you think this wouldn't happen as much (because everybody knows everybody), it most certainly does.
When we think of the term generalist, we often think in terms of being an eclectic counselor. Someone who draws from a variety of counseling philosophies to custom-tailor their therapeutic approach. Someone who can use Gestalt with a client one hour, then move into pure CBT or REBT the next. And in terms of rural counseling, this approach is as valid as anywhere else. In order to truly serve our clients, we need to be ready to customize their treatment, as much as is possible and advisable given their individual circumstances.
But I think, after nearly 3 years of counseling in rural areas, it's not enough to be a generalist. One needs to be a generalist, with a trauma-informed mindset and approach. The rates of trauma I have seen in my short time here have been staggering, and the majority of it appears to be domestic violence-driven. While this is certainly not a thorough review in any sense, a brief internet search on rates of Domestic Violence in the state of Wyoming (which is predominantly rural), for example, yielded disturbing results.
In October of 2014, Wyoming Public Media reported that Wyoming ranked #1 in the nation for gun-related deaths. This report also stated that women in Wyoming in abusive relationships are about 5 times more likely to be killed if their abuser has a gun.
In January of 2016, Wyoming Public Media reported that despite the extremely high number of sexual assault cases on the Wind River Indian Reservation, there are no funds available for a Safe House. The tribal member interviewed for the article stated that between 95-100% of the females on the reservation will experience sexual violence in their lifetime. About seven in ten boys will experience the same.
In April of 2017 the Casper Star Tribune ran a report quoting state prosecutors saying that Wyoming's domestic violence laws overall are weak, and completely lacking in many cases.
In May of 2017 the Rural Health Information Hub dove deeper into statistics regarding rates of violence in rural areas across America in general, demonstrating unequivocally that rates of violence and abuse overall are higher in rural America. Further, the article also makes the important connection between poverty and higher rates of violence. Rural America typically has higher rates of poverty.
I can tell you the inferences in the above-referenced articles have been borne out as true in the time I've been counseling here. I would estimate that approximately 98% of the clients I've seen in the past year have been sexually assaulted or victims of other intimate partner violence at some point in their life. This includes clients of all ethnicities.
So in addition to custom-tailoring my therapeutic approach to my clients, I also need to be trauma-informed, competent in trauma-informed treatment, and well prepared to assess for safety and offer support and connection to resources to help anyone ready to escape their abuser.
Author Rollins is right. You need to be “ready for anything.” And you need to be making those community connections, so you know with whom you can connect clients when the time comes. As a fairly new professional, I've found myself quickly immersed here into what may be seen at times as a violent culture. It's a rude awakening. It brings you up short. At first, I took a lot of it home with me, thinking about it into the hours of the night, contemplating what it meant for so many people to be leading such lives.
And then, I returned to doing what I've come to love best: using my skills and knowledge to help one person at a time.
I've provided links to the above-referenced articles if you are interested in reading those in full. And as always, I'd love to hear from you regarding your experiences.
Stormy Filson is an independently licensed counselor living and working in Wyoming, with special interests in treating trauma, community building, and empowering women. She is also passionate about writing, photography and film.