Amithea M Love is a 2015 graduate of the PsyD Program in Clinical Psychology at Antioch University, New England

Dissertation Committee

  • Roysircar-Sodowsky, Gargi, Ph.D., Committee Chair
  • Gina Pasquale, Psy.D. Committee Member
  • Daniel Lafleur, Ph.D. Committee Member


rural mental health, clinicians, ethical dilemmas, burnout, well-being, ethical decision-making

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Mental health clinicians are bound by professional ethics codes that are intended to ensure beneficence toward clients. When clinicians reside in rural areas, ethical dilemmas result from the distinct nature of rural life and clinical practice. Despite extant literature on the ethical dilemmas of rural practice, little research has examined the effect of ethical dilemmas on the social-emotional functioning of clinicians. In response to this need, the study investigated the relationships of frequency of and discomfort from ethical dilemmas on clinician social-emotional functioning. Participants were rural and small town clinicians (N = 60) between ages 24-65 and primarily Caucasian (83.3%), from 19 states of the U.S., and one from Costa Rica. They responded to an online survey. Answer formats ranged from a Likert scale to open-ended statements to multiple choice options. Survey questions addressed demographic information; frequency and discomfort related to ethical dilemma types; decision-making strategies used; confidence in and stress relief from use of decision-making strategies; and frequency of service denial due to payment problems. The Friedman Well-Being Scale and Maslach Burnout Inventory were also included. Hypotheses predicted that frequency of encounters with ethical dilemmas and increased discomfort from ethical dilemmas would relate to lower well-being and higher burnout. Research questions were aimed at understanding the types and frequency of ethical dilemmas experienced by rural and small-town clinicians and decision-making strategies used. Differences between well-being and burnout scores of the study participants and participants of the normative studies for these measures were studied. Results indicated that frequency of and discomfort level from ethical dilemmas predicted the burnout dimension of Emotional Exhaustion. Dual role and clinician visibility dilemmas were most common. Most participants used a case-by-case, multiple-strategy approach for decision-making. Participants reported confidence in decisions made and relief from stress by using decision-making strategies. T-tests indicated that study participants had a significantly lower well-being mean score than a normative college student sample, and significantly higher Personal Accomplishment than the MBI-HSS normative sample. The majority of participants indicated turning away clients due to client payment difficulties. These results, the study’s limitations, and suggestions for future research are addressed.