Far beyond the northern boundaries of the contiguous United States is Alaska. Seen from a global map, it is stunning in its isolation. Villages, most of them Alaska Native, dot the vast landscape. Indigenous ways of being are deeply valued and interpersonal connection is key to well-being if not survival.
Because of the large expanses and the small populations in rural villages, relationships are immediate and overlap naturally. One person fulfills many roles – an aunt might be a family advocate and protector, an administrator of a community board who can make a job recommendation, a respected elder who instructs and advises and a child welfare worker.
A psychologist who takes a job in rural Alaska may discover to her delight the inter-connection of people with the land, with wildlife, with the weather – and with each other, socially, politically, biologically and occupationally. She is related in some way to all and all to each other.
Alaska’s population, estimated in 2016 at just over 740,000 people, varies socially, politically and culturally. It has over 20 distinct Alaska native cultures and languages, a white European presence dating back hundreds of years and, historically speaking, a relatively recent arrival of immigrants from international communities.
A psychologist new to rural Alaska is dependent on others for help in adjusting to the new way of life, including an increased transparency that changes her degree of privacy and few, if any, services such as restaurants, museums, gyms or coffee shops.
Connecting with a competent peer is the preferred means to good practice among psychologists and very helpful to the rural psychologist. The psychologist who is providing therapy to a white-European school teacher presenting with seasonal affective disorder may want to consult on how to manage their landlord/neighbor relationship or the flow of the teacher’s students to and from the apartment of the psychologist with whom the students have formed a friendly bond and reliance. (See APA Ethical Principles of Psychologists and Codes of Conduct 2002, Standard 3.05, Multiple Relationships.)
Talking with peers who know the dynamics and history between a teacher of white European ancestry and his Alaska Native students is essential to competent conceptualization, analysis and decision-making (Standard 2.01, Boundaries of Competence), to boundary and confidentiality issues (Standards 4.01, Maintaining Confidentiality & 4.02, Discussing the Limits of Confidentiality) and to potential conflicts of interest (Standards 3.06, Conflict of Interest and 3.08, Exploitative Relationships).
Consultation with a trusted colleague gives the space and time to consider the issues and, at times, emotional conflicts that can arise in the course of practice in a small community.
The psychologist may process her personal reaction, whether it is to worry about the how the teacher’s reactions to the student friendships will impact the therapy and to avoid the temptation to withdraw or to isolate (Standard 2.06 Personal Problems and Conflicts).
Given the shortage of health care providers in many rural areas, including Alaska, a good consultant is a precious resource and should be carefully evaluated for his or her area of expertise. Consultants often have a good fund of knowledge but that knowledge may be limited in its range.
For example, a consultant may have significant clinical or ethical knowledge but lack expertise in the community or its culture. To cover the gap, the psychologist may consult with another expert, such as a medical provider who grew up in the village or an Alaska Native elder.
If the consultant is related to the client in question, the psychologist may protect the client’s confidentiality by consulting outside the community or talking to an expert outside Alaska (Standard 4.06, Consultations).
Working in rural Alaska requires a willingness to tolerate the anxiety of adapting to a small community and to vast terrain with a limited road system and limited public services.
However, the rewards are undeniable: enjoying the slowed pace and wild beauty of the environment, getting to know people with diverse cultural backgrounds, values and knowledge; exposure to and facility in treating a wide range of presenting concerns and being a valued citizen and member of a community.
References available from author.
Suzanne Womack Strisik, Ph.D., is a licensed psychologist in independent practice in Anchorage, Alaska. She chairs the ethics committee for the Alaska Psychological Association. Her email is: firstname.lastname@example.org.