Abstract
Research on psychologists in integrated behavioral health care (IBHC) remains sparse and appears nonexistent for rural-based psychologists. Using consensual qualitative research, this study examined the nature of the work of rural psychologists in IBHC, the impact of being in a rural setting, and characteristics important for working effectively in such settings. We found that, in general, the roles of rural-based IBHC psychologists were more expansive with a focus on availability and flexibility in meeting clients' needs. This generally conflicted with ethical issues of continual boundary maintenance and issues related to the stretching of competence and valuing self-care. Stretching of competence and valuing self-care intersected with issues related to a broad scope of practice and vast catchment areas, where constraints in resources impacted patient care and called for valuing advocacy. Psychologists in these settings underscored the importance of communication as a member of an integrated health care team and valuing team relationships, where physical proximity facilitated collaboration among health care providers. We also found ethical dilemmas involving confidentiality due to communication mediated by electronic health records. Finally, IBHC settings in rural areas are more inclusive, which might help to reduce stigma related to mental health care. These findings have implications for (re)considering how well current training models prepare psychologists to meet the challenges of IBHC settings in general and in rural areas.