About 220 miles from Iowa City lies the small town of Algona, a community built on a foundation of farming and family businesses, known statewide for its rugged forests and beloved annual festivals.

One Algona native, Aubrey McEnroe, grew up farming her family’s land with her father and cherishes her rural roots. Now, as a third-year doctoral candidate in the counseling psychology department at the University of Iowa, she is working to give back to her community through access to mental health care.

As an undergraduate student at the UI, McEnroe experienced a bit of disorientation in accustoming herself to the new community and environment, which is a challenge many students coming from a rural community may face.

“Coming from a smaller community which I really enjoyed and am really grateful to have grown up there, I did have a little bit of a culture shock coming to the University of Iowa,” McEnroe said. “I remember walking into my first lecture hall and having the lecture be as big as my high school was.”

McEnroe’s focus as a Ph.D. candidate is within the Telepsychology Training Clinic, a branch of the Rural Psychology Collaborative at the UI. It was designed with the mission in mind to better serve rural Iowans through community-based research and practice.

Chelsey Gates, clinical director of the Telepsychology Training Clinic, graduated with a Ph.D. in the counseling psychology program from the UI. She describes the clinic as offering no-cost mental health care to Iowans with otherwise limited access to care.

“More people are becoming interested in receiving counseling to support their mental health,” Gates said. “This growing interest comes alongside the reality that much of Iowa is considered to have a mental health care professional shortage, particularly in rural communities.”

She said one of the draws to a remote therapy option is that it allows people in rural communities to get therapy even though they are in an area that has a mental health care shortage.

“Rural communities face unique stressors and challenges which can influence their mental health,” Gates said. “These factors often pose challenges for people to reach out and receive help. We hope that the Telepsychology Training Clinic can offer support to reach Iowans across the state and help individuals address their concerns from the comfort of their homes.”

The goal of the Telepsychology Training Clinic is to train future psychologists to provide care for mental and behavioral health needs to all Iowans. McEnroe said being from a small community drives her to bring these services to underserved areas.

“In rural communities, we have this collectivistic nature,” McEnroe said. “Learning how to bring that into a therapeutic space has been really wonderful by being able to advocate for individuals in rural communities and say that it’s okay to need help and to want help and to access these services that they maybe haven’t been able to before.”

With the rise of telehealth, particularly telepsychology, since COVID-19, the Rural Psychology Collaborative has grown to include multiple fields of research and work, including training opportunities for counseling psychology Ph.D. candidates like McEnroe.

“The counseling psychology Ph.D. program and the Telepsychology Training Clinic have both allowed me to grow professionally and personally towards my goals,” McEnroe said. “In my current training thus far, I’ve achieved why I’m here and I’m consistently reminded that I’m not done yet.”

Telepsychology is becoming an asset to rural communities, where access to mental health care is often difficult to reach or inconvenient. By meeting from the comfort of one’s home over a video conferencing platform, therapy becomes more obtainable for more individuals.

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Martin Kivlighan, a counseling psychology professor at the UI, assists in supervising the Rural Psychology Collaborative and works with multicultural counseling, which includes rurality.

“Ideally, folks should know that services are available, and they are able to take advantage and utilize those resources as they desire,” Kivlighan said. “Therapy is not the thing for every single person, but for those who do believe in it and want it, we want them to have the best access possible.”

Kivlighan said the need to stay at home during the pandemic helped develop the use of remote therapy services. He said these services are particularly useful for people with mobility challenges or who are living in underserved areas, like McEnroe.

In Iowa, 80 percent of the counties in Iowa is designated as a critical mental health workforce shortage area, he said.

“The main goal is to help psychology doctoral students gain an appreciation of rural spaces. Not just how to better serve rural spaces, but the strengths and values of rurality and developing that appreciation and understanding,” Kivlighan said.

Students like McEnroe are studying telepsychology to bring mental health care back to their small hometowns or other rural communities, stating the importance of access for all to psychological care.

There is an abundance of research being done by the Telepsychology Training Clinic, including the incorporation of AI tools into the curriculum for trainees. Through a Seattle-based website called Lyssn, therapist trainees can get active and immediate feedback on their sessions that analyzes their levels of empathy and uses of therapeutic skills.

“Working with rural communities, we haven’t often thought of rurality as a cultural identity, but it is,” Kivlighan said. “This tool provides different aspects to be able to access multicultural competence, and that will be really critical for students working with people that are different from their own lived experience.”

Rural psychology is a growing field, as many communities such as the one McEnroe grew up in have very few, if any, resources available for mental health care.

There is a stigma that surrounds mental health care in small towns and rural areas, McEnroe said. Oftentimes, individuals will help their neighbors when they need it but not ask for help themselves, she said. This leads to a lack of access and availability when it’s needed most.

“I wanted to challenge that stigma and show people that it’s okay to access mental health services and that it doesn’t mean that there’s a weakness or an inferiority,” McEnroe said. “Rural mental health services shouldn’t be a luxury. They should be a right for everyone, and it should not be difficult to access mental health services.”