Urban or rural? Psychologists weigh the pros & cons

When looking to set up or join a new psychological practice, there are so many questions to address. Whether it’s an early career choice, a move to a new part of the country, or a therapist looking to make major changes, the first hurdle is deciding where to practice. What matters most to you in your surroundings from both a personal and professional point of view?

From the two extreme opposites, urban versus rural settings, we draw our examples today. (Suburban-based psychologists will fall somewhere in between the two, with access to a larger amount of resources, a bit more natural surroundings, and a lot of time in a car to get anywhere).

Working in either location has both benefits and drawbacks and much of it really depends on personal preference. The trick, of course, is to make personal preference fit a professional lifestyle. Or, maybe it is the other way around. For married psychologists, Kristin Hurd, Psy.D., and Adam Ameele, Psy.D., that was their story.

Leaving Boston for rural Vermont in 2010, the couple knew they wanted the slower lifestyle and link to the natural world that they would not find in the city.

Today, they live with their two children in a small town, spend time outdoors and have built strong community connections. Ameele has even joined the local volunteer firefighting brigade, fulfilling a childhood dream that would not be possible in a larger city.

But they did feel some anxiety over leaving the connections and resources a big city offers. This turned out to be a bonus instead, allowing them to expand their work, reach out across the community, and build connections in new ways.

“I think the initial main reason for us leaving was because of the lifestyle change we wanted,” said Hurd. “But, from a professional standpoint, it has allowed us to be far more creative in terms of crafting the kinds of jobs we wanted to have and letting those evolve. To me, it was first sort of a personal reason and then unexpected benefit professionally.”

Hurd is the district psychologist for the 1,500-student Springfield school system and Ameele is director of behavioral health for the Springfield Medical Care System.

As the only psychologist in each of their organizations, the two have also had opportunities to work together, creating school-based health centers with social workers on staff and thinking about ways to improve health outcomes from an earlier age.

“I don’t imagine we would have had that opportunity to work together in the same way if we were in a more urban setting with more compartmentalized and specialized professionals,” said Hurd.

Hurd is also the director of training for an internship consortium with William James College, a program that she started in her area before teaming up with the school.

With the dearth of rural mental health professionals, introducing more early career psychologists to the work can help them to see the benefits that Hurd and Ameele have experienced.

On the other side, Pamela Enders, Ph.D, is a clinical psychologist and performance coach in Cambridge, Mass. With an office situated close by Harvard, Massachusetts Institute of Technology (MIT) and the booming technology center of Kendall Square, she has found a constant stream of people that need her help.

“Most of these people are really bright and articulate and stressed out beyond belief,” she said. “They find it convenient because they can walk to me or pop in an Uber. One big advantage is the sheer numbers of people seeking therapy.”

An urban location provides more in terms of professional support, a stronger referral base, and opportunities for continuing education close at hand. It is also easier to specialize when there is a greater pool of clients.

Being a performance coach, using sports psychology to help people work through issues with performing either on stage or in the board room, was a specialty she developed after following her own interests in overcoming stage fright.
The niche would probably not have been an option in a more rural location and those who would not seek out traditional therapy could miss out.

“Some people will see my profile on Psychology Today and see performance coaching and they say that is me,” said Enders. “It kind of lowers the bar for people to come into therapy who might have ambivalence about identifying as a therapy patient.”

Working in a more populated area makes it easier to maintain ethical and professional boundaries, an issue that can become stressful for those who operate in a rural setting.

“It is easier to maintain anonymity here, which I imagine rural people say is harder because you may bump into someone at the grocery story,” she said. “I am not rubbing elbows with them at local libraries and they don’t see me walking down street and having a squabble with my husband.”

For some, city life is exhausting but for others it is vibrant and thrilling and there are always a myriad of people to meet and from which to learn.

“I have access to restaurants and cultural events of all kinds,” said Enders, “and the ability to walk down the street and hear different languages and meet people from all over world who are working here or studying here.”

So, urban or rural?

Of course so much of this comes down to preference. There are ways to thrive in a rural location where a lack of resources and other professionals can be freeing. The support systems and wide open opportunities with a more urban setting can help to build a new practice or provide opportunities not found outside a city.

Ameele encourages people to think about quality of life both personally and professionally and make sure that the direction they are headed allows for that element

“And it is unique for each individual,” he added. “Identify what your needs are now and what they will look like if/when you have a family and what are your needs for your professional goals. And remember nothing is written in stone ultimately. We are constantly living and learning.”

Enders suggests starting out where there are more opportunities.

“Work in the city where you are more likely to be able to build a larger practice sooner,” she said, “and save pennies to be able to buy a country home.”