Rural psychology reaches into Ozarks

Don McGehee combines faith and psychology to help people of the hill country.

By Patrick A. McGuire and Scott Sleek
Monitor staff

Most people who travel through the tangled forests of the Ozark mountains in southwestern Missouri see only one type of road: the treacherous, sharply curved, two lane wrist-twisters that wear out brake linings and make hair stand up on the back of the neck.

But as psychologist Don McGehee, PhD, coolly navigates these hills behind the wheel of a red Oldsmobile, he looks for another type of trail--the invisible inroads that lead into the twisting emotions and behaviors of the people who live here. And in a region where, McGehee says, incest is all too common, where husbands use the Bible to justify beating their wives and where "guns are as natural as toothpicks," these invisible roads can raise just as many hackles.

"Rural psychology," explains this ordained Baptist minister who became a psychologist, "means going out to the people. Finding them."

He and the students he trains at the Forest Institute of Professional Psychology in nearby Springfield do just that. Through a Forest program called Reaching Out to Rural Ozarks, or RORO, teams of advanced-level psychology trainees, interns, residents and psychologist supervisors, bring affordable testing, assessment and counseling services into the ridges and hollows of a 10-county area.

Yet while services are sorely needed--19 of every 20 school children are on Medicaid and half the population has no insurance--it's not as simple as just sending in teams, even ones with four-wheel drive. This is an isolated population, where many lack transportation, and are the product of an education laced with a strict interpretation of the Bible.

"Down in the hill country," drawls McGehee, "it's not masculine to ask anybody for help or to spill your guts. There are people with a very strong fear and lack of trust for 'Godless psychologists.' Missouri's slogan is 'Show me.' That's why most of them look at us skeptically. So we try to make connections to them."

The faith connection

Making and maintaining those connecting inroads has been McGehee's life's work. As the executive director of the nonprofit Ozark Christian Counseling Service and its related foundation, he has organized a network of churches in these mountain communities. Pastors allow his teams the use of their buildings for everything from assessments, to running a clinic.

"Don does a very important thing," says James "Gil" Hill, PhD, APA's director of the office of rural health in the Practice Directorate. "He's involving students in an outreach situation where they don't just sit in the clinic and wait for the patients to come to them. They're in a part of the world where the interaction of psychologists and the patient population is facilitated by the faith community. And a strength of Don's program is that his students learn about that culture."

McGehee learned it more than half a century ago by following his father on his Ozark rounds as head of the local fish hatchery. He studied engineering in college, but in 1958 became a Baptist minister.

"I needed to be able to help people more," says McGehee, a gregarious man with shining white hair and a moustache to match. Now, as a psychologist who has spent more than 20 years at Forest, McGehee says he tries to integrate spiritual and moral values into his therapeutic work.

"Religion is a tremendously significant part of life here," he says. "It's wonderful, it's powerful and it gives strength. But it has its dark sides. "

Typical was the Ozark father who demanded McGehee convince his teen-age daughter that the Bible commands children to obey their parents, right or wrong. McGehee deftly noted that the Bible also says parents should not provoke their children's wrath.

"We have to work within the confines of local religious values rather than trying to steer clients outside of those limits," he says. "It's a matter of understanding their belief system, and then helping them see it from a different perspective. But if they think you're judging them, you've lost them."

Integration with the culture, says Hill at APA, is only half the mission of rural psychology.

"Specialty care in rural areas is practically nonexistent. So, psychologists need to work with whomever is out there."

Community empowerment

The Ozarks is one of 600 areas designated by the federal government as Mental Health Professional Shortage Areas. The National Health Service Corps Loan Repayment Program will pay off educational loans of psychologists accepted into the program and who then move to those areas. In a rural community, says Hill, interdisciplinary teams often form around psychologists, primary-care doctors, social workers and nurse-practitioners.

"If the faith community's interested, you pull them in, too," he says. "This is a community empowerment model."

"We make connections from all kinds of sources," says McGehee. "If a patient needs medication, we work with a family practice physician. We might work with a business, say, like a Mom-and-Pop grocery. They all know Susie, who says 'I don't know what to do with my kid.' They'll say 'why don't you check with the RORO people. They can help.'"

RORO also helps clients referred by Missouri's Division of Family Services and local and juvenile courts. The closely linked Ozark Christian Counseling Foundation--directed by McGehee--supplies the outreachers with vehicles and cell phones, and supplements RORO's $20 fees for services.

Profound poverty is a main culprit behind the need for RORO's services. Ironically, the influx of summer tourists into the glitzy Branson area hasn't helped much. During the winter, popular attractions are closed. Even during the high season, many earn only minimum wage and are lucky to afford electricity. As many as four families crowd into each unit at a nearby trailer park.

Most of the people connected to Branson's entertainment industry are migratory, says McGehee. "There are about 10,000 people not on anybody's books. And we try to reach these people."

The RORO program has 26 therapists under both group and individual supervision, says McGehee. Last year they conducted more than 4,300 sessions with about 600 clients. Already, this year, those numbers have grown.

"There are people who will not see us, but that's changing," he says. "When you're hurting bad enough, sometimes you're willing to start."

Sometimes, though, the start is almost too late. Take the case of a 46-year-old single mother referred to RORO by a local physician. Diagnosed with terminal cancer, she was in total denial.

"We've been working with her," says McGehee." The other day she said she wanted to have a goodbye party. We're calling in friends and family to help. It's heavy stuff. We get some whoppers."

Crisis teams

The biggest in a while was the kindly 70-year-old artist arrested for taking pornographic photos of young girls.

"We had a crisis team there immediately," says McGehee. They met with the angry families of the girls and defused the rage building in the local men who wanted revenge.

"It's easy to leave you with the impression that this is all just a hodgepodge of horror," he says. "But on the other side are lots of people who are just busily engaged in positive activities like raising kids." In between, he says, come the everyday problems psychologists confront in any part of the country. He told of a man in his late 50s, raised in a small hill town, who wears women's clothing under his overalls.

"His neighbors think he's crazy," says McGehee. "But he has just hated his gender from the very beginning."

RORO referred him to the department of psychiatry and urology at the University of Missouri in Columbia, where he has undergone hormone therapy. "We work with him from a supportive psychological approach," says McGehee. "People are the same. You'll find them everywhere."

That includes the small cracker box of a shack he points out on the hillside up ahead, as he rounds yet another curve in these Ozarks. With a hearty chuckle he recalls how he once went into that shack to do a clinical assessment of a client. In the living room he encountered a goat, then unknowingly sat in a chair in which the animal had left a rude surprise.

"You have to accept people where they are," he grins. Because, as he knows too well, hardly a day goes by when a rural psychologist isn't challenged by the horns of one dilemma or another.



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