Appalachian clients are often ‘invisible’ within the majority culture and possess characteristics unique to the region that must be considered within the counseling relationship (Tang & Russ, 2007). Individuals in Appalachia have higher incidences of certain mental health disorders and substance use as compared to the national average (Appalachian Regional Commission [ARC], 2008). Although the need for mental health services is evident, limited research exists to inform mental health professionals how to deliver culturally competent interventions to build a working alliance with Appalachian clients. The authors will discuss a framework for mental health professionals to develop a strong working alliance through a review of the cultural distinctions of Appalachian individuals, culturally appropriate counseling interventions, and a case illustration.
Jake Protivnak, Cassandra Pusateri, Matthew Paylo, and Kyoung Choi. "Invisible outsiders: Developing a working alliance with Appalachian clients" The Practitioner Scholar: Journal of Counseling & Professional Psychology (2017): 79-91.