Date of Submission

2026

Degree Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department Chair

Stephanie Felgoise, PhD, ABPP

First Advisor

Robert A. DiTomasso, PhD, ABPP

Second Advisor

Stephen R. Poteau, PhD

Third Advisor

Michael B. Roberts, PsyD

Abstract

Adults living in rural regions experience mental illness at rates comparable to those in urban areas yet utilize mental health services significantly less. Underutilization of psychotherapy in rural populations has been attributed to structural barriers (e.g., geographic inaccessibility, limited provider availability, reduced anonymity) and sociocultural factors such as stigma. However, rural adults may remain reluctant to initiate treatment due to attitudes toward psychotherapy, limited help-seeking engagement, or inaccurate knowledge about psychotherapy. The present study developed and examined the psychometric properties of the Liebelt Attitudes, Knowledge, and Engagement Scale (LAKES), a self-report measure designed to assess psychotherapy-related attitudes, knowledge, and engagement among rural adults. Participants residing in rural regions of the United States were recruited online and completed a demographic questionnaire, the LAKES, and a validated measure of self-stigma related to seeking psychological help. Exploratory factor analyses and reliability analyses were conducted to evaluate scale structure and internal consistency. Results supported a two-factor structure reflecting Attitudes and Knowledge, both of which demonstrated strong internal consistency. The Engagement subscale did not meet criteria for factor analysis and was excluded from further analyses. Correlational analyses indicated that more positive attitudes and greater knowledge about psychotherapy were associated with lower self-stigma toward seeking psychological help. Findings provide preliminary evidence for the reliability and construct validity of the LAKES as a measure of psychotherapy-related beliefs among rural adults. Attitudinal and knowledge-based factors may represent modifiable barriers to treatment initiation, with implications for outreach, psychoeducation, and stigma-reduction efforts aimed at improving rural mental health service utilization.

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