Treatment Tips for Working with Native American Clients Understanding Traditional Views on Health

BY Kim Scott, M.A., M.F.T. Managing Partner Practical CE Seminars In Consultation With Ben Hale, of Navajo Descent

Before treating Native American clients, it is important to become culturally aware by understanding their traditional views on health. For example, the Native American does not tend to see his or her health from a linear perspective, but instead tends to view their individual health as being a symbol that their life or actions are in harmony with nature (Thomason, 322). This might mean that they are living by the rules, traditions and values of their tribe. Living in harmony with nature might also mean that they are respecting the earth and all living creatures or avoiding taboos of their tribe. This also reflects the Native American perspective regarding the relative insignificance of the individual in comparison to that of nature, spirit, the tribe, or the family. Considering the importance of the family and tribe, it is no surprise that an individuals problems are not resolved in isolation. Their relationship with nature, the family, tribe and community is taken into consideration as an integral part of an individuals struggle. This leads to the family, community or entire tribe being involved in the resolution of the individuals problem. The relative insignificance of the individual in Native cultures also make Western based therapies, which are client-centered, uncomfortable and incongruous for the indigenous client. Therefore, using a more directive approach, or family therapy, or even guided imagery or hypnosis may be more effective. As Duran states, . . . The centered-therapist paradigm is one that has been proven useful in the shamanic tradition for thousands of years and should be acknowledged as useful by modern therapists (65). It becomes even more important when using a therapist-centered approach that the therapist be conscious of his or her worldview and prejudices in order to avoid inflicting them on the client.

Clients Level of Acculturation

At the beginning of therapy with a Native American client, it is important that the therapist determine the clients degree of acculturation. Acculturation is defined as assimilating anothers

culture into ones own culture and identity. Usually, the minority culture assimilates the dominant culture. Individuals with different levels of acculturation face different emotional issues and require different treatment approaches. For instance, an individual who has lived his or her entire life on a reservation would have very different issues than the individual who was born and raised in the suburbs of a large city. Acculturation also plays an important part in the individuals sense of identity. Often the individual, who seems most removed from his or her heritage, may need the most assistance and prompting to re-explore and re-integrate Native beliefs back into his or her identity. Understanding the extent of an individuals acculturation will help the therapist determine, which treatment approaches may be most helpful. Assessing an individuals degree of acculturation will also help the therapist determine when and how to weave traditional Native treatment modalities into psychotherapy. In Mental Health Care for Urban Indians Tawa M. Witko (12) describes the five categories of Indianness outlined by La Fromboise, Trimble, & Mohatt. These categories are: I. Traditional The traditional individual has had very little interaction with the world outside of his or her tribe. This person shows very little, if any, signs of acculturation. Transitional The transitional person has been exposed to Western culture, but does not fully accept the dominant cultures practices and beliefs. Although, the transitional person continues to practice the traditions of his or her tribe, he or she is not fully immersed in these beliefs and traditions. Marginal The marginal individual does not practice the traditions or live by the values of his tribe, but he is also not comfortable with the practices and beliefs of Western society either. The marginal individual does not feel that he or she fits-in, in either culture. Assimilated The assimilated person has fully embraced the Western culture and does not practice any of his or her tribes traditions or values. The assimilated individual may even deny his or her Native American heritage. This can lead to identity issues.

II.

III.

IV.

V.

Bicultural The bicultural individual both accepts his Native American heritage and the Western culture. The person who is assimilated at a bicultural level is the most functional because this person can move between both worlds and can accept both parts of himself. This person can also seek help and strength from both cultures.

It is also important at the beginning of therapy, to assess the impact colonization had on the individuals tribe and family. This can also be a factor contributing to the individuals presenting problem. Often, individuals do not realize that sociological and political issues can be contributing to their psychological problems. It is important to help the individual explore how the historic genocide of Native Americans has impacted his or her family and emotional development. This framing helps the individual look at his or her problem from a broader perspective. It also helps normalize the issues and can reduce the pathological stigma and shame associated with the diagnosis. Some Native Americans are so thoroughly acculturated that they have virtually no connection to their heritage. Simply working with them on re-connecting to their culture and spirituality can be the most important goal of therapy. This reconnecting with ones culture plays an important part in helping the individual understand their life and challenges. It also helps the individual improve their self-esteem, develop their sense of identity, and let go of any internalization of oppression experienced by their ancestors (Duran & Duran, 1995, 89-91). The therapist must be able to see beyond his or her preconceptions about the Native American client, and allow the therapeutic relationship to unfold. If you have enjoyed this article and would like to learn more about working with Native American Clients, we have a 6 CE Credit call entitled: Reawaken Native Roots To receive 20% off one of our online courses use discount code: S8RK

Work Cited Brendel, Johnson. Counseling Multicultural and Diverse Populations: Strategies for Practitioners. Ed. Nicholas A. Vacc and Susan Beck DeVaney. 4th ed. New York: Brunner-Routledge, 2003. Duran, Eduardo. Healing the Soul Wound. New York: Teachers College P, 2006. Duran, Eduardo and Bonnie Duran. Native American Postcolonial Psychology. New York: State University of New York Press, Albany, 1995.

Garrett, J. T., and Michael Tlanusta Garrett. Medicine of the Cherokee: the Way of Right Relationship. Santa Fe, NM: Bear & Pub., 1996. Print. Mehl-Madrona, Ph.D., M.D. Narrative Medicine: The Use of History and Story in the Healing Process. Vermont: Bear & Company, 2007. Thomason, Timothy C. "Commonalities Between Ericksonian Psychotherapy and Native American Healing." Journal of Mental Health Health Counseling 31.4 (2009): 351-62. EBSCO. Web. 10 Feb. 2010. Thomason, Timothy C. "Counseling Native Americans: An Introduction for Non-Native American Counselors." Journal of Counseling & Development 69.March/April (1991): 321-27. EBSCO. Web. 11 Feb. 2010. Witko, Tawa M. Mental Health Care for Urban Indians: Clinical Insights from Native Practitioners. Washington: American Psychological Association, 2006.