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									 Counseling Strategies with
  American Indian Clients:
Approaches and Techniques

   ICA Conference 2010
Mike Cutler, PhD, LPC, NCC
   Boise State University
               Why not just go to counseling?

Studies by Blue (1977) and King (1999) found that Natives
   do not utilize or value counselling services that do not
   acknowledge or are not adapted a Native helping model.

Most services are based on non-Indigenous conceptions and
 values of health and healing (Government of Canada,
 1991; Health Canada, 2003; Waldram, 2004).

Counsellors are not educated about Indigenous worldviews,
  current issues, and histories; a counsellor may be using a
  western-based approach that does not value the client’s
  worldview (Trimble & Thurman, 2002).
               • Suzanne L. Stewart, 2007
          Why not just go to counseling?

Patronization – lowering expectations for
  Native clients.
Missionary zeal – may think Indians are
Therapist may have an agenda – to get the
  Native person “up to speed”
Counselor may want to work on anger, when
  anger is justified
                      John F. Bryde, 1971

Seven qualities Native college students would
  like to see in a counselor:
• The counselor would be Indian
• The counselor would be a friend
• The counselor would be available
• The counselor would be open-mined
• The counselor would be patient
• The counselor would have a thorough knowledge of Native
      culture and values
• The counselor would be professional and a good listener
                            John F. Bryde, 1971

Bryde identifies eight concepts of self that Indians hold which are
  different than those held by most whites:

1. One of the strongest foundations for the Indian self concept is how
   well the individual gets along within the group. Usually getting
   along within the group forces conformity which eliminates the
   highly competitive type of atmosphere that exists in Anglo
                     John F. Bryde, 1971

2. A second important part of the Indian self-concept
   is that Indians tend to try to work for the good of
   the whole group rather than for the individual, or
   self. When the group is doing well, individual
   Indians feel strong and good, but when the group
   is doing poorly, the individual, no matter what his
   station in life, has feelings of anxiety.
                     John F. Bryde, 1971

3. The third trait largely determines how the Indian
   uses time. The individual Indian believes in
   concentrating upon the "now," without worrying
   about the future. Where in Anglo society it is
   extremely important to "build for the future," in
   Indian society, it is extremely important to have a
   good time "now" so that good memories in the
   future will dignify the past.
                         John F. Bryde, 1971

4. The fourth trait explains the individualism of most Indians,
   and one of the underlying reasons for Indian problems with
   the Anglo world. In white society most individuals, while
   striving to "get ahead," let others make decisions for him
   or follow the course marked out for him. The Indian tends
   to listen closely to advice, then to make up his own mind.
   Betterment of the group holds precedence in his decisions,
   but at the same time his decisions are highly individualistic
   in nature, putting him into conflict with the Anglo
   pressurized way of doing things.
                   John F. Bryde, 1971

5. A fifth trait helps Indians to face hard times
  with an impassive face. Poverty,
  embarrassment, fear, etc., are hid behind an
  outward composure that cannot be upset by
  the feelings going on inside of the self.
                     John F. Bryde, 1971

6. The sixth trait can be explained by saying that,
  generally, the Indian uses nature, but at the same
  time feels a reverence for nature. Indians also
  tend to limit their use of nature so that some of
  nature’s good will always be left for tomorrow.
  An excellent example of the Menominee view
  toward nature is their development of selective
  logging techniques during the late 1800s and
  early 1900s.
                   John F. Bryde, 1971

7. A seventh trait makes the many Indian
  people highly aware of the presence of God.
  Acts of religious worship are often
  spontaneous and they may occur at any
  time. In the ideal, Indian worship is a part of
  his very breathing, exploding at times into a
  joyful awareness of the goodness of life and
  the importance of God.
                  John F. Bryde, 1971

8. The eighth trait is in some ways related to
  the fifth trait. The Indian does not feel at
  home in the Anglo world, and when he is in
  that world he feels uneasy and fearful.
  However, he inevitably covers up his
  uneasiness and fear by presenting an
  impassive face to the world. He knows fear;
  but he does not show it.
   Teresa LaFromboise, Joseph Trimble,
                Carolyn Attneave, et al

• Essential to know the history of American
  Indian communities in order to counsel
  Native people effectively
• Always account for the “myth of
• American Indians and other ethnic
  minorities have been socialized to interpret
  their experiences in the world much
  differently than in the larger culture
    Teresa LaFromboise, Joseph Trimble,
                 Carolyn Attneave, et al

• Most American Indians have no desire to fully
  assimilate into Euro-American society
• Among children however, there is strong
  identification with larger or other cultures until at
  least middle childhood
• According to Trimble, “Many young Indians are
  not socialized to expound on inner thoughts and
  feelings. Thus, reliance on the client’s ability to
  achieve insight would be a mistake.”
    Teresa LaFromboise, Joseph Trimble,
                 Carolyn Attneave, et al

• Effective counseling strategies:
   • Get to know the community, and let the community get
      to know you (you will be “checked out”)
   • Establishing trust and rapport
   • Assess level of acculturation
   • Include families in interventions
   • Pay attention to local styles of greeting, dress, and
      introductory conversation
   • Acknowledge the client’s tribal affiliation
   • Acknowledge the client’s familial affiliation
    Teresa LaFromboise, Joseph Trimble,
                 Carolyn Attneave, et al

• Effective counseling strategies:
   • Cite studies indicating a preference for an experimental,
      non-directive style emphasizing approval/reassurance
      and self-disclosure
   • But then cite other studies indicating young Native
      people prefer a more directive approach as long as it is
      anchored in a solid knowledge of the client’s culture
   • High efficacy for group counseling among this group
       Teresa LaFromboise, Joseph Trimble,
                    Carolyn Attneave, et al

• Effective counseling strategies:
   • Be involved in the Native community to greatest extent possible
   • Attend ballgames, powwows, and if invited, attend ceremonies
   • Educate self about appropriate etiquette and comportment
      involved in social and ceremonial attendance
   • To get a true sense of the client’s world, it is necessary to
      experience that world as much as possible
   • Be initially cautious, however, and approach from the
      traditional perspective of watching before fully participating
        Teresa LaFromboise, Joseph Trimble,
                     Carolyn Attneave, et al

• Effective counseling strategies:
   • Respectfully reference the client’s family and tribal history
   • Be extremely careful with confidentiality – a challenge in
      Native communities as everyone knows everyone else
   • Be aware of traditional communication patterns
   • Be aware of dual roles and the differences that are found in
      Native communities, differences that can often confound
      professional ethical codes
   • Be open to working on issues involving racism and
                            Donna Grandbois

• Who is an AIAN client
• Only three published community epidemiology studies
• Western conceptualizations of pathology of AIAN people
      have been the focus of studies rather than their
      tremendous strengths and coping strategies
• Studies that focus only on alcoholism and suicide among
      AIAN people perpetuate stereotypes and fail to
      explore causation, or help to improve the well-being
      of AIANs
                       Donna Grandbois

• Diversity among AIANs
  • Commonalities in beliefs and traditions, but
     profound background differences
  • Two AIAN people may have greater
     differences than two Europeans from different
  • The role deculturation and reculturation and
     their influence on stigma
                           Donna Grandbois

• Concept of Mental Illness
  • Prior to European contact, there was no AI/AN concept
     about mental illness.
  • Native people often do not tend to see mental illness as
     separate from physical or spiritual illness.
  • The mental, physical, and spiritual are all seen as
     influencing health.
  • All must be considered when treatment is planned.
    Worldview Differences that Impact Mental Health Care

• American Indian/Alaska Native   • Majority Culture
• Relational, Circular            •   Linear, Point A to B
• Mind, Body, Spirit/One          •   Psyche is the focus
  Mystical/Acceptance             •   Scientific/Verification
• Ceremonials/Rituals             •   Psychotherapy
• Tribal connectedness            •   Individualism
• Spirituality & Balance          •   Organized Religions
• Cooperation/Sharing             •   Competition/Winning
• Humility/Respectful             •   Assertive/Forceful
• Present oriented                •   Future Oriented
• Herbs, plants, nature           •   Psychopharmacology
                                           •   Grandbois, D.M., 2005

                           Donna Grandbois

• Origins of stigma of mental illness among
  various AI/AN
  • A form of supernatural possession
  • A sign of imbalance with the rest of the natural world
  • Persons with MI possess a special gift
  • Mental disorder is a hopeless state, much like a
     terminal illness
  • Sharing private thoughts is taboo & often intermingled
     with mistrust
                        Donna Grandbois

• Cultural beliefs support the stigma
  • Belief that the person has “bad spirits” or that
     “bad medicine” was used
  • If a person is crazy he or she should go live in
     the state hospital
  • Mental illness puts a bad name on the family:
     illness in genes or family bloodline
  • Family members are embarrassed by their ill
     member’s behavior
                           Donna Grandbois

• Stigma on the Reservation is Expressed
  in Various Ways
  • Stigma is maintained & perpetuated through close tribal
     communities & connectedness
  • Privacy is protected by denying the presence of mental
     illness, thereby maintaining the unspoken rule about
     not talking about mental illness
  • The ill person needing services will “try to handle
     problems alone”, so not to be a burden
  • AIs are socialized to handle their problems & avoid
     becoming a burden to their families
                               Donna Grandbois

• Stigma directed at AI/AN People with
  Mental Illness
  • The cultural “blind spot” surrounding mental illness must be
     confronted & resolved before effective treatment can be
  • AI/ANs need to become educated about, own, & integrate their
     own history into the history of this country.
  • The “historical journey” of AI/AN people must be told & heard by
     other Americans. It must be written.
  • American Indian & Alaska Native people need to find ways to
     assume their rightful place in American society.
                         Donna Grandbois

• The Hiawatha Asylum for Insane Indians
  • A mental health benchmark in AI/AN History
  • “Kill the Indian, Save the man”.
  • (Yellow Bird, P. (2001) @
                                        Donna Grandbois

“Native peoples generally do not have a notion of “insane” or “mentally ill.” I have
been unable to locate a Native Nation whose indigenous language has a word for
that condition. The closest I can come is a word more closely aligned with “crazy,”
which means someone is either very funny, or too angry to think straight” p.4.
(Yellow Bird, P.,
Traditionally-based Counseling
        American Indian Religious
                    Freedom Act

• Signed in 1978
• Challenged in 1990 - Employment
     Division of Oregon v. Smith
     (494 U.S. 872, 1990)
• Reestablished in 1994 by Clinton -
     American Indian Religious Freedom
     Act (42 U.S.C. 1996, Aug. 11, 1978)
     and known commonly as the Peyote Bill
  The Foundations of AI/AN Mental/
                Emotional Struggle
1. Historical and Multigenerational Trauma
  •   Loss of Power = Abuse of Power
  •   Have to make peace with parents to make             peace
      with children
         •   Maria Yellowhorse Braveheart/Eduardo Duran

2. Unresolved Grief
  •   We’re always grieving
  •   Work to change the perception of the loss - reframe
         •   Gene Thin Elk/Rick Thomas
   Ceremonies and related healing
• Traditional Spiritual and Healing Ceremonies
      (vary from tribe to tribe)
• Native American Church membership and
• Use of prayer supported by burning of sacred
      plants (sage, sweetgrass, cedar, tobacco are
• Use of prayer supported by use of sacred objects
      (sacred pipe, eagle feathers, drums, stones,
      other sacred objects – “The World We Used to
      Live In by Vine Deloria, Jr.)
   Traditionally-minded explanations for
                          mental illness

• We have to pay attention to the reality
    of the unseen from the client’s

• We need to honor the client’s worldview,
    even if it significantly challenges our
Traditionally-minded explanations for
                       mental illness

•   Object Intrusion
•   Sorcery
•   Breach of Taboo
•   Spirit Intrusion
•   Soul Loss/Soul Wound
                        Object Intrusion

• The belief that an object has intruded into
  the body. The object can invade the body by
  some random event, or it can be placed
  there by someone wanting to cause
  suffering. Therapy for this type of illness is
  removal of the object by extracting it
  through cutting, bleeding, or sucking.

• Illness that occurs if someone with power
  willfully inflicts physical, psychological, or
  spiritual illness on another. Often done
  through obtaining strands of another’s hair
  or nail clippings.
                     Breach of “Taboo”

• Illness due to the guilt caused when an
  individual violates a societal or spiritual
  rule. This can involve an act of disrespect
  toward a ceremonial ritual, a natural spirit
  (an animal during a hunt, etc.), crossing a
  kinship taboo (talking to an in-law, etc) or a
  menstruation taboo.
                       Spirit Intrusion

• The belief that illness is caused by an
  outside entity invading the personality.
  Relevance can be found in the Western
  concept of MPD. Severity of spirit intrusion
  can be found on a wide spectrum.
                Soul Loss/Soul Wound

• The belief that one’s soul has been lost. This can
  be easily understood as a depersonalization in
  which the person may have lost contact with
  reality. Can also be seen in cases of emotional or
  psychological dissociation. The “wounded soul” is
  often one that has been “lost” to some extent, due
  to the historical destruction of the culture and the
  accompanying distress
                             Eduardo Duran

• Has published several articles and three
  books of note:
  • Duran, E. & Duran, B. (1995) Native American
    postcolonial psychology. Albany: State University of
    New York Press.
  • Duran, E., (2000). Buddha in redface. Lincoln, NE.
  • Duran, E. (2006) Healing the soul wound: Counseling
    with American Indians and other native peoples. New
    York, NY, Teachers College Press, Columbia
     Relies Heavily on Traditional

• Liberation Psychology

• Historical/Intergenerational Trauma

• The Psychology of the Healer
       Relies Heavily on Traditional

• Works against the concept of pathology of
  individuals, communities, and peoples
  •   Transference toward Native people
  •   Dx as a Naming Ceremony
  •   Therapists as Perpetrators of historical trauma
  •   Clinical racism in Indian Country
            Use of Spiritual Articles

• Openly uses sacred plants in therapy, and
     encourages others to do the same
• Very comfortable with dream work
• Very comfortable with traditional
     interpretations of diagnosis
• Mixes direct with indirect counseling
     techniques and questions
           The Healing/Therapeutic Circle

• Beginning therapy

• The Healing Container

• Your identity as a healer

• Initial Sessions
          Treating The Soul Wound

• Recognizing violence as a historic
     inheritance (a “vampire”)
  • Acknowledging intergenerational issues
  • Assessing and working with typology

• Working with the feeling function
              The Spirit of Alcohol

•   Teachings on the Spirit of Alcohol
•   Addiction as a spiritual disorder
•   “Alcoholic” as a Name
•   Relating to the Spirit of Alcohol
•   Transforming suffering into healing
•   Inpatient dream groups
      Treating Emotional Problems as
                      Living Entities

• Visited by depression and anxiety (Narrative)

• Not for Beginners

• Somatic Complications

• The Spirit of Suicide
            Community Intervention

• Problems with Research
• Interventions with Tribal Communities
  • Raising Awareness
  • Devising a plan to continue the process
  • Evaluating tribal government buy-in
• Addressing religious differences in Native
• Healing the Land
• The Process will be slow

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