Native american clinical considerations

Counseling

Considerations for

Native Americans

Maggie Dunham

Kathy Telljohann

A Caveat

Although this information is presented as considerations for Native Americans as a group, it is vital to remember that each tribe is different, and each person within a tribe is unique.

It is important to ask the client how their culture plays into their life.

Never assume you are an expert.

Native Americans

Subgroups are determined by the tribal location– They do not form a

single ethnic group

– “they always have resisted a homogeneous definition”

Northeastern

Southeastern

Southwestern

Northern Plains

Northwest Coast

Alaska Natives

Oklahoma Indians

Indians of the Plateau, Great Basin, and Rocky Mountains

California Indians

Kline, M.V. & Huff, R.M. (2007). Health and disease of American Indian and Alaska Native populations: An overview (2nd ed.). Thousand Oaks, CA: SAGE Publications, Inc. p. 355-392.

Schwarzbaum, S. E. & Thomas, A. J. (2008). Dimensions of multicultural counseling: A life story approach. Thousand Oaks, CA: Sage Publications, Inc.

Native Americans of Today

Smallest racial minority in the US

– Poorest

– Least educated

29.1% of 25 year olds hadn’t completed high school

– Most neglected minority group

– Young populations


Spiritual Beliefs

Spirit of balance and harmony with:

– Others

– The natural world

– The spirit world

All have spirits

– Good or evil

“Life depended on the careful cultivation of these spirits.”

One’s health reflected upon the spirits

Major Historical Impacts

Manifest Destiny ultimately allowed white settlers to take land from

Natives

Indian Removal Act of 1830.

o Impacted beliefs:

Racism

Material progression

Trail of Tears in 1838

o “The forced march westward of the Cherokees… Approximately

16,000 Cherokees were held in disease-infested camps prior to

their departure for Indian Territory.”

o “Removal enforced reservation living, creating dependence on

governmental housing, food allotments, and general

subsistence.

Langer, C.L. (2005). The effect of selected macro forces on the contemporary social construction of American Indian ethnic identity. Journal of Health & Social Policy, 20(2), 15-32.

Significant Events

Ghost Dance of 1890

– “An example of Native revitalization among these Western tribes

Placement of Indian Children in Non-Indian Foster Homes

– Prior to the Indian Child Welfare Act (ICWA) of 1978, a sinister attempt at assimilation, perhaps even cultural genocide, was the placement of Indian children in non-Native homes.

Formation of American Indian Movement (AIM)

– AIM is one of those Indian-initiated events that inspired Natives and non-Natives alike to begin to redress the many grievances of civil rights violations.

– In addition, Indian identity was strengthened.Langer, C.L. (2005). The effect of selected macro forces on the contemporary social construction of American Indian

ethnic identity. Journal of Health & Social Policy, 20(2), 15-32.

The Aftermath of Historical Events

Historical trauma due to what is perceived as cultural genocide

“For those who work with Native American populations, understanding this history is a critical piece in the process of acquiring cultural competence.”

“An understanding of this history helps to explain how and why such cultural nuances and social problems might exist among contemporary populations, including those who have been so marginalized that they might only recently have discovered their heritage.

A historical and analytical model of macro identity formation begins to emerge when these historical phenomena are examined and connected.Langer, C.L. (2005). The effect of selected macro forces on the contemporary social construction of American Indian

ethnic identity. Journal of Health & Social Policy, 20(2), 15-32.

Common Clinical Concerns

Depression Depressive

symptomology case– Rate of 41%

– Triple U.S. general population

Substance abuse Alcohol mortality 5x

higher– 37.2 vs. 6.8 per 100,000

Fetal Alcohol Syndrome

– 33 times higher– 37.2 vs. 6.8 per 100,000

– Domestic violence Women age 18-59

– 53% have experienced

Women age 50<– 28% have experienced

– Sexual Assault Young girls used as

objects in trade for alcohol

– Accidents Youth

– 75% die due to violent accidents and injury


Risk Factors and Strengths

Risk Factors– Unemployment

Financial barriers

– Lack of education No jobs on reservations, thus

education seen as non-essential

– Differing cultural beliefs Ex. Tobacco use

– Mistrust of non-tribal members

– Communication barriers

Strengths– Tribal sovereignty

– Unity Desire to care for

and heal others

– Federally recognized IHS health system


Native American Family SystemsMore of a circular pattern

–Everyone deserves equal respect and dignity – no one is higher than anyone else

Rabbit and Turtle

–The rabbit moves too fast and becomes afraid of what the turtle can do.

Metaphor for Western culture and Native American culture

Need to be mindful that different does not mean bad

Derrick, J. M. (2005). When turtle met rabbit: Native family systems. In M. Rastogi & E. Wieling (Eds.), Voices of color: First-person accounts of ethnic minority therapists (pp. 43-64). Thousand Oaks, CA: Sage Publications, Inc.

Offering Interventions with

Awareness Tobacco use has spiritual merit for Native culture, though

today’s toxins in cigarettes allow smoking-related illness to be #1 cause of death in Natives.

Smoking cessation courses are offered by standards are offered by national organizations, a better recommendation might be for Red Road or Talking Circle.

“These models emphasize the importance of community, connection of self to everything else in harmony, and are culturally sensitive to the nature of Native spirituality.”

“The ecological perspective is important to all populations, but the web of complexities surrounding Native Americans and their history with this country and the government makes use of the ecological perspective absolutely critical.”

Thoughts on Treatment

Ben Hale, a Navajo talks about different takes on treatment and things to keep in mind when counseling and working with Native Americans.

Hale, B. (2010, October 8). Part IV: Reawaken native roots: Treatment [video file]. Retrieved from http://www.youtube.com/watch?v=WAyKoM3vPoY

Transcript Highlights

“There are some critical factors, that I think I'd like to highlight at this point. One is that in our, in our greeting of, ah, Ms. Pete, we, I thanked her, thanked her, for having the courage to come in, for having the courage to, begin to change, ah, some things that are problematic that she identifies as problematic within her family, so that we might change the history of her family. I'm taking the stand, the stand in speaking for her relatives in a sense and thanking and honoring her, and also being honored for ah, being a part of that change. One of the other issues, that we have discussed and, and looked at is that history of struggle and, that, and what we will look at and we've got a permission to look at now, is the traumatic history of the family and how the traumatic history has basically led this family to a point where, the family is, is, seeking help, ah, from professionals. And it's, it's very important to understand when native people that's seeking help from professionals may be the hardest thing, to do. Typically native families, native individuals will not come in under their own volition but through the suggestion of someone else or even the pressure of someone else. In that respect, we talk about changing the family history by beginning to make the individuals within the immediate family healthier by setting out on a road of traditional healing that is congruent with what, the mother has already identified as her goals. “

Microtraining Associates. (2000). Innovative approaches to counseling Native-American Indian people [video file]. Culturally Competent Counseling and Therapy. Retrieved from http://0 ctiv.alexanderstreet.com.bianca.penlib.du.edu/View/529686/clip/11304

Use of Humor with Native

Americans

The stereotype of the “Stoic Indian”

–Part of self-control and listening, but also recognize importance of humor

Storytelling as a means of communication

Can take several different forms:Teasing, storytelling, anecdotes, dances,

songs, etc.

Garrett, M.T., Garrett, J. T., Torres-Rivera, E., Wilbur, M., & Roberts-Wilbur, J. (2005). Laughing it up: Native American humor as spiritual tradition. Journal of Multicultural Counseling & Development, 33(4), p.194-204. Retrieved from http://0-search.ebscohost.com.bianca.penlib.du.edu/login.aspx?direct= true&db=a9h&AN=18572246&site=ehost-live

One Liners from Native Americans

A young Indian was asked one day what a peace treaty was. He replied, "That's when the white man wants apiece of your land." (Deloria, 1988, p. 166)

A Pueblo artist was quizzed one day on why Indians were the first ones on this continent. "We had reservations," was his reply. (Deloria, 1988, p. 166)

Question: Are you a full-blooded Indian? Reply: No, I'm a pint low, I just came from the blood bank. (Northrup, 1997, p. 2)

Question: Do Indians have psychic powers? Reply: I knew you were going to ask me that, I just knew it. (Northrup, 1997, p. 12)

Question: Why is the white man in such a hurry to get to Mars? Reply: They think we have land there. (Northrup, 1997, p. 13)

An Indian woman of mixed ancestry was giving a talk once to an audience in which a heckler remarked to the speaker, "You don't look Indian," and the speaker quickly retorted, "You don't look rude." (M. T. Garrett, personal communication)

Implications for

Counseling with HumorImplications

Powerful tool, especially with Native Americans

Can be used to develop deeper and more intimate relationship

Be aware of culturally relevant acceptable topics for humor

Allow client to initiate humor as a tool

Cautions

Should not be used when:

– Avoiding client’s feelings

– Viewed by client as unrelated to counseling

– Perceived as insulting

– Used too frequently

– Used at inappropriate times

Gay Lesbian and Bisexual

Native Americans

Natives are more likely to be accepting of someone being gay or bisexual in Native American culture, as their capacity for acceptance is less dichotomous than the general public (in terms of identification).

“When considering sexual dimension, sexual orientation is something one discovers over time, sexual behavior is what one does, and sexual identity is a label one chooses”.

Appropriate term in Native culture for someone who identifies with homosexuality or bisexuality is “Two Spirit”, meaning that the individual identifies with both male and female spirits.

This term, however, can be identified differently depending on the variation of tribal culture language.

Garret, M.T.; Barrett, B. (2003). Two Spirit: Counseling Native American gay, lesbian, and bisexual people. Journal of Multicultural Counseling & Development, 31(2), 131-142.

To Recap…

Traits to Keep in Mind

Sharing is more important than punctuality.

Independence, Individuality, and Respect.

To attain maturity one must face great suffering.

– Testament to endurance of their culture by surviving the onslaught of white man.

“the courage to be” ~ Humor :)

Spiritual belief of both good and bad.

Sign of respect to not look people in the eye.

Lewis, R.G., Ho, M.K. (1975). Social work with Native Americans. Social Work. 20 (5), 379-382.

Misconceptions The Native American is pessimistic, low-

spirited, unhappy and without hope.

–Should instead be regarded as “optimistic toughness”

The Native American is quiet, stoic and vulnerable.

– Is actually a control of emotions and poise, as well as a potential mistrust of non-Natives.


Engaging with a Native

American Client Client might perceive a non-Native clinician as a

coercive figure of authority.

Client will not be impressed with academic standing of clinician.

“willingness and capacity to share depend mutual consideration, respect, and non-coercion.”

Worker’s advice should be objective and flexible

In order to best “determine the appropriate techniques for helping a Native American client deal with personal and psychological problems, the worker should carefully observe the client’s cultural framework and his degree of defensiveness”.


References Derrick, J. M. (2005). When turtle met rabbit: Native family systems. In M. Rastogi & E. Wieling

(Eds.), Voices of color: First-person accounts of ethnic minority therapists (pp. 43-64). Thousand Oaks, CA: Sage Publications, Inc.

Garret, M.T.; Barrett, B. (2003). Two Spirit: Counseling Native American gay, lesbian, and bisexual people. Journal of Multicultural Counseling & Development, 31(2), 131-142.

Garrett, M.T., Garrett, J. T., Torres-Rivera, E., Wilbur, M., & Roberts-Wilbur, J. (2005). Laughing it up: Native American humor as spiritual tradition. Journal of Multicultural Counseling & Development, 33(4), p.194-204. Retrieved from http://0-search.ebscohost.com.bia nca.penlib.du.edu/login.aspx?direct=true&db=a9h&AN=18572246&site=ehost-live

Hale, B. (2010, October 8). Part IV: Reawaken native roots: Treatment [video file]. Retrieved from http://www.youtube.com/watch?v=WAyKoM3vPoY


Langer, C.L. (2005). The effect of selected macro forces on the contemporary social construction of American Indian ethnic identity. Journal of Health & Social Policy, 20(2), 15-32.

Lewis, R.G., Ho, M.K. (1975). Social work with Native Americans. Social Work, 20(5), 379-382.

Microtraining Associates. (2000). Innovative approaches to counseling Native-American Indian people [video file]. Culturally Competent Counseling and Therapy. Retrieved from http://0-ctiv.alexanderstreet.com.bianca.penlib.du.edu/View/529686/clip/11304

Tailfeathers, O. (2005). Universe song. On Ninihkssin [mp3]. Styles Music Canada.

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Native american clinical considerations