Counseling Strategies with American Indian Clients: Approaches and Techniques

1. Counseling Strategies with American Indian Clients: Approaches and Techniques ICA Conference 2010 Mike Cutler, PhD, LPC, NCC Boise State University

2. 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

3. Why not just go to counseling? Patronization – lowering expectations for Native clients. Missionary zeal – may think Indians are TOTALLY AWESOME! Therapist may have an agenda – to get the Native person “up to speed” Counselor may want to work on anger, when anger is justified

4. 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

5. 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 society.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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 homogeneity” American Indians and other ethnic minorities have been socialized to interpret their experiences in the world much differently than in the larger culture

14. 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.”

15. 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

16. 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

17. 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

18. 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 discrimination

19. Donna Grandbois Who is an AIAN client Only three published community epidemiology studies exist 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

20. 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 countries The role deculturation and reculturation and their influence on stigma

21. 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.

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

23. 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

24. 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

25. 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

26. 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 implemented. 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.

27. 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) @ www.mindfreedom.org/pdf/wildindians.pdf

28. Donna Grandbois