Cultural Sensitivity in Counseling Native Americans

Cultural Sensitivity in Counseling:
A Prospective on Native Americans
Kevin Canfield
Liberty University
October 12, 2010

Abstract

Three of the most popular techniques in use by the counseling profession were examined in relationship to Native American culture and worldview, in order to determine the reasons for their ineffectiveness among these people groups. The results indicate that a lack of understanding and sensitivity to Native American culture and belief systems by counselors may be the major contributing factors in the failure of these methods to produce lasting change. Three alternative methods were then investigated. Together, these examinations show that cultural sensitivity and an in-depth understanding of belief systems and practices are critical in helping Native Americans heal from historical traumas and affect real transformation within the Native American community.

Cultural Sensitivity in Counseling: A Perspective on Native Americans
Why is it that many Native Americans fail to benefit from counseling? Why is there such an enormous “burn-out” rate among counselors who work with this people group? These questions are becoming increasingly more important in the counseling profession.
There have been many studies on competencies and practices in multicultural counseling. One such study although dealing primarily with career counseling (Vespia, Fitzpatrick, Fouad, Kantamneni, & Chen, 2010), reinforced the necessity for training in developing a counselor’s competency with diverse cultures. Another study which dealt specifically with psychotherapy (Lambert, Smart, Campbell, Hawkins, Harmon, & Slade, 2006), echoes this sentiment. However, the cause of ineffectiveness may not necessarily be the incompetence of counselors, but their tendency to use inappropriate methods which fail to consider the unique cultural heritage of Native Americans. These culturally-insensitive methods can sometimes compel clients to violate basic personal values. For example, Native Americans place great emphasis on a harmonious co-existence with nature. If a counselor advocates individual responsibility for mastering the environment, he is, in fact, asking his Native American client to disregard a part of his client’s cultural belief system.
Take the case of Robert Red Elk (not his real name), a White Mountain Apache, hired at a manufacturing plant in Phoenix, Arizona. Robert’s supervisor witnessed many instances where Robert’s fellow employees asked to share his lunch or complete their work assignments. Robert never refused and willingly overworked himself (to the point of exhaustion) finishing the tasks of others. Eventually, after several absences from work, Robert was referred to counseling by his supervisor. The counselor, after an initial assessment, enrolled Robert in assertiveness training. The counselor, however, failed to understand one very important aspect of Robert Red Elk’s value system: Native Americans are not individualistic. Their culture places great value on sharing and service. There are over 500 federally recognized Indian tribes in the United States. Each tribe has its own beliefs, customs and traditions. Many Native Americans have left the reservation and know very little of their tribal culture, having assimilated into White society. There are, however, many common threads running through Native American culture and philosophy, which if misunderstood can open a breach between counselor and client that can be difficult to heal. For the purposes of this paper, we will be dealing primarily with Native Americans raised and residing within traditional Indian reservation communities. These individuals have retained much of their cultural identity, as opposed to those who have moved into the cities and have become westernized into the White culture. Nearly every tribe has wide-spread personal and social issues which are threatening lives and creating broken homes and broken people. Compared with other racial and ethnic groups, Native Americans have more serious problems with mental health disorders (Olson & Wahab, 2006, p. 19-33). For example, on the Pine Ridge Reservation of the Lakota Sioux, over 50% live below the poverty level. In 2007, the suicide rate there was 3.2 times that of Whites, between 50% and 90% were unemployed, and the death rate due to alcoholism was 7 times the national average (Diller, 2007).
Counselors employ many methods in an attempt to help Native American clients heal from brokenness. This investigation will examine three popular techniques: Free association, cognitive therapy, and behavior modification. In addition, we will discuss why these methods are failing with many Native American clients. First, however, there is a need to explore the average Native American value system.
The Native American Value System
Silence and Talking
Native Americans believe that listening is the best way to learn. They understand that there are many “voices” to hear, not merely from other people, but from the earth, the wind, the sky, and the animal kingdom. They listen not only with their physical ears, but with their whole being in an attitude of “watch, listen and then act” (Nerburn, 2002). They believe it unwise to speak before completely formulating one’s thoughts. They understand the power of words, and so they speak carefully, choosing words judiciously. In most non-native cultures, interaction with others must be filled with words and speaking that can sometimes become argumentative. Just the opposite is true in most Native American cultures. When asked a question, there will normally be a pause before answering, because any question worthy of an answer is worth considering. When they finally do speak, it is expected that the hearer will listen. Interrupting is considered rude and a sign of ignorance. This practice of silence has a tendency to disconcert someone who is unfamiliar with it, and historically, Caucasians have viewed it as a sign of stupidity.
Freedom and Honor
Native American cultures value honor far above freedom. Honor is the internal guide for nearly everything they do. The focus is more on what is right, rather than what is wrong. This is one reason why Native Americans have a difficult time understanding the concept of sin. In addition, honor is something that cannot be taken away. If one loses his freedom, he still retains his honor. These views of freedom and honor are very different from those held by western peoples. In the White world, honor means paying homage to or admiring an individual’s accomplishments. To the Native American, honor means knowing and doing what is right for oneself and for one’s community. It has no relation to laws or the desire to avoid punishment. Freedom only becomes important after one has been “chained up,” either literally or by the enactment of laws and restrictions (Nerburn, 2002).
All My Relations and Racism
According to the New Lakota Dictionary, “Mitakuye oyasin” translates to “all my relatives” in Lakota Sioux (Ullrich, 2008, p. 337). The concept of all my relations constitutes an understanding of and honor for the sacredness of each person 's individual spiritual path. It acknowledges the sacredness of all life (human, animal, plant, etc.) and creates an awareness that strengthens not only the individual, but the entire planet. It essentially means that everything is inter-related. In the living of daily life, all my relations “means learning how to connect with certain constructive or creative forces, and disconnect from destructive forces” (Portman & Garrett, 2006). It’s the understanding that whatever hurts one aspect of the world hurts everything else.
Rolling Thunder, the late spiritual leader of the Cherokee and Shoshone tribes, said, “Too many people don 't know that when they harm the earth they harm themselves, nor do they realize that when they harm themselves they harm the earth…We say there 's room for everyone, if we all share as brothers and sisters” (“Plowboy Interview,” 1981).
This belief in the brotherhood of the human race is one reason why Native Americans abhor racism. Another reason is their suffering because of it. “From the 1490 's to the 1890 's, Europeans and white Americans engaged in an unbroken string of genocide campaigns against the Native people of the Americas” (BigFoot & Willmon-Hague, 2008, p. 54). A study on multi-faith perspectives in family therapy made note of the following historical treatment of Native Americans: “In government and missionary programs to educate and acculturate Indians in Christianity and Western ways, children were forcibly taken from their families to boarding schools and stripped of their cultural and spiritual heritage” (Walsh, 2010, p. 3). Consequently, Native Americans view racism as evil and most avoid retaliation, because they believe it creates a loss of honor. However, many American Indians still retain an inherent mistrust of Whites (Bryant-Davis & Ocampo, 2006, p. 16). In a study on reservation violence, it was noted that traditionally one important factor regarding Native American philosophy was “humility to those with whom one does not share beliefs; and teaching nonviolent behaviors” (Hukill, 2006, p. 249). A reintegration with traditional beliefs and practices could help stem the violence on reservations.
Concept of Time
Native people are not enslaved by a clock or calendar. Their concept of time is related more to the seasons, nature, relationships, and life spans. Time is a cycle as, in the sacred hoop. Time is not measured in linear fashion, having a past, present and future. Living each day as it comes is linked to the belief that one should focus more on being than becoming. This concept of time can explain why Native Americans might be late for counseling appointments by the hour or by days. Adherence to a rigid schedule is not traditionally an Indian practice. Things are done as they need doing. Time is flexible and geared to the activity at hand.
Some other examples of this concept of time are: * A right time and a right place, as opposed to making every minute count. * Today is a good day, as opposed to preparing for tomorrow.
Other concepts that affect how Native Americans react to traditional counseling methods include striving for anonymity, discouraging aggressiveness (such as boasting and loud behavior), the value of inaction over action, and the use of tribal healing ceremonies. “Understanding Native American healing practices requires helping professionals to have knowledge of the cultural belief systems that are unique for each tribal nation…” (Portman & Garrett, 2006, p. 455).
Culturally Insensitive Counseling Methods

Counseling methods that fail to consider culturally-relevant issues are realizing few successes with native peoples. Three of the most prominent techniques fail to take into account the Native American’s holistic belief system and attempt to merely change behavior by changing one’s thinking.
Free Association
Free association is a spontaneous, logically unconstrained and undirected association of ideas, emotions and feelings in which words or images suggest other words or images in a non-logical chain reaction. The basic concept is for the client to sort things out, and assign reasons to their feelings, with the intention of changing unhealthy ideas and emotions into a more acceptable way of living.
Native American clients typically shy away from participating in this type of activity, because they see it as senseless babbling that accomplishes little and makes a person appear to have lost their mind. They much prefer being silent and listening to talking and babbling themselves into a reasonable state of mind. In addition, they are very cautious about sharing personal and family problems, and have difficulty communicating their reactions to situations.
Cognitive Therapy
Cognitive therapy aims to identify and correct distorted thinking patterns that lead to feelings and behavior that are troublesome, self-defeating or self-destructive. The objective is to replace distorted thinking with a balanced view that leads to more fulfilling and productive behavior. Due to the epidemic of depression, alcoholism and suicide among Native Americans, this is an admirable objective for counselors to attempt to achieve. However, for a people, who are holistically-minded, cognitive therapy considers only one facet of the whole person, and ignores the connection humans have with nature and the world. This approach disavows the unity of the person, a central core belief in Native American culture. To separate the mind from the body and spirit, and with the rest of creation, is an illogical and foreign concept to them.
In addition, most Native Americans are pragmatic and tend to see life in concrete terms rather than abstract ones. Therefore, “counselors may consider working from a holistic, wellness-based framework,” so that harmony and balance can be restored (Rayle, Chee, & Sand, 2006, p. 72).
Behavior Modification
This approach is a treatment approach based on operant conditioning that seeks to extinguish or inhibit abnormal or maladaptive behavior by positive or negative reinforcement. As with cognitive therapy, behavior modification focuses entirely on one facet of the whole person. Native Americans are very resistant to this approach, because they do not always focus on their thinking. Historically, they have been exposed to the inconsistency of people thinking one way and behaving another way. According to Native American culture, behavior reflects belief. Attempting to change behavior from the outside and failing to deal with internal issues is viewed as a waste of energy and considered unproductive. Typically, Native Americans respond better to holistic methods that involve the whole person: body, mind and spirit.
Culturally insensitive approaches to counseling can actually introduce a sense of mistrust into relationships between native clients and non-native counselors derailing attempts to help them overcome the issues that defeat them. This is one reason why Native Americans “underutilize mainstream mental health resources” (Parrish, 2006, p. 15).
Culturally Supportive Approaches to Counseling
As understanding and knowledge of cultural beliefs and practices grows, holistic approaches to counseling are becoming more prevalent in clinics and practices in which the majority of clients are Native American. There are several methods which are showing great promise in helping these clients.
Inner Healing Prayer Because Native American culture is infused with the spiritual and encompasses a holistic view of the body, soul and spirit, the concept of listening, which is the foundation of this method, lends itself to a more culturally-relevant way of approaching the mental and emotional issues found among indigenous peoples. Native cultures are already accustomed to listening because of their practice of being attentive to the sounds of nature and the practices of oral traditions passed down through the stories of tribal elders. They understand that listening is one of the best ways to learn. The inner healing prayer can offer Native Americans a way to re-establish harmony with their body, their emotions, and their spiritual selves (Rayle, Chee & Sand, 2006, p. 77), since it begins with addressing one’s emotional hurts. “It is counselor-led and client-consented prayer intervention with the specific intent of healing and breaking the chains of past traumas” (Clinton & Ohlschlager, 2002, p. 240). When woundedness goes unresolved, it affects the whole person creating disharmony within the body, soul and spirit. Native American culture already understands this concept. The typical scenario is to give the client permission to experience what they feel, and allow their inner emotions to express themselves in a controlled, safe environment. Encouraging them to remember those painful places and the trauma that occurred there helps bring emotions to the surface where they can be explored, felt, owned, and released from the captured place within the spirit. Once accomplished, the counselor can then ask the Lord Jesus [Great Mystery] to minister His love and grace, revealing truth in whatever manner He chooses. The counselor then remains silent, encouraging the client to verbally express whatever is transpiring within them and articulate whatever truth the Lord is revealing to them. The counselor’s role is to discern whether the client is receiving truth from the Lord (according to the revealed Word of God) or error manifested from within themselves, which would constitute feelings and/or thoughts that run contrary to scripture. Once it is determined that authentic truth has been received, the counselor then asks the client what is now different about that traumatic event when they reconsider it. At this point, an entirely different perspective is usually revealed by the client. It is important when using this method, as it is with any technique, to “weave Western counseling techniques with elements of the AI [American Indian] culture, beliefs, and philosophy” (Rayle, Chee & Sand, 2006, p. 73-74) [emphasis mine]. It is well to remember, however, that many Native Americans do not believe in the “white man’s God.” It is important, therefore, to use terms for deity that are culturally relevant, such as Great Mystery, Great Spirit, etc. This approach has shown great potential in overcoming issues such as depression and addiction.
Spiritual Talking Talking circles, storytelling and remembering/reflecting on life is very common in Native American culture. Many indigenous children receive their first life lessons sitting at the feet of their elders as grandmothers and grandfathers recount tribal stories that teach the traditions of the tribe (Rybak & Decker-Fitts, 2009, p. 337). Since native people relate more to “the now,” it is very therapeutic to recall and embrace the good things in one’s present situation. Talking aloud about pleasant experiences helps clients see the good in their present circumstances and allows their spirit to “be as one” with their body-mind uniting them with the world at large. This enables them to see the big picture and brings everything into a healthy perspective. The role of the counselor in this technique is to facilitate the talking and keep the client on track, while providing a safe environment for them. Another form that spiritual talking may take is in the use of humor. Native cultures inherently understand the old cliché: Laughter is the best medicine. Encouraging clients to share comical stories and experiences can provide insight into the client’s identity and self-image. However, counselors should exercise caution in using humor. It should only be introduced “when and if the client invites it, meaning that the client trusts the counselor enough to connect on that level” (Garrett, et al., 2005, p. 202).
The Holistic Medicine Wheel or Red Path One of the most effective healing techniques and one which incorporates extensively the Native American culture is the Medicine Wheel, sometimes called the Red Path or Red Road. The Medicine Wheel is a symbol of Native America in which four colors (white, black, yellow and red) are used to represent the four directions and the four races of people (Caucasian, African, Asian and Indian), respectively. This symbol also represents the harmony and balance of the mind, body and spirit with nature. The Medicine Wheel is regarded as sacred among Native Americans, since “medicine” is a spiritual entity within their culture. The Medicine Wheel is recognized by all tribes and is a common symbol of unity. It represents healing, not only for oneself, but for the entire native community. This technique, when employed in the counseling setting, includes not only the counselor and client, but also family and friends. It can also be a good tool for use in group counseling where all participants share in a common issue. The facilitator/counselor invites all present to form a circle. The concept of the four directions and their meanings is then discussed. A good representation is: * East represents the rising sun and the spirit or inner being of man (red). * South is connected to full daylight and represents a connection with nature (yellow). * North is the home of winter and represents the mind or thoughts (white). * West is where the sun sets and is connected with the body or physical being (black). (Molina, Monteiro-Leitner, Garrett & Gladding, 2005, p. 9).
The counselor then explains the concept of circles within circles. Dallas Williard’s Model of the Person is an excellent starting pattern for this concept (Clinton & Ohlschlager, 2002, p. 190). Molina, et al. explain this technique well:
An inner circle represents the connection to one’s Spirit and to the Greater Spirit; an outer circle represents the importance of relationships with family members; and a community circle represents the importance of relationships with the greater community. At this point, volunteers sit behind each person in the inner circle, forming an outer circle. Finally, the remaining participants form a third circle, which lends support to the inner and outer circles. Throughout the process, life stories emerge. Counselors identify client strengths and validate their experiences, and participants offer support to one another and create “happy” endings to their stories (p. 9). This method helps clients see “how they create and remove the masks of the self” (Molina, Monteiro-Leitner, Garrett & Gladding, 2005, p. 9). The removal of masks allows the client to be open with their true feelings and to see their issues from a different perspective. A doctoral dissertation by Mark Parrish (2008) offers another well-described view of the Circle Within Circles Approach:
The elements of the circle within circles includes: (1) the spirit within us including the culmination of each individual’s experiences representing the power that comes from the very essence of one’s being; (2) the family and/or clan, the relational center of the community; (3) the natural environment and all of its relationships with living beings; and (4) the spirit world which includes the other elements as well as the Creator, ancestors and other spirit helpers and guides. In essence, all life is interdependent and exists in a dynamic state of harmony and balance which maintains a continuous flow and cycling of energy which each living being contributes to the Circle of Life (p. 16). The Medicine Wheel and the Circle Within Circles “serves as a reminder that all aspects of life are important and need to be balanced” (Rybak & Decker-Fitts, 2009, p. 336). Although most individuals will still require more intensive therapy, the Medicine Wheel is a good starting point to help clients remember that they are not an island, but are connected to other individuals and to the world as a whole.
Personal Reflections
Understanding Native American culture, and learning their views life has caused me to reconsider my own lifestyle and my Caucasian worldview. As westerners, we are an inherently individualistic society, whereas Native Americans are more collective. The mindset and complex belief systems of indigenous people are more similar to God’s original plan for mankind than that which White society has developed. Jesus prayed to the Father for unity: that His followers would “be one, as we are.” (John 17:11b, KJV). Native American culture appears to mirror His prayer more than that of Caucasians. Native Americans are more in tune with their spiritual natures than we, and were the original holistic healers. They understand the concept of man’s triune nature as set forth in 1 Thessalonians 5:23: “And the very God of peace sanctify you wholly; and I pray God your whole spirit and soul and body be preserved blameless unto the coming of our Lord Jesus Christ” [emphasis mine]. This concept has been a vital part of their culture for hundreds of years, whereas we are just now (within the past decade) becoming more sensitive to a holistic approach in counseling and medicine. It is very interesting that as one learns the culture and values of Native Americans, one begins to see that there are many aspects that reflect basic biblical principles.
Western counseling methods, which have been imposed upon the Native Americans for many years, are very foreign to a people who already understand an important truth of God’s Word. It makes much better sense to first understand their culture and beliefs and then adapt our methods and techniques accordingly, in order to be more effective facilitators in the healing process. Not only will these historically-wounded people be set free with true inner healing, but at the same time many may come into a full knowledge of and a relationship with the true Lord Jesus Christ. Jesus healed the blind man of his physical ailments before healing him of his spiritual malady. Therefore, if we connect with Native Americans through their ways of life, love them in Christ, and keep the Holy Spirit as the center of our ministry to them, many of these forgotten people can enjoy a fullness of life that only comes through the healing power of Christ.
As a Christian counselor, I will be committed to providing the Native American people with a biblically-sound, culturally-relevant approach to helping them heal the issues from which they suffer, both historically and personally. As I become more knowledgeable in their beliefs, traditions and worldview, I can foresee a time when what I am learning now will blend with that insight to produce techniques which will enable me to be a more effective counselor to the people to whom God has called me to minister.
Conclusion
To be effective counselors within the Native American community, it is not enough that we increase our knowledge of psychology and our skills in counseling. We need to immerse ourselves in the cultural issues pertinent to each individual client and the community which has shaped them. This comes by understanding belief systems and cultural contexts, and determining what methods can and cannot work based upon these parameters.
Native American culture is centered on certain holistic viewpoints: the wholeness of the individual (body, mind and spirit), the individual’s interconnectedness with creation, and the relationship all people have with one another. Counseling such a people involves understanding and respecting values, beliefs and traditions, and tailoring our methods and techniques around restoring harmony and balance in ways which do not demand or manipulate Native Americans into ceasing to be Native American. One very good exercise for assisting in the development of counselor competency in this area is cultural auditing, which is a “systematic and practical reflective method designed to address critical elements of the multicultural competency development process” (Collins, Arthur & Wong-Wylie, 2010, p. 340-346). The 13 steps of this process lead counselors through the first to last counseling sessions by helping them reflect on key issues of culture that can help them develop competent strategies and monitor their practices “to ensure that the goals and processes of counseling are consistent with clients’ perspectives and needs” (Collins, Arthur & Wong-Wylie, 2010, p. 341).
In order for greater effectiveness to be realized in counseling Native Americans (and indeed people of all cultures), mental health professionals and researchers must understand that all methods do not work with all people. Milton Erickson, one of psychotherapy’s most respected figures, who was of Native American descent, understood this very well (Thomason, 2009, p. 351).
A 40-year study of multicultural counseling, completed in 2008 by Michael D’Andrea and Elizabeth Foster Heckman, discovered many inconsistencies and out-dated methods being utilized with clients of diverse cultures, and called for researchers to “expand their outcome studies to examine the impact of other types of helping services among culturally different populations” (D’Andrea & Heckman, 2008, p. 362). Their final statement summarizes beautifully what is needed for effective, long-term resolution for Native Americans:
We suggest that the multicultural counseling movement is a movement of faith and hope: faith in counselors’ ability to generate new understanding of mental health from a multicultural perspective and hope that future counseling and research endeavors will be implemented to more effectively promote human dignity and development through people’s collective diversity (D’Andrea & Heckman, 2008, p. 362). The increase of diverse of cultures within the United States makes it imperative (a) “that therapists have the skills to work with a variety of clients from a multitude of social backgrounds (Murphy, Park & Lonsdale, 2006, p. 310); and (b) “for the counseling profession to take a proactive stance on cultural diversity” (Phiri-Alleman & Allman, 2010, p. 157). Culturally competent counseling has been addressed by the American Counseling Association Code of Ethics (ACA) and the Council for Accreditation of Counseling and Related Educational Programs (CACREP). Both of these groups stress the importance of social and cultural diversity in training programs for counselors, and emphasize the need for culturally-relevant treatment planning, especially when working with Native Americans (Parrish, 2008, p. 17). The competency of multicultural counselors can best be developed by encouraging them to become knowledgeable in the beliefs, traditions and worldview of various cultures and utilize that knowledge to tailor their counseling techniques in ways that will boost the effectiveness of their practice.

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