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Native american clinical considerations Presentation Transcript

  • 1. Counseling Considerations for Native AmericansMaggie DunhamKathy Telljohann
  • 2. 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.
  • 3. Click to continue
    "Humankind has not woven the web of life. We are but one thread within it. Whatever we do to the web, we do to ourselves. All things are bound together. All things connect."    Chief Seattle
    “This ambiguous, multivocal world makes it increasingly hard to conceive of human diversity as inscribed in bounded, independent cultures.”
    – James Clifford, The Predicament of Culture, 1988, p. 23
    “Out of the Indian approach to life there came a great freedom, an intense and absorbing respect for life, enriching faith in a Supreme Power, and principles of truth, honesty, generosity, equity, and brotherhood as a guide to mundane relations.” Luther Standing Bear Oglala Sioux (1868-1937) Retrieved from: http://www.ilhawaii.net/~stony/quotes.html
    "Being Indian is an attitude, a state of mind, a way of being in harmony with all things and all beings. It is allowing the heart to be the distributor of energy on this planet; to allow feelings and sensitivities to determine where energy goes; bringing aliveness up from the Earth and from the Sky, putting it in and giving it out from the heart."  - Brooke Medicine Eagle
    When questioned by an anthropologist on what Indians called America before the white man came, an Indian simply said, "Ours." (Deloria, 1988, p. 166)
    “The lack of success on the part of social workers can be attributed to a multitude of reasons but it stems, in general, from the following: (1) lack of understanding of Native American culture, (2) retention of stereotyped images of Native Americans, (3) use of standard techniques and approaches.” (Lewis, Ho, 1975).
    “No discoverers, no scientists, no treaties, no anthropologists, no government agents, and no missionaries of scientism have ever had the moral cause or ethical authority to determine the outcome of native rights, consciousness, or sovereignty.”
    – G. Vizenor, Fugitive Poses,1998, p. 76
    “The impact of history might be cultural dislocation, but an astute social worker can advocate for culturally sensitive models of practice and service delivery systems for clients with Native ancestry.”
    – Carol L. Langer, The Effect of Selected Macro Forces on the Contemporary Social Construction of American Indian Ethnic Identity, 2005, p. 29
    Song by: Olivia Tailfeathers – Universe Song, 2005
  • 4. Native Americans
    Northeastern
    Southeastern
    Southwestern
    Northern Plains
    Northwest Coast
    Alaska Natives
    Oklahoma Indians
    Indians of the Plateau, Great Basin, and Rocky Mountains
    California Indians
    Subgroups are determined by the tribal location
    They do not form a single ethnic group
    “they always have resisted a homogeneous definition”
    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.
  • 5. 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
    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.
  • 6. 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
  • 7. Major Historical Impacts
    • Manifest Destiny ultimately allowed white settlers to take land from Natives
    • 8. Indian Removal Act of 1830.
    • 9. Impacted beliefs:
    • 10. Racism
    • 11. Material progression
    • 12. Trail of Tears in 1838
    • 13. “The forced march westward of the Cherokees… Approximately 16,000 Cherokees were held in disease-infested camps prior to their departure for Indian Territory.”
    • 14. “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.
  • 15. 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.
  • 16. 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.
  • 17. 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
    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.
  • 18. 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
    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.
  • 19. Native American Family Systems
    More 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.
  • 20. 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.”
  • 21. 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
  • 22. 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
  • 23. 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
  • 24. 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)
  • 25. Implications for Counseling with Humor
    Implications
    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
  • 26. 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.
  • 27. To Recap…
  • 28. 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.
  • 29. 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.
    Lewis, R.G., Ho, M.K. (1975). Social work with Native Americans. Social Work. 20 (5), 379-382.
  • 30. 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”.
    Lewis, R.G., Ho, M.K. (1975). Social work with Native Americans. Social Work. 20 (5), 379-382.
  • 31. 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
    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.
    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.