Cultural Awareness in Therapy with American Indian Clients By Patti Higgins

Guidelines APA & DSM-IV American Psychological Association and the Diagnostic and Statistical Manual IV recommend several guidelines and ethical principles regarding treatment of culturally diverse clients. Psychologists need to consider clients’ cultural beliefs and backgrounds in making diagnoses, providing services and recommending treatment plans.

Cultural respect Awareness of and respect for American Indians’ spirituality, healing ceremonies and cultural customs may facilitate therapeutic processes. Several specialized treatment centers and recovery resources for American Indians are located throughout the country.

Culturally sensitive therapy America's multicultural society needs increased development, implementation and assessment of culturally sensitive drug and alcohol awareness, prevention and treatment programs (Gordon, 1994). Ellen (1999) reported that the increasingly diverse U.S. population indicates a need to focus on culturally competent interventions. Existing research emphasizes the urgency of culturally competent treatment models (Ellen, 1999).

Cultural rapport-building Studies have revealed that people generally develop a rapport more easily with people from similar ethnic backgrounds than with those from different ethnic backgrounds (Diller, 1999). People of color have been turned off by the one-size-fits-all approaches (Diller, 1999). Ask about clients’ background, beliefs, customs, traditions, etc. in order to get to understand them better. Respect their differences!

Historical oppression & grief American Indians experienced massive losses of lives, land, and culture from colonization. This has caused a legacy of trauma, oppression and unresolved grief for American Indians. Brave Heart and DeBruyn (1999) report that this phenomenon, called historical unresolved grief, contributes to the current high rates of suicide, homicide, domestic violence, child abuse, alcoholism and other social problems among American Indians.

Recognizing Indian history The legacy of racism and prejudice may be the root cause of Indian alcoholism, addiction and suicide (Taylor, 2000). California was one of the most oppressive states for Indians. San Diego County reported more than 20,000 American Indians according to the 1990 census. Roy Cook, a Cross Cultural Studies Instructor at San Diego State University, advocates a more accurate reflection of the history of California and American Indians. Also, he contends states will continue to clash with Indians over historical facts, gambling, money, land, & other issues.

APA Ethical Guidelines APA Ethical Guidelines and Principles for Psychologists includes several sections about clinicians’ need to become culturally aware and nondiscriminatory Human differences 1.09 Respecting Others 1.10 Nondiscrimination

Guideline 2.04 of Ethical Code includes information on the use of assessment in general and with special populations. It states: (a) Psychologists who perform interventions or administer, score, interpret, or use assessment techniques are familiar with the reliability, validation, and related standardization or outcome studies of, and proper applications and uses of, the techniques they use. (b) Psychologists recognize limits to the certainty with which diagnoses, judgments, or predictions can be made about individuals. (c) Psychologists attempt to identify situations in which particular interventions or assessment techniques or norms may not be applicable or may require adjustment in administration or interpretation because of factors such as individuals' gender, age, race, ethnicity, national origin, religion, sexual orientation, disability, language, or socioeconomic status. (APA, 1992)

Cultural differences - not disorders Koocher and Keith Spiegel (1998) illustrate need to investigate before diagnosing. 5-year-old Native American girl who was in critical need of an organ transplant gained inspiration from talking to dead ancestors. Talking to dead is not unusual for Indians and does not signify disorder. Need for understanding culture is reflected in the DSM-IV’s section on cultural factors to consider. It includes an outline for cultural formulation and a glossary of culture- bound syndromes.

Cultural biases Sue and Sue (1999) suggest that everyone has some cultural biases. Ethnicity affects families' values, cohesion, attitudes, patterns of behavior and communication (Piercy, Sprenkle, Wetchler & Associates, 1998). Factors to consider: high rate of mental disorders in ethnic groups; the effects of racism; and acculturation (Niolon, 2000).

Level of acculturation Acculturation is a highly complex, often misunderstood, process that involves the stress of finding one’s place between diverse cultures. Both higher and lower levels of acculturation account for various conflicts and related mental distress.

Adjunct Cultural Practices Colmant and Merta’s (1999) research of the sweat lodge ceremony used at a residential treatment center for Navajo males aged 6-15 years old with disruptive behavior disorders, demonstrated that the ceremony encompassed all of Yalom's 11 therapeutic factors.

Culturally sensitive treatment approaches Nelson, McCoy, Stetter & Vaderwagen (1992) American Indian community-developed and managed treatment within tribal organizations present the most hopeful approach to Indian alcoholism and substance abuse treatment. Healing ceremonies include members of the family and community, so that their joint forces can solve or heal the problem LaFromboise (1993). Therapeutic efficacy of all religious healing traditions lies in restoring sacred power (Garrity, 1998).

Circle as symbol of rebirth Lowery (1998), there are four intersecting "circles" that characterize American Indians' perspective of alcoholism and recovery from substance abuse. (1. cultural wellness, 2. oppression of colonization, 3. alcoholism at betrayal of spirit, 4. time for healing. ) Talking circles Drumming circles Medicine wheels (circular) Fire pit of sweat lodge (circular)

Cross-cultural psychology Cross-cultural psychology is an increasingly important part of modern psychology. There are significant conceptual differences regarding the ways in culture and behavior influence each other (Marshall, Segall, Lonner & Berry, 1998).

Healer and client both bring to the session a set of assumptions about the nature of the universe, sociocultural models, the type of information that promotes healing, how it should be applied and why it works. Cross-cultural observations tell us that the more congruent these assumptions are between healer and healee, the more likely it is that healing will happen. (Gagan, 1998, p. 42)

Healing practices Sacred dances Sweat lodges Talking circle Drumming Sacred medicine Medicine wheels Power animals Peacekeepers Shamans, medicine men Pow Wows Healing ceremonies

Appreciation of culture “Culture is not a vague or exotic label attached to faraway persons and places, but a personal orientation to each decision, behavior, and action in our lives” (Pedersen, 1988, p. vii).