1. when working with Maori clients? Getting practical
How do we honour
Te Whare Tapa Wha
when working with Maori clients?
Getting practical
Workshop
New Zealand College of Clinical Psychologists Conference
March, 2011
Lisa Cherrington
Te Ara Whatumanawa/ Psycho-Oncology Service, Massey University
Photocopy pikitia
What has been passed down to you from forebears – personality, tikanga, understanding, Maori gifts

2. Overview Part 1: Assessment (1hr) What is Te Whare Tapa Wha (TWTW)?
2) Case study – Meet Pearl
Part 2: Reflecting on practice using Te Whare Tapa Wha (45mins)
3) Hua Oranga (Maori Mental Health Outcomes Measure) (Kingi, 2002)
4) Self-Reflective questions

3. WHAT IS TE WHARE TAPA WHA (TWTW)?
A Maori model of health/ well-being developed by Mason Durie in 1980’s
Holistic view of well-being that states in order to be at one’s optimal health, all area’s need to be in balance and working order
Each dimension is integrated, intertwined
Several presentations at this session
Themes developed into four main dimensions- the emphasis being on wairua as starting point
1982 – Rapuora – Maori Women’s Welfare League
Kaumatua emphasized wairua as being starting point for health

4. TE WHARE TAPA WHA Compared health to four cornerstones of health
All four necessary to ensure strength and symmetry
BRAINSTORM – If you were to research these area’s, keeping in mind indigenous psychology, what would you be interested in?
Themes and Key aspects – break into groups of 4

5. The capacity to communicate, to think and to feel (Durie, 1998)
Te Taha Hinengaro
The capacity to communicate, to think and to feel (Durie, 1998)
often refers to psychological processes – thoughts/ feelings/ behaviour/ cognitive functioning/ thinking styles
–Hine (female) – conscious part
ngaro (hidden ) – subconscious (Pere, 1991)
Mental, intuitive and feeling
So what might this mean

6. Te Taha Tinana (physical health and environment)
The capacity for physical growth and development (Durie, 1998)
Good physical health is necessary for optimal development (Durie, 1998)
Sacredness of the body - Tapu and noa emphasis
Taha tinana is turning to nature for herbal compassion, utilising rituals for physical appeasement, keeping the soul and body intact (Te Roopu Awhina Tautoko, 1987)
Practical issues – income, housing, food
Body functions/ rituals kept separate from other activities – food and body, ‘sitting on tables’, teatowels and clothes separate, toenail clippings. Excellent hygiene standards in comparison….
Durie questions about body image different – less wahine with anorexia nervosa. Been my experience. Increasingly a new generation of wahine, sporting, image focused where this will change
Non-verbal communication
Clients often abusing their body – drugs, eating, smoking. He tapu te tinana….

7. Te Taha Whanau (family and relationships)
The capacity to belong, to care and to share (Durie, 1998)
Refers to family, extended family and sense of belonging and connection with
Individuals are part of wider social systems (Durie, 1998)
Identity/ whakapapa/ connection
Interdependence a strength
Gang culture – a whanau
Muru – taking away person’s belongings
Family taking over from parents where child abuse occurs
Family is primary support system for Maori – care and nurturance in physical terms but also culturally and emotionally
Identity and purpose – interdependence
Development goals clash ie with teenager development – goal is to strive for independence
Whanau support at interviews

8. Te taha wairua (spirituality)
Te taha wairua is probably the most difficult area to define, assess and understand – yet it is the most important area and intertwined with every other taha
Refers to spiritual well-being, not just religion
- Beliefs in a non-physical dimension or force (Kingi, 2002)
The capacity for faith and wider communion (Durie, 1998)
Health is related to unseen and unspoken energies (Durie, 1998)
A relationship also with the environment, ancestors
Individual inter-generation continuum – what do you think that means?
Past, present and future – co-exist – very important concept amongst Maori. Need to understand past. When look at I nga ra o mua…the past
Look at psychology definitions….of indigenous and psychology

9. Na Heather Delamere Thomson
Wairua
Na Heather Delamere Thomson
“Koro, what is wairua?” the child asked, eyes wide
“Wairua, my moko is what gives us life
Handed down to us from a time past
At the moment of your beginning
You shared with me the wairua of your tipuna:
For I am your link with the past
And you are my link to the future
The aroha of the whanau has wairua
And their words, their laughter, their tears
The marae, tangi, waiata and whakapapa
Have a wairua that strengthens us, gives us pride

10. So too the sunrise and sunset
The soft summer rain, the raging storm,
The song of the birds in the trees,
The waves on the beach
The mist rising from the bush
The moonlight on the water
And the embracing darkness of the night
To sit quietly in the wharenui or the urupa
And feel the presence of your tipuna is to feel wairua
Your arms around my neck, your breath on my cheek,
Fills me with a special wairua
For there is wairua in all things that give meaning to life
To love, to the future

11. So moko, open your mind,
Let your heart love
Your eyes see
Your ears hear
Your hands feel
Give of yourself, my moko
For in giving, you receive
And the wairua grows.”
Na Heather Delamere Thomson

12. Case study 1: Pearl Hei mahi: Exercise 1
Read through case study and allocate identified issues into each taha
Physical environment – pollution of tribal waterways
Turangawaewae – cultural, social and economic significance – MARAE
Level of Access to marae – a measure of well-being
Taonga tuku iho – te reom intellectual and philosophical traditions, cultural heritage – intellectual and cultural property rights
Social Policy emphasis

13. TE TAHA WHANAU Clinical: Cultural:
Argued that the perspectives would override clinical priorities ie whare tapa wha extended focus for health beyond the individual…how could diabetic regain health if the land injustices remained?
Ie sociological, economic and political agendas override clinical resource
Was taha wairua any practical value if it could not be measured? NO
Clinical/ cultural issues
Identity as a Maori
Tuakana/ teina
Kuia/ kaumatua
Obligations to whanau
Whakapapa
Whanau, hapu, iwi connections
Whakawhanaungatanga – sense of connection with family, medical staff
Whanau beliefs about cancer
Support from whanau – appropriate?
Expectations of whanau, ability of whanau to communicate with clinician’s
Involvement with other groups/ associates (gangs, sports, church, Maori)

14. Te Taha Hinengaro Clinical: Cultural: Mana ake
Cultural/ clinical issues:
Use of te reo to communicate
Beliefs about cancer, what’s causing it?
Understanding/ comprehension about medical treatment process
Feelings of isolation/ disconnection in medical system
Beliefs about tikanga, tapu/ noa, wairua
Whakama
Pouri
Lack of motivation to engage in treatment process

15. Te Taha Tinana Clinical: Cultural:
Group activity: to each draw one triangle of what that represents to them. Will discuss more
Cultural/ clinical issues
Western medicines vs rongoa/ karakia
Sense of tapu about own body parts
Hospital environment – eating, washing, toileting in same place
Shelter and food
Accessing medical system at a very late stage
Urban vs rural/ turangawaewae

16. Te taha wairua Clinical: Cultural: Clinical/ cultural issues
Beliefs and connection with spirituality and /or religion
Tapu and noa
Makutu, mate Maori – what’s causing cancer?
Use of and beliefs in tohunga, rongoa, karakia, moemoea, purakau, taonga, tohu
Tangihanga
Life’s purpose
Connecting with spirituality – how do they do this?
What makes them feel centred, uplifted in some way (ie listening to music, going to the ocean, laughing with their children)

17. Part 2: Reflecting on practice using Te Whare Tapa Wha
Hua Oranga (Maori Mental Health Outcomes Measure) (Kingi, 2002)
Developed a Maori mental health outcomes measure based on Te Whare Tapa Wha
Through consultation/ hui with key stakeholders identified components within each taha as a way to evaluate outcomes of interventions
Clinician, whanau and tangata whaiora forms
Useful questions to ask ourselves when working with Maori

18. (this intervention – assessment process, therapy session etc)
As a result of …
(this intervention – assessment process, therapy session etc)
…are you/ is your client/ is your relative…
- More able to set goals for yourself/ him/herself (Te taha hinengaro)
- More able to move around without pain and distress (Te taha tinana)
- More able to communicate with your whanau? (Te taha whanau)
As a result of this intervention do you feel stronger in yourself as a Maori person? (Te taha wairua)
Environment
Scoffed at our tradition of planting a new tree after chopping one down, referred to as Maori and their gods. Everything in the universe has a divine right….
How might you investigate this taha? What questions would you ask?

19. The capacity for faith and wider communion * Personal contentment
Te taha wairua
The capacity for faith and wider communion
* Personal contentment
As a result of this intervention do you feel more content within yourself?
identifying what might assist with feeling more content, more at peace
* Spirituality
As a result of this intervention do you feel healthier from a spiritual viewpoint? (Kingi, 2002)
- Imagine if sessions at were held on a mountain top, at the river, at the beach
- spiritual practises
- karakia, prayers, rituals of significance for client, church
- creative processes – singing, drawing, writing, building

20. Hei Mahi: Reflecting on practice
Consider Pearl. Identify a treatment plan based on te whare tapa wha
Taha Hinengaro:
Taha Tinana:
Taha Whanau:
Taha Wairua:

21. Does your plan:
Enhance her capacity to communicate, think and feel?
Enhance her capacity for physical health and development?
Enhance her capacity to belong, to care and to share?
Enhance her capacity for faith and wider communion? In particular:
Does she feel more valued as a person?
Is she stronger in herself as a Maori person?
Is she more content within herself?
Healthier from a spiritual view point?

22. HOW DO WE HONOUR TE WHARE TAPA WHA WHEN WORKING WITH MAORI CLIENTS
Ask yourself these questions when assessing, planning and treating (or in self-reflective review)
Have I/ will I/ will the intervention/ has the intervention
enhanced his/her:
capacity to communicate, think and feel?
capacity for physical health and development?
capacity to belong, to care and to share?
capacity for faith and wider communion?
Pearls final words….