Download pdf - Navigating Two Worlds: Experiences of Counsellors Who … · 2013-08-02 · Revue canadienne de counseling et de psychothérapie ... interviews were conducted in person and three

346 CanadianJournalofCounselling andPsychotherapy/Revuecanadiennedecounselingetdepsychothérapie

ISSN0826-3893 Vol.44No.4 ©2010 Pages346–362

NavigatingTwoWorlds:ExperiencesofCounsellorsWhoIntegrateAboriginalTraditionalHealingPracticesNavigantdeuxmondes:LesexpériencesdeconseillersquiintègrentlespratiquestraditionnellesdeguérisonAutochtone

OlgaOulanovaRoyMoodleyOntario Institute for Studies in Education, University of Toronto

abstractTheuseoftraditionalhealingamongCanadianAboriginalcommunitieshasexperiencedarevival,andthetherapeuticbenefitsofthesepracticeshavereceivedmuchresearchatten-tion.Anargumentisrepeatedlymadeforincorporatingindigenoushealingintoclinicalinterventions,yetrecommendationsonhowthismaybeaccomplishedarelacking.Thepresentstudyaimedtoaddressthislimitation.Weinterviewed9mentalhealthprofes-sionalswhoroutinelyemploybothWesternpsychologicalinterventionsandAboriginaltraditionalhealingpractices.Groundedtheorydataanalysisidentified4corethemesandledtoamodelthatillustratesparticipants’integrativeefforts.ImplicationsforcounsellorsworkingwithAboriginalclientsareaddressed.

résuméLespratiquestraditionnellesdeguérisonrefontsurfacedanslescommunautésAutoch-tonesduCanada et lesbénéfices thérapeutiquesde cespratiquesontdéjà fait l’objetdeplusieursétudes.Malgrélessuggestionsrépétéesd’intégrerlespratiquesdeguérisontraditionnellesenpratiqueclinique,iln’existepasdelignesdirectricespourguiderceprocessus.Cetteétudeviselalacune.Nousavonsinterviewé9praticiensensantémentalequi intègrentdespratiquestraditionnellesdeguérisonAutochtonedans leurpratiquepsychologique.Enanalysantlesdonnéesselonlathéorieàbaseempirique,nousavonsidentifié4thèmesprincipauxetélaboréunmodèlequiillustrecommentlesparticipantsarriventàcetteintégration.LesimplicationspourlesconseillersquitravaillentavecdesclientsAutochtonessontdiscutées.

TherehasbeenmuchdiscussionintheliteratureabouttheofteninappropriateandinadequatementalhealthservicesprovidedtoNorthAmericanAboriginalpeoples(e.g.,Gone,2004;Kirmayer,Brass,&Valaskakis,2009).Critics(e.g.,McCormick,2009;Poonwassie,2006;Stewart,2008;Trimble,1981)arguethatconventional psychological interventions fail to take into account the holisticunderstandingofhealthandthecentralplaceofspiritualitythatpersistinindig-enous1communities.Thisinturnresultsinunderutilizationofservicesandearlyterminationoftherapy(Duran,1990;Juntunen&Morin,2004).Consideringthehighprevalenceofmentalhealth-relatedproblemsinAboriginalcommunities(e.g.,Kirmayer,Tait,&Simpson,2009),thissituationposesaseriousconcern.

IntegratingAboriginalTraditionalHealingPractices 347

TraditionalformsofhealingsubsistinmanyAboriginalcommunities,some-timessubstitutingforinadequatementalhealthcareandoftenusedconcurrentlywithmainstreamservices(Waldram,1993).TraditionalhealingpracticesoftheNorthAmericanindigenouspeoplesinclude,amongothers,talkingcircles,shar-ingcircles,smudging,andMedicineWheelteachings(France,1997;Portman&Garrett,2006).Theseritualsreflectaholisticoutlookonhealthandemphasizeconnectednesstothecommunity(LaFromboise,Trimble,&Mohatt,1990;Mc-Cormick,1996;Poonwassie&Charter,2005).Largesurveystudies(Bealsetal.,2006;Gurleyetal.,2001;Kim&Kwok,1998;Novinsetal.,2004;Wyrostok&Paulson,2000)aswellasinterviews,focusgroups,andcasestudyaccounts(Ca-nales,2004;Iwasaki,Bartlett,&O’Neil,2005;McCormick,2005;Stewart,2008;Waldram,1993;Wieman,2006)suggestthatthereisarevivalandanincreasedutilizationoftraditionalhealinginAboriginalcommunities.

Asa response to theshortcomingsofmainstreammentalhealthcareand inlightof traditionalhealing resurgence, scholars andclinicianshave argued forincreasedcollaborationbetweenmentalhealthprofessionalsandhealers,andforintegratingtraditionalpracticeswhencounsellingAboriginalclients(Duran,1990;Heinrich,Corbine,&Thomas,1990).Atfirstsight,suchintegrationrepresentsastraightforwardsolutiontotheissuesofserviceunderutilizationandprematuretermination.However,theworldviewthatinformsAboriginaltraditionalteach-ingsdiffersfromtheoneunderlyingWesternpsychologicalpractice(France,1997;McCabe,2007).Therefore,thenatureofthisintegrationremainsunclear.Thecounsellingliteraturereflectsthisambiguity.

Apartfromasmallnumberofcasestudiesthatreportincorporatinghealingritualsintoconventionalcounsellinginterventions(Heilbron&Guttman,2000;Wilbur,Wilbur,Garrett,&Yuhas,2001)andafewpapersproposingintegrationofceremoniesintoindividualtherapy(Garrett&Garrett,2002;Robbins,2001)andgrouptherapy(Garrett&Crutchfield,1997;Garrett,Garrett,&Brotherton,2001;WalkingstickGarrett&Osborne,1995),generalconceptualizationoftra-ditionalhealingintegrationincounsellingandpsychotherapyislacking.DespitetheconsensusthatincorporatingtraditionalhealingisfundamentaltoprovidingadequateservicestoAboriginalpeoples,thereappearstobeverylittlediscussiononhowmentalhealthprofessionalscanintegratetraditionalpracticesintheirwork.WebelievethatthisgapinclinicalliteraturerepresentsasignificantimpedimenttoimprovingmentalhealthcareforAboriginalcommunities.

However,anumberofCanadianmentalhealthprofessionalsroutinelyinte-grateAboriginalhealingpracticeswithcounselling.Theirworkhasreceivedlittleacademicattention,andtheireffortshavenotbeendocumented.Inthisstudy,wesoughttoexplorethewaysinwhichtheseprofessionalsintegrateWesterncounsel-lingandtraditionalhealing.Byinterviewingindividualswhopracticeintegration,thestudyaimedto(a)describetheirexperiencesintermsofhowandwhentheyintegratethetwohelpingmodalities;(b)explorefactorsaffectingtheirintegrativeefforts,includinganychallengesorbarriersthattheyhaveencountered;and(c)offerrecommendationstomentalhealthprofessionalswhoseeAboriginalclientsintheirpractice.

348 OlgaOulanovaandRoyMoodley

methods

Weusedaqualitativeapproachthatprovidedanextensivedescriptionofandinsight intothehumanexperienceand,moreover, supportedthe investigationofaminimallystudiedarea,suchastraditionalhealingintegration.AsMcLeod(2001)wrote,“Qualitativeresearchisaprocessofcareful,rigorousinquiryintoaspectsofthesocialworld”(p.2).Traditionalhealingintegrationhasreceivedlittleresearchattention,apartfromgeneralrecommendationsinfavourofsuchefforts.Wefeltthataqualitativeinquirywassuitabletoaddressthisgapinknowledge.

Becausethisstudyposedaquestioninvolvingtraditionalhealing—anelementofgreatsignificanceforindigenouscommunities—itwasimportanttoconductthisstudyinarespectfulandsensitivemanner.Forthisreason,weconsultedwithcul-turalinformants(Elders,communitymembers,Aboriginalscholars,andclinicians)throughouttheresearchprocess,astheirfeedbackandguidancewerecriticaltothesuccessoftheresearch.Moreover,participantsthemselveshadanactivepartinthestudysincetheirinvolvementextendedbeyondthedatacollectionphase.Prelimi-naryfindingsweresharedwiththeparticipants,andtheircorrectionsandelabora-tionsoftheemergentthemesinformedsubsequentanalysisoftheinterviews.

Participants

Inaccordancewithguidelinesforqualitativeresearchsampling(Morrow,2005),weusedapurposefulcriteria-basedsamplingapproachtorecruit9participants(6womenand3men)whoroutinelyusedbothAboriginaltraditionalhealingpractices andWestern counselling interventions with clients. All participantswereCanadianmentalhealthprofessionals(psychologists,counsellors,andsocialworkers)whohadtrainedinapostsecondaryinstitution.Theirmeanagewas45years(SD=9.10)andtheyhadworkedinmentalhealthsettingsforanaverageof12years(SD=5.09)atthetimeoftheinterview.Weidentifiedpotentialpar-ticipantsthroughinformalnetworkingwithcolleagues,atresearchconferences,andsubsequentlythroughsnowballsampling.Theinterviewer(firstauthor)wasacquaintedwithtwooftheparticipantsinaprofessionalcapacitypriortotheirparticipationinthestudy.Whilethislikelyfacilitatedrapportbuilding,itdidnotseemtolimittheirwillingnesstosharedetailsoftheirexperiences.

ParticipantsresidedinOntario,Saskatchewan,Alberta,andBritishColumbiaandwereofdiversebackgrounds:3wereOjibwa,1wasOjibwaandOdawa,2wereMétis,1wasDene,and2participantswereofEuropeandescent.Theirworksettingsincludedprivatepractice,urbanAboriginalhealthcentres,governmentorganizations,acollegecounsellingcentre,andaregionalhospital.

Instrument

Weusedasemi-structuredinterviewguidethatincludedfiveopen-endedques-tionsconcerningparticipants’experiencewithincorporatinghealingpracticesintoconventionalhealthcare.Sinceweconsideredtheinterviewguideaflexibletool,inaccordancewiththegroundedtheoryapproach(Glaser&Strauss,1967),we


modifieditthroughoutthedatacollectionphaseinordertoclarify,orelucidate,elementsofparticipants’experience.

Procedure

Theinterviewer invitedparticipants tospeakabout theirpathtopracticingintegration,describe their integrativeefforts, and talkaboutanychallengesorobstacles.Interviewsrangedinlengthbetween45minutesand2hours.Sixoftheinterviewswereconductedinpersonandthreewereconductedoverthetelephone.Thetelephoneinterviewswerenotsignificantlydifferent intermsof lengthorelaborateness.Allinterviewswereaudio-recordedandtranscribed.

Data Analysis

Weconductedananalysisoftheinterviewdatainaccordancewiththegroundedtheoryguidelines(Strauss&Corbin,1990),andthisoccurredconcurrentlywiththedatacollection.Duringtheinitialstage(open coding),wecodedtranscriptsus-ingwordsclosetoparticipants’language(Strauss&Corbin,1990).Asadditionaltranscriptsbecameavailable,wecomparedthesecodestootherunitsoftext,andconnectionsbetweencodesbegantoemerge.Thesecondstage(axial coding)en-tailedcondensingopencodesintomoreinclusivecategories(themes)thatunitedanalogousconcepts.Wesharedthesethemeswithparticipants,andtheyprovidedminorcorrectionsandelaborations.Forexample,duringthisstage,oneindividual(Frank)furtherexpandedonhisviewoftherelationshipbetweentraditionalandWestern approaches tohealing.Overall,mostparticipants confirmed that thethemeswereindeedrepresentativeoftheirexperiences.Thisprocess ledtothedevelopmentofamodel(Figures1and2)thatorganizestheemergentthemesintoacoherentframework.

Throughouttheanalysiswerecordedpreliminaryinterpretationsinresearchernotesormemos.These ideasweretherebystoredfor futurereference,enablingtheresearchertoremaingroundedinthedata(McLeod,2001).Wealsousedthemethodofconstantcomparison(Glaser&Strauss,1967).Thisinvolvedcontinu-allycomparingemergingthemeswiththerawdatatoensureaccuratereflectionofparticipants’experience.

results

Weidentifiedfourcorethemesinparticipants’accounts:(a)becomingahelper,(b)decidingwhentointegrate,(c)describingintegrativeefforts,and(d)experi-encewithintegration.Inthissectionwewillpresenteachofthesecorethemesandtheunderlyingsubthemesandprovideillustrativequotesfromtheinterviews.

Core Themes

becomingahelper

AtthebeginningoftheinterviewweaskedparticipantstorecounttheirpathstopracticingbothtraditionalhealingandWesterncounsellingor,inotherwords,


todescribetheirpathstobecominghelpers.Weusethewordhelper torefertotheparticipantsfortworeasons.Sinceseveralindividualsusedthiswordspontane-ouslyduringtheinterview,itseemstoreflecttheirownconceptualizationoftheirrole.Wealsobelievethatitcapturestheirexperienceofbothbeingmentalhealthprofessionals,andpossessingknowledgeandexpertiseintraditionalindigenouswaysofhealing.

Most participants indicated that the presence of traditional healers amongtheirancestorsinfluencedtheircareerjourney.Theyalsomentionedgrowingupwithceremony,whereintheir familyandcommunitypassedonprotocolsandtraditionalvalues.Alice,apsychologistwhostatedthatshehadalwaysbeenan“informalhelper”inherfamilyandinhercommunity,talkedabouttheteach-ingsshereceivedinAboriginaltraditionalpractices.Shenoted,“AnythingthatIknowaboutindigenoushelpingandhealinghasreallycomethrough,youknow,growingupintheNativecommunity,thingsthatIlearned,teachingsfromwithinmy own family, from my grandparents, from Elders in the community.” TheAboriginalvaluesandteachingsthattheparticipantsweretaughtbytheirfamilyandcommunityincluded“non-interference,focusonapositivedirectionandoninnerstrength,interdependenceandimportanceofrelationships,strongfamilyconnections,andbelievinginone’sownwisdom.”

SeveralindividualsexplainedthattheirAboriginalidentitymotivatedthemtopursueacareerinmentalhealthto,asAmeliaputit,“givebacktomyownpeople.”Ameliahadbeenworkingasamentalhealthprofessionalfor5yearsatthetimeofthisinterview.SimilartoAlice,whilegrowingupinhercommunityAmeliahadreceivedmanytraditionalteachingsandlearnedprotocolsfromhermother,grandmother, andcommunityElders.Otherparticipantsexplicitlymentionedadesiretoadvocateforindigenouspeoplesasasignificantmotivatingfactorontheirpathtobecominghelpers.

Astheyspokeabouttheircareerpaths,mostparticipantsmentionedtheinflu-enceoftheirpersonalhealingjourney.ElaboratingonwhatledhertopracticeWesterncounsellingandtraditionalhealing,Evelyn,amentalhealthworkerinanurbanAboriginalagency,stated,“MyownpersonaljourneyisprobablythebiggestdrivingforcebehindeverythingthatIdo.”Severalparticipantsappearedtounderstandtheircareerpathasacallingorastheirdestinywhentheyreflectedonthisjourney.Frank,whoworkedasacounselloratauniversitycentre,said,“It’snotlikeitwasaconsciousdecision[topursuecounselling].Isortoffellthisway;thewindsortofpushedmethisway.”

Anotherinfluenceconsistedofparticipants’personalqualitiesandrecognizingone’spotentialasahelper.Aliceexplaineditthisway:“Workingasaninformalhelperinmyfamilyandcommunityhasalwaysbeenapartofmylifeandfromthereitwasanaturalprogressionintotheprofessionalhelpingfield.SothatwashowIgotintothefieldofpsychology.”Whileparticipantsobtainedcounsellingtrainingthoughpostsecondaryeducation,mostdescribedhavingacquiredknowl-edgeoftraditionalpracticesinaninformalfashion–throughfamilyteachings,oraltraditions,andlivinginthecommunity.


decidingwhentointegrate

Whenaskedabouthowtheydecidetoincorporatetraditionalpracticesintotheir work with a particular client (versus resorting toWestern interventionsalone),severalparticipantsexplainedthattheirconceptualizationoftheclient’sconcernsincludesanimplicitculturalassessment.Leslieshared,“SoItryto,youknow,justlikeemotionallyandpersonally,Itrytoreadwheretheyareatcultur-ally.”Leslieenteredthementalhealthfieldlaterinlifefollowingacareerchange,andsheconceptualizedhercounsellorroleasanadvocateforAboriginalpeoples.Othersreportedamoreexplicitapproach,statingthattheyaskclientsdirectlyaboutinvolvementintraditionalpractices.

Participantsemphasizedthattheydonotinitiatetheuseoftraditionalhealingelements,believingthatsuchpracticesneedtobeinstigatedbyclients.However,astheyspokeaboutparticularclientcases,theydiscussedinstanceswhenit“felt”appropriatetoofferatraditionalpracticeoraculturallygroundedintervention.John,anon-Aboriginalcounsellorwhohadbeenworking incloseconnectionwithAboriginalcommunitiesfornearly30years,mentionedtrustinghis“owninternalcompass”atsuchtimes.

Ingeneral,moststatedthattheyavoidassuminganexpertroleandinsteadfollowtheclient’slead.Forexample,Ameliaexplainedthatherclientshave“visualaccess”totraditionalhealingelements,suchasanEaglefeatherinheroffice.Ac-cordingtoher,havingsuchthingsaccessibleallowstheclienttoinitiatetraditionalhealingintegration.

describingintegrativeefforts

Threeaspectsof integrationwere identified in this study: (a) incorporatingtraditionalhealingelements,(b)theunderlyingapproach,and(c)referral/col-laboration.Whilewediscusstheseelementsofparticipants’integrativeeffortsinseparatesections,thesolefunctionofsuchdivisionistofacilitatediscussion.Inreality,theseaspectsofintegrationwerecloselyrelated,andeachparticipantoftenmentionedusingallthreeelementsinhisorherwork.

Incorporating traditional healing elements. When asked to explain how theyusebothAboriginaltraditionalpracticesandmainstreaminterventions,severalparticipantstalkedaboutconcretetraditionalhealingelementsthattheybringinto a session. These included smudging, using an Eagle feather, drumming,andtakingtheclientoutoftheoffice.Forexample,FrankdescribedusingtheAboriginaltraditionaltoolofdrummingalongsideeyemovementdesensitizationand reprocessing (EMDR) technique, while Amelia noted that clients find ittherapeutictoholdtheEaglefeatherthatshehasinheroffice.Alicetookclientsoutontheland:

AnotherthingthatIdoquitefrequentlywithaclientiswemoveoutoftheofficeandintonatureorintosomewhereintheircommunitythattheyfeelcomfortablewith.AndI see thatasbeingmoreofa traditionalmethodofworkingwithaclient.


The approach. Asparticipantsreflectedonparticularapproachesthatguidetheirinterventions,themajorityemphasizedusingaholisticapproachthatinvolvedworkinginaccordancewithtraditionalteachings(e.g.,MedicineWheelteach-ingsthataddressphysical,mental,spiritual,andemotionaldimensions).Othersreportedworkingsystemically,takingintoaccounttheinfluenceoftheclient’sfamilyandcommunity.

SeveralparticipantstalkedaboutbeingmindfulofthehistoryoftraumaandoppressionthatcharacterizestheexperiencesofmanyAboriginalcommunities,andstatedthatfosteringastrongpositivesenseofidentityinthiscontextisinitselftherapeutic.Lesliesharedthatwhileshemayprovidepsychoeducationoncognitive-behaviouraltechniques,sheintegratesthiswithpsychoeducationontheeffectsofthetraumatichistoryofindigenouspeoples.

Lillian was another participant who spoke about taking into account thehistoricalcontextanditsimpactontheclient’sself-identity.Lillianwasanon-AboriginalpsychologistwithalonghistoryofcloseinvolvementwithAboriginalcommunitiesthroughparticipationinhealingceremonies,workingwithElders,andreferringclientsfortraditionalhealing.Reflectingonherworkwithclientsshesaid,“Astrongsenseofidentityisanimportantpartofthehealingprocess.”

Referral and collaboration. Anotheraspectofparticipants’self-describedintegra-tiveeffortsconsistedofreferralandcollaboration.Allparticipantsindicatedthattheyreferto,andconsultwith,Aboriginaltraditionalhealerswhenaclientneedsaninterventionthattheyareunabletoprovide(suchasasacredceremony),orwhentheirresourceshavebeenexhausted.Margaretdescribedroutinelyworkingalongsidetraditionalhealersinhercounsellingpractice.Margaret’sintegrativeef-fortscommencedwhenshebegantoworkincollaborationwithanElder,takingdirectionfromthatElderintermsofselectingappropriateinterventionstoem-ploywithclients.Sheexpressedabeliefthatsuchcollaborativeeffortswill“movesomeonequickerontheirpersonalhealingjourney”thantheinterventionofapsychologistalone.ShereportedconsultingregularlywithEldersandstatedthatthenatureofthiscollaborationvariesaccordingtotheclient’sneeds.

MargaretexplainedthatinherworkanEldermayinfactguidethetherapyprocess.Reflectingontheircollaborationandreferralwithotherhelpingprofes-sionals,Alice,John,andLillianstatedthattheyalsorefertoandconsultwithWesternmentalhealthworkers.

participants’experiencewithintegration

Oneofthegoalsofthisstudywastoexplorehowmentalhealthprofession-als who practice integration experience do this kind of work.To address thiswe explicitly asked each participant to speak about the process of integratingAboriginaltraditionalhealingpracticesandmainstreamcounsellingonadailybasis.Inresponse,someparticipantsmentionedbarriers,butthemajoritysimplyreflectedontheiroverallexperiencewithworkinginthismanner.Forexample,participantsstressedtheimportanceofself-careanddescribedusingAboriginaltraditionalpractices for theirpersonalhealing.Alex,whohadgrownup“ina


traditionalway”andsubsequentlyapprenticedwithanElder,disclosedthatheoccasionallyseestraditionalhealersorElderstodebriefandtopreventburn-out.

MargaretexplainedthatEldershaveanimportantrolein“nurturingmentalhealthworkersasprofessionals.”WhilesheoftenapproachesEldersforsupport,sherefrainsfromseekingoutWesternmentalhealthprofessionalsforpersonalcounselling,statingthat“therearepiecesmissing”intheirhelpingapproach.

Intermsofchallenges,Leslie,Frank,andEvelynreportedfinancialbarriersand indicated that the scarcityoffinancial support is amajor impediment tointegrating elementsofAboriginalhealingwithmainstream interventions.AnimportantfacilitativefactorwasbeinggiventhelibertytoengagewithclientsinwaysunconventionalforWesterncounselling(e.g.,takingtheclientoutoftheoffice,orsmudgingduringthesession).Indeed,mostparticipantsstatedthattheyworkbestwhengivensubstantialleeway.Forthesementalhealthprofessionals,leewaysignifiedtheabilitytoincorporatetraditionalhealingtechniquesintotheirwork,astheysawfit.AsLesliesaid,“IamhappiestwhenIworkforsomeonethatgivesmeenoughlatitudetodowhatIfeelneedstobedone.Ineedacertainamountofautonomy.”

Participantsspokeofthechallengesthattheyencounteredwhilestudyingmen-talhealthcareinaWesternpostsecondarysetting.Aliceexplainedthatobtainingacounsellingpsychologydegreewasastrugglebecauseofminimalsupportfromfaculty,lackofculturalawareness,andthedominanceofWesterntheoryinthecounsellingfield.Sheshared:

Itwasdefinitelylonely.TherewerealotoftimeswhenIfeltlikejustgivingupandwalkingawaybecauseofthecolonialmentalityofcounsellingpsychol-ogyandalotofthelackofacceptanceandracismthatIexperiencedwithinpostsecondaryeducation.

Reflectingonotheraspectsoftheirexperience,manyparticipants indicatedthatearningclients’trustandestablishingrapportrepresenteddemandingpartsofintegrativework.ForLeslie,thistrustmeantbeingapproachable(thisincludedherappearance,herconductinthesession,eventheset-upoftheoffice),whileEvelynstatedthatitistheprofessional’sownpersonalhistoryandreputationasahelperthatprimarilyfosterstrust.Manyparticipantsperceivedaneedtolivetheirlivesinaccordancewiththeprinciplesthattheypromotebecauseahelper’sactionsareopentothecommunity’sscrutiny.

Someindividualsconceptualizedtheirintegrativeeffortsassynonymouswithvalidating Aboriginal ways of learning, knowing, and thinking. As Margaretexplained, working alongside Elders and integrating traditional teachings letsindigenouspeoplesknowthattraditionalpracticesrepresent“valid,acceptable,believed,nurtured,andpracticed”waysofhelping.Shesaidthatsuchintegration“allows[us]toreclaimandembrace[Aboriginal]knowledge.”

Althoughmostparticipantsdeniedhavingexperiencedconflictbetweenintegra-tiveworkandtheirprofessionalregulatorybodies,severalindividualsexpressedworryaboutthepossibilityofsuchdifficulties.Forexample,Margaretreported


concernaboutwhetherherprovincialcollegeofpsychologistswouldinterpretherroleasahelperinahealingceremonyasavalidmeansofworkingwithaclient.Shealsowonderedaboutthecollege’sreactiontoherroutinelytakingguidancefromEldersindevisingtreatmentplans.

Integrating the Themes

Theproposeddescriptivemodel,orframework(Figures1and2),bringstogeth-erthefourabove-describedcorethemesandtheunderlyingsubthemes.Thisvisualtoolcanhelpconceptualizetheintegrativeprocessinallitscomplexity.InthissectionwewillfirstexplainFigure1,whichillustratestheinfluentialcomponentsoneachparticipant’sjourneytopracticingintegration,andthendiscussFigure2,whichcentresonparticipants’actualintegrativework.Itisimportanttonote,however,thatbothfiguresarepartofthesameexplanatorymodelthatvisuallyrepresentsparticipants’pathstopracticingintegrationandtheirintegrativeefforts.

Theinfluencesonparticipants’pathstobecominghelperswhopracticeintegra-tionarerepresentedasAncestors,Aboriginal Community,andMainstream EducationcirclesinFigure1.Thethemesinsidethesecirclesrefertotheelementsthateachofthesecontributedtotheparticipant’sjourney.Thearrowspointingfromthese

Figure 1: Path to Becoming a Helper

Mainstream Education

Formal training

Limitations (spiritual

dimension missing)

Acquire skills & techniques

Ancestors

Family helpers &

healers

Learning traditional

ways of self-care

Calling/destiny

Aboriginal identity

Personal journey

HELPER

Advocacy role

Personal qualities

Aboriginal

Community

Teachings from Elders

& community

Learning local protocols

Oral traditions

Growing up with

ceremony/tradition

No formal training

Traditional/

spiritual teachings

Helping is a core value

Figure1Path to Becoming a Helper


threecirclestowardthecentralHelpercirclecommunicatethatthesecomponentstaughtparticipantsskillsandparticularapproaches.However,allteachingswerefiltered throughtheparticipants’Aboriginalidentity,personaljourney,personalqualities,perceptionofcalling/destiny,andadvocacyrole.Thesethemesarecap-turedinthecentralcircle,depictingthehelper,or,theparticipant.

ThethreearrowsleavingthecentralcircleinFigure2representparticipants’self-describedintegrativework.First,however,theyassesswhethersomeformofintegrationisappropriateforagivenclient.Participants’experiencewithinte-grationisalsocapturedhere,sinceelementssuchasperceivedautonomylikelyinfluencethenatureoftheintegrativework.

The three circles labelled Traditional Elements, Approach, and Referral and Collaborationrefertoparticipants’integrativeefforts.Thesearerelatedsinceoneindividualoftenpracticesallthreeformsofintegration.Forexample,amentalhealthprofessionalmayconceptualizeaclient’sconcerninaholisticmanner,refertoEldersandtraditionalhealers,andprocessintherapytheclient’sexperience

Figure2Integrative EffortsFigure 2: Integrative Efforts

Referral and

Collaboration

Elders

Community

members

Traditional healers

Western counsellors

Calling/destiny

Aboriginal identity

Personal journey

HELPER

Advocacy role

Personal qualities

Approach

Systemic & holistic

Culturally-based

Work with client’s

Aboriginal identity

Mindful of history

(trauma, oppression,

colonization)

Traditional Elements

Smudging, Eagle feather

Drumming

Access to traditional

medicines

Away from office/out on

the land/water

Assessing when to integrate

Indirect cultural assessment, Ask directly

Client-centered approach, Intuition

Experience with integration

Self-care, Financial barriers, Lonely path,

Trust, Validate traditional ways, Autonomy,

Flexibility, Professional conflicts,

Interconnectedness

Mainstream

counselling

interventions

Mainstream

counselling

interventions


ofbeingwithanElder,orhavingparticipatedinahealingceremony.TheboxesnamedMainstream Counselling Interventions indicate thatparticipantsalsouseelementsofWesterncounsellingapproaches.

discussion

ByexaminingtheexperiencesofCanadianmentalhealthprofessionalswhointegrateconventionalcounsellingandAboriginaltraditionalhealingpractices,thisstudyidentifiedimportantinfluencesontheseindividuals’careerpaths,exploredtheirtherapeuticapproacheswithclients,andinquiredaboutfactorsthathinderorfacilitatetheirintegrativework.Inthenextsectionwewilldiscussemergentthemesinthecontextofpreviousresearch,addresstheimplicationsofourfindings,offerrecommendationsforclinicians,andproposedirectionsforfurtherresearch.

Reflectingontheirpathstobecominghelpers,mostparticipantsemphasizedthefundamentalrolesofancestors,theAboriginalcommunity,andtheirpersonalhealingjourney.Indeed,havinghealersamongone’sfamilyandundergoingaheal-ingjourneyhavebeenreported,inotherresearchwithindividualswhopracticetraditional healing (e.g., Skye, 2006; Solomon &Wane, 2005), as influentialcomponentsinbecomingahelper.Frompreviousresearchandfromthefindingsofourstudy,itseemsthatthehelper’spersonaljourneycanfacilitateaprofoundunderstandingof teachingsandceremoniesthat is requiredtoassistothersonthehealingpath.

Theroleofancestorswasnotlimitedtoinstructioninprotocolsforhealingcer-emonies,andmostparticipantsstatedthatthefamilyprovidedthemwithculturalteachingssuchastheimportanceofnon-interferenceandthevalueofrelationships.Thesequalities closelyparallel traditional indigenous teachings thathavebeendocumentedintheliterature(e.g.,Garrett&Wilbur,1999;McCormick,2005).

Interestingly,thetwonon-Aboriginalinterviewees(JohnandLillian)experi-encedmostoftheinfluencesreportedbytheAboriginalparticipants(i.e.,personaljourney,perceivingtheirroleasacalling,teachingsfromEldersandcommunitymembers).AlthoughtheywerenotbroughtupinAboriginalcommunities,theyreportedlong-lastinginvolvementwithindigenouscommunitiesandasadultswereofferedteachingssimilartothoseoftheirAboriginalcolleagues.Infact,thepathoftheseprofessionalswasremarkablysimilartothatoftheotherparticipants.Thisfindingsuggeststhatsomenon-AboriginalindividualswhoarefirmlygroundedinanAboriginalcommunityandhaveundergonepertinentlifeexperiencescan,anddo,practicetraditionalhealingintegration.

Severalparticipantsmentionedcarryingoutaculturalassessmentandembrac-ingaclient-centredorientation.ThisnotionofconductingaculturalassessmentisconsistentwithsuggestionsforprovidingservicestoAboriginalclients(e.g.,Wie-man,2006).Further,describingthetraditionalAboriginalworldviewofhealing,PoonwassieandCharter(2005)statethatcounsellorsshouldemployclient-centredmodalitieswhenworkingwithindigenousindividualsasthisenablesclientsto“havetotalcontrolofthepaceanddirectionoftheirhealingjourney”(p.23).


AnumberofparticipantsconceptualizedprovidingvisualaccesstotraditionalhealingelementsasawaytovalidatetraditionalknowledgeandAboriginalwaysofhelping.McCormick(2005)offersadditionalinsightwhenhesuggeststhat“oneoftherolesoftherapyfortraditionalAboriginalsocietyhasbeentoreaffirmculturalvalues”(p.298).Kirmayer,Simpson,andCargo(2003)furtheraffirmthevalueinofferingsuchaccesstotraditionalwaysofhealingwhentheywrite:“Recuperating these traditions therefore reconnects contemporary Aboriginalpeoplestotheirhistoricaltraditionsandmobilizesritualsandpracticesthatmaypromotecommunitysolidarity.Morebroadly,therecoveryoftraditionitselfmaybeviewedashealing”(p.16).Communicatingtoclientsthattheyconsidertradi-tionalwaysofhealingtobevalidandimportantseemedtobeacorecomponentofthehealingprocess.

Oneformofintegrationinvolvedreferralandcollaboration.MostparticipantsindicatedthattheyroutinelyworkwithAboriginaltraditionalhealersandcom-munityElders.Thereisagreementamongscholarsandcliniciansthatcollaborationwithtraditionalhelpersisintegraltoimprovingmentalhealthcareforindigenouspeoples(Gone,2004;LaFromboiseetal.,1990;Poonwassie&Charter,2005;Wyrostok&Paulson, 2000). Indiscussing the role of traditional practices inCanadianAboriginalhealth,Waldram,Herring,andYoung(2006)stated,“[A]ttheheartofthematteristheneedforincreasingdialoguebetweenhealersandphysiciansincludingthepossibilityofcollaboration”(p.247).

Participantsdidnotseemtoencounterdifficultiesinconsultingwithandre-ferringtheirclientstotraditionalhelpers.OnepossiblereasonforthisisthattheparticipantsdidnotregardWesterncounsellingandtraditionalhealingpracticesasopposinghelpingapproaches.Indeed,asFrankstated,“Idonotdrawadivi-sion,alinebetweentraditionalandmodern,orWestern.Idon’tbuyintothatdichotomy.”IfweweretoconceptualizeWesternandindigenouswaysofhelpingasfundamentallydissimilar,assomescholars(e.g.,Struthers,2003)havedone,integratingthemwouldnotbepossible.Incontrast,byunderstandingthemtobesomewhatdifferentbutnotentirelydisparateapproaches,astheparticipantsinthisstudyseemedtodo,“muchcanbegainedincombiningthehealingwisdomoftwocultures”(McCormick,1997,p.20).

Astheintervieweesreflectedontheirpersonalexperiencewithcarryingoutintegrativework,afewrecountedtheircareerpathasalonelyandchallengingjourney.Thesefindingsareconsistentwithresearchinvestigatingthepathofin-digenousprofessionalsinthemainstreameducationsystem(e.g.,Heilbron,2005).BecausesuchnegativeexperienceslikelyimpedeAboriginalindividualstraininginmentalhealth,webelievethatthisissuemeritsfurtherstudy.

While some expressed apprehension about potential professional conflictspertaining to their integrative efforts,mostparticipantsdidnot reporthavingexperiencedsuchproblems.Thisisnotable,giventheliteratureonconflictsinsupervisionwhenprofessionalhelpersincorporateelementsofspirituality(West,2005)andtraditionalhealingpractices(Helms&Cook,1999).Itislikely,how-ever,thatintervieweesdidnotexperienceprofessionalconflictsbecauseaconsider-ablelevelofautonomyfacilitatedtheirintegrativework.


Giventhesmallsamplesizeandthequalitativeapproach,theproposedframe-workillustratingintegrativeeffortsofparticipatingmentalhealthprofessionalsmaynotgeneralizetootherindividualswhointegratetraditionalpracticeswithmainstreamcounselling.Inparticular,thecoretheme—experience with integra-tion—may vary among professionals working in this field, depending on thebarriersandsupportsavailableattheirparticularworksetting.FurtherstudyoftheproposedframeworkinCanadaandintheUSAcouldexplorewhethertheemergentthemesfullycapturetheexperienceofothermentalhealthprofessionalswhopracticeintegration.

conclusion

Thethemesgeneratedfromthisinquiryandtheemergentframeworkrevealedthatinparticipants’experience,integrationoftraditionalpracticesinvolvedamorecomplexprocessthansimplyincorporatingelementsofAboriginalhealingintotheirinterventions.Participantsarrivedatworkinginanintegrativemannerasaresultofanumberofinfluencesontheirpathsuchastheirpersonalhealingjour-ney,oraltraditions,andcommunityteachings.Therefore,theirintegrativework(i.e.,incorporatingtraditionalhealingelements,usingparticularapproaches,andcollaborationwithtraditionalhealersandcommunitymembers)representedanintricateprocessthatnecessitatedacomplexanddynamicinteractionoffactors,suchasparticipants’uniquelifeexperiences,theirculturalassessmentoftheclient,andtheirappreciationofinterconnectedness.Drawingonourfindings,itseemsthatintegrationcannotberemovedfromitsabove-describedelaboratecontext.

OnecriticalimplicationoftheabovediscussionpertainstoprovidingservicestoAboriginalclients.Shouldacounsellorbelievethatatraditionalhelpingapproachmayenhancetherapy,itmaybevaluabletorefertheclienttoaprofessionalwhoroutinely practices integration. Such referral would necessitate a collaborativeprocessandadiscussionwiththeclientregardinghisorherinterestinpursuingthisroute.Asourfindingssuggest,integrativeworkisinformedbyfactorssuchasmentalhealthprofessionals’owncareerpathandexperiences,andtheirabilitytocarryoutaculturalassessmentoftheclient.Therefore,itisnotadvisableforamentalhealthworkerpracticingexclusivelyfromamainstreamorientationtoincorporateelementsofindigenouspractices.Incaseswhereaclient’sinvolvementintraditionalpracticesappearsbeneficialandtheclientexpressesinterest,webe-lieveitisbesttoreferorcollaboratewithaprofessionalwhopracticesintegration.

It is imperative thatwecontinue tonavigate the roleof traditionalhealingpracticeswithinmentalhealthcare.Oneapproachis toraiseawarenessamongcounsellingtraineesaboutAboriginaltraditionalwaysofhealing.Thiscanbeac-complishedbyintroducingspecificcoursesontraditionalhealingand/orinvitingguestspeakersfromAboriginalcommunities.Professionaldevelopmentseminarsinmentalhealthagenciesneedto includeeducationontraditionalAboriginalwaysofhelping,offeravenuetodiscusscollaborationwithhealersandElders,andprovidenamesofpotentialreferralswhoworkfromanintegrativeapproach.


Suchawarenessandenhancedknowledgecaninturnfacilitatecollaborationwithandreferralofclientstotraditionalhelpers,ortomentalhealthprofessionalswhopracticeintegration.Furthermore,suchdialoguecanhelpalleviatethefeelingofisolationthattheparticipantsreportedexperiencing,aswellasfacilitatemutuallearningandthebuildingofreferralnetworks.

Intermsoffutureresearchdirections,wewouldliketosuggestseveralareasforfurtherstudy.First,thereisaneedtobetterunderstandthenatureofcollaborationbetweenmainstreammentalhealthworkersandAboriginalhealers.Allparticipantsinthisstudystatedthattheyreferto,andworktogetherwith,traditionalhealers.However,giventhepresentstateofacademicknowledge,itremainsunclearwhatthesecollaborativeeffortsactuallylooklike.ResearchexploringcollaborativeeffortsbetweenmainstreamhealthprofessionalsandindividualspracticingAboriginaltraditionalhealingwouldofferinsightintothispresentlyobscurearea.Suchinsightcouldinturnenhancedialoguebetweenthesetwogroupsofhelpers.

Second,researchneedstoexamineexperiencesofclientswhoobtaintreatmentfromamentalhealthprofessionalpracticingintegration.Whilethepresentstudyoffersinsightsintotheclinicians’experienceswiththiskindofwork,itisimportanttolearnaboutclients’reactionstobeingofferedsuchintegrativeservices.

Lastly,whilethepresentresearchfocusedonintegrationofAboriginaltradi-tionalhealingpractices,weknowfromtheliterature(e.g.,Moodley,Sutherland,&Oulanova,2008;Moodley&West,2005)thatwithincounsellingandpsycho-therapy,integrationoftraditionalhealingpracticesalsooccursinCaribbean,SouthAsian,andAfricancontexts,amongothers.ThepresentstudycouldbeparalleledwithmentalhealthprofessionalswhointegrateotherformsoftraditionalhealingpracticeswithWesterncounsellingtechniques.

Acknowledgements

ThisresearchwaspartiallysupportedbyagrantfromtheSocialSciencesandHumanitiesResearchCouncil.WeareverygratefultoPatriciaA.PoulinforhertranslationoftheabstracttoFrench.

Note1. ThewordsAboriginalandindigenousareusedinterchangeablyinthisarticle.

ReferencesBeals,J.,Novins,D.K.,Spicer,P.,Whitesell,N.R.,Mitchell,C.M.,Manson,S.M.,…&Protec-

tiveFactorsProjectTeam.(2006).HelpseekingforsubstanceuseproblemsintwoAmericanIn-dianreservationpopulations. Psychiatric Services, 57(4),512–520.doi:10.1176/appi.ps.57.4.512

Canales,M.K.(2004).Takingcareofself:HealthcaredecisionmakingofAmericanIndianwomen.Healthcare for Women International, 25,411–435.doi:10.1080/07399330490438323

Duran,E.(1990).Transforming the soul wound.Delhi,India:AryaOffsetPress.France,M.H.(1997).FirstNations:HelpingandlearningintheAboriginalcommunity.Guidance

and Counseling,12,3–8.Garrett,M.T.,&Crutchfield,L.B.(1997).Movingfullcircle:Aunitymodelofgroupworkwith

children.Journal for Specialists in Group Work, 22,175–188.doi:10.1080/01933929708414379


Garrett,M.T.,&Garrett,J.T.(2002).“Ayeli”:CenteringtechniquebasedonCherokeespiritualtraditions.Counseling and Values,46, 149–158.

Garrett,M.T.,Garrett,J.T.,&Brotherton,D.(2001).Innercircle/outercircle:AgrouptechniquebasedonNativeAmericanhealingcircles.Journal for Specialists in Group Work,26(1),17–30.doi:10.1080/01933920108413775

Garrett,M.T.,&Wilbur,M.P.(1999).Doesthewormliveintheground?ReflectionsonNa-tiveAmericanspirituality.Journal of Multicultural Counseling and Development,27,193–206.

Glaser,B.G.,&Strauss,A.L.(1967).The discovery of grounded theory: Strategies for qualitative research.Chicago,IL:Aldine.

Gone,J.P.(2004).MentalhealthservicesforNativeAmericansinthe21stcenturyUnitedStates.Professional Psychology: Research and Practice,35(1),10–18.doi:10.1037/0735-7028.35.1.10

Gurley,D.,Novins,D.K.,Jones,M.C.,Beals,J.,Shore,J.H.,&Manson,S.M.(2001).Com-parativeuseofbiomedicalservicesandtraditionalhealingoptionsbyAmericanIndianveterans. Psychiatric Services, 52(1),68–74.doi:10.1176/appi.ps.52.1.68

Heilbron, C. L. (2005). The journey of Aboriginal healthcare workers. Doctoral dissertation,UniversityofToronto,Canada.RetrievedfromProQuestDigitalDissertationsdatabase.(Pub-licationNo.AATNR07563).

Heilbron,C.L.,&Guttman,M.A.J.(2000).TraditionalhealingmethodswithFirstNationswomeningroupcounselling. Canadian Journal of Counselling. Special Issue: Counselling First Nations people in Canada, 34(1),3–13.

Heinrich,R.K.,Corbine,J.L.,&Thomas,K.R.(1990).CounselingNativeAmericans.Journal of Counseling and Development, 69(2),128–133.

Helms,J.E.,&Cook,D.A.(1999).Using race and culture in counseling and psychotherapy: Theory and process.Boston,MA:Allyn&Bacon.

Iwasaki,Y.,Bartlett,J.,&O’Neil,J.(2005).CopingwithstressamongAboriginalwomenandmenwithdiabetesinWinnipeg,Canada.Social Sciences and Medicine,60,977–988.doi:10.1016/j.socscimed.2004.06.032

Juntunen,C.L.,&Morin,P.M.(2004).TreatmentissuesforNativeAmericans:Anoverviewofindividual,family,andgroupstrategies.InD.R.Atkinson(Ed.),Counseling American Minorities (6thed.,pp.171–192).NewYork,NY:McGraw-Hill.

Kim,C.,&Kwok,Y.S.(1998).NavajouseofNativehealers.Archives of Internal Medicine, 158(9),2245–2249.doi:10.1001/archinte.158.20.2245

Kirmayer,L.J.,Brass,G.M.,&Valaskakis,G.G.(2009).Conclusion:Healing/Intervention/Tradi-tion.InL.J.Kirmayer&G.G.Valaskakis(Eds.),Healing traditions: The mental health of Abo-riginal peoples in Canada(pp.440–472).Vancouver,BC:UniversityofBritishColumbiaPress.

Kirmayer,L.,Simpson,C.,&Cargo,M.(2003).Healingtraditions:Culture,communityandmentalhealthpromotionwithCanadianAboriginalpeoples.Australasian Psychiatry(Supple-ment),11,15–23.doi:10.1046/j.1038-5282.2003.02010.x

Kirmayer,L.J.,Tait,C.L.,&Simpson,C.(2009).ThementalhealthofAboriginalpeoplesinCanada:Transformationsofidentityandcommunity.InL.J.Kirmayer&G.G.Valaskakis(Eds.),Healing traditions: The mental health of Aboriginal peoples in Canada(pp.3–25).Van-couver,BC:UniversityofBritishColumbiaPress.

LaFromboise,T. D.,Trimble, J. E., & Mohatt, G.V. (1990). Counseling intervention andAmericanIndiantradition:Anintegrativeapproach. Counseling Psychologist, 18(4),628–654.doi:10.1177/0011000090184006

McCabe,G.H.(2007).Thehealingpath:Acultureandcommunity-derivedindigenoustherapymodel.Psychotherapy: Theory, Research, Practice, Training,44(2),148–160.doi:10.1037/0033-3204.44.2.148

McCormick,R.(1996).CulturallyappropriatemeansandendsofcounsellingasdescribedbytheFirstNationspeopleofBritishColumbia.International Journal for the Advancement of Counsel-ling,18,163–172.doi:10.1007/BF01407960

McCormick,R.(1997).Anintegrationofhealingwisdom:TheVisionQuestceremonyfromanattachmenttheoryperspective.Guidance and Counseling,12,18–21.


McCormick,R. (2005).Thehealingpath:What can counselors learn fromAboriginalpeopleabouthowtoheal?InR.Moodley&W.West(Eds.),Integrating traditional healing practices into counseling and psychotherapy (pp.293–304).ThousandOaks,CA:Sage.

McCormick,R.(2009).Aboriginalapproachestocounselling.InL.J.Kirmayer&G.G.Valaskakis(Eds.),Healing traditions: The mental health of Aboriginal peoples in Canada (pp.337–354).Vancouver,BC:UniversityofBritishColumbiaPress.

McLeod,J.(2001).Qualitative research in counselling and psychotherapy.London,UK:Sage.Moodley,R.,Sutherland,P.,&Oulanova,O.(2008).Traditionalhealing,thebodyandmindin

psychotherapy.Counselling Psychology Quarterly, 21(2),1–13.doi:10.1080/09515070802066870Moodley,R.,&West,W.(Eds.)(2005).Integrating traditional healing practices into counselling and

psychotherapy. ThousandOaks,CA:Sage.Morrow,S.L.(2005).Qualityandtrustworthinessinqualitativeresearchincounselingpsychology.

Journal of Counseling Psychology,52(2),250–260.doi:10.1037/0022-0167.52.2.250Novins, D. K., Beals, J., Moore, L. A., Spicer, P., Manson, S. M., & AI-SUPERPFPTeam.

(2004).UseofbiomedicalservicesandtraditionalhealingoptionsamongAmericanIndians:Sociodemographiccorrelates,spirituality,andethnicidentity. Medical Care, 42(7),670–679.doi:10.1097/01.mlr.0000129902.29132.a6

Poonwassie,A. (2006).Grief and trauma inAboriginal communities inCanada. International Journal of Health Promotion and Education, 44(1),29–33.

Poonwassie,A.,&Charter,A.(2005).Aboriginalworldviewofhealing:Inclusion,blending,andbridging.InR.Moodley&W.West(Eds.),Integrating traditional healing practices into counseling and psychotherapy (pp.15–25).ThousandOaks,CA:Sage.

Portman,T.A.A.,&Garrett,M.T.(2006).NativeAmericanhealingtraditions.International Journal of Disability, Development and Education,53(4),453–469.doi:10.1080/10349120601008647

Robbins,R.(2001).Thedreamcatchermeditation:AtherapeutictechniqueusedwithAmericanIndianadolescents.American Indian and Alaska Native Mental Health Research,10(1),51–65.

Skye,J.S.(2006).Anorchidintheswamp:Traditionalmedicine,healing,andidentityatanur-banAboriginalcommunityhealthcentre.Unpublishedmaster’sthesis,McMasterUniversity,Canada.

Solomon,A.,&Wane,N.N.(2005).Indigenoushealersandhealinginamodernworld.InR.Moodley&W.West(Eds.),Integrating traditional healing practices into counseling and psycho-therapy (pp.52–60).ThousandOaks,CA:Sage.

Stewart,S.L.(2008).PromotingIndigenousmentalhealth:CulturalperspectivesonhealingfromNativecounsellorsinCanada.International Journal of Health Promotion and Education,46(2),49–56.

Strauss,A.L.,&Corbin,J.(1990).Basics of qualitative research: Grounded theory procedures and techniques.NewburyPark,CA:Sage.

Struthers,R.(2003).Theartistryandabilityoftraditionalwomenhealers.Healthcare for Women International,24,340–354.doi:10.1080/07399330303961

Trimble,J.E.(1981).ValuedifferentialsandtheirimportanceincounselingAmericanIndians.InP.Pedersen,J.Draguns,W.Conner,&J.Trimble(Eds.),Counseling across cultures(pp.203–226).Honolulu,HI:UniversityPressofHawaii.

Waldram,J.B. (1993).Aboriginal spirituality:Symbolichealing inCanadianprisons.Culture, Medicine, and Psychiatry,17,345–362.doi:10.1007/BF01380009

Waldram,J.B.,Herring,D.A.,&Young,T.K.(2006).Aboriginal health in Canada: Historical, cultural, and epidemiological perspectives (2nded.).Toronto,ON:UniversityofTorontoPress.

Walkingstick Garrett, M., & Osborne,W. L. (1995). The Native American sweat lodge asmetaphorforgroupwork.Journal for Specialists in Group Work,20(1),33–39.doi:10.1080/01933929508411323

West,W.(2005).Crossingthelinebetweentalkingtherapiesandspiritualhealing.InR.Moodley&W.West(Eds.),Integrating traditional healing practices into counseling and psychotherapy(pp.38–49).ThousandOaks,CA:Sage.


Wieman,C.(2006).Westernmedicinemeetstraditionalhealing:TheexperienceofSixNationsMentalHealthServices.Crosscurrents: The Journal of Addiction and Mental Health,10(1),10–11.

Wilbur,J.R.,Wilbur,M.,Garrett,M.T.,&Yuhas,M.(2001).Talkingcircles:Listen,oryourtonguewillmakeyoudeaf.Journal for Specialists in Group Work,26(4),368–384.doi:10.1080/01933920108413785

Wyrostok,N.C.,&Paulson,B.L. (2000).Traditionalhealingpractices amongFirstNationsStudents.Canadian Journal of Counselling,34(1),14–24.

About the AuthorsOlgaOulanovaisadoctoralstudentincounsellingpsychologyatOntarioInstituteforStudiesinEducation,UniversityofToronto(OISE/UT).HermaininterestsareinAboriginalmentalhealth,indigenoushealingpractices,andsuicidebereavement.

RoyMoodleyisanassociateprofessorofcounsellingpsychologyatOISE/UT.Hismaininterestsareincriticalmulticulturalcounselling,race,cultureandpsychotherapy,traditionalhealing,andgenderstudies.

Address correspondence to Olga Oulanova, Department of Adult Education and CounsellingPsychology,OntarioInstituteforStudiesinEducation,UniversityofToronto,252BloorStreetWest,Toronto,ON,Canada,M5S1V6;e-mail:[email protected]