Navigating Two Worlds: Experiences of Counsellors Who … · 2013-08-02 · Revue canadienne de...

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.

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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]

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