Mental health concerns are a universal part of the human experience that affects every person at some stage of life regardless of race, ethnicity, gender, sexuality, religion, or socioeconomic status.  Unfortunately, equal access to quality mental health care is not a universal privilege. This truth becomes even more sobering when we consider that some of the most marginalized people in America are the least likely to have access to quality mental healthcare and may feel dubious about seeking out support from a psychotherapist or psychiatrist. This reality is everpresent for many Indigenous people in this country who often experience Indigenous Erasure, an oppressive practice that eliminates, minimizes, overlooks, and rewrites the narratives of Indigenous Americans (Sasa, S.M., Horse, A. J., 2022). Mental health providers have an important role in creating and maintaining a safe, inclusive, and empowering space for clients of Indigenous heritage to process the historical and present traumas within their experience. It is equally important to create safe spaces for Indigenous people to celebrate the delights in their lives. In this blog post, we’ll explore how to honor and reflect the Indigenous experience within the counseling space. 

Get Comfortable with Indigenous Terminology

Words are the building blocks of language that directly impact our thoughts, emotions, and behaviors. Getting comfortable with basic words and terminology surrounding Indigenous cultures is a great place to start when learning how to communicate with dignity, confidence, and pride about Indigenous experiences. For example, there are several different ways in which a person of Indigenous background may identify themselves, such as Native American, American Indian, First Nations, and, Indigenous (Roessel, n.d.). There is no right or wrong way to identify, however, the difference may be extremely important and personal to each individual and should be noted.

For Clients

Don’t be afraid to provide feedback to your clinician if you find their language to be misinformed, misrepresentative, outdated, or harmful (for more support with this see our blog post: How to Give Feedback to Your Therapist). Effective mental healthcare hinges on your comfort in bringing your perspectives, needs, and expertise to the table. Your honesty is a valued and integral part of the process, and remember, you’re the expert in your experience.

For Therapists

Mirroring your client's language is generally a great rule of thumb. Prioritizing the language your client uses to self-identify themselves can help to create and maintain an aura of respect and attentiveness within sessions. It is also acceptable to ask questions and open up a dialogue about the language your client prefers you to use when referring to them and their cultural experiences. 

Avoid Harmful Tropes

Popular culture is rife with harmful tropes and stereotypes about the Indigenous experience and often portrays Indigenous people as mythical and wild, or as supporting characters in romanticized stories of Western settlement and manifest destiny. The pervasiveness of these false narratives is so great that we may unknowingly uphold or internalize insidious stereotypes about Indigenous people. The effects of these subconscious and conscious beliefs impact the way we think, feel, and behave and can cause undue harm or create intense symptoms of worry, anxiety, and depression. Examining these age-old tropes can help us avoid marginalizing others and depreciating ourselves to fit a monolithic narrative. An example of a prevalent stereotype is the Vanishing Indian trope which depicts native people as declining and destined to go extinct (Fling, n.d.). For some, this trope may be something very familiar, for others, it may be the first time they’ve heard about it. The power of tropes is that we don’t have to be aware of them for them to change our outlook and create biases. Therapy is an opportune place to unpack these predisposed beliefs and do a deep dive into the who, what, when, where, why, and how of their origins.

For Clients

Consider this: holding on to negative stereotypes with the intent to prove them wrong can be just as exhausting and mentally taxing as seeing ourselves as fulfilling the stereotype. In fact, this can result in experiences of imposter syndrome, perfectionism, and chronic stress. Are there any stereotypes that you hold about your identity that cause psychological pressure? If so, therapy can be a great opportunity for you to release some of that pressure you’ve been carrying, and reclaim your identity from insidious tropes.

For Therapists

Continually challenge your biases as your perceptions of authenticity may be skewed (Pokhrel, 2011). Expand your frame of reference with literature and film from indigenous creators, and avoid taking on the role of the all-knowing professional to foster trust in the counseling relationship (SAMHSA, 2015). Consider the use of modalities such as narrative therapy, and cognitive behavioral therapy (CBT) to assist clients in making connections between their conscious and unconscious beliefs and their self-perceptions and behaviors.

DeColonize Mental Health

Although rooted in a Eurocentric context, therapy doesn’t have to be partial to Eurocentric ideals on health and wellness. Eurocentrism is a phenomenon that implicitly and explicitly asserts that the European or Western standard of living is preeminent or superior to that of other cultures (Sasa, S.M., Horse, A. J., 2022). This belief imposes undue and burdensome judgment on people from various cultural backgrounds (i.e. African Americans, Latinx Americans, Asian Americans, and Indigenous Americans). Therefore we must ask ourselves, how can I decolonize this space? What would it look like to make room for a broader worldview that encompasses, and even exalts different cultural outlooks and remedies for mental and emotional ailments?  

For Clients

Decolonization may look like readily bringing forth your spiritual and cultural outlooks, allowing your worldview to shape the therapeutic work as much as the therapeutic work shapes you. Exploring the intersection of psychological, political, ancestral, and collective conflicts and strengths, provides the opportunity for you to highlight your uniqueness, promote personal harmony and well-being, and leave feeling empowered, authentic, and whole.

For Therapists

While we do practice within the medical model, there are appropriate and effective ways to incorporate aspects of the wellness model (Perry, 2017) into our thinking and interventions, so that we may effectively serve diverse client populations. For example, Indigenous cultures emphasize the inseparable nature of the mind, body, and spirit, a concept that also exists in the realm of therapy. There is an opportunity for harmony between psychological concepts and our client’s cultural experiences if we are flexible and eclectic in our applications. We must look beyond talk therapy to assist clients in leveraging the benefits of incorporating spirituality, community support, fitness, and diet into their efforts toward achieving their therapeutic goals and objectives. 

Make Time for Joyful Narratives

While there is certainly struggle within the Indigenous experience, it is important to remember that the Indigenous experience is so much more than the struggle, or the experience of trauma, and systems of oppression. The Indigenous experience is a rich one that long predates the interruption of Western settlement and marginalization, and we can honor that by making space for joy and gratitude.  It’s essential to retain the focus on each individual and their unique hopes, aspirations, joys, and dreams. Surely some sessions will be heavy, however, life-affirming narratives have an unquestionably significant place within the Indigenous experience and within the therapeutic space. 

For Clients

Many first-time therapy clients fear that therapy will be an ineffective, upsetting, or punitive experience. A part of this misconception is supported by the idea that therapy is where we go to talk about our problems. While that is part of the work, therapy is also a place where you can talk about your joy and things that are going well in your life. Taking time to focus on gratitude and solutions is a valid and encouraging use of your time in therapy.

For Therapists

Make time for problem-free talk during sessions to discuss subjects that are life-giving and light-hearted. Go at your client's speed as you navigate the hills and valleys of their lived experience, and allow time to focus on building rapport and trust. Modalities such as strength-based therapy, positive psychology, and humanistic/ client-centered therapy may help to support a sense of hopefulness, agency, and levity.

Taking the Next Step

The Indigenous experience is one of diversity, complexity, striving, and resilience, that has been historically overpowered by Eurocentric ideals, glamorized Hollywood narratives, and other constricted and false beliefs. Therapy is a place to reclaim these very important narratives, and to provide a safe space for Indigenous healing, joy, and respite.  If this describes your experience, consider taking the next step with us, by signing up for individual, group, couples, or family therapy. We’d be happy to have you and look forward to the journey.

Fling, S. (n.d.). The Myth of the Vanishing Indian. White House History. https://www.whitehousehistory.org/the-myth-of-the-vanishing-indian#:~:text=As%20politicians%20used%20the%20Myth,was%20unavoidable%20and%20nearly%20complete. 

Perry, C. (2017, March 25). Aca Counseling Corner Blog. Medical Model vs Wellness Model. https://www.counseling.org/news/aca-blogs/aca-counseling-corner/aca-member-blogs/2017/05/25/medical-model-vs-wellness-model 

Pokhrel, A.K. (2011). Eurocentrism. In: Chatterjee, D.K. (eds) Encyclopedia of Global Justice. Springer, Dordrecht. https://doi.org/10.1007/978-1-4020-9160-5_25

Roessel, M. H. (n.d.). Working With Indigenous/Native American Patients. American Psychiatric Association. https://www.psychiatry.org/psychiatrists/diversity/education/best-practice-highlights/working-with-native-american-patients 

SAMHSA. (2015). Improving cultural competence. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. 

Sasa, S. M., & Yellow Horse, A. J. (2022). Just data representation for Native Hawaiians and Pacific Islanders: A critical review of systemic Indigenous erasure in census and recommendations for psychologists. American journal of community psychology, 69(3-4), 343-354.