Tag Archives: Native Americans

Looking back, moving forward: COVID-19 and Indian Country

By Nicola A. Meade, Roni K. White and Carol ZA McGinnis November 10, 2022

Throughout American history, the United States government, despite well-documented treaties, has unjustly treated Native Americans. Treaties ratified in 1851 and 1868 were violated during the COVID-19 pandemic national emergency, which may be surprising to people who believe that the failure to uphold such legal documents is an outdated issue. 

As noted by the Substance Abuse and Mental Health Services Administration (SAMHSA), there are eight domains of wellness — physical, relational, occupational, mental/emotional, intellectual, spiritual, environmental and financial — and any domain can affect another. This article will highlight how COVID-19 disproportionately impacted several domains of wellness for Native people and how counselors can address increased mental health concerns. 

The physical toll 

In a December 2021 article published in The Princeton Review, Riis Williams reported about a study conducted by Princeton University researchers, which found that U.S. COVID-19 mortality rates of Native Americans were 2.8 times higher than white people. Comparatively, this study also found that mortality rates were 1.6 higher for Black Americans and 1.8 higher for Latinos than white people. Comorbid factors contributing to these significantly higher rates include lack of access to affordable health care, poverty, historical and current treatment by the U.S. government, and higher rates of high-risk health issues. 

Shortly after the pandemic began, Kolby KickingWoman highlighted a distressing problem in a June 2020 article published in Indian Country Today, writing that “tribal leaders are working to keep their citizens safe from the coronavirus while juggling attacks on tribal sovereignty.” For example, in April 2020, the Cheyenne River Sioux and Oglala Sioux tribes implemented highway checkpoints for the purpose of contact tracing to reduce the spread of COVID-19. According to a May 2020 article in Indian Country Today, Cheyenne River Sioux Chairman Harold Frazier said that vigilance was required because the health care system on his reservation had “only eight hospital beds and six ventilators,” which was alarming given the high rate of infection that was occurring in the United States at the time. Nevertheless, South Dakota Gov. Kristi Noem tried to stop these efforts by giving the Native nations a 48-hour timeline to remove the checkpoints. The Cheyenne River Sioux Chairman Frazier and Oglala Sioux Tribe President Julian Bear Runner ignored the order, stating that they would remove the checkpoints when they deemed that it was safe to do so. Gov. Noem then involved the Bureau of Indian Affairs and threatened legal action. In May 2020, an increased number of positive COVID-19 cases led the Rosebud Sioux Tribe to also implement checkpoints on tribal land highways. 

In an action of solidarity, a bipartisan group of state lawmakers wrote a letter in support of these tribal actions to Gov. Noem, and they cited the 1851 and 1868 Fort Laramie Treaties, which clarify that the state “has no jurisdiction over the highways running through Indian lands in the state without tribal consent.” Gov. Noem responded by sending a written plea to then President Donald Trump for federal intervention. Citing this plea, U.S. Sens. John Thune and Mike Rounds and U.S. Rep. Dusty Johnson sent a letter to U.S. Interior Secretary David Bernhardt requesting clarification on jurisdiction. The Association for Multicultural Counseling and Development’s Native American Concerns (NAC) group also wrote a position letter in support of tribal sovereignty. In the end, Native sovereignty was maintained, and the decision to have contract tracing checkpoints was applauded. 

This conflict, however, did not end with the unjust challenge over highway checkpoints. As predicted by Chairman Frazier, when members of the Cheyenne River Sioux Tribe and Oglala Sioux Tribe fell ill with COVID-19, they did not have sufficient medical resources to meet the needs of their communities. And despite having available hospital beds in South Dakota, tribal members were forced to seek medical assistance in other states, traveling as far as Denver and Cheyenne, Wyoming. This not-so-subtle form of discrimination led to an Eight Circuit ruling that supported the 1868 Great Sioux Nation Treaty, which requires the United States to provide “competent physician led-health care.” 

A similar discriminatory health care policy occurred at the Lovelace Women’s Hospital in Albuquerque, New Mexico, where pregnant Native American women were singled out for COVID-19 testing based on their race and zip code. In a June 2020 article in ProPublica, Bryant Furlow unveiled that this hospital’s secretive policy resulted in some Pueblo Nation mothers being separated from their newborn babies for up to three days. No other hospital in the area enacted a similar policy for new mothers, and the practice was finally identified and stopped months later. This egregious practice is evocative of the 1860 U.S. cultural genocide policy to separate Native children from their parents and place them in government boarding schools, which ceased in the 1970s. Policies of this nature are reminiscent of historical traumas, and they also create new traumatic experiences and contribute to negative mental health outcomes. 

The financial toll 

The pandemic also severely hurt Native Americans economically when public commerce restrictions led to a significant economic downturn. Many of the revenue streams Native nations rely on are in the hospitality and service sectors, gaming industry and public-driven enterprises, such as the Hualapai Tribe’s Skywalk over the Grand Canyon. Generally, these enterprises were either closed or experienced significant revenue losses during the pandemic, which decreased the economic health of the community-based tribes. 

Although many Americans experienced financial hardship due to the ramifications of the pandemic, the Native American circumstances were compounded due to the intersection of the high percentage of COVID-19 deaths with tribal economic interdependence for survival. According to the 2020 report by the National Center for American Indian Enterprise Development, more than two-thirds of Native-owned businesses suffered significant revenue losses. 

As noted in a 2020 report by the Federal Reserve Bank of Minneapolis, Native American employment had the biggest drop in April 2020 of any racial group. This decrease in employment was also highlighted by Robert Maxim, Randall Akee and Gabriel Sanchez in a 2022 Brookings article that exposes the vast differences in unemployment rates across Native American, Asian American, Black and white populations. In January 2020, the unemployment rate for Native Americans was 7.5%, Black Americans was 6%, Asian Americans was 3%, and white Americans was 3%. In March 2020 the unemployment rate drastically increased, with 28.6% unemployment for Native Americans, 16% for Black Americans, 14% for both Asian Americans and whites Americans. The unemployment rate in January 2022 displayed improvements, with 11.1% unemployment for Native Americans, 8% for Black Americans, and 4% for both Asian Americans and white Americans. The authors of this article acknowledged a prolonged disparity, noting it was the “first time the government published monthly unemployment data on Native Americans.” This former exclusion has had negative effects on economic recovery efforts, supports and research, which was highlighted in a 2022 Journal of Counseling & Development article by NAC members.  In addition, as noted in a 2021 report by the Food Research and Action Center, the pandemic also exasperated food insecurities in a unique way for Native communities, resulting in locations running out of basic supplies at unprecedented rates.

On a positive note, Mark Trahant, in a May 2022 article published in Indian Country Today, noted that members of Congress intended to use a recent U.S. Congress report that detailed persistent structural barriers that have limited economic opportunities within Native communities to inform public policy. The American Rescue Plan’s investment of $31 billion into Indian Country is an attempt to bridge these gaps. The U.S. Congress report highlighted the interconnectedness of economic status and resources in relation to health outcomes. Much is still unknown, including the investment’s impact, yet the hope is that these positive movements can make a tangible difference.

The mental health toll

The loss of multiple family members and tribal elders who were the carriers of traditional knowledge and language can be especially difficult to bear, given the depth and breadth of such cultural information on personal and tribal identity. This can be especially devastating when the elder was the last living person with knowledge that predated the U.S. policy of boarding schools, which systematically removed Native American youth from their families and was an intentional form of cultural genocide.  

These losses were experienced by Native Americans in various geographical areas, including rural, suburban and urban areas, and on reservations. Native clients living in urban areas away from their Native communities, which have suffered great losses, might have faced barriers and restrictions that prevented them from participating in grieving rituals, thus complicating their grief. These clients may have also experienced isolation and disconnection from ceremonies, cultural practices and community support due to limitations caused by the pandemic, adding further emotional challenges. 

Local, state and federal policies that have racial disparities can add exponentially to bio-psycho-socio-spiritual aspects of the presenting problem with severe implications that reach beyond the non-Native pandemic experience. Due to these distressing impacts, practitioners should be aware of the historical trauma that the pandemic has triggered for Native American people who have suffered multigenerationally from U.S. betrayal and a failure to support Native interests. In a November 2021 NPR article, Adrienne Maddux, executive director at Denver Indian Health and Family Services, and Spero Manson, director of the University of Colorado’s Center for American Indian and Alaskan Native Health, shared that the pandemic had heightened

Ruslana Iurchenko/Shutterstock.com

historical trauma and the “sense of pain, suffering of helplessness and hopelessness” for Natives who have endured oppressive circumstances for generations. These observations dovetail with Allyson Kelley and colleagues’ findings in a 2022 article published in the American Indian and Alaska Native Mental Health Research that confirm significantly higher rates of American Indian and Alaska Native (AI/AN) children experiencing orphanhood as a result of the pandemic. 

The shelter-in-place orders and other mandates contributed to disturbances in physical and mental health due to the disruption in social, cultural, and economic practices and norms that are at the core of what it means to identify as a Native American. These circumstances contributed to increased rates of depression, suicidality and other pandemic-related stressors. A post-pandemic poll conducted by NPR, the Robert Wood Foundation and Harvard T.H. Chan School of Public Health found that Native Americans now suffer from increased depression, anxiety, sleep problems, stress and posttraumatic stress disorder. 

Before the pandemic, 50% to 88% of homes on tribal lands lacked internet, broadband and even phone services, so it is easy to see how these disparities elevated difficulties for Native Americans to transition to shelter-in-place orders, virtual opportunities and telemedicine. In a 2022 article published in American Indian and Alaska Native Mental Health Research, Amanda Hunter and colleagues reported that some Native American researchers used funding and advocacy to improve technological infrastructure, yet this help was limited to a few areas. These honorable efforts, however, were not able to mitigate the long-term effects of the technological disparities. 

A 2022 article in Shift Nursing reported that the depression rates for people in North Dakota had risen from 19.2% in 2020 to 33.3% in fall 2021. And of particular concern, the 2019 Fargo Cass Public Health Assessment found “a suicide rate of 45.1 for Native Americans in North Dakota, compared to the national average of 13.4.” This article also highlights access to insurance and costs as barriers to mental health treatment. 

On the positive note, mental health practitioners benefit from knowing that protective cultural factors can serve as a resource for Native American clients. Amanda Hunter and colleagues detailed how the protective factors of community, relationality, abundance, strength and resilience found in AI/AN communities have improved outcomes during the pandemic. These protective factors may exist for Native American clients who are struggling with post-pandemic issues and help them to pave a way forward through their struggles with anxiety, stress and depression. Many Native communities executed resilience during the hardships, disparities, challenges to sovereignty and disruptions to protective factors. Continued mental health support is essential to sustain resilience. 

Clinical considerations

Mental health practitioners demonstrate ethical care by incorporating how the aforementioned tolls affect Native clients while also seeking knowledge and understanding to maintain cultural competency. Counselors can learn more about current events within Native American communities by reading Native news resources such as Indian Country Today, IndianZ and Native News Online. Along similar lines, it is culturally responsible to understand that each tribe has its own culture and to be aware of tribal resources. Here are a few tribal resources that might be helpful depending on location: Northwest Portland Area Indian Health Board, Native Hope, Indigenous Story Studio, One Sky Center, We R Native, Center for Native American Youth at the Aspen Institute, First Nations Development Institute, and Centers for American Indian and Alaska Native Health. More general resources can also be found at the Indian Health Service (an agency under the U.S. Department of Health and Human Services) and SAMHSA’s Tribal Training and Technical Assistance Center websites.

In September, Kristi Taylor-Bond, a nationally certified addictions counselor and a chemical dependency clinical supervisor in Alaska who works with Alaskan Native populations, shared the following description of how the pandemic has affected the Alaska Native community with the NAC group: “COVID has halted in-person gatherings, which are essential to Native communities. It is common for Alaska Native crafters and artists to gather at the Native hospital and other corporation-run locations to sell crafts [and] traditional foods and to visit with friends. With these activities ceasing, many elders have been more isolated and unable to earn income from selling their art. Elders are especially vulnerable to mental health decline when they are not able to connect with loved ones.” This statement reverberates how important it is for counselors to access clients’ understanding of culture and their sense of belonging to culture as well as how disruption from this culture affects mental wellness. 

AI/AN clients benefit when counselors include the following spectrum factors for cultural consideration during sessions:

Connection/disconnection: Explore how AI/AN clients are experiencing connection to their community and cultural practices.

Contributor/burden: Ask AI/AN clients how they perceive their community is experiencing their needs. Does the client see their needs as a burden to others? Is there balance to how the client views their own contribution and needs? 

Collective/isolation: Determine AI/AN clients’ degree of connection to elders. This is important because elders hold wisdom for healing and challenging times.

Balance/imbalance: Guide AI/AN clients to reflect on what is working and explore the balance of wellness from the client’s cultural perspective. 

Cultural responsible therapeutic services also include the method in which counseling is offered. Telehealth is becoming a more widely used modality, so additional considerations are important to keep in mind. Taylor-Bond also shared the following with the NAC group: “While telephonic and video sessions may be a very successful alternative for urban and younger folks, Alaska Native elders and those living in more rural settings are not finding the same success, in my opinion. There is a really beautiful part of building rapport with AN elders that I have found, and that is just being with them. … Lots of the rural kids and adults I’ve worked with first get to know you by experiencing you.”  

SAMHSA and the U.S. Department of Health and Human Services have shared research informing how cultural disruption is a risk factor for suicide and mental illness in AI/AN communities. 

What counselors can do

Policy informs funding and laws, and funding delivers resources to initiate change. Counselors can engage in local and federal advocacy to improve facilities, research, treatment and access. There are many ways counselors can advocate and encourage changes. Understanding how local laws affect mental and behavioral health allows clinicians to discuss the impact and needs of Native American clients and practitioners with legislators. It is essential for counselors to know the systemic barriers that create limitations for Native American clients to obtain mental health care in order to inform elected officials on ways to improve access to these services. Identifying methods to deliver culturally appropriate services will improve the quality of service and access to care. 

When counselors advocate for efficacious culturally appropriate services, policy makers can pass legislation that protects vulnerable communities, builds access to culturally competent services and designates funding to increase equitable services and research. Supporting scholarship through funding is necessary to increase culturally appropriate interventions for therapeutic services. Currently, the funding for AI/AN research is 0.01% of the mental health research budget of the National Institutes of Health. In their article, Hunter and colleagues revealed how the pandemic has disproportionately affected Native communities, and more research is needed to explore the underlying factors and impacts of COVID-19. 

In their 2022 article, Kelley and colleagues shared how communities across Indian Country established policies, adapted services, created education and service delivery strategies, and developed resources to keep individuals and families safe. Many of these communities partnered with federal agencies, including the Centers for Disease Control and Prevention, Federal Emergency Management Agency, and Indian Health Service. 

Advocacy and progress take time and can provide healing to Native American communities. It was not until the passing of the American Indian Religious Freedom Act of 1978 that Native Americans could more freely worship in the United States. In 2021, Deb Haaland became the first Native American to serve in the presidential cabinet as the U.S. Secretary of the Interior. In August, Mary Peltola became the first Alaskan Native elected to the U.S. House of Representatives. In July, more than 1,000 acres of land were returned to the Onondaga Nation in New York, acknowledging them as the original stewards of the land. This recognition allows for healing and restoration as it further emphasizes sovereignty.  There remain numerous injurious land policies fueling advocacy efforts, including the Dakota Access Pipeline and national monuments such as Bears Ears and Grand Staircase-Escalante.

The American Counseling Association began its 2022 Conference & Expo with a land acknowledgment. This acknowledgment is essential in the collective healing process and promotes an understanding of the compounding historical and current trauma many Native people endure in their lived experiences. This understanding provides counselors with a window into how the complex traumas may present in symptomatology and offers insight to healing pathways. It truly takes all of us to create a representative government and institute change to heal and progress together.



AMCD Native American Concerns group

The Native American Concerns group is one of seven focus group for the Association for Multicultural Counseling and Development (AMCD), a division of the American Counseling Association that works to promote ethnic and racial empathy and understanding. AMCD encourages changing attitudes and enhancing understanding of cultural diversity. The Native American Concerns group actively supports Native voices in research and provides advocacy for Native counseling issues. It is a resource and community base for Native counselors and those who serve Native populations. Learn more by visiting multiculturalcounselingdevelopment.org.



Nicola A. Meade is a national certified counselor, a licensed clinical professional counselor in Maryland, a licensed professional counselor in New Jersey, the co-vice president for the AMCD Native American Concerns group, and an assistant professor of counseling and psychology at Georgian Court University. Her extensive work includes serving as a domestic violence advocate for Native women, increasing counselors’ understanding and awareness of Native voices, and researching counselor identity and workplace-based racism. Contact her at nicolaameade@gmail.com. 

Roni K. White is a national certified counselor, a licensed clinical professional counselor in Maryland and a co-vice president of the AMCD Native American Concerns group. She founded Apricity Wellness Counseling, a small private practice in Gaithersburg, Maryland, focusing on trauma, spirituality, minoritized women and relationships. Visit her at apricitywellness.com. 

Carol ZA McGinnis is a certified spiritually integrated psychotherapist, a board-certified telemental health practitioner, a national certified counselor, a licensed clinical professional counselor in Maryland and a current member of the AMCD Native American Concerns group. She is an associate professor of counseling in the graduate counseling department at Messiah University. Her research interests include functional anger, spirituality in counseling, and Xbox video gaming. To learn more, visit www.anger.works.


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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

A collective voice: Indigenous resilience and a call for advocacy

By Roni K. White, Alaina Hanks, Susan Branco, Nicola Meade and Isaac Burt February 11, 2020

Resilience is one of the characteristics hallmarking the experience of North America’s indigenous tribes. These tribes predate the European exploration and colonization that led to the renaming of these inhabited lands to the United States of America. These acts of occupying launched the dominant discourse and fallacious narrative that Original People no longer exist and began long before the Occupy movement. This ability not just to endure but to remain resilient, despite more than a quincentenary of atrocious acts, government policies, and intentional genocide, speaks to the strengths that exist within Native communities.

With modern technologies expanding platforms for Native people to share history and current events, professional counselors have the opportunity to further their understanding, increase competencies, and expand efficacy. Perhaps the perceived silence of Native voices is not because they are not speaking, but because few are listening.

Too often, professionals who interact with or provide services to a Native tribe record a narrow view. This limited representation misinforms others about the realities that exist and undermines the plurality that is alive. As counselors committed to improving social justice, promoting growth, supporting healing, and championing thriving, we offer a pathway to consider a more informed perspective and tools for advocacy.

Historical relevance

When truth is hidden or unheard, it leads to false teachings and misinformation. Historical accounts are complex, and tribal nations carry their own histories. Explorers, traders and colonizers disrupted the way of life for millions of human beings across North America from the 15th through the 20th centuries. By some accounts, as many as 112 million people — a number that can never be resolved or agreed upon — lived in North America in tribal nations prior to the arrival of European explorers and colonies. The people, constituting self-sufficient nations deeply connected to the lands of North America, have endured immense psychological pain, physical abuse, genocide, and torture at the minds and hands of European colonizers and their descendants.

Despite the intentional disregard and destruction of human life and communities, Native nations continued to promulgate their existence through advocacy and engaging with the U.S. government. In 1824, the U.S. government established the Bureau of Indian Affairs (BIA). In 1830, then-President Andrew Jackson signed the Indian Removal Act, forcing a massive and involuntary migration that resulted in immeasurable fatalities, internment, and the disruption and loss of customs and culture. Persistent broken treaties, ill treatment and racism did not deter Native nations from standing up to the U.S. government or against injustice, discriminatory laws, and other methods to prevent prosperity, equity and health.

From a space of incredible resistance and intelligence, Native nations have effectively changed U.S. laws and practices and transformed the BIA over the years, including the governance and collaboration of sovereign nations. The BIA led the implementation of the Indian Self-Determination and Education Assistance Act of 1975 and the Tribal Self-Governance Act of 1994, which changed how the federal government and sovereign tribal nations interact and conduct business with one another. 

Impact of trauma

The great Oglala Sioux chief Red Cloud understood change and the implication of actions. Red Cloud shared that one’s actions impact seven generations. Change is slow, and the impact of change continues over numerous decades. When we look at the undesirable conditions and circumstances various tribes have faced, it is imperative to comprehend the ways in which the ripple effects of history and laws can impose complex trauma on these individuals and communities.

Science reiterates Red Cloud’s sentiments by demonstrating how prolonged stress, inequality and trauma change neurobiological responses. These changes, also known as epigenetics and psychoneuroimmunology (PNI), support understanding of the increased levels of stress hormones found in Holocaust survivors and their children, resulting in high levels of anxiety and depression, ineffective coping abilities, and decreased social functioning. People from Native nations live under perpetual inequality and discrimination and endure many social injustices. It is reasonable to apply scientific understanding to appreciate the epigenetic and PNI changes experienced within Native nations.

Honoring the privilege to serve Native populations includes incorporating a neuroscience-informed traumatology framework. Having this competency promotes a multifaceted lens to conceptualize the presenting problem and address the underlying root causes that might be outside of the client’s awareness. Neuroscience-informed traumatology provides a pathway of healing, growth, advocacy and improved agency. 

Present snapshot

The U.S. government consistently uses “less than 1%” to describe the population of Native people, but that number represents millions of human beings. Today, there are 573 federally recognized tribes and an unknown number of unrecognized tribes, which at some counts may be around 196. The number of unrecognized tribes fluctuates due to determination of petition to the U.S. government.

Despite the federal government having recognized tribes, a person may be of Native ancestry and not have tribal membership. Not every person with an identity that acknowledges Native ancestry or who has tribal membership lives on land known as an Indian reservation. Tribal governments have the sovereignty to govern tribal land, and these structures vary from tribe to tribe. When working with these clients, understanding their individual experience and relationship to ancestry and identity is essential in establishing and maintaining a healthy therapeutic alliance. One size does not fit all; history teaches us a fraction of one’s experience.

SEATTLE: Indigenous activists march in solidarity with the people of the Standing Rock Sioux in their fight against the Dakota Access Pipeline, September 2016. John Duffy image/Wikimedia Commons https://bit.ly/31NrgqQ

Cultural revitalization efforts

Even with a long history of oppression, violence and genocide, many tribal communities today are reclaiming their histories through cultural revitalization efforts. In areas with high Native populations, you will often see efforts to bring back cultural knowledge in many ways. These efforts expand beyond the occasional localized community event; instead, they intertwine in the very fabric of daily living in these communities.

Although most cultural programs and initiatives are located within tribal territories, you can often find similar efforts in cities with larger Native populations. Look to the American Indian corridor on Franklin Avenue in Minneapolis as an example of the efforts of urban Indians to stay connected through culture. This neighborhood houses an American Indian Center, urban tribal offices, culturally centered schools, Native housing projects, art galleries and more.

The Indian Pueblo Cultural Center is another example of restoring connection. The Pueblos constructed this center on reclaimed land in the city of Albuquerque, New Mexico. It supports cultural, social, educational and economic needs for the 19 Pueblo communities and other Nations of the Southwest. In many major cities, you can often find at least one entity that supports Native people with culturally specific services and programs.

Reclaiming cultural connections is also a global focus. The United Nations declared 2019 as the year of Indigenous languages, and you can see language revitalization efforts everywhere within heavily populated Native communities. These efforts include immersion programs in day care facilities and schools, language camps, community classes, language bowls and the reproduction of media with Indigenous languages. The fact that children are now able to watch the Berenstain Bears in Lakota is evidence of language immersion and acknowledgement. For many tribes, various cultural values are embedded within their respective language. Thus, language efforts closely interconnect to ways of being.

In addition to the multitude of cultural initiatives and programs that exist, Native people are becoming more actively involved in mental health. In October 2010, Dirk Lammers wrote about the outstanding work conducted by the Urban Indian Health Center throughout the cities of South Dakota to improve both the physical and mental health of Native people living off reservations (see https://sduih.org to learn more).

In June 2011, White Swan reported on a program called Dream Makers in Washington state that youth started to assist other students who were struggling with suicide. The youth made small cards with supportive contact information that the students received. This effort, along with training from a specialist from Indian Health Services, led to zero loss of life due to suicide and an unprecedented referral to the school counselor for mental health needs.

In April 2017, Dan Beaton, from the Iroquois Nation, wrote about his work to assist in culture and ceremonies in Canada, and particularly his encounter with the Attawapiskat Nation. He described the beauty of sharing stories and prayers between different tribes and the healing that such events bring through a common reconnecting to a tribal heritage. Mental health continues to be a priority among Native nations. 

Promoting wellness

A plethora of organizations and professional communities are dedicated to promoting wellness among Native nations. The American Indian Health Service (AIHS) serves the urban Native American community in Chicago. It works to address health holistically and has developed innovative medical and behavioral health programs to address the unique needs of indigenous communities. Among these include a Youth Development Program that aims to address emotional health and cultural resiliencies and offers Youth Mental Health First Aid training (visit http://aihschgo.org to learn more about AIHS).

The National Indian Health Board strives to promote successful strategies, identity challenges, support prevention and increase awareness for the behavioral health needs of all American Indian and Alaskan Native people. To acquire valuable resources, visit https://www.nihb.org/behavioral_health/resources.php. Intentional efforts to address prevention and evidence-based treatment for Native people are ongoing. For example, One Sky Center upholds and advocates for culturally appropriate treatment and training to provide mental health and substance abuse services for Native people.

The resilience of Native people encompasses surviving, advocating, healing and thriving. Native Nations and American Indians continue efforts to this day, working on policy issues and engaging in policymaking. The National Congress of American Indians organizes efforts into five policy areas:

  • Community and culture
  • Economic development and commerce
  • Education, health and human Services
  • Land and natural resources
  • Tribal governance

Each year, multiple bills are introduced on the floor of the House of Representatives, and multiple cases are heard in the Supreme Court concerning policies in the aforementioned areas. Today, Vice President of Special Projects for the Cherokee Nation Kimberly Teehee is advocating along with Cherokee Nation Principal Chief Chuck Hoski Jr. to enact the 1835 Treaty of Echota, which would seat a delegate in the House of Representatives. 

Ethics in advocacy

Distinguished endeavors and strides to achieve equity and fairness for Native people have support from collaborative and cooperative organizations, individuals and agencies. Codes of ethics call on professional counselors on multiple levels to advocate with and on behalf of the communities in which they serve. Specifically, the  2014 ACA Code of Ethics includes promoting social justice in its preamble. Furthermore, Standard A.7.a. charges counselors to engage in advocacy efforts to remove barriers to access and equity for their clients. Ratts, Singh, Nassar-McMillan, Butler and McCullough provide professional counselors with guidelines to include advocacy efforts in their work with clients in the 2015 Multicultural and Social Justice Counseling Competencies (MSJCC). Counselors can use these tools in considering how to best collaborate with Native American clients.

Corresponding with the MSJCC, the idea of humility is of utmost importance when an outsider (non-Native) wishes to serve Native American clients. In certain tribes (such as the Navajo), the act of being humble is a primary concern. Although counselors receive education in empathy, techniques and self-awareness, the ability to be humble is not normally taught.

Non-Native counselors looking to work in Native American communities need to acknowledge that they are outsiders. Even though counselors may have good intentions, they will nevertheless need to prove themselves. Having to go through this vetting process is difficult and something that many counselors find arduous and time-consuming. The mindset of the non-Native counselor can mirror the following: I want to help and cannot quite understand the rationale for the resistance I am encountering. However, the belief of the Native American community can mirror the following: People have come and gone and did not have our best interests at heart. It is clear to see the disconnect between these two mindsets.

One way to resolve this issue is to utilize a combination of humility and the MSJCC. For example, consistent with the MSJCC, non-Native counselors need to have self-awareness and critically comprehend their clients’ worldview. This multicultural outlook includes understanding historical privileges and marginalization.

Counselors who operate within this culturally competent framework understand that it is not entirely about their self-identification but also about how one’s identity may be perceived by others. For non-Native counselors whose self-concept is one of overcoming poverty, stress and discrimination, they may see themselves as having a connection to the communities they wish to serve. Conversely, for those in the Native American community, instead of the personal image the counselor wishes to display, they could potentially see an individual who represents past brutalities and halfhearted efforts to help. It takes movement (e.g., courage, patience, openness) on both parties (primarily the counselor) to understand this mindset and have the humility to accept it and be able to move forward positively.

To gain more in-depth understanding of advocacy efforts, it is beneficial to begin learning about a particular Nation or topic area. Attend meetings or sessions on a Nation or topic, learn about the existing efforts and challenges, and use your skills and time with the permission of the appropriate Native leader. Given Native histories, it is important for non-Native counselors to be aware that there might be times when they need to wait for a leader to invite them into a group they are looking to serve. It will also take time for them to be valued as an ally; interest does not equal automatic acceptance.

Sometimes the best gift one can offer is to be the student. History is ever being amended and recorded; remaining open to learning, increasing awareness of one’s relational existence to others, and identifying noninjurious ways to contribute to the change you imagine will allow you to share in amplifying voices and dismantling inequalities.



Roni K. White is the founder of Apricity Wellness Counseling and designer of the “Women in the Workplace: Leadership, Barriers, & Struggles” series. She is a national certified counselor and licensed graduate professional counselor. She aspires for equity in a decolonized world. Contact her at rkwcounseling@gmail.com.

Alaina Hanks is Anishinaabeg and enrolled in the White Earth Nation in Minnesota. She is a licensed professional counselor-in-training and a community advocate with HIR Wellness Center in Milwaukee. Contact her at alaina.hanks@gmail.com.

Susan Branco is a clinical assistant professor with Counseling@Northwestern’s clinical mental health counseling program. Contact her at Susan.Branco@northwestern.edu.

Nicola Meade is an adjunct professor with Old Dominion University. Contact her at nicolaameade@gmail.com.

Isaac Burt is an associate professor at Florida International University. His research interests entail working with historically disenfranchised and marginalized populations. Contact him at iburt@fiu.edu.




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Voice of Experience: Invisible people, Part 1: Native Americans

By Gregory K. Moffatt March 18, 2019

The little girl sitting next to me was no more than 5. Her bony little body was draped in clothes that appeared to have been worn for several days. Unmistakably Apache, she looked up at me and smiled from her seat on the school bus in which we were riding. As is sadly common among children on the sprawling Apache reservation in Arizona, her teeth were rotted off at the gum line.

“Does your daddy hurt you?” she asked me matter-of-factly. After four years of working with these children, I was still shocked at how rampant the ills of society were among these populations. Child abuse, suicide, domestic violence, addiction, unemployment, substandard education, truancy/dropout and, yes, poor dental hygiene are just a few of the problems that are so disproportionately part of the experience of Native Americans who live on reservations.

In traveling the world, I have encountered cultures so vastly different from my own that it is hard to describe them to my friends and family members. You don’t have to leave the United States to have that experience, however. My heart breaks for the lovely people I have met — Apache, Hopi, Navajo — on reservations located within our borders.

Native Americans on reservations are among three groups that I will be addressing in a series of monthly columns on “invisible people.” One or more of these groups may be within walking distance of our counseling offices without our even knowing it.

I live in Georgia, the home of the Cherokee Nation, but many in our state have no idea that the Cherokee people are here. They know the Cherokee only from movies or perhaps because they have seen someone on the roadside in the north Georgia mountains dressed in traditional clothing and offering to pose for a photograph with tourists who are willing to pay a few dollars.

Sadly, the mention of “Cherokee Nation” likely causes many people to think of a sports mascot and not the literal nation of the Cherokee. I sometimes wonder if the average person realizes how many of our states, roads, rivers, cities and towns are named after one tribe or another or are otherwise derived from Native American words. Yet the heritage of these people gets lost in the blur of movie stereotypes, school mascots and advertising caricatures. It’s heartbreaking.

Because Native Americans are often “invisible,” so are their struggles. I suspect the typical American knows more about Middle Eastern culture than about the rich and beautiful cultural heritage of their Native American neighbors who may live only doors away. Native Americans who live on reservations are often inaccessible to those who might try to understand them, and those who live off the reservations possess a heritage that is largely misunderstood by nearly everyone.

Do you know the difference between a Seminole and a Blackfoot, an Apache and a Hopi, or a Cheyenne and a Tonkawa? Did you even know that the Karuk, Wichita, Koi and Kaw are tribes? Seeing all Native Americans as the same is as insulting as assuming that all Spanish speakers are from Mexico.

Misunderstandings abound. For example, for some tribes, feathers are indeed a part of the honor of a headdress. What you probably don’t know is that many tribes would never use a feather as decoration because it is part of what is dead, and that is sacred — not to be worn as jewelry or adornment.

It is next to impossible for tribes to perpetuate their traditions, religions, languages and cultural values as a subset of mainstream American culture. So, they are relegated either to abandoning these things or to moving onto a reservation, where life options for themselves and their children are significantly limited. What a bitter choice to make.

But even in 2019, in a culture in which we have removed cartoons such as the “Frito Bandito” from advertising, some Native Americans are still forced to look at caricatures of themselves in sports team mascots and advertising. If you think that I’m being overly dramatic, watch the documentary In Whose Honor. Only a cold-hearted viewer would not be moved.

I worked for years with Apache and Navajo parents, teens and children on a reservation, but in general, most of them never grew to trust me. I was a white man, so there was no reasonable cause for them to trust me. As we have all been taught in other arenas, distrust is to be expected when you represent the population in power. I have found that it is sometimes easier these days to practice with other minority groups, but not so much with Native Americans.

Unless you have gone out of your way to learn about Native Americans, my guess is that this article has opened some eyes. We pride ourselves on cultural diversity as counselors, but I’m not confident that the blinders we wear allow us to really see how much we don’t see — at least when it comes to the three groups of “invisible people” I am addressing in this series. I hope this first column on invisible people will open counselors’ eyes to what we might be missing.


Gregory K. Moffatt is a veteran counselor of more than 30 years. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.


Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Trauma and the soul wound: A multicultural-social justice perspective

Judy Daniels and Michael D’Andrea June 18, 2007

Compared to traditional Western views about counseling, the multicultural-social justice movement promotes very different ways of thinking about mental health, psychological development and the important roles counselors can play in fostering these concepts. The issue of trauma is an excellent example. Significant differences exist in the way many traditionally trained counselors think about trauma and the manner in which culturally competent counselors conceptualize the meaning of this term and the roles they can play in addressing the needs of traumatized clients.

One of the most respected multicultural experts in the mental health professions today is Eduardo Duran, and he presents a very different view of trauma. He describes trauma from an American Indian viewpoint in his book Healing the Soul Wound: Counseling With American Indians and Other Native Peoples (Teachers College Press, 2006).

Some counselors are likely to dismiss the manner in which Duran describes trauma and the approaches that can be used to effectively deal with this experience. Nevertheless, we have written this month’s column to help expand the thinking of counselors who remain open to new ways of thinking about trauma and different approaches to addressing this experience from a multicultural-social justice perspective.

Culturally different approaches

In discussing issues related to mental health in general and trauma in particular, Duran emphasizes the American Indian belief in holism. This perspective includes directing particular attention to the important interconnections that are thought to exist between a person’s mind, body and spirit, as well as one’s connections with the larger cultural community and environment to which she/he is a part. Although space restrictions limit our ability to address these issues in much detail, we want to illuminate several central points about the American Indian perspective of holistic interconnectedness and harmony as they relate to the problem of trauma.

As Duran points out, healthy human development is intimately linked to the holistic and harmonious mind-body-spirit connections that individuals can realize in their lives. Thus, unlike traditional Western counseling theories that focus on the manner in which traumatic events adversely impact a client’s mental and physical state of being, this American Indian perspective emphasizes the need to attend to the ways that traumatic events disrupt a person’s mental, physical and spiritual life forces. This perspective further suggests that traumatized clients commonly exhibit problems in their lives because some recent or historic event has fractured the harmonious interconnections believed to naturally exist between their mind, body and spirit.

The emphasis placed on ensuring that individuals’ spiritual energy is in harmony with their mental and physical life forces is an important consideration that distinguishes American Indian psychology from most traditional Western counseling theories. Duran’s writing directs particular attention to the ways in which traumatic events inflict “a wounding on the soul.” This phenomenon is referred to as the “soul wound.”

A second important concept asserted in the theory of the soul wound relates to what Duran calls “historical and intergenerational trauma.” This trauma involves the recognition that horrifically violent experiences inflicted on individuals in the past result in unhealthy outcomes that are passed on to one’s offspring and manifested in future generations.

Duran notes that the past genocide of American Indians represents the sort of historical violence that results in intergenerational trauma. Briefly stated, this means that the horrific physical suffering, death, psychological harm and soul wounding that occurred during the genocide continues to be experienced today by many persons of American Indian descent. Multicultural-social justice counseling theorists and researchers suggest that the disproportionately high levels of substance abuse, domestic violence and suicide among American Indians today is partially due to a failure to heal the soul wound that was transmitted intergenerationally as a result of the historic trauma that their ancestors experienced.

Duran encourages mental health practitioners to address three levels of interventions when working with people who are suffering from trauma:

  • Working with individual clients who are experiencing problems due to trauma
  • Providing outreach, advocacy and healing services to the larger community of which the client is a part
  • Engaging in efforts that are aimed at what he calls “healing the land”

New professional roles and services

Unlike traditionally trained counselors, who are encouraged primarily to address the psychological and physical manifestations of trauma, culturally competent counselors are sensitive to the importance of addressing traumatized clients’ spiritual needs as well. The concept of the soul wound and the helping strategies that Duran outlines provide counselors with a broad range of practical interventions that can be used to promote more harmonious mind-body-spirit connections with traumatized clients in individual counseling settings.

Duran also describes working with the broader cultural community as a vital component of trauma counseling. This requires counselors to be willing to implement advocacy, consultation and social change services aimed at fostering a greater level of justice among those individuals who continue to be subjected to the sort of historic trauma that American Indians have experienced in this country.

Finally, Duran discusses the importance of counselors working to “heal the land.” He emphasizes the American Indian belief in the vital interconnections that exist among all animate beings and inanimate entities, as well as the spiritual energetic connections that exist between all people and Mother Earth. He further notes that the current trauma being inflicted on the Earth by our collective polluting and poisoning of the global environment has a significantly negative and traumatizing impact on our own mental health and sense of psychological well-being. From this perspective, counselors are encouraged to consider how the role of environmental activist is linked to the work that counselors can do to address the various forms of trauma experienced by millions of people in contemporary society.

Clearly, the ideas presented in this cultural perspective of trauma counseling are very different from those used in many counselor education training programs and professional development workshops. Space limitations restrict the presentation of these concepts to a very rudimentary discussion. For this reason, we encourage readers interested in obtaining more detailed information about an American Indian view of trauma and the types of culturally sensitive counseling strategies being used to address this problem to check out Duran’s book, Healing the Soul Wound: Counseling With American Indians and Other Native Peoples.