Art Therapy with American Indians and Alaska Natives: Strategies for Healing By Elaine Smith-Bontempi University of Oklahoma

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AI/AN Natives & Art Therapy

Art Therapy with

American Indians and Alaska Natives: Strategies for Healing


Elaine Smith-Bontempi

University of Oklahoma

All Rights Reserved 2010

No portion of this paper may be

used at anytime without the written permission of the author.


Although Native Americans and Alaska Natives are perhaps the ethnic group within the United States most in need of health services, including mental health and counseling services, they are also among the most underserved of all populations. Part of this is due to the differences in cultural values, including communication styles, ways of expressing emotions, spiritual beliefs, etc.. In helping Native American and Alaska Native populations, the use of creative arts can be extremely beneficial because it accommodates for cultural differences in communication (non-verbal expression), emotional expression, and spiritual worship. This paper examine some of the cultural differences among Native Americans/Alaska Natives and the dominant U.S. culture, and how the creative arts can be effectively used in therapy with this population.Art Therapy with American Indians and Alaska Natives: Strategies for Healing

Since the beginning of time, and across all cultures, people have created art in one form or another: cave drawings, paintings, ceramics, sculpting, carving, beading, jewelry making, dancing, making music, etc. For example, among American Indians and Alaska Natives, art is inseparable from religion and spirituality, and has been used during worship to praise, promote meditative thought, to honor, teach, represent creation or creation stories, expedite spiritual cleansing and promote spiritual healing/wholeness, etc. Art therapy is seen as the “marriage” of two disciplines: art and psychology. “Aspects of the visual arts, the creative process, human development, behavior, personality, and mental health, among others, are important to the definition and scope of art therapy” (Malchiodi, 2007, p.3). Although there are various definitions for the term art therapy, most fall into one of two general categories. The first involves a belief that there are healing powers inherent in the process of creating art. This view perceives art making as therapeutic and is often referred to as art as therapy. The second general category of definitions falls under the concept that art is a means of symbolic communication. This approach may be referred to as “art psychotherapy” and emphasizes the products of art as helpful in communicating issues, emotions, conflicts, and underlying feelings that are often too deep or at a subconscious level for verbal expression (Malciodi, 2007, p. 6).

This paper examines the use of creative art therapies with American Indian and Alaska Natives, and for the purpose of this paper, the terms American Indian and Native American refer to indigenous peoples of the lower 48 states. Both terms are used interchangeably throughout this paper. “Alaska Native,” refers to indigenous peoples of Alaska, including the several Native American groups that reside in Alaska. Currently, there are 562 tribal entities recognized and eligible for funding and services from the Bureau of Indian Affairs, and an estimated 250 different languages spoken amongst these tribes. There are 229 federally recognized Alaskan villages and five unrecognized Tlingit Alaskan Indian tribes. Native Alaskans make up 20% of the population of the state of Alaska, and the states with the highest population of American Indians are Alaska, Montana, North Dakota, Oklahoma and South Dakota. According to the 2000 Census Bureau, within the state of Alaska, approximately 119,241 Alaska Natives resided within the state.

John Goff, a professional art therapist who has worked with Native Americans for many years throughout the United States, noted that:

Art, like music is universal in many major aspects. It transcends the artificial boundaries of language, politics, etc., that cultures have developed to separate themselves from others. From the earliest cave paintings and pictographs, we have no trouble seeing what they were depicting. Men were men, animals were animals, etc. No words needed. The most valuable contribution, in my opinion (of using art therapy with various cultures) is that it is the only therapeutic milieu that utilizes the power of the whole brain. The exercises demand a wonderful mixture of right hemisphere and left hemisphere in the problem solving process. Staying in the left brain only is like going to Norman to Tulsa via Houston. You might eventually get t here but it will take a long time, will not be as satisfying, and beneficial as a much shorter, enjoyable and exciting trip! Art therapy simply cuts across boundaries by avoiding the intellectual traps provided by straight talk therapy. (J. Goff, personal communication, November 30, 2010)

American Indians/Alaska Natives and Health Services

Out of all of the ethnic minority groups within the United States, Native Americans are perhaps the most in need of effective social, health, and mental health services (LaFromboise, 1988; Manson, 1982).

They are among the poorest and hardest hit by unemployment and have a disproportionately high incidence of tuberculosis, cirrhosis of the liver, cancer, alcohol and tobacco abuse, depression, infant mortality, and childhood developmental disabilities. They are also at a greater than average risk of death by homicide and preventable accidents, and their academic delinquency and arrest rates are among the highest of all ethnic groups. (Renfrey, 1992, p.321)

When it comes to cancer, the difficult health status of American Indians and Alaska Natives is even more pronounced. American Indians and Alaska Natives have the lowest five year cancer survival rates of all groups in the United States (Spirit of Eagles, 2007, p2).

Cultural Incongruity.

According to Renfrey (1992), Native Americans are seriously under-serviced by the mental health professions in general, and by psychology in particular. There are claims that they are the most neglected ethnic group by the mental health field, and the number of Native American psychologists in proportion to the native population is about one fourth that available to the general public (LaFrombois, 1988). Native Americans often refuse services that are available to them and have higher than average dropout rates for these programs. Several reasons for this have been suggested by researchers in the past, including cultural discontinuity.

The common perception by Natives that Western psychological services are insensitive and unresponsive to their needs; are to be feared and mistrusted; and tend to impose a Western cultural bias onto Native American problems, resulting in efforts to shape client behavior in ways that conflict with traditional values and lifestyle preferences. Anther highly cited reason for dropout was a preference for traditional (Native) forms of healing; conflicts in values held by non-Native counselors; and disagreement with non-Native counselors regarding approaches and treatment of problems. (Renfrey, 1999, p. 324)

Thus, cultural ignorance or insensitivity of non-Native therapists is largely responsible for the underuse of mental health services, and these cultural biases may result in therapy being either ineffective or even harmful (Renfrey, 1999). In order for Native Americans and Alaska Native to seek mental health services, there must be a perception among Native clients that cultural biases will not be present, there must be an understanding of and appreciation for American Indian culture, and inclusion of traditional Native approaches to healing. However, another large problem within the mental health field is the fact that the majority of diagnostic classifications were developed and normed largely with members of dominant cultures rather than among Native Americans or Alaska Natives. For example, symptoms of depression in American Indians or Alaska Natives may not be consistent with middle class expectations (Goldwasser & Badger, 1989).

Many non-Natives tend to group all Native Americans/Alaska Natives together, naively thinking that they all embrace the same language, culture, values, traditions, and beliefs. In reality, there are too many within group differences to mention. For example, in the US alone, there are over 250 different Native American languages spoken, although there are several major “families” of languages that these can be grouped under. Edward Sapir, in 1929, arranged the numerous linguistic groups in six major unrelated linguistic stocks, or families. These are Eskimo-Aleut, Algonquian-Wakashan, Nadene, Penutian, Hokan-Siouan, and Aztec-Tanoan (Silver & Miller, 2000). Even among the Alaskan tribes, 20 different languages are spoken in five geographic areas, which are organized under thirteen Alaska Native Regional Corporations that consist of eleven different cultures. Diversity can also be seen in varying degrees of cultural commitment among members of a given tribe based on variances in values orientation (Herring, 1999; 1997). “At least 63% of all Native people live off reservations, as a result of the shifting to urban and rural areas is reflected in an increase of intertribal and interethnic marriages, resulting in over 60% of current Native people being of mixed ancestry” (Herring, 1997, p. 3).

American Indian worldviews and cultural environments can be very different from those found in the dominant culture, resulting in interpretation bias by non-Natives. Despite the assault by the dominant U.S. culture on Native American life, many Native Americans and Alaska Natives have not become acculturated.

Many Native Americans, especially those on reservations and in rural areas, think of themselves as Indians, rather than as members of a minority group. This opposition to being defined by the dominant culture shows how very different their perspectives on, and assumptions about, the world are from Eurocentric values and traditions. (Locke, 1998)

The tendency for educational institutions and mental health agencies to approach education and treatment through an ethnocentric approach only contributes to the existing cultural discontinuity.

John Ogbu (2008), a cultural anthropologist, researched and wrote on cultural discontinuity and the effects of cultural opposition on motivation in an academic setting, and these same theories could also be applied to therapy approaches. Ogbu (2008) proposed that minorities could be classified based upon their voluntary or involuntary minority status. Voluntary minorities are those that willingly immigrated to another country seeking political or religious freedom, economic, or educational opportunities. These groups of people assimilate into the dominant culture more easily because they do not see the dominant culture as being oppositional or threatening to their culture of origin. As a result, they readily accept new ways of thinking, dressing, speaking, etc. in order to fit in with the main group. Involuntary minorities, however, are those who were either forcefully brought to a new country (such as in the case of African and some Hispanic groups forced to countries such as the U.S. for slavery), or were conquered by the dominant culture (as is the case with American Indians in the US or Aboriginal people in Australia were conquered by European descendents). In opposition to the dominant culture, involuntary minorities tend to develop secondary cultural differences, which include variations in dressing, speaking, thinking, etc. These secondary cultural differences are not different language per se, but different dialects or expressions of dress, music, worship, food, etc. For example, African Americans may pick up Ebonics and Hispanics may speak “Spanglish.” These secondary cultural differences are developed as a direct result to opposition of the dominant culture in attempts to show sovereignty. To adopt the ways of the dominant culture would be seen as “selling out one’s culture” and “acting White.” It is the mindset of having to choose one culture or another, rather than selectively maintaining some traditional values upheld by one’s culture of origin and adopting new values embraced by the dominant culture. Thus, as Ogbu (2008) pointed out, for many African Americans, Hispanics, and Native Americans, valuing school, worshiping, or speaking in ways promoted by the dominant culture might be viewed as a threat to one’s own culture. Thus a paradox emerges. Success becomes failure and failure becomes success. In other words, succeeding in the dominant culture is equated to failure in one’s native culture. Failure in the dominant culture is viewed as success in one’s original culture. A similar phenomenon might be applied to counseling. Since culture permeates virtually every aspect of one’s being, including ways of communicating, worshiping, learning, working, dressing, behaving, creating music, grieving, playing, and expressing emotions, a cultural mismatch between therapist and client might prove to be as equally ineffective. At the very least, it would promote cognitive dissonance, but ultimately result in a higher attrition rate.

It is important to understand the cultural background of an individual prior to attempting to communicate, work, educate, or counsel. Although there is an immense assortment of demographics reflected in the Native American Indian and Alaska Native population, commonalities can be found among all tribes. Furthermore, many of the cultural values and belief structures embraced by Alaska Natives are analogous with those of the American Indians of the lower 48 states. For example, a prevailing sense of “Indianness” based on a common worldview appears to bind Native Americans together as a “people of the peoples” (Herring, 1999).

Among Native peoples, religion or spirituality, impacts the use of symbols, myths, folklore, storytelling, and art. According to Locke (1998),

Native Americans understand nature as the essence of God. If there were no God, there could be no nature. Having the right relationship with nature gives the right relationship with God, which gives the right relationship with self. Sin is not represented by offending God, but in effecting an imbalance in nature. Living in ignorance of one’s relationship to nature is more likely than moral sin to cause destruction.

In addition, among Natives, there tends to be a holistic mindset. In other words, the way children have been taught to learn and see, is by seeing the “big picture” rather than focusing on the small, individual parts. Other common traditional American Indian values include:

  1. Strong sense of autonomy. (Native Americans traditionally have respected the unique individual differences among people. Common Native American expressions of this value include staying out of others’ affairs and verbalizing personal thoughts or opinions only when asked.); (b) Patience (based on the belief that all things unfold in time. In social situations, patience is needed to demonstrate respect for individuals, reach group consensus, and all time for “the second thought.”); (c) Open work ethic (In traditional Indian life, work is always directed to a distinct purpose and is done when it needs to be done). (d) Mutualism. (As a value, attitude, and behavior, mutualism permeates everything in the traditional Indian social fabric. Mutualism promotes a sense of belonging and solidarity with group members cooperating to gain group security and consensus.); (e) Non-verbal communication (Traditionally most Indians have tended to prefer listening rather than speaking. Talking for talking’s sake is rarely practiced. Talk, just as work, must have a purpose. In Indian thought, words have a primordial power so that when there is a reason for their expression, it is generally done carefully. In social interaction, the emphasis is on affective rather than verbal communication.); (f) Seeing and listening (Historically, hearing, observing, and memorizing were important skills among Native Americans because this is an oral culture. Storytelling, oratory, and experiential and observational learning were all highly developed in Native American cultures.); and finally, (g) Present time orientation. (This orientation stems from the deep philosophical emphasis on being rather than becoming.) (Northwest Indian Applied Research Institute, 2010, para. 2-10).

Differences in values, preferences of learning, worshiping, communicating, expressing emotions, raising children, perceiving time, etc. exist between Native Americans and Alaska Natives raised in traditional environments as opposed to those held and expressed by those raised in the dominant culture. As a result, cultural awareness and sensitivity are essential for therapeutic rapport and credibility, as well as classification for therapists working with Native Americans/Alaska Natives. These cultural differences may be very obvious or they might be subtle verbal and non-verbal components of communication, but even subtle differences can impede communication between Native Americans and an uninformed therapist (Renfrey, 1999). For example, the expected “pause time” between alternating speakers may be longer for many Native Americans than for non-Natives (as much as 4-5 seconds fro some tribes). Another subtle difference is the amount of eye contact American Indians and Alaska Natives (especially younger patients) might maintain with an adult. Native children raised in a traditional environment are taught not to look adults and elders straight in the eye as this is viewed as being disrespectful and challenging (Hall, 1969; Attneave, 1985). Similarly, other non-verbal forms of communication such as handshakes, posture, facial expressions and physical distancing may differ significantly between the Native client and the non-Native therapist. For this reason, many Native American and Alaska Native clients would benefit from having a therapist who is either Native American themselves, or culturally sensitive so that they might develop and employ interventions that are congruent with the client’s worldview and cultural practices. In most tribes, traditional healers hold central and respected positions, and some researchers suggest that working collaboratively with traditional healers is the most effective approach to counseling Native clients (Renfrey, 1999).

Another very important, but more general difference between American Indian/Alaska Natives and the dominant culture can be made regarding individualism vs collectivism. Although the United States is considered an individualistic culture, Native Americans, Alaska Natives and Native Hawaiians are all considered subcultures within the United States, and each are collectivist cultures. Individualistic cultures tend to embrace an independent view of self and parents teach children that they will be expected to “stand on their own two feet” and be independent at some point in their life (adulthood). Within an individualistic culture, individual competition, gain, and recognition, as well as an independent view of self are valued and promoted. In an individualistic culture, there is a strong sense of individual property rights whereas collectivist cultures view property as shared with the group. Individualistic cultures promote seeking knowledge on one’s own, and collectivist cultures adhere to the transmission of knowledge through elders.

Collectivist cultures, on the other hand, promote the concept of obligation to others, relying upon the group, adhering to traditional values, fulfilling a role within the group, taking care of one’s own (family, tribe, group), and developing an interdependent view of self. Collectivist cultures value harmony with nature, and embrace a sense of interconnectedness with nature and the spiritual world (Renfrey, 1999). It is important to consider the general differences between individualistic and collectivist culture, but it is equally imperative to recognize that values, like any human characteristic, fall along a continuum. For example, most members of a collectivist culture will maintain values at the collectivist end of the continuum, although each individual might be at a slightly different spot on the continuum, and some will even be at the individualistic end. Where each individual’s values are located on this continuum between collectivism and individualism is based upon how closely they identify with traditional culture, their level of education, and the ethnic mix of the community in which they were raised.

Creative Arts Therapy and the American Indian/Alaska Native Client

Although as human beings, we share more similarities than dissimilarities, it is important to consider the impact that culture has on one’s values, communication styles, preferences in learning, worship, etc. It is these differences that can make all the difference in an educational or counseling setting, and can either promote or undermine the effectiveness of a program. Conventional counseling approaches may be inappropriate for Native American communities if culturally irrelevant therapeutic processes are used rather those of the upheld by the Native culture. Native Americans who engage in individual counseling have often expressed concern regarding therapeutic approaches that shape behaviors in a manner inconsistent with their cultural beliefs and traditions. As a result, “many Natives fear that European American counselors will try to influence their value system and thereby alienate them from their own people and traditions” (Appleton & Dykeman, 1996). This statement echoes research conducted by Ogbu (2008), that identified the cultural discontinuity that exists in the educational systems within the United States, resulting in an undermining of academic motivation among individuals identified as involuntary minorities.

Culturally sensitive counseling approaches with Native American clients incorporate the use of a variety of nonverbal techniques. These techniques include (a) using art and play therapy, (b) becoming comfortable with long pauses in conversation, and (c) facilitating group work rather than individual counseling. It is also very important to pay close attention to non-verbal communication. (Appleton & Dykeman, 1996)

As mentioned earlier, one of the differences among Native Americans/Alaska Natives is that Native clients are likely to prefer indirect communication and to take exception to the frankness typical of Western conversation. For this reason, researchers have suggested that Ericksonian like open ended injunctions, rather than detailed prescriptive directions should be used (Renfrey, 1992). It has also been suggested that the use of traditional and non-traditional myths, and brief case histories of clients who successfully coped with similar problems may be useful.

While counseling Native American and Alaska Native populations, the use of creative arts can be extremely helpful because it accommodates for cultural differences in communication (non-verbal expression) and spiritual beliefs. There are several specific advantages of using creative arts therapy with Native clients. The first is that Native Americans and Alaska Natives tend to be comparatively less verbal than non-Native people. The use of silence in personal and social interactions, especially in the presence of real or perceived authority figures is common, and the use of the creative arts may promote disclosure of feelings without verbalizing. Due to cultural differences in communication patterns and styles, misdiagnosis of Native youth and adults is common. Ferrara (1999) pointed out that Native patients were commonly misdiagnosed as having alexithymia. The term alexithymia means “lacking words for feeling” and the dimensions of alexithymia include the following:

  1. an inability to describe feelings; (b) an inability to distinguish emotions from feelings; (c) a paucity of fantasies; (d) an incapacity for introspection; (e) focus on external world; (f) affective arousal often somatized; (g) expressive style is stoic, unemotional; and (h) thinking is pragmatic and instrumental. (p. 22)

Patients with alexithtymic characteristics were considered to be unresponsive to psychoanalysis or psychodynamic psychotherapy and were referred for other treatment modes including art therapy. Ferrera (1999) provided a case example of a Cree Indian boy, “Tom,” who was diagnosed as having alexithymia and was referred for art therapy. Ferrera (1999) noted that

within the Cree cultural experience, suppressing one’ emotions is not necessarily considered s ‘unhealthy,’ but rather as a coping skill. Children are socialized to suppress their emotions, to be reticent and not verbally expressive of t heir feelings. …as children mature both their verbal and emotional expression becomes muted. Cree children are encouraged to channel their feelings through other forms, such as hunting, dreams, and arts and crafts. Thus, it is not that emotions are lacking or non-existent, but that they are expressed through various culturally appropriate channels that are not essentially verbal. (p.96)

Tom used his artwork as a means to re-connect with his cultural identity and he became dedicated to his work and his self discovery. Art is used as a natural form of communication. The author claims that the children’s drawings have a narrative function, in that they contain elements of a narrative and the drawings are used to communicate discursively among the Cree children. (pp. 65-66)

Herring (1997) provided another example of the importance of therapists and physicians being familiar with the culture of their patients. The example given was of a Navajo woman, who was originally diagnosed by a doctor who was unfamiliar with her cultural background.

She was admitted to an inpatient psychiatric unit for evaluation of acute schizophrenia because a doctor, giving her a routine physical examination, became alarmed when she sat in his office for 45 minutes without speaking to him. He in turn notified a psychiatrist who had her hospitalized for nearly 3 weeks. The doctors had failed to consider silence as a cultural aspect. (Herring, 1997, p. 2)


A symbol is any thing that may function as the vehicle for a conception. Such a thing may be a word, gesture, ritual, dream, work of art, or anything else that can carry a concept (Sandner, 1991, p. 12). Among American Indians and Alaska Natives, symbols have been used throughout history as a way of passing along tradition, culture, and beliefs, and have come in many forms including storytelling, folklore, myths, dance, dreams, music, medicine, and art, and have played an integral part in religious ceremonies throughout time. Robbins (2010) stressed that the “emphasis on ‘being Indian’ is very important in the development of self-identity for American Indian adolescents” and noted that “thousands of American Indians derive spiritual, social, cultural, and psychologically satisfying experiences from the rituals and symbolism of Native American Church peyote meetings, stomp dances, sun dances, and many other ceremonies” (p. 51). Hammerschlag (1988, as cited by Robbins, 2010), also expressed the usefulness of “American Indian rituals and sacred symbols used in rites of passage and ceremonies for religious renewal to effect balance and a proper frame of mind among American Indian participants” (p. 51). There are various ways symbols are used by Native peoples in art, music, storytelling, poetry, and folktales. When asked if there are any significant advantages of using art therapy with Native Americans or Alaska Natives, John Goff, a professional art therapist who has worked with Native Americans and Alaska Natives for many years in Montana and Oklahoma, noted that “through the use of graphics, symbols, etc., that are the backbone of art therapy, a natural cultural bridge is formed, facilitating the entire therapeutic process” (J. Goff, personal communication, November 30, 2010).

Sandpaintings, Medicine Wheels, Mandalas, & Dreamcatchers.

Sandpaintings, medicine wheels and dream catchers all incorporate the use of the circle. To American Indian people, “the circle represents wholeness, enhancing communication, promoting equality, mirroring the roundness and symmetry of our spirits, and reflecting the natural cycle” (p. 52).

The art of sandpainting continues to be used by traditional Native healers in their rituals. For example, Navajo healers recite every word for the ceremony in the right order, each line with its appropriate melody. As they sing, they sprinkle sand on the ground with movements of their thumbs and forefingers, creating what many believe to be the greatest folk art on this continent. Herring (1999) described an example of sandpainting.

In one ritual to restore balance to a female who had been separated from her tribe since youth, the completed sandpainting depicted a Navajo legend about a child who was lost to the tribe, but returned in another form. The healer asked the subject to sit in the middle of the painting so she could actually mingle with the heroic figures and absorb their strengths. (p. 114)

Similarly, Lofgren (1981) used sandpainting in an evaluation with this female Navajo client who drew a female figure. Lofgren concluded that her sandpainting represented her inability to integrate mind and body.

After becoming aware of the significance of sandpainting in Navajo culture, Lofgren learned that her client communicated as much through what she omitted as well as through what she included. Review of the client’s artwork trough her eyes and culture enabled Lofgren to understand the client’s feelings, symbols, and expressions of spirituality. (Herring, 1997, p. 2)

The medicine wheel is a ceremonial circle of stones that are also often used in Native American ceremonies. Typically, the medicine wheel has horizontal and vertical lines through the center.

The circle symbolizes the earth, the lines represent sacred paths, and the four colors marked on the wheel (black, white, red and yellow) symbolize the four races of humanity. The four colors also symbolize the four cardinal directions. Among the Cherokee, white represents the north (quiet wisdom and mental concepts), green symbolizes the south (peace, innocence, and natural man), black connotates the west (introspection and the physical), and the east is symbolized by yellow (sun, enlightenment and spirituality). Color symbolism for the directions on the medicine wheel varies among tribes but the concept of service to others is universal. (Dufrene, 2010)

John Goff noted that he used “the medicine wheel many times to demonstrate the need for attention to the whole being to be complete, and the need for many avenues of healing to be employed.” He added that it was “most helpful in that it left the mental health part up to (him) in therapy and made room for their spiritual beliefs as well” (J. Goff personal communication November 30, 2010).

Mandalas are also circular symbols Much of the symbolic geometry of Native American art and ritual is rooted in the balance of the circle and its natural division.... the four directions; North, South, East, and West. To the Navajo, the mandala represents the cosmos in miniature, and at the same time, the pantheon. Its construction is equivalent to a magical re-creation of the world. The famous Lakota Shaman "Black Elk," called the circle the "Sacred Hoop" (Sandner, 1998).

Storytelling, Myths, Folklore, Dreams, and Healing.

A second advantage of using the creative arts in therapy is that Native concepts of spiritualism and humanism have traditionally been infused in the production of Native creative arts. The creative arts represent avenues of emotional, religious, and artistic expression that remain an essential part of the life of many Native peoples. Throughout North America, there are Native societies such as the Iroquois of the Mystic Animals, the Midewin of the Ojibwa, and the numerous societies of the Pueblos and Navajos that combine various aspects of the arts into their healing and spiritual ceremonies. “Spirituality, medicine, and art are intertwined in a unity of purpose in which the healing principles are (a) the return to the origins; (b) confrontation and manipulation of evil, (c) death and rebirth, and (d) restoration of the universe” (Dufrene & Coleman, 1994, p. 2).

American Indians and Alaska Natives regard art forms as elements of life, not as separate aesthetic ideals. “Native people see painting as indistinct from dancing, dancing as indistinct from worship, and worship as indistinct from living” (Highwater, 1976, as cited by Herring, 1997, p2). Dancing, painting, drumming, and entering into trances are all central to shamanism and among traditional Native Americans and Alaska Natives, human beings, nature and the spirit world are reflections of each other (Dufrene & Coleman, 1994). Native peoples believe that the earth is a member of one’s family and should be respected and cherished and not controlled. According to Bruchac (1991, as cited by Herring, 1999), “to the native people of North America, what was done to a frog or a deer, to a rock, a tree or a river, was done to a brother or a sister” (p. 115). Native Americans and Alaska Natives have an oral culture, and therefore beliefs are passed down from one generation to the next through experience and storytelling. Stories and folktales are used for educating as well as entertaining. For example, most folktales have morals to each story, and children who have misbehaved are often told a story rather than being punished.

Every culture has a type of symbolic healing that is used, in addition to scientific healing, that does not rely upon scientific knowledge or organs. It can be referred to as cultural healing, and relies for its effect on identification of the patient with supernatural power through the mediation of the symbol. This kind of healing is regarded by the Navajo as the heart of their system, and is given priority over scientific healing (among traditional Navajos). The cause and cure of disease are connected with the greater mythological whole, and the “doctor” in symbolic healing is the medicine man or shaman. In order for this type of symbolic healing to be effective, the patient has to have knowledge of and practice this type of the basic beliefs that the shaman has. An individual’s healing is often based upon the amount of confidence or trust that the patient has in the shaman (Sandner, 1998). Although specific practices of spirituality differ per tribe, Dufrene and Coleman (1994) suggested that counseling sessions should being and end with a prayer that would be acceptable to the individual because they indicate acknowledgement of higher powers that play a role in one’s physical and mental well being, and many Native Americans believe that healers can only be successful if they seek the aid of spiritual forces.

For years, traditional values, beliefs and practices of American Indians and Alaska Natives were suppressed by the dominant culture, but in the late 1950’s and early 1960’s, some of the religious ceremonies of many tribes were conducted openly. As the tribal religions and practices began to reemerge, it attracted younger Native Americans and many problems began to emerge as a result of years of cultural genocide and suppression. Many Natives were experiencing cognitive dissonance as a result of the struggle between the many behaviors that were enforced by the dominant culture, but feeling drawn back to their roots. Many elders refer to these younger children as “the lost generation” because they don’t know who they are (in terms of cultural belonging). However, the revival of indigenous customs and traditions is one of the answers to many of the problems currently faced by American Indians and Alaska Natives (Dufrene & Coleman, 1994). For example, Gone (2009) recorded a statement made by a female Native American who was a survivor of a government mandated boarding school for American Indians. She stated,

I lost my culture…When I attended the university, that’s the first time I saw a powwow…I never used to see sweat (ceremonies)…it’s only now (that) I start learning my culture, half a century (later)…I didn’t know the meaning of the symbolics of our culture. Instead, I know the symbolics of the Catholic faith. (p. 12)

This woman’s statement is consistent with a reoccurring theme among American Indians who survived the boarding school experience. Many of these children were sexually assaulted, beaten, and even died. It was a form of cultural genocide where Native language and culture were forcefully stripped of these children. The impact of colonization is referred to as historical trauma and it is evident on the lives of American Indians everywhere. Even though many of the children raised in boarding schools have passed away, their descendents have been robbed of their cultural heritage. Studies have shown that coming full circle and finding who one really is, and having a strong sense of cultural identity provides a buffer from assaults against self esteem (Gale, 1989; Harris & McFarland, 2000; Whitbeck, Hoyt, Stubben, & LaFromboise, 2001). For example, Harris & McFarland (2000) found that among the Nez Perce youth and adults, greater identification with the Nez Perce culture (for youth, particularly spirituality) was related to lower alcohol use. Among youth, greater identification with Nez Perce spirituality was also related to lower drug use, whereas greater identification with bicultural peer associations, beliefs about education, and involvement in sports wee related to higher alcohol and drug use..

Healing remains one of the major strengths of tribal religion, and the Public Health Service has begun to recognize and allow Native religious figures who have received particular healing powers to perform certain ceremonies. In addition, grants have been awarded to more medicine men and women, allowing them to work closely with physicians, counselors, educators and other professionals helping Natives. Storytelling has played an important role in cancer prevention and screening among Native populations. Cancer is the second leading cause of death for American Indians and the leading cause of death among Alaska Natives, so it is important to educate this population about the risks of smoking and other behaviors that might increase their risks of cancer. According to Ramsey (2008), “art and storytelling remains a very powerful means for communicating information among American Indians and Alaskan Natives and may be the best way to educate people in these communities about health behaviors related to cancer screening and prevention” (para. 1).

Presenting cancer information through the symbolism of storytelling and art is thought to be less frightening and intimidating. A common concern among some Native people is that belief that if a person acknowledges a disease or speaks its name, it creates a connection to the disease and perhaps brings it on. Cancer, in particular, can be seen as a very intelligent, formidable opponent, and so there may be a belief among some (Native American) healers that out of respect to cancer’s power, that you don’t call its name casually. Art takes you out of the picture and creates a safe learning environment. (Ramsey, 2008, para3)

In traditional American Indian healing, myths, chants, songs, and art are intertwined. For example, the Navajo have chants that are loosely based upon myths. Then, sandpaintings specific to the chant are made, and next prayer sticks are brought in and set up around the sandpainting. The healing process may also include painting the patient’s body with symbolic designs and then giving the patient a feather plume or bead token to keep. Songs contain the great body of chant imagery and accompany ritual action during the chant, such as drumming and rattling (Sandner, 1998). One of the main functions indigenous healing shares with mythology in general is the construction of a symbolic world in which the individual can feel familiar, safe, and comfortable. John Goff stated:

In my opinion, (the use of myths in art therapy) varies tremendously by tribe or band of Native Americans or Alaska Natives. I found, in general, the less assimilated groups, such as those in the remote areas of Alaska were more into their traditional myths, and thereby the myths played an important role. We have vivid demonstration of this by an Alaskan chief at an experiential exercise we conducted one year in Seattle. He drew and sculpted in 45 minutes a marvelous depiction of a myth (perhaps not a myth to his people!) and then spent 30 minutes explaining it. (J. Goff, personal communication, November 30, 2010).

Similarly, Goff noted the value of dreams when working with American Indians and Alaska Natives. He wrote,

(dreams) are the foundations of much of their spiritual belief systems, the avenues to knowledge, rites of passage, etc. ..The expression of these dreams and visions in experiential exercises used in art therapy are invaluable. They often allow them to express these experiences in ways they have not been able to previously. You know, of course, that the initial way you reveal a dream or vision is verbally to someone else. The opportunity to express them in the same artistic format can, and often does, add a tremendous meaning and impact of the dream or vision to the patient. (J.Goff, personal communication, November 30, 2010)

Similar to storytelling, myths, and dreams, poetry also has therapeutic value when working with Native peoples. Poems are often accompanied by music, and those that are open to discussion tend to be the most effective (Herring, 1999) and have been useful when working with “at risk” youth.

A third advantage of using creative arts in therapy is when working with Native American and Alaska Native youth, especially those who are living in rural areas or isolated reservations or villages, who may speak their Native tongue only. John Goff stated,

Due to symbolic nature of Native American communications, plus their reliance on non-verbal communication, in addition to many of them just not being very verbal, especially the male patients, is the reason I went into Art Therapy in the first place. The use of art therapy with the women and children was particularly effective, especially in cases of abuse, as well as enhancing the quality and speed of therapy in general. Many of the men responded well also. Primarily art therapy gave me a powerful additional communicative technique that provided a means to (a) be more effective with this population; and (b) gave me a means to communicate at a cultural level that traditional talk therapy would never have done. (J. Goff, personal communication, November 30, 2010)

Art is a natural language across all cultures, but also among children from ages 3-10. It allows the therapist to “recognize symbols and metaphors that might otherwise be missed through verbal communication. Since Native children are socialized from birth to understand and respect the spiritual aspects of art forms, this plays a fundamental mode of generationally transferring Native cultures and values over time” (Herring, 1997).


American Indians and Alaska Natives are both disproportionately underserved populations in the United States due to the devastating social, economic, and environmental pressures of racism, poverty, alcoholism, and cultural genocide among these groups (Dufrene & Coleman, 1994). Due to the various cultural differences between Natives and non-Native peoples, including preferences in communication styles (Natives tend to be more non-verbal), learning (collaborative and holistic vs. individual and analytical), parenting, use of symbols, religious beliefs and worship styles, and general world views, art has proven to be a valuable tool in bridging two cultures. Since Native cultures tend to be more non-verbal than Euro-American culture, art allows therapists to gain insight into the patients’ minds when words are used sparingly or have limited usefulness. The Native culture is rich with symbols, and religion and art cannot be separated. Dance, painting, sandpainting, dreamcatchers, mandalas, medicine wheels, storytelling, folklore, poetry, mask making, carving, and music are all used in religious ceremonies so art is part of the Native American and Alaska Native culture.

In preparation to work with American Indians and Alaska Natives, art therapists and other mental health professionals need to familiarize themselves with the cultural beliefs and practices of the clients they plan to work with. Renfrey (1992) suggested that “mental health care professionals, with other social and health-care professionals and tribal elders and healers, should develop research-based tribal-specific intercultural training techniques” (p. 335). In addition, therapists need to be aware of the geographical and regional differences that exist among Native Americans. These differences reflect ceremonial beliefs and practices, Indian language use or non-use, the degree of acceptance or rejection of mixed-blood Indians, urban versus rural environments and reservation versus non-reservation status. Thus, art therapists have a responsibility to their clients to determine through observation, which clients’ creative productions are influenced by ethnic, tribal, religious and other cultural factors.

Creative arts therapists interested in learning about indigenous healing techniques have to approach the subject with respect and caution. John Goff advised non-Native art therapists who wanted to work with American Indians or Alaska Natives should:

Read everything you can find about the particular tribe you are working with, as well as everything you can find about the symbols and myths they emphasize. For instance, the Owl is sacred to some tribes and an evil spirit to others. READ, READ, and READ. If at all possible, attend any ceremony you can, with permission and as a participant, not as an observer. Sit down with the Tribal elders, ask as few questions as possible to get them started on a topic you want to learn about and then shut up. DO NOT make it into a Q&A session, it won’t work. They have the knowledge, and you are very respectfully asking them to share as much as they want to with you. They may or may not share much initially. Be patient, they will get to know you and either trust you or not. Always be honest and always be a participating student. DO NOT BE an educated observer satisfying your curiosity! (J. Goff, personal communication, November 30, 2010)

Additionally, Renfrey (1992) suggested that prior to working with Native clients, therapists should determine the level of acculturation of the client into the dominant culture. This pre-assessment allows therapists to determine the level of cultural awareness necessary for a good fit between therapist and client.

The development of clinically useful ways to determine the acculturation status of Native American clients would help clinicians to provide services at an appropriate level of cultural adjustment. Variables that may be examined initially for their discriminative potential include language competency and preference, traditional versus non traditional religious affiliation, the extend and recently of participating in ceremonials, sociographic location, extent of formal education, peer group preferences, and self identified cultural commitment. (p. 334)

Other important factors for ensuring a good fit between client and therapist are therapist ethnicity, age, gender, therapeutic and communication styles, value system, and degree of recognition by the Native American community in question. In general, counseling with American Indians or Alaska Natives must respect the spiritual, symbolic, and artistic dimensions of Native culture.

In sum, art therapy has proven to be an effective tool used with American Indian and Alaska Native clients because it relies heavily upon non-verbal communication and the use of symbols: two of the main traits held by many traditional American Indian and Alaska Natives. However, in order to be effective with this population the therapist must familiarize himself/herself with the cultural beliefs, traditions, and values embraced by their clients rather than coming in with little knowledge or respect for their clients’ culture, or approaching the therapy in an ethnocentric manner.


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