The following lines are taken from a poem of Tuhoe origin, recounted in 1987 in Ranginui Walker’s book, Nga Tau Tohetohe: Years of Anger. It shows one person’s awareness of their own culture
Being Māori is-
Having the greatest grandparents in the world
Respecting your elders because they earned it
Having 250,000 brothers and sisters
Fouling up the government and its statistics
Having no where for the kids to go, and getting a visit from the police who want to see them
…Not laughing at your children when they mispronounce your language
…To miss work because so many of your relations are dying
…Owning land and not being able to use it
…Going to school to eat lunch
Watching the teacher teach the other kids
…Belonging to a particular tribe which is the best in the country
…Having your friends and relatives accuse you of being a traitor if you earn more than $7000, wear a tie and drive a new car
…Being Māori is hard, being Māori is sad, being Māori is to laugh, being Māori is to cry, being Māori is forever.
(Walker, 1987: 136) In developing cultural competence, practitioners both Māori and non-Māori need to be aware of their own cultural background, values and beliefs. Through an examination of their own beliefs, a practitioner can begin to see how this may or may not impact on their interactions with people from other cultures. In teaching practitioners about becoming more aware of their own cultural background, a useful exercise has been to get them to complete their own poem, entitled:
Being [however they define their culture] is… Such an exercise requires participants to give meaningful consideration at more than just an intellectual level. For many New Zealanders, such an exercise has been an eye opener in beginning to lay the foundations of ‘Pākehatanga’ and/ or ‘Kiwi culture’ and/ or acknowledgement of their own rich tapestry of ancestry that combines a variety of cultures. As the following whakatauaki suggests, a practitioner needs to have examined their own culture before working with people from other cultural backgrounds:
Maatua whakapai i toou marae, ka whakapai ai i te marae o te tangata.
First set in order your own courtyard before you clean up another’s.
Cultural competencies: Knowledge and skills
Te Ao Māori principles and protocols relevant to delivery of conduct problem programmes
Knowledge about the intent behind certain protocols can help in the transition of some traditional Māori practices into a contemporary setting. In relation to conduct problem programmes there are protocols and principles that are seen as paramount in enhancing connections and identity for Māori tamariki, taiohi and whānau.
Yesterday, Today and Tomorrow (YT&T) (2007) developed a Māori cultural competency framework which is aligned with the powhiri and hui process. Thirteen areas related to Māori cultural competency were identified, ten of which are outlined to give practitioners insight into ways identity and connections can be enhanced.
1. Powhiri – Transactional engagement9
In considering Te Ao Māori principles and protocols relevant to the delivery of conduct problem programmes, the protocols and beliefs imbedded in the powhiri (welcome) process would appear most applicable in both generic services and Kaupapa Māori programmes. Durie (1999b) described the marae encounter and the resulting tikanga as evidence of a Māori psychology and way of thinking and behaving both in traditional and contemporary times.
The powhiri process has also been acknowledged by the Mental Health Commission as an important component to cultural assessment and, as such, needs to be used routinely in district health boards (DHBs) (Mental Health Commission, 2004). The powhiri process has also been identified in therapy contexts as the beginning process to a learning and spiritual journey for whānau that can address feelings of ‘loss, despair and alienation’ (KA&AT, 2005).10 YT&T (2007) describes powhiri as a ritual of encounter that provides an effective process of engagement. They go on further to describe powhiri as a transactional engagement. Traditionally, powhiri occurred on the marae and involved a process of greeting between the tāngata whenua (people belonging to that marae) and manuhiri (people visiting the marae).11 However, the powhiri process has the potential to be utilised on a marae setting and also for a meeting encounter between tamariki, taiohi and whānau and professionals involved in a particular case.
Te Ngaru Learning Systems developed the powhiri poutama model which has been used predominately in the alcohol and drug treatment area.12 While there is no published literature on the specific details of the model, it has been identified as a model that Māori child and adolescent mental health workers wanted more training in as a Māori model of practice (Te Rau Matatini, 2004). The model has also been introduced in Kaupapa Māori mental health services. For example, Turoa Haronga, kaumatua, used this model to provide the framework from which he practiced in Kaupapa Māori mental health settings (T. Haronga, personal communication, 1997). The model is related to the process of powhiri when a clinician meets with a client. The issues of karanga (who has called the meeting), whaikorero (who lays down the kaupapa or purpose of the meeting) and issues related to boundaries, time and space as identified by Durie (1999), are integral to the powhiri process and the subsequent successful engagement of a client.
In considering the engagement of Māori whānau through the use of powhiri, it is important to consider the components of powhiri both within a formal setting such as a marae and in a less (culturally) formal setting such as a clinical interview room. The components important in this powhiri process would include the karanga (call), karakia (incantation), whaikōrero (speech), mihimihi (introductions), haruru (shaking of hands) and hakari (feast). This aligns with Durie’s proposed Māori psychology framework (Durie 1999b). Karakia and mihimihi are discussed further on.
Traditionally, karanga is when the kuia (senior woman) calls the manuhiri (visitors) onto the marae. It is a ritual of encounter and requires that the manuhiri return this call through their kai karanga (caller). The karanga is typically conducted by the kuia, who has a good command of the language. Mihipeka Edwards, a well known kuia, noted that ‘the words issued in karanga are spiritual, like a prayer, issued in love and compassion’ (Edwards, 2002: 17). The karanga is very much a spiritual process where the deceased are acknowledged and the purpose of coming together on the day identified. It is important to note that in traditional times the manuhiri could not come onto the marae until they had been called by a kai karanga. To do so would have been disrespectful, and more than likely a sign the group was not coming in peace.
The karanga as a ritual of encounter could be applied to engaging Māori and trying to make a connection in a modern context. In considering engagement issues, who is the person asking the tamariki, taiohi or whānau to come and meet with them? How is this call made? Is it by letter, telephone call or face to face? Special Education have a form in which it is made clear how whānau want to be contacted, either via mail, phone call or kanohi ki te kanohi (face to face). How is the karanga put to the whānau? Is there acknowledgement of the past as in the traditional karanga? Is there a clear statement of the purpose of the meeting and who will be there? Traditionally, a kuia does the karanga and typically holds a lot of mana. Does this have the same meaning as a letter sent out stating an appointment time? In essence the karanga is the first point of contact with whānau. A karanga in a modern context is the work that is done to invite, to call, to get whanau to the venue to further the process of engagement. How this is done has a huge impact on whether or not whānau turn up. Practitioner and service providers need to consider how they conduct this first point of contact to make a connection and increase chances of effective engagement.
2. Ahu whenua – Use of environment
The place where an encounter occurs will affect how Māori processes are conducted. For example, a meeting at the child or young person’s own home may have a different process to that conducted on a marae, and possibly to hui conducted in an office or therapeutic room. The environment in which an interaction occurs is important for engagement.
The importance of the environment and having a family and whānau friendly environment is referred to in Family Inclusive Practice within the addictions area (KA&FT, 2005). This describes the need for child friendly environments as well as a friendly atmosphere and somewhere for a ‘cuppa and something to eat’. The ability to partake in eating or drinking after powhiri is very important for Māori and is related to the concept whakanoa (making free of tapu).
Where a whānau is coming to meet a professional, the waiting area can provide important information about the acceptance of Māori culture and values. Posters depicting positive Māori images can help normalise Māori culture and be culturally appropriate. C&CDHB’s tikanga guideline refers to reception as the first point of contact and therefore very important. The guidelines advocate having Māori images in the waiting room or significant landmarks that will give a sense of connectedness with the community and land. Having Māori magazines or te reo books in the waiting area also show a sense of acceptance of Māori as part of the community.13 Holding hui on marae has been identified as contributing to the engagement of Māori whānau in parenting programmes (Gifford & Pirikahu, 2008; Cargo, 2008). A marae-based rehabilitation programme for Māori youth was successfully trialled in Gisborne and is now being considered in other parts of the country where there are Māori youth court judges (Radio New Zealand, 9 June, 2009).In addition, a number of primary prevention and injury prevention programmes have been conducted on marae (Brewin & Coggan, 2004; Ratima, Fox & Te Karu, 1999; Simmons & Voyle, 2003). Increasingly, the marae is seen as the most culturally appropriate place to conduct meaningful hui and ensure participation and engagement of Māori whānau.
Ahu whenua refers to the interconnectedness and relationship Māori have with the natural world. Not only does this incorporate the use of natural rongoa to assist with healing but also the natural environment. The whenua (land), moana (sea), ngahere (forest), awa (river) and maunga (mountain) are important components of wellbeing. When considering development of programmes for Māori tamariki and taiohi, the use of land, sea, forest, rivers and mountains need to be implemented. In training psychology students, the writer has often asked students to consider how a session with a child or adolescent may differ if it occurred in a different environment, such as in the ngahere or at the beach. Alternatively, to undertake a session by a child’s own ancestral river or mountain has the potential to enhance identity and connections at all levels; physically, spiritually, and emotionally, both at individual and whānau level.
3. Karakia – Transition
YT&T (2007) refer to karakia as a mechanism to support transition for tāngata whaiora, whānau and kaimahi. The concept of transition may include the spiritual perspective but also to lay the foundations for a safe and effective engagement with clinicians and whānau. Salmond (1976, cited in Durie, 1999b) describes the purpose of karakia as being to create a sense of unity with ancestors, the environment and spiritual powers. The concept of interconnectedness and finding commonalities are also components inherent within the use of karakia.
Kaumatua in Māori mental health settings advocate the use of karakia in every clinical encounter, whether this is done formally in a session or in private before a session. However, not every Māori patient will expect a karakia. Māori culture is dynamic:
Like those of all other populations, will have their own preferences and beliefs. Just as not every male patient likes to talk about sports during his examination and not every female patient worries about her weight, not every Māori patient will expect a blessing (karakia) before a medical procedure. It is up to the provider to learn the preferences of each patient, Māori or non-Māori, and to strive to put them at ease, in order to create and sustain a respectful, trusting and therapeutic relationship. (Mauri Ora Associates (MOA), 2008:3) This is in line with Ministry of Health guidelines for the process of a Māori cultural assessment where flexibility is also recommended by the assessor. It is advocated that the assessor establish the protocol needs before any meeting. For example a whānau may prefer mihimihi rather than the more formal process of powhiri. By ascertaining the cultural needs of the whānau before a meeting takes place the assessor will be able to carry out the appropriate karakia and mihi when required (MOH, 2004). It is important to note that these guidelines and recommendations are centred on hui and encounters that do not occur on the marae or typically in a Kaupapa Māori setting.
Some clinicians have argued that the use of traditional or Christian karakia have served to further alienate Māori, especially those who do not have traditional or Christian belief systems. In teaching tauiwi and Māori psychology students about the use of karakia with tāngata whaiora, the writer has advocated the need for identifying what is meaningful to the client and what they connect with at a spiritual level. First, the clinician needs to model to the whānau the use of karakia. It is important that the whānau and tāngata whaiora hear what and why this has been done. This whakamarama (explanation) helps to further engage whānau who have had less exposure to these processes. In addition, by later identifying what is meaningful to the whānau they can also participate in the process of karakia. This is especially relevant for tamariki and taiohi. The intent of the karakia whether it be through a poem, a song or a video clip is the same: safety and unity.
While as Māori, our first option is to refer to our kaumatua to begin and end our sessions with karakia, this is not always available. Within Māori mental health services, when working individually with Māori tamariki and taiohi, the writer has assisted them in writing their own karakia about acknowledging those things in their life that uplift them and that they wish to acknowledge.
In essence, the intent of karakia is to create a safe environment for all concerned so that further rituals of engagement can occur. Milne (2005) relates the story of a kaumatua and tohunga working together under ACC. She notes:
This tohunga went on to explain about the tikanga Māori process of creating a safe place between people who meet. This he likened to the process engaged in powhiri and whakawatea or clearing spiritual pathways which creates the safe environment. Aroha, tautoko and manaaki needed to exist before the trauma could be addressed. This he explained as the difference between Māori process and thinking as compared to Pākehā. (Milne, 2005: 13) 4. Te reo Effective communication
Tangohia te reo o te tangata ka tu tahanga.
Tangohia te tikanga o te tangata ka noho ngoikore.
Take away a people’s language and you take away their identity.
Take away a people’s culture and you take away their dignity. The greatest value of cultural competence is to enhance communication between clinician and client, and to ensure the desired outcome is achieved (MOA, 2008). In communicating with Māori and whānau, clinicians need to be aware of differences. For example:
Māori whānau will at times agree with what a doctor is saying to avoid small disagreements. This does not necessarily mean they agree with a clinician or that they will adhere to what has been recommended
silence by Māori whānau does not necessarily mean agreement
it is important to be guided by the patient and whānau about the need for customary Māori practises such as hongi and karakia (MOA, 2008).
Correct pronunciation of Māori names is identified as the best way to show respect to Māori patients (MOA, 2008). The following poem highlights how such an issue can impact immediately on the relationship between people.
Can you spell that?
I reckon I can,
Will you spell it please?
H I N E W A I R A N G I
High knee we rah gee
Will high knee do?
Call me Rose
(Kohu, 1993: 56)
The words used in an interaction between whānau and a kaimahi are also important. The use of Māori words helps to model the acceptability and promotion of te reo Māori within that particular setting. This would be expected If, for example, the interaction was on the marae. There are fewer expectations for this to occur in a clinical interview room. However, the use of te reo may assist the whānau in feeling more comfortable and engaged with the practitioner.
Some clinicians have argued that the use of te reo Māori by tauiwi might be seen as condescending and intimidating by whānau who are not able to speak Māori. The same care may need to be taken when a clinician is using Western psychological jargon. For a Māori clinician, it is about assessing their level of comfort with te reo and continuing to model the use of te reo with them. For Māori, the reo is at the base of identity and therefore needs to be modelled and promoted in a sensitive and appropriate manner by Māori. The use of te reo by tauiwi shows a normality and acceptance of te reo within the therapeutic setting.
It is also important to consider the number of tamariki, taiohi and whānau who have gone through kohanga reo (preschool Māori immersion), kura kaupapa (Māori immersion primary) and whare kura (secondary school immersion). While knowledge of te reo and culture is a indicator of a secure identity and is seen as a protective factor against conduct problems, that alone can not prevent the prevalence of conduct problems. Therefore it is important that interventions for bilingual tamariki, taiohi and/ or whānau reflect their preferences in language. The ability for practitioners to talk in te reo with a child, young person and or whānau members who speak Māori will assist greatly with engagement and connections.
5. Mihimihi – Structured communication
The purpose of mihimihi in a powhiri process or less formal process (mihi whakatau) is to identify each person present by where they are from and their whakapapa connections. Bennett (2009) discusses the need for a clinician and client to establish a relationship. For this to occur,
Māori need to get to know the other person. It is important to know who the person is, where they come from and who their family is. Thus time needs to be set aside for the clinician, the patient and whānau/ support person to get to know each other. (Bennett, 2009: 64) Mihimihi typically involves each person stating where they are from and who they are. Facilitating this process in a meaningful way is a definite skill. The purpose is so connections can be made with all people present at a hui or meeting. For many, these connections can be made through whakapapa – making whānau, hapū and iwi connections. Sometimes the process of mihimihi can be used to disclose other information that might connect participants, especially if it is a mixed group. For example a clinician may begin a mihimihi process and include whakapapa information as well as disclosing information such as where he/ she was raised, current interests, a landsite in New Zealand that he or she identifies with, etc. By then asking the people at a hui to disclose this information, connections are able to be made with participants without necessarily needing to be a whakapapa connection. If the intent is to ensure connections are made, then at times it may require a facilitator to provide information, or to ask the appropriate questions that can ensure this occurs at the beginning of hui. This is an essential tool in engaging and working with Māori whānau. It would be very useful in making connections with non-Māori participants as well.
Pepeha are proverbs that pertain to a specific iwi, and the use of them tells where that person is from. In many cases, pepeha refer to a maunga, awa, marae, tūpuna (ancestor), hapū and iwi. Each pepeha is unique to the area from which that person identifies with. Some Māori, as the following poem highlights, do not know of their traditional pepeha.
Sad Joke on a Marae
Tihei Mauriora I called
Kupe, Paikea, Te Kooto
Rewi and Te Rauparaha
I saw them
Grim death and wooden ghosts
Carved on the meeting house wall In the only Māori I knew
(Taylor, 1993:277) This example highlights disconnection, whakamā (shame) and connection of the person all at once. The process of mihimihi would work to establish what other commonalities could be established. For many Māori youths, a commonality could be not knowing their tribal pepeha. Mihimihi is an essential tool to establish connections. Often it requires the practitioner to skilfully identify where one is going to make a connection.
6. Whakawhanaunga – Multiple system dynamics
The concept of whānau and its wider applicability in relation to the many systems that an individual and whānau are involved in has already been discussed. Whakawhanaunga refers to the connections and relationships that exist and that need to be established for optimal wellbeing. In relation to engagement in programmes, whakawhanaunga is vital in ensuring meaningful connections. It is a continuing process, not a one-off event. Embedded in whakawhanaunga are concepts such as aroha, manaaki and tautoko (support). Moreover, whakawhanaunga contributes to a person’s sense of belonging and can improve outcomes for Māori, strong identity and healing and recovery (YT&T, 2007).
Immediate whānau relationships refer to the sense of connection and relationships with kuia and kaumatua, in addition to tūpuna and ha a kuia ma a koro ma (aspects of tikanga that have been passed down from ancestors) to whānau (Pere, 1991). The potential use of the teina/ tuakana (youngest/ oldest) model as a mentoring and buddying system when working with Māori tamariki, taiohi and whānau is an important consideration for whakawhanaunga and establishing connections. As highlighted by Durie (2005) the whānau can also take a much wider approach. Whakawhanaunga also acknowledges the promotion of intersectoral working and a multi-systemic approach to working with whānau (YT&T, 2007).
A tatau mahi kia kaha
The processes and protocols used within Special Education services highlights the importance placed on whakawhanaunga and the importance of the first point of contact as discussed earlier (that is, karanga). There are clear protocols that occur when a Māori child is referred to the service. These protocols include the involvement of a kaitakawaenga at the outset of a referral and, if agreed on with the whānau, a manakitia te whānau form (cultural profile) being completed. These processes help identify the cultural needs of the whānau and with engagement and connection of whānau within specialist education services. The role of the kaitakewaenga, being the first point of contact with a whānau coming into the service, may be a critical factor in the engagement and ongoing support of the whānau in Special Education and also the conduct problem arena. As discussed by Berryman and Bateman (2008):
Kaitaiawaenga expertise and knowledge is an integral component to the service delivery process, as they are able to draw from Kaupapa Māori ways of knowing and engaging, enabling whānau to bring their own cultural realities and preferences to interactions.14 There are also clear review protocols for working with the bicultural service and involvement of the kaitakawaenga and lead worker service agreement forms (that is, working with the wider whānau or kaupapa whānau).
In Pikinga ki Runga, Macfarlane (2008) maps the processes of partnership, protection and participation for whānau, tamaiti and the classroom, referring to the concept of huakina mai (opening doorways; that is, engagement), mana motohake (based on te whare tapa wha) and he tikanga whakaaro. Much emphasis is placed on how GSE will engage and collaborate with whānau during programme planning.
Engagement is described as an ongoing process. Listed are ways in which Special Education workers and teachers can increase this engagement. This includes:
negotiating meeting times and venues with whānau
whakawhanaungatanga – investing time in establishing and maintaining quality relationships
whakarongo – actively listening to whānau, leaving a draft copy of notes taken in the session with whānau
awhi mai, awhi atu – sharing knowledge and information about one another
whakapapa – making family connections and increasing knowledge and awareness of connectedness
whenua – making links with mana whenua through connections with the land
service negotiation – involving whānau, child, and key and co-workers.
In the Department of Corrections Māori Strategic Plan, the engagement and inclusion of whānau is highlighted as one way to improve responsiveness to Māori. It is noted that other agencies have whānau-inclusive services and that the department’s service to Māori can be improved by incorporating whānau involvement. The appointment of whānau liaison workers in all Māori focus units was one way this was being addressed. In addition, the department was to explore the feasibility of appointing whānau liaison workers to all the youth units and women’s prisons.15
7. Manaaki – Honouring and supporting
The concept of manaaki is also connected to the process of powhiri. It is also an ongoing process. Manaaki refers to nurturing relationships, looking after people and being careful about how others are treated. Manaakitanga is a key component of Māori culture. Manaakitanga is about positive human behaviour and ‘encourages people to rise above their personal attitudes and feelings towards others. The aim is to nurture relationships and to respect the mana of other people no matter what their standing in society may be.’16 Treating people with dignity and respect, acknowledging mana tāngata (respect for human kind) and kaitiakitanga (guardianship) are aspects of manaaki.
Manaaki can be seen in both clinical and cultural encounters. It can be expressed at an individual level and at a service level, in the way a service promotes ‘active hosting and support of tangata whaiora and whānau’ (YT&T, 2007). Hospitality, a component of manaaki can range from the type of reception whānau may receive in a waiting room and being offered a drink while waiting to be seen, to being greeted by kaumatua in a formal powhiri process and partaking in shared eating afterwards.
8. Aro matawai – Assessment
The process of powhiri, mihimihi and whakawhanaunga, if implemented appropriately, can lay the groundwork for a meaningful assessment where rapport and trust have been established with tamariki, taiohi and whānau and the assessor. Bennett (2009) emphasises the importance of ascertaining the ‘self-defined cultural identity’ of a client from the start. The importance of determining a person and whānau sits along the identity continuum (Stevenson, 2004), and will influence the assessment process as to how a clinician sensitively promotes a positive Māori identity.
The assessment process needs to be holistic. As discussed, Te Whare Tapa Wha is a model that can be used in both generic and Kaupapa Māori services. As recommended by TRK, the assessment process with Māori tamariki, taiohi and whānau needs to integrate cultural, clinical, educational and social dimensions. From this thorough assessment, comes a personalised treatment plan that addresses cultural, clinical and whānau needs (TRK, cited in AGCP, 2009a).
In outlining the guidelines for a cultural assessment for Māori under the Intellectual Disability Compulsory Care and Rehabilitation Act 2003, it is noted that the ‘process of engagement’ is one of the ways of determining whether a Māori cultural assessment might take place. In addition, it states that:
The assessment process validates Māori healing methodologies, such as karakia, rongoa, spiritual assistance, tikanga, whanaungatanga, te watea, awhi, manaakitanga, whakapapa, whakawhanaungatanga, moemoea, matauranga Māori, taha wairua and mauiuitanga. (MOH, 2004:6) While many generic services may not have the skills to conduct a cultural assessment or have extensive knowledge in the above concepts, the process of engagement may help identify whether a cultural assessment is necessary. It is important, therefore, that generic services have a minimum level of knowledge, understanding and exposure to components of whanaunga, whakawhanaungatanga, karakia, taha wairua, manaakitanga and tikanga.
9. Ohaoha – Partnership
The concept of ohaoha refers to aspects of generosity and reciprocity between clients, whānau and professionals. The therapeutic relationship can be viewed as a reflection of ohaoha (YT&T, 2007). Being able to acknowledge that each person brings with them their own mana and knowledge is important in facilitating the concept of partnership. For example, a tauiwi clinician with very little te reo knowledge may be working with a whānau who speak te reo. The clinician can bridge the gap and power imbalance by acknowledging whānau expertise in this area and having the whānau assist the clinician in learning phrases. The clinician can provide advice and knowledge about his or her own area of expertise. In essence, the acts of giving and receiving, mai and atu are a part of ohaoha. It has the potential to bridge the power imbalance sometimes felt by Māori when being assessed by professionals both Māori and tauiwi.
10. Aroha – Strength and encouragement
The word aroha has a range of meanings depending on the context in which it is used. Love, sorrow, sympathy, compassion, encouragement are all words its meaning encompasses. In a clinical setting, aroha can be expressed in practical actions, such as having positive Māori media images around the service, access to water and ensuring there are appropriate times for hui (YT&T, 2007). Aroha is related to the concepts of tautoko, manaaki and awhi (embracing). Being compassionate as a clinician and being able to see when aroha is ‘running low’ in other whānau is also important in implementing interventions that can help a whānau to reconnect, feel aroha and subsequently begin to heal (YT&T, 2007).
Macfarlane (2007) describes aroha as being fundamental to the Hikairo Rationale, a culturally responsive approach when working with students with learning and behavioural difficulties. He says: ‘Aroha does not mean a soft approach. In the context of discipline, aroha connotes co-operation, understanding, reciprocity, and warmth’ (p. 118).
Given that aroha is a fundamental concept within Te Ao Māori (Macfarlane, 2007), it deserves consideration in clinical and cultural supervision. Aroha in action can mean, at times, that practitioners have to make difficult decisions a tamariki, tamaiti and whānau may not agree with; for example, a CYFS notification. For some Māori practitioners the concept of aroha in action can have non-Māori practitioners questioning boundary issues etc. Maintaining aroha requires supervision. For kaimahi Māori there are particular issues around shared grief and loss and hopelessness in working with our own that need to be attended to (H. Elder, personal communication, 2009).