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Native
American “Traditional” and “Western” Practice in the Field of Substance
Abuse
A Critique of the NM State
LADAC Licensure System.............................2
Rationale
for Traditional Native American Therapies...............................9
Proposed Guidelines
for Traditional Native American Counselors..........16
Send comments to:
Matthew Kelley Ph.D. Hina’ ah Bits’os Society (HBS) Na’ Nizhoozhi Center Inc, (NCI) 2205 East Boyd, Gallup NM 86339 (505) 722-2177 NM
State LADAC Licensure Requirements
for
Alcohol and Drug Treatment Counseling
Na’ Nizhoozhi Center Inc, Gallup NM As the country’s largest alcohol detox and treatment center, we support the improvement of standards in the field of alcohol and drug treatment. We support a thoughtful science-based approach consisting of relevant education, skill building, and accountability. Unfortunately, both the State’s current and the proposed licensure strategy, is unfair to rural-based Native American and Hispanic bilingual counselors, does not reflect the scientific literature regarding cultural and professional competence, and will ultimate damage an already struggling system. As a solution we are suggesting creating three (rather than the State’s one) complementary tracks of professional entry-level regulation along with giving the applicant the option of taking an oral exam in their indigenous language (rather than a written exam in English). Proposed Changes: By July 1st 2003, all people working in the field of substance abuse must have a bachelors degree in a human service related field (or be currently licensed in New Mexico as a Licensed Alcohol and Drug Counselor (LADAC), have 3,000 hours of “sanctioned” internship experience, and pass a three hour written exam. Those applicants without a bachelors degree who are attempting licensure before this date must first accumulate 4,000 hours of clinical supervision and also pass the written LADAC exam. A State issued “Internship License” must be obtained before these hours are counted. Any experience before the issue of this Internship License will not be counted. If you do not have BA or BS degree along with a LADAC license you can no longer work as a substance abuse counselor or therapist. No other certificates or licenses are accepted. In 2006, the entry hurdle will rise to a required Masters-level. Because only 1,500 hours per year are physically possible, very few rural-based Native American or Hispanic counselors will have time to accumulate their required “supervised” hours. To make matters worse, even if our counselors could collect these “officially-sanctioned” hours, few read English well enough to pass the written exam. The written LADAC exam is a long, complicated and subtle multi-choice exam requiring college level English-comprehension skills. Many of the exam questions are designed with similar looking answers requiring both thorough English Language skills and advance skills in Western cultural-discrimination. Most bilingual Native American and Hispanic counselors do not have these English reading skills. They usually speak and counsel in their Native language. Because these competent counselors are also mid-life adults with families usually living under marginal and rural conditions, few will return to college. In addition to these logistical difficulties, because many find their own lives and traditional culture satisfying, few have a interest in studying urban-based subjects of marginal relevancy. Many of these Hispanic and Native American counselors are as experienced, as ethical, and as proficient as any academically qualified therapist.
Problems:
NCI has identified problem areas in both the current and in the proposed
licensing regulations. These new regulations;
While we respect the many qualities of academic education we often see that a BA, MA, or Ph.D. degree is of limited use when it comes to real-life, client communication. Perhaps rural New Mexico programs should develop a licensure requirement of their own forbidding “urban-trained” therapists to practice outside the city limits until they learn an indigenous language, study local culture and psychology, and then survive on the street for a few years. While it is true that many “lay-counselors’ need better training, updated-techniques, and closer regulation/management just insisting that they get into a university BA program is far from the realistic answer.
When these current regulations are enforced, an estimated 250 Native American and Hispanic counselors (along with all lay-counselors within the prison system) will be dismissed from the field. Eliminating this wealth of often well-trained, ethical, affordable, altruistic, and experienced people from this profession is another shot in the belly of the faltering behavioral health system.
Solution:
We offer the following
solution. 1. Insure the current “Native American Traditional Counselor” waver remains in place for those counselors utilizing indigenous medicine practices. 2. Establish a three-tiered or “three-type” system of licensure regulation. Type I; without requiring a AA or BA but still requiring basic knowledge and experience. These counselors will be allowed to practice under licensed supervision (similar to the current Certified Chemical Dependency Professional);
Type II; meets all LADAC requirements and can practice independently of supervision. Type III: Native American Traditional Counselor with some ethic and 12 core function standard.
3. Re-design the LADAC exam to simply test ”core-knowledge” rather than testing advance reading, comprehension, and interpretation skills. Many of the current questions are nebulous, out-dated, not-relevant, not-supported by the scientific literature, and written in a fragmented way. The current LADAC test needs extensive revision, update, and simplification. 4. Decrease the educational requirement for Drug information hours from 90 hours down to 40. 90 hours of dedicated drug information is unrealistic when so much of the “alcohol” curriculum also involves drug-relevant information. 5. The proposed Ethic requirement states that Ethic credits “must be acquired two years prior to submitting a application.” In many cases (for various reasons) people have had ethic classes not accepted by the licensing board. Requiring a two year wait for this one simple requirement is unfair and counterproductive. We encourage rigorous ethic classes but why wait two years if all other requirements are in place. Wavier
for Native American Healers: Currently, for Native American healers, a NM License in substance abuse treatment (LADAC; Licensed Alcohol or Drug Counselor) is not required by the New Mexico Counseling and Therapy Practice Board (61-9A-6 Exemption). All Traditional Healers at NCI are currently operating under this important wavier. Although this present wavier is satisfactory, there are indications that NM LADAC requirements may eventually eliminate it – or restrict it to reservation-based facilities. We want this wavier formally written into the regulations.
Problem
Areas with current and proposed regulations: Although NCI believes in rigorous training, professional standards, unbending ethics, extensive experience, and scientific competence we believe that forcing either our “traditional-medicine-oriented” Native American therapists, Native American “lay-therapists,” Hispanic-oriented therapists, or prison-based “lay-therapists” to follow the BA degreed LADAC mold is not appropriate for the following reasons: 1. Rigorous consumer protection and professional quality is already assured with our present Native American Traditional Practices guidelines.
2. The LADAC exam requires approximately four hours of very detailed English reading and comprehension skills. NCI’s Native American therapists speak English as a second language. Some of our best counselors don’t speak English at all. The exam itself is structured as multiple choice involving a range of subtlety different and tricky options often even confusing (or controversial) to experienced English readers. Forcing this exam on Navajo-speaking therapists is unfair, unethical, and disrespectful to America’s first people. Eliminating these people from a fair exam significantly hurts the field and the population they serve. 3. Even the currently required licensure curriculum (276 classroom hours) is very difficult for many low income, rurally located, traditional counselors. Requiring a BA degree will make the Licensure requirement impossible for 95% of rural-based Native American counselors. The great majority of Traditional Native American counselors are in mid-life, with families, live rurally, and exist on low incomes. Unless fair access is available rurally this requirement will close out the people best suited for the job.
4. There is no scientific (or even antidotal) evidence that a higher degree better prepares a counselor for the most difficult parts of this profession. Insisting that traditional Native American and “lay” practitioners get a higher degree is both culturally and urban biased.
5. There is no scientific evidence that Western psychological and sociological techniques are more efficacious than Traditional Native American Techniques. On the contrary, several papers show both the Native American Church and other traditional-oriented programs as the most efficacious therapeutic technique available today for traditionally-oriented Navajo People. Many other papers state that the past treatment outcomes for Native American programs run by highly academic staff only illustrates 50 years of expensive failure (the word “fraud” has even been harshly used in several papers). Effective treatment must match the needs, language, culture, and environment of the client. Urban trained, BA graduates (even if they were available regionally and willing to work for low pay) can not do this job alone. 6. Many of the questions in the current LADAC written exam have poor scientific efficacy (are based on outdated AA, Minnesota model-like, and disease model procedures). The exam itself seems to be a relatively out- dated urban-based model. 7. Several of the original LADAC Board members (after helping design both the rules and the requirement for the LADAC curriculum) launched themselves a new self-created profession as ‘much–in-demand” commercial workshop instructors. This is a serious ethical violation and may create be a potential legal problem. Their desire to profit on their legislation also places doubt upon their original motivation, calling forth the unpleasant concept of “personal gain, turf creation, and protectionism.”
8. Although the LADAC training process is still new, a significant amount of exam material is not covered by the “sanctioned” training classes. Although “essential” exam material does cover a broad spectrum, one definitive LADAC source should be available, “If you know this material you will know the exam.“ As an example of the incomplete training the classes on Ethics, was remarkable simplistic. The “State’ certified classes omitted most of the “unrealistic” scenarios found on the exam. In another workshop the instructors gave the participants a list of more than 30 books, all good material, but not focused tight enough for none-university, marginal-English readers.
9. The majority of rural service providers can not afford to pay all their counselors for a BA degree. At NCI we have 27 counselors serving over 18,000 residential clients per year. Their rates begin at minimum wage, moves up to $9 per hour after five years of experience, and a few may end up at $12 per hour. We can not afford significant employee benefits. Few counselors investing in a BA or MA degree will work at this low level. The decreasing level of public dollars and the increasing demand of the growing target populations creates an impossible and unrealistic dilemma. ‘Give a big percentage to HMO administrators, pay the line-staff more, spend more money on training and education, do more paperwork without increasing their work week, increase your direct service quality, see more people, but then do this with far fewer dollars, with fewer beds, and fewer supporting services.’ End result - decreasing service quality and increasing unmet need.
10. Every scientific paper that come out decries the fragmentation and “wall building” occurring in substance abuse, mental health, and the medical profession. Over 50% of our clients have co-occurring problems which usually make treatment difficult. The fragmentation in both our thinking an our organizations is one reason efficacy is so low. A diverse but unified strategy is required. These regulations are designed to breed more impotence specialists.
Recommended
Solution
Three
types of Licensures: Type 1. Chemical Dependency Professional Counselor (CDPC), Allowed to practice under the supervision of a LADAC. Proficient in the basic core subjects. Experience is at a medium level. Exam is in written form (Or verbal for therapist’s with either learning or language limitations). Can practice fully with some form of limited but responsible supervision system. possible in rural settings.
Type 2. LADAC. BA degree with other standard requirements. 3000 hours experience as LADAC Intern, LADAC I, or other relevant professional setting. Type 3. Traditional Native American Therapist; Licensed to serve Native American Clients or non-indigenous clients within a cultural relevant environment. Must achieve the following criteria (pages 12-16): (Na’
Nizhoozhi Center Inc, Gallup NM) Sophisticated and Contemporary Techniques – Many Native American therapeutic practices (within the right context) are sophisticated psycho-physiological practices for contemporary, intelligent, dynamic, adaptive, and enduring Native American people. For the majority of Native American clients, many traditional therapeutic practices are as effective, as measurable, as objective, as rigorously developed, as complex, as relevant, and as cost/conscious as any current Western-oriented psycho/social model. In many cases, such practices are more intense, engaging, dramatic, and complex then the majority of commonly practiced Western psycho/social techniques. Like all valid practices, such protocols must be appropriately applied to the right person, within the proper context, at the right time, and by a respected Practitioner. When this occurs these techniques are usually intense, fully encompassing, environmentally-oriented, physical, psychological, and spiritual, experientially-based therapies. Examples of such techniques include Native American Church practices, sweat-lodge sessions, extended sessions (which might involve prayer, blessings, ceremonial smoke, drumming, singing, dancing, long-sitting-periods, sensory stimulation or depravation, physical exertion, or fasting), usage of herbs, community and family healing sessions, therapeutic sun-dance protocols, and deep group dynamics such as "talking" or "medicine" circles. In addition, these protocols are generally presented within a powerful cultural and philosophy context.
Science-Based Criteria Historically, traditional Native American techniques were looked upon as being both unscientific and superstitious by early "mainstream", lab-oriented American psychologists. Today's more mature and experienced professionals generally recognize both the sophistication, personal skills, and largely untapped scientific efficacy of such practices. Psycho-physiological Basis: When appropriately applied to traditionally oriented Native Americans such practices measurably improve metabolism including a range of techniques which self-stimulate neuro-physiological brain coherence. Done properly, they may actually promote psycho-physiological homeostasis;" - a self-induced, healthy state of physical, emotional, and spiritual balance. Homeostasis also involves “stabilized parasympathetic relaxation and unconscious self-regulation – the largely unconscious complex system of physiological self-healing mechanisms required to maintain good health and positive mental outlook. Behavioral Models: Additionally, the best Western clinical theories readily illustrate the contemporary and integrated nature of Native American therapeutic models. For example, Prochaska & DiClemente's famous "Readiness to Change Model" easily fits into a Native American framework. The ten most important principles of UNM-CASAA's Community Reinforcement Model (requirements for change) are also well matched by most holistic traditional models. In addition, the contemporary models of both "individualizing" and "treatment-matching" are familiar principles within traditional American treatment approaches.
Psychological Models: Some of the critical, active ingredients found within traditional Native American practices include complex cognitive reframing, depth psychology, emotive-cathartic release, stress resiliency, coping enhancement, self-empowerment, and family-social relationship skills. As in the best Western techniques, greater emphasis is generally placed on experience, insight, and physiological shift rather than just simple alcohol education. A extensive literature bibliography on the therapeutic benefits of traditional Native American practice is available from NCI. Multi-Faceted: Traditional therapeutic skills are very complex (certainly more so than the general practices within mainstream clinical psychology). Traditional Counselors commonly undergo extensive training beginning at a young age, later apprenticeships, proficiency tests, and constant social evaluation. To make things even more challenging (unlike the artificially controlled and somewhat protected environment enjoyed in an office or hospital) Traditional Counselors often provide services within complex family, social, and environmentally-challenging conditions.
Best of Both Worlds: It is important to state that traditional practices are rarely exclusive of, or in conflict with, the best Western psycho/social or allopathic medical techniques.
A Way of Life - In many ways, the professional, ethical, and personal demands of Traditional Counselors are often greater than the requirements of their contemporary Western counterparts. While ideally the duties, values, and talents of each tradition should be similar, Traditional Counselors are generally required to follow their healing principles as a "way of life" rather than simply utilizing their skills professionally. Traditional Counselors are required to exemplify their skills (show natural leadership) in all areas of their life often under close social scrutiny. Identifying oneself as a Traditional Counselor is both a public and personal promise to the community regarding the therapist's personal "heart, spirit, practices, and behavior". Most Traditional Healers also spend far more time and effort during their training than the typical Western-only counselor.
Culture as Part of Treatment – A Brief Literature Review
In an attempt to design more effective treatment protocols for traditionally-oriented Native American people, several anthropologists state that such programs must utilize traditional cultural techniques, traditional settings, and traditional self-empowerment programs (French, 1989; Grobsmith & Dam, 1990; Kavlahan, 1985; Westermeyer & Canino, 1994). A growing number of medical and psychosocial service professionals also insist that Native American cultural values and practices are essential when assisting traditionally-oriented Native Americans ((Brady, 1995; Garrett & Garrett, 1994) (Mail & Wright, 1989) (Mitchell & Patch, 1986, May; Rankin & Kappy, 1993; Terrell, 1993; Young, 1986). Jilek (1994) also presented a strong case that most community-recognized traditional medicine practitioners are “potentially useful to modern health care schemes as an inexpensive therapeutic resource,” especially in important and crippling psychosomatic and psychosocial issues (Jilek, 1994) (p. 219). He also believed that effective intervention must always be relevant to the socio-cultural context from within which the substance abuse occurs. He also stated that “cultural-congenial practices of indigenous traditional healers” are often the most relevant psychotherapy. As support for his beliefs, Jilek cited a Buddhist healing center for addicts in Laos which credited a 70% success rate, a Malay Islamic center with a well documented complete abstinence rate of 8-35% (depending on the healer), a traditional Japanese center who published a 6 month 53% abstinent rate, an Arab Islamic center showing significant improvement over the government’s medical-based center, and a group of young problem drinkers from the North American coastal Salish tribe who had a long-term abstinence rate of over 50% after being initiated into their traditional dance society.
As another illustration of the importance of spiritual values in treatment, Jilek also mentioned one Saudi hospital study which stated that 75% of their clients who were motivated by inner religious values were able to maintain abstinence for at least two years. This compared to only 33% of the participants who were also strongly motivated, but who were lead by non-religious considerations in that same facility.
Jilek (1994) sees these same important therapeutic values in many Native American therapeutic/spiritual practices (e.g., sweat lodge, Sun Dancing, social and personal ceremonies, winter spirit dancing, the Native American Church, and other methods of spontaneous enhanced-altered states of consciousness). When properly done within the right context, such complex techniques are often applied more with groups than with individuals. They also generally involve the sacred use of culturally validated symbolic acts, words, and objects; the client’s public admission and promise of a behavioral correction; and specific internal and external purification (herbs or action). An enhanced altered state of consciousness is often critical. Jilek describes this beneficial state as “ a culture-congenial situation that facilitates psycho-dramatic abreaction and affective release achieved through catharsis triggered by adequate sensory stimulation, or an altered state of consciousness induced by psychological, physiological, or phyto-chemical means” (p.247). He went on to say that the therapeutic effects of local healing practices are also usually magnified by the empathy and support shown by kinspeople and community members. When comparing accepted western methods with such indigenous therapies, Jilek believed that (within a proper context) indigenous procedures often have the following advantages: (a) there is absolute cultural-congeniality between client and practitioner (unlike many western relationships which occur between doctor and patient); (b) the personality, “power,” and rapport of the healer is emphasized more than the mechanical technique (a point often downplayed in both medicine and formal psychotherapy); (c) such therapies are generally holistic by integrating psychology, physiology, social, and spiritual components (unlike the trend towards specialization and fragmentation in many western techniques); (d) traditional healers are generally very accessible, available, and permanent (urban health clinics tend to be difficult to enter and undergo constant personnel changes); (e) enhanced-altered states, engaged emotional conditions, and sharply focused awareness are often utilized in conjunction with culturally validated images (in contrast to the general western insistence that change occurs through intellectual insight and education); (f) therapies usually involve the re-integration of family, kinspeople, and community (unlike the often isolated western clinics which mainly work on individuals outside of their personal context); (g) indigenous therapies tend to be most cost-effective due to their lower overhead and group orientation. Indigenous practitioners may also act as community role models (very unlike the usual aloofness and isolation of western health care providers). More Intensity: In a further comparison between the two styles of therapies, even the intensity level of Native American therapies are often severe when compared to standard western practices. Most of the favorite Dine’ practices, for example, involve hours (and some times days) of therapy. A family sponsored health-promoting Yebache’ dance lasts seven days and nights. The Sun Dance lasts four days and nights. Sweat-lodge practices last from two to four hours. Even the daily talking circles in HBS rarely take less than two hours. Many of these practices involve the extremes of emotion such as fatigue, fear, pain, tears, hunger, nervousness, joy, altered states of consciousness, laugher, boredom, heat, cold, and heightened expectation.
Several days at a Sun Dance or a few hours in the sweat-lodge will cause almost any psychotherapist to re-analysis the commonly accepted intelligence of trying to affect behavior change during a 55 minute-hour (in an air conditioned office from across a desk). Not a Miracle but hard, good work: Cultural practices are not, of course a panacea. They do have obvious limits and disadvantages. As in western practices, harm and mistreatment can occur. Importantly, most indigenous people manage to balance (compliment) the mechanical emphasis of the western approach with the psycho/social/spiritual emphasis of their own practitioners. Jilek did maintain (especially in the field of substance abuse where even Western efficacy has been so low, and where the downside of abuse is so immediately terrible), that even the most drastic indigenous intervention is usually worth the risk. It is also important to note that a treatment protocol which emphases positive cultural values is almost never intended to return participants to the lifestyles of the past (hunting and horseback). On the contrary, such today’s therapeutic are intended to carry empowering values forward into a modern and dynamic future.
Challenge of Scientific
Efficacy: Jilek (1994) also
commented that a rigorous scientific investigation of traditional therapies is
often thwarted due to the sacredness of such activities, the personal tendency
of the practitioners to guard the details of these activities, the historical
experience of religious and medical persecution from outsiders, the invasive
nature of most “study” methods, and the confusing (albeit necessary)
multi-variable nature of these activities.
Rigorous outcome studies, he stated, are also limited by the lack of
reliable records, the logistical challenges of rural life, the problem of
finding the post-treatment participants, the legitimate fear of authorities, and
the problem of verification. The lack of reliable outcome studies among the
often highly mobile Native American population was also expressed by Grobsmith
and Dam (1990). Although Jileck acknowledges the lack of well controlled data,
he also stated that the collection of broad evidence on many different
continents and in many different contexts illustrate that many indigenous
therapies are generally more
successful than what we’ve come to know as the “Minnesota” or “western
psychosocial medical model of prevention and treatment. [ It is important to recognize the lack of scientific efficacy applied to the great majority of current Western-based substance abuse practices. Peer-reviewed journals frequently decry the lack of scientific rigor placed on the present popular and emotionally defended strategies.]
At the very minimum, Jilek suggests that health care providers of minority populations should always identify the indigenous culture-specific concepts of both care and disease, the attitudes towards substance usage and abuse, and the views regarding prevention and treatment. He also encouraged active collaboration between western and indigenous health care providers. He strongly stated that the “therapeutic and scientific world” has a professional obligation which is legally and ethically required (after the United States repeatedly signed the World Health Organization’s declaration on primary health care; originating in Alma Ata in 1978). Is Licensure Culturally Appropriate? Many aspects of the licensure or certification process are, in themselves, contrary to the basic principles of traditional Native American individuality, traditional spiritual integrity, and traditional social norms. Even within the Western model, the best regulations do not guarantee professional or ethical quality. Several past presidents of the American Psychological Association along with many noted theorists (such as Carl Rogers, Abraham Maslow, Rollo May) were continually frustrated with the inadequacies of developing "standards" as a public promise of therapeutic and ethical ability. Special care must also be taken to not confuse "certification or licensure" with "standardization". Traditional Counselors are generally strong individuals with natural spiritual, counseling, and leadership skills. Any accurate and productive certification model must honor both their differences and specialties without compromising integrity, ethics, skill, and professionalism. Appropriately, certification requirements for Traditional Counselors must be considered as strongly recommended guidelines rather than legal "rules". Many of Native American traditional skills (stories, practices, beliefs) which a Traditional Counselor might utilize are also considered both sacred and private. Placing these attributes as "requirements" into public documents (certification procedures) is both inappropriate and unnecessary. For this reason useful certification guidelines must focus on the Therapist's attitude, behavior, public practices, ethics, productivity, and community acknowledgment rather than his or her pool of detailed traditional knowledge. The correct and ethical utilization of such knowledge is the traditional counselor's professional "skill, and power". The correct utilization of personal knowledge is the holistic domain of the traditional counselor. Similar but more complex Ethical Standards: The majority of LADAC ethical principles and regulations should be followed by Native American traditional therapists. On the other-hand, because of the small size of rural communities and the difference in cultural values; “dual-relationships,” “gift exchange”, and “avoidance of personal disclosure” becomes much more complex. Spending time at a family feast, in a sweat lodge, or at a seven day ceremony brings up a range of ethical challenges unfamiliar with the simplified Western perspective. In these cases, not participating presents it’s own ethical violation.
Proposed
Guidelines for Traditional Native American Counselors Alcohol and Drug Counseling
(Na’ Nizhoozhi Center Inc,
Gallup NM) Acknowledging the tremendous differences among tribes, areas, and individuals we believe the following guidelines can be met by everyone in some way. Criteria
for Traditional Native American Therapists 1. Be of at least ¼ Native American Blood (or be raised in a significant Native American community). 2. Personal and Professional Beliefs - Counselor must first (and foremost) accept their own Native American traditional beliefs, spirituality, religion, and culture as his or her primary therapeutic tools and personal path. In general, traditional values are a way of life and must be widely demonstrated in areas of the Counselor's life. Counselor is expected to personally practice (walk) a significant amount of what he or she teaches. Christian beliefs, and Western psycho/ social practices, may also be fully honored and utilize are seldom the primary tools of the traditional therapist's life. Those Counselors who utilize traditional Native American practices and principles only on a secondarily level may still be excellent therapists but shall not practice primary as Native American Traditional Counselors. 3. General Knowledge - Although Traditional Counselor's can specialize in one (or several areas) in general they must; (a) express human relationships frequently in terms of K'e (Kinship or Clanship); (b) have a full knowledge of "Creation" and many "life-teaching" cultural stories; (c) have a significant understanding (familiarity with but not necessarily expertise or personal participation) about the range of local "medicine-way" techniques and practices including the Native American Church and the use of herbal medicines (if this is appropriate for their area); (d) significantly utilize cultural story’s or metaphors as teaching aids; (e) utilize humor and laugher therapeutically; (f) are familiar with a significant majority of cultural beliefs, practices, crafts, and religion or their region; (g) are significantly familiar with local history; (h) openly support, teach, and encourage healthy cultural practices. 4. Specific Practices - The Traditional Counselor must have a range of general knowledge and practices (even if they specialize in just a few). Traditional Counselors must professionally utilize at least five of the following (depending upon their own Tribal practices); (a) talking or medicine circles; (b) sweat-lodge; (c) minor blessing ceremonies utilizing paraphernalia such as smoke, cedar, sage, feathers, or prayer; (d) traditional drumming and, or, dancing; (e) Native American Church practices to a Roadman level; (f) sacred crafts; (g) therapeutic games; (h) sun-dance practices; (i) vision-quest practices; (j) medicine-way ceremonies; (k) peacemaker protocols; (l) other significant "un-named" cultural therapeutic practices relevant to Tribe, Nation, or Pueblo. Counselor must acquire this knowledge appropriately through a recognized Mentor and must be acknowledged by the majority of their immediate community to be worthy of such practices. 4. Additional Education and Skills - In most cases, the Traditional Counselor is expected to be, at least, familiar with Western models of therapy and medicine. Some formalized education in substance abuse treatment and psychology/sociology/health is expected (or equivalent experience). Although encouraged, a Western licensure in substance abuse treatment is not required by the New Mexico Counseling and Therapy Practice Board (61-9A-6 Exemption). Knowledge of the local dominate "health and treatment continuum-of-care" is also expected as in the 12 Core Functions. Traditional Counselors are also encourage to refer to, and interface with, Western practices when appropriate. Because a Counselor is expected to match the treatment needs of their "relatives", under no circumstances is a Counselor allowed to withhold appropriate Western-oriented assistance if such practices are necessary. As a cultural, therapeutic, and community leader, a Traditional Counselor's education must be demonstrated during individual sessions and in group settings. Important skills can also be gathered through apprenticeship, life-experience, military service, work-experience, or formalized education. If writing skills are not adequate, Counselor is expected to compensate verbally. Fluency in a Native American Language is always preferred. As a guideline, the Traditional Counselor is expected to also utilize a culturally appropriate therapeutic protocol similar to, or equivalent to, the following 12 core functions of professional intervention. In some cases this guideline can be significantly modified to better suit individual, agency, or environmental needs; 1. Initial screening and brief appraisal. 2. Professional intake and administrative procedures. 3. Client orientation, education, rights, and policies. 4. Deep assessment into client needs. 5. Treatment selection of short and long-term goals along with treatment process and strategy. 6. Practice, counseling, teaching, or therapeutic experience. 7. On-going case management, coordination, progress evaluation. 8. On-going crises intervention as needed throughout the healing process. 9. Preventive education to both client and community. 10. Client referral to additional services, if necessary. 11. Important reports and record keeping, if appropriate. 12. Ongoing interactions and consultations with other professional to maintain the most up-to-date quality care. A Traditional Counselor's primary authority and efficacy comes from implied acknowledgment from the group or community he or she serves. A Traditional Counselor must, first and foremost, establish and maintain community respect. The Traditional Counselor is not only accountable to his or her "relatives" and Agency but also accountable to their own cultural principles, Mentors, and relevant sacred organizations. Traditional Counselors are also expected to maintain significant community involvement as a traditional participant or advisor. 5. Personal and Professional Ethics - Due to a high community profile, high expectations place upon him or her, and the close family/community connection strict ethical standards are essential. A Traditional Counselor rarely has the luxury of being protected behind his or her a desk or "title". The traditional Counselor accepts his or her leadership role along with the significant weight such responsibility carries.
A Traditional Counselor abides by all State and local professional codes of ethics along with his or her own cultural taboos. Due to the unusually open relationship between a Traditional Counselor and his community "Relatives", abuse or misconduct towards "Relatives" is considered "spiritual" abuse and cannot be tolerated. When a Client looses faith in a Western therapist only time and effort is wasted. However, when a "Client-Relative" looses faith in a Traditional Counselor, they may also loose faith in their basic culture, religion, and purpose. High ethics, compassion, empathy, patience, optimism, honesty, polite language, and humility are absolute requirements for a Traditional Counselor. Spiritual tolerance, flexibility, and resiliency are important components of Traditional Counseling. Criticism of other cultural or spiritual traditions is not accepted. Traditional Counselor's must also accept the wide-range of protocol and practice differences among traditional individuals; recognizing that "correct" practice comes from the "heart" and "intention" rather than replication of “exact” methodology. The "right-way" to practice traditional counseling primarily demands love, dignity, respect, good intention, personal balance, and "connection". In the case management of "witchcraft" trauma, only the healing, blessing, and protecting protocols are utilized.
Alcohol and recreational drug use has no part in traditional Native American values. Total absence is required for licensed Traditional Counselors and must be established for at least a full year before initiation. Relapse incidents must be immediately reported to a panel of traditional peers for intervention (hopefully the Counselor's own Native American Examining Board). Licensing Board Procedures - An Examining Board of at least four Traditional Counselors must jointly appraise each applicant. Such a standing Board can be developed by any Agency, Tribe, or community. All Board members also comply to all principles within this document. When necessary, small communities or Tribes are allowed to interface with outside traditionalists to build a four-person Board. Although modest traditional gift exchanges are acceptable, board members are not allowed to charge a monetary fee for their services. In addition, each Counselor is expected to have, and honor, their individual Mentors or specialized teachers. Such Mentors may serve on the Board.
After a significant period of experience, internship, and demonstration, applicants are formally interviewed and appraised. The Licensure Board can recommend additional skill building, or even restrict the conditions of a Counselor's practice. All evaluations, recommendations, conditions, and final Licensure must be given to the applicant in writing. Initiation into traditional licensure warrants life-time status provided all of the above behaviors are upheld. All Board members must be present at the licensure initiation. The Licensure Board Committee is responsible as a joint-sponsor throughout the Counselor's full professional term. The Counselor's sponsoring Board may revoke their sponsorship at any time with written notice. Their names and addresses must be placed upon the certifying document. As mentioned above (unlike most Western models), a Traditional Counselor's primary authority and efficacy comes from implied acknowledgment from the group or community he or she serves. Counselor must, first and foremost, establish and maintain community respect. The Traditional Counselor is not only accountable to his or her "relatives" and Agency, but also remains accountable to their cultural principles, Mentors, and relevant sacred organizations. ******************** Please send comments to; Matthew Kelley Ph.D. Traditional Native American Counselors, Na'nizhoozhi Center (505) 722-2177
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