An Aboriginal Mental Health Approach To Personal Wellness:
A Formative Evaluation

William Thomas
BFNAC, Brandon University, 2000

Thesis Submitted In Partial Fulfillment Of
The Requirements For The Degree Of
Master Of Social Work

The University Of Northern British Columbia
November 2005

© William Thomas, 2005

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Abstract
This study field-tested a six-session Aboriginal mental health personal wellness program.
The cross-cultural integrated program combined the Aboriginal healing circle with the
psychotherapy technique known as “focusing.” This study located in Winnipeg, Manitoba
and involving 6 Aboriginal participants was formative in nature and grounded in
qualitative inquiry. Conversational style interviews were conducted with each participant,
followed by a participant focus group. Out of the data analysis process, five salient
themes surfaced that captured the breadth of the participants’ first-hand experiences of
the piloted program.

Ill
Table of Contents
Abstract................................................................................................................................ ii
Table of Contents...............................................................................................................iii
List of Figures..................................................................................................................... v
List of Tables...................................................................................................................... vi
Acknowledgments.............................................................................................................vii
Chapter 1; Introduction.......................................................................................................1
Purpose of the Study.............................................................................................. 4
Rational of the Study..............................................................................................4
Research Design......................................................................................................5
Theoretical Orientation of the Research...............................................................6
Chapter 2: Literature Review............................................................................................. 9
The Colonization of Aboriginal Peoples in C anada............................................9
Impacts of Canadian Social Policy on the Well-Being and Health
of Aboriginal Peoples...........................................................................................15
Focusing...............................................................................
20
Traditional Healing C ircles................................................................................. 24
Integrative Approaches to Mental Health .........................................................27
Chapter 3: Research D esign........................................................................................... 30
Case Study D esign..............
30
Data Collection M ethod......
35
Data A nalysis......................
39
43
Ethical Considerations........
Methodological Integrity....
43
46
Limitations of the Research
Chapter 4: Data Analysis..................................................................................................48
Experience.............................................................................................................50
Relationships.........................................................................................................53
Spirituality and Connectedness........................................................................... 57
Empowerment.......................................................................................................63
Self Awareness..................................................................................................... 66
Chapter 5: Discussion on the Research Findings.......................................................... 73
Focusing................................................................................................................77
The Healing Circle.............................................................................................. 77

IV

Chapter 6: Implications of the Research Findings......................................................... 84
The Participants’ Journey.................................................................................... 84
My Journey...............................................................................
85
Research on Aboriginal Issues by Aboriginal Practitioners
86
The Need for Greater Numbers of Aboriginal Therapists....
87
Aboriginal Frameworks for Social Work Education............
88
Conclusion
89
References......................................................................................................................... 90
Appendix A: Self-Reporting Mental Health Assessment...........................................112
Appendix B: Interview Questions..................................................................................114
Appendix C: Therapeutic Criteria..................................................................................115
Appendix D: Information Letter and Informed Consent............................................. 116
Appendix E: Informed Consent .................................................................................... 118

List of Figures
Figure 1

Mortality rates, 1996/97.......................................................................... 17

Figure 2

Age-standardized suicide rates, 1996/97................................................18

Figure 3

Integrated medicine wheel and focusing model....................................79

VI

List of Tables
Table 2.1

Chronic Disease....................................................................................... 16

Table 3.1

Column 1, 2, and 3 of the Data Analysis W orksheet...........................41

Table 3.2

Column 2 , 3 and 4 of the Data Analysis Worksheet............................42

vil
Acknowledgments
I wish to acknowledge the Creator for life and health and for giving me the inner
strength to achieve my academic and personal dreams.
I wish to acknowledge my mother, who has passed on to the spirit world, for
giving me inspiration to further my academic and personal healing.
I wish to acknowledge my wife Ely, who has supported and motivated me in my
darkest moments during this process.
I wish to acknowledge the survivors of the Residential School Experience and
their voice, as without their voice, pain, suffering and spirit to carry on after this
Aboriginal holocaust this study would not have been possible.
I wish to thank Anne and Shirley who have guided, motivated and supported in
fulfilling my academic and career dreams.
I wish to acknowledge the social work educators of the University of Northern
British Columbia for their dedication and commitment to Aboriginal and Northern social
work practice.

Chapter 1: Introduction

The domination, oppression, and exploitation of the Aboriginal peoples^ in
Canada is well documented in a large number of governmental committee and task force
reports (Alberta, 1991; Manitoba, 1991; Nova Scotia, 1989; Saskatchewan, 1992),
scholarly publications (Adams, 1999; Armitage, 1995; Assembly of First Nations, 1994;
Fournier & Crey, 1997), academic research journals and articles (Chrisjohn, 1991; Ing,
1990), and critical policy reviews by royal commissions and parliamentary committees
(Berger, 1977; Canada, 1996a; Fenner, 1983) dating back over several generations.
Regarded as a watershed event in the history of Aboriginal Canadians, the
Mackenzie Valley Pipeline Inquiry, commonly known as the Berger Commission,^ is
largely credited with raising public awareness of the plight of Aboriginal peoples when it
ruled that a 10-year moratorium should be placed on the construction of the pipeline
(Berger, 1977). In the commission’s final report, entitled Northern Frontier, Northern
Homeland: The Report o f the Mackenzie Valley Pipeline Inquiry (Berger, 1977), Justice
Thomas Berger presented a retrospective assessment of the cultural impact of white
civilization on native people. He described this relationship as follows:
Euro-Canadian society has refused to take native culture seriously. European
institutions, values and use of land were seen as the basis for culture. Native
’ The term Aboriginal peoples does not imply or refer to one homogeneous group. The Aboriginal
population is described as including four categories: North American (First Nations) Indians registered
under the Indian A ct (Registered Indians); North American Indians not registered under the Indian Act;
Métis people; and Inuit (Canada, 1996a).
^ The Berger Commission was established in 1974 “to consider the social, environmental, and
economic impacts” o f building a pipeline from the shores of the Arctic Ocean south through sections o f the
Yukon Territory and the Northwest Territories (Berger, 1977).

institutions, values and use of land were rejected, ignored or misunderstood and—
given the native people’s use of land—the Europeans had no difficulty in
supposing that native people possessed no real culture at all. (p. 85)
The Penner Report,^ released by the Special Committee on Indian SelfGovernment six years later, in 1983, described the relationship between Indian people
and the federal government as not working. While the focus was on control of the system
rather than on designing a new approach, it emphasized the need for a more holistic
approach to health care. It also suggested that Canada’s federal policies and agencies
were operating in a manner that was leading to increased Indian poverty and dependence
(Penner, 1983):
We have come to appreciate very much the relevance and the utility of traditional
approaches, particularly to mental health problems—approaches which address
the suicide rate, approaches which address addiction problems. We believe that in
areas such as those the application of traditional medicine and native culture
perhaps can be more successful than anything we could offer in terms of
contemporary psychiatric approaches to those kinds of problems, (p. 35)
More recently, the Royal Commission on Aboriginal Peoples’ (RCAP) fivevolume report, released in October 1996, not only linked the disproportion of social and
health problems among Aboriginal peoples to decades of oppressive social policies, it
also underscored the inability of “mainstream” institutions to effect significant change
(Canada, 1996a). The report (Canada, 1996b) observed that:

^ The Special Committee of the House o f Commons on Indian Self-Government, also known as
the Penner Commission, was appointed in 1982 to review legal and institutional issues related to the status,
development, and responsibilities o f band governments on reserves (Penner, 1983).

...non-Aboriginal health and social programs have not served Aboriginal people
very effectively, and in response to pressure from Aboriginal organizations, the
courts, and human rights authorities, policy makers have instituted a number of
strategies over several decades in an attempt to sensitize mainstream health and
social services providers to the needs and aspirations of Aboriginal peoples. It is
instructive to examine some of these approaches, to analyze why they have
generally produced such limited results, and to explore what can be done
differently in the future, (section 3.4, para. 11)
The report also acknowledged that “a clinical one-to-one approach” does not
work well for Aboriginal people because they “cannot divorce the healing of individuals
from the healing of families and communities” (section 2.1, para. 43), and stressed that
Aboriginal people “need to redefine professional training to make it more holistic, more
grounded in Aboriginal experience, and more relevant to Aboriginal circumstances”
(section 3.3.19, para. 14).
Hart (1997) further insisted that ethnocentric social work practice maintains a
condition of colonial domination over Aboriginal peoples. This view is also expressed in
a report submitted to RCAP by the Canadian Association of Social Workers (1994),
where it was argued that mainstream ethnocentric social work practices contribute largely
to the distrust and rejection of the social work professional by the Aboriginal community.
The report called upon the social work academic establishment to support the
development of culturally relevant social work education and models of practice.

Purpose o f the Study
This study field-tested a six-session Aboriginal mental health personal wellness
program that brought together the healing properties of the Aboriginal healing circle and
the self-awareness and empowerment powers of the psychotherapy technique known as
“focusing” to form a safe, effective, and culturally appropriate means for Aboriginal
people to meet their healing needs. This study located in Winnipeg, Manitoba and
involving 6 Aboriginal participants was formative in nature and grounded in qualitative
inquiry.

Rational o f the Study
Aboriginal issues have achieved a prominence on the agendas of governments, the
media, and the public that would scarcely have been imaginable a decade ago. Yet this
heightened interest in and attention to Aboriginal issues has not been matched by a
decolonizing pedagogical approach to education that is currently grounded by dominant
cultural theories using Western frameworks for teaching (Battiste, 1998; Castellano,
2002; Smith, 2001). The forms, content, and intent of post-secondary social work
education have not been challenged nor has there been reconsideration of the practice of
social work from an Aboriginal worldview. Sinclair (2004, p. 49) argues that “culturally
appropriate and sociologically relevant teaching and healing models must evolve and
translate into practice and service delivery that will meet the needs of future generations.”
While I acknowledge that schools of social work are beginning to address the demands
for Aboriginal social work education by hiring Aboriginal faculty, developing curriculum
and educational streams that focus on specific Aboriginal issues, and offering culturally

appropriate practicum placements, the gap remains wide.
The rapid devolution of social programs and services to Aboriginal authorities has
dramatically increased employment opportunities for Aboriginal people and raised the
demand for new culturally appropriate services and models of practice. The increased
interest among both Aboriginal and non-Aboiiginal people in Aboriginal traditions,
culture, and spirituality has resulted in the use of spiritual healing, traditional healers, and
ceremonies and rituals in Aboriginal homes, communities, institutions and workplaces.
Aboriginal spirituality is not perceived as a “cure-all,” but is effective in conjunction with
certain mainstream treatment modalities. Thus, it is increasingly important that
Aboriginal and non-Aboriginal graduate social work students and educators take a more
active stance and engage in research opportunities that can contribute to the knowledge
base of Aboriginal social work education and practice.

Research Design
The case study design employed a formative approach to evaluation and was
grounded in qualitative inquiry. Conversational style interviews were conducted with
each participant, followed by a participant focus group. Out of the data analysis process,
five salient themes surfaced that captured the breadth of the participants’ first-hand
experiences of the piloted program. The three research questions addressed in the study
were:
1. What is the perceived experience of Aboriginal participants engaged in the
piloted personal wellness program?
2. Can combining a mainstream psychotherapy technique (focusing) with the

traditional healing approach of the Aboriginal healing circle provide an
effective cultural alternative to mainstream mental health treatment models?
3. What are the implications of the results of this study for social work practice
and education?

Theoretical Orientation o f the Research
This study is informed by the theory and practice of the “seventh moment” of
qualitative inquiry, which “asks that the social sciences and the humanities become sites
for critical conversations about democracy, race, gender, class, nation-state,
globalization, freedom, and community” (Denzin & Lincoln, 2003, p. 3). Further, the
study is informed by critical theory, which raises the questions of knowledge defined by
whom, about whom, and for what purpose (Lather, 1986; Wallerstein, 1999), and invites
a more critical stance by challenging current ideology and initiating action towards the
search for social justice (Foucault, 1980; Freire, 1982; Gitlin & Russel, 1994). It views
knowledge as historically and socially constructed and mediated through perspectives of
the dominant society. The main task of critical inquiry is seen as being one of social
critique, in which the restrictive and alienating conditions of the status quo are brought to
light. Thus, it calls for knowledge that challenges researchers to go beyond conventional
worldviews and create new social relations (Guba & Lincoln, 1994; Flabermas, 1987;
Kemmis, 2001).
To date, traditional social work education and research has led to little
advancement in practice within the Aboriginal community (Canada, 1996a; Collins &
Colorado, 1987; Hoare, Levy, & Robinson, 1993; Morrisette, McKenzie, & Morrissette,

1993; Webster & Nabigon, 1992). From a critical perspective, this is largely the result of
the dominant epistemological European positivist paradigm upon which Western social
work education and research was founded (Beardsley, 1980; Ellis, 1990). As Hartman
(1994, p. 459) asserts in Setting the Theme: Many Ways o f Knowing, there is “nothing
more crucial in shaping and defining the social work profession and its practice than that
profession’s definition of the truth.” According to Hartman, it is essential that researchers
declare their epistemologies and worldviews, their biases, and their convictions about the
nature of knowledge and knowledge-seeking, as these affect the entire research process,
from conceptualizing a problem, to collecting and analyzing data, to interpreting findings.
My own theoretical foundation—that is, the context within which I undertake this
study—is firmly grounded in critical theory, including feminism, anti-oppressive theory.
Aboriginal worldview, structural social work, and social constructionism. As an
Aboriginal person committed to anti-oppressive practice, I am conscious of the broader
issue of the research context in relation to the history of Aboriginal people in this
country. I submit that the direction of much research under the Eurocentric “positivist”
research paradigm since the early 1800s has acted to oppress Aboriginal peoples and
served to literally destroy entire communities and ways of life (Collins & Colorado,
1987; Hoare, Levy, & Robinson, 1993; Webster & Nabigon, 1992).
Hart (1997) points to the conflicting values inherent in Eurocentric research
approaches. He explains that the natural worldview is based on natural knowledge that
originates from Mother Earth, whereas the technological worldview is based on manmade technology. According to Hart (1997), the natural worldview is in direct conflict
with the technological worldview, an approach which aggressively exploits and

8
dominates the natural world for monetary gain or academic acclaim.
From this starting point, I elected to proceed with a qualitative approach, because
it is more in line with the cultural oral traditions (Clarkson, Morrissete, & Régallet, 1992)
and non-positivist epistemological worldview of Aboriginal people. Unlike a positivistic
approach, which would “tend to discount intuitive wisdom, and indigenous knowledge”
(Hoare, Levy, & Robinson, 1993, p. 46), a qualitative method allows participants to be
more actively involved in the research process. 1 believe that a qualitative approach can
better address the previously mentioned issues of distrust, oppression, and lack of
involvement in the research process experienced by Aboriginal people. A qualitative
approach also allows participants to have and give voice, and captures unique contextual
nuances within the research process.

Chapter 2; Literature Review

In order to frame the issues that provide relevance and background to the study,
an extensive literature review was conducted. The review encompassed a critical review of
the literature on the colonization of Aboriginal peoples in Canadian society and its impact
on the well-being and health of Aboriginal peoples, an examination of the literature on
the psychotherapy technique of “focusing” and Aboriginal healing circle as established
methods of interventions within the field of mental health, and a review of integrated
approaches in dealing with mental health needs of Aboriginal peoples.

The Colonization o f Aboriginal Peoples in Canada
The history of the European colonization of North America is a disturbing story
of the Aboriginal population’s decimation by infectious disease, the destruction of
Aboriginal social and cultural institutions, and the active suppression of culture and
identity, which was tantamount to genocide (Frideres & Gadacz, 2001). It is estimated
that before the arrival of the Europeans, there were thousands of autonomous Aboriginal
bands, tribes, or nations, with a population of about 7 million (Trigger & Wasbum, as
cited in Kirmayer, Brass, & Tait, 2000). It is further estimated that 90% of the Aboriginal
population died “as a result of the direct and indirect effects of culture contact”
(Kirmayer, Brass, & Tait, 2000, p. 6).

10
The colonization of Canada’s Aboriginal peoples is a legacy of over a century of
colonial policies (Canada, 1996a). Both the federal and provincial governments have
subjected Aboriginal people to many forms of systematic abuse and discrimination over
several generations in an attempt to assimilate them into the dominant society through
education, religion, law, and theft of land (Morrissette, McKenzie, & Morrisette, 1993;
Waldram, 1997). The impacts of these policies are clearly visible today among the
Aboriginal peoples of Canada. While the federal government has made some effort to
rectify this situation by developing programs specifically designed to assist Aboriginal
people in their healing processes, significant change in the overall social, economic, and
health status of Aboriginal people has not occurred (Smylie, 2000; Voss, Douville,
Soldier, & Twiss, 1999).

The Residential School Era
Residential schools for Aboriginal children were established by the Canadian
government, and run by churches and governments, to provide for the education of
Aboriginal children (Miller, 1996). Under the authority of the Indian Act, children were
forcibly removed from their parents, homes, and communities and relocated to residential
schools (Chrisjohn, Young, & Maraun, 1997). It is estimated that from 1879 to 1973,
over 100,000 children were taken to residential schools, often far removed from their
home communities, for the entire school year (Law Commission of Canada, 2000).
According to RCAP (Canada, 1996b), the removal of Aboriginal children to
residential schools was based on an explicit policy of assimilation:

11
Residential schools were more than a component in the apparatus of social
construction and control. They were part of the process of nation building and the
concomitant marginalization of Aboriginal communities. The department's
inspector of education wrote in 1900 that the education of Aboriginal people in
frontier districts was an important consideration, not only as an economical
measure to be demanded for the welfare of the country and the Indians,
themselves, but in order that crime may not spring up and peaceful conditions be
disturbed as that element which is the forerunner and companion of civilization
penetrates the country and comes into close contact with the natives, (residential
schools, para. 8)
Sealey (1980, p. 34) explains, “the ties between parents and children were broken
during the years of school attendance.” The vast majority of the children who returned to
their home reserves after their years of residential schooling felt out of place and
confused, and were not well received by their communities:
Upon returning to the normal social and economic life of the reserves, the
students were baffled and discouraged. They are often condemned as shiftless
because most lack finesse and the skills necessary to follow the traditional means
of livelihood such as trapping, hunting and fishing. (Sealey, 1980, p. 34)
Kelm (1988, p. 79) further points out, what better way to break down a culture
than by attacking the weakest link, “the defenseless children.” Not only did children
experience trauma as a result of being taken away from their parents, but many
experienced added trauma upon their return, as they were not easily accepted back into
the community, having “changed” as a result of their assimilated residential school

12
experience.
The physical and sexual abuse that some of the survivors lived through was not
spoken about for many years, as the survivors carried the shame of what they had
experienced. Dolha (1998, p. 1), in a study of the impact of the residential school system
on individuals, offers the following account of the experience of Nahanee, a residential
school survivor: “I didn't bring it to mind (sexual abuse) until 1984, when my daughter
committed suicide. Then I began to look at myself. Why 1 was addicted to alcohol? Why
1 wasn't a good parent?” This is one of many similar stories that are now told by other
survivors as they continue on their healing journey. In the same interview, Nahanee
describes the torture that she witnessed as a child in residential school:
Before speaking of the murder she witnessed at the age of 11, Nahanee stopped to
compose herself to dry her eyes. I did not consider it a murder because when you
are just a kid it is just another painful memory. On December 24, 1946, school
administrators told Nahanee she would not go home for the holidays because she
did not bow her head in prayer. While in the playroom, she heard someone
shouting. Nahanee followed the sound, went to the bottom of the staircase, and
climbed them half way. She saw Mr. Caldwell and a female supervisor at the top
of the stairs. There were arguing about a little girl who was running up and down
the stairs. Mr. Caldwell was always drunk. You could smell the liquor on his
breath all the time. While batting her eyelashes to hold back the tears. Nahanee
continued telling her nightmare. He kicked a little girl and she fell down the stairs
and died. That’s murder. There are other kids in the infirmary that had their
appendix burst. That is murder. Other children were beaten so badly they died.

13
That’s murder no one bothered to take to hospital. (Dolha, 1998, p. 2).
It has been estimated that two-thirds of Aboriginal people have suffered a trauma
as a direct result of the residential school era (Manson, 1996, 1997, 2000). The
unfortunate reality of this number is that the effects of the residential school era can be
expected to be felt for many generations to come (Canada, 1996b).

Residential school syndrome.
According to Fournier and Crey (1997, p. 63), far from becoming assimilated
members of mainstream Canadian society, many residential school students went on to
“experience symptoms of post-traumatic stress disorder.” Fournier and Crey (1997, p. 63)
further argue that survivors of residential schools experienced symptoms “not unlike
those suffered by war veterans or police officers,” including “panic attacks, insomnia,
uncontrollable anger, alcohol and drug use, sexual inadequaey or addiction, the inability
to form intimate relationships, eating disorders.” Similarly, Brasfield (2001), a British
Columbia psychiatrist with over 20 years of experience working with Aboriginal people
traumatized by their time spent in residential school, writes:
Whether residential schools are seen as an attempt at benevolence or a plan to
annihilate a culture, many native people who attended the schools present with
symptoms similar to those of post-traumatic stress disorder. This constellation of
symptoms has come to be known as residential school syndrome, (p. 1)
Brasfield is an advocate for having the disorder Indian Residential School Syndrome
(IRSS) included in the D SM IV TR (personal communication, January 13, 2003).
The American Psychiatric Association (2000) Diagnostic and Statistic Manual o f

14
Mental Disorders (DSM IV TR) describes Post Traumatic Stress Disorder (PTSD) as an
experience of or exposure to a traumatic event with the presence of actual or threatened
death or serious injury, or a threat to the physical integrity of self or others. The
symptoms of PTSD include persistent avoidance of stimuli associated with the trauma
and numbing of general responsiveness (not present before the trauma) indicated by at
least three of the following symptoms: (a) efforts to avoid thoughts, feelings, or
conversations associated with the trauma, (b) efforts to avoid activities, places, or people
that aroused recollections of the trauma, (c) inability to recall an important aspect of the
trauma, (d) markedly diminished interest or participation in significant activities, (e)
feeling of detachment or estrangement from others, and (f) restricted range of affect (g)
sense of foreshortened future (American Psychiatric Association, 2000). There also may
be persistent symptoms of increased arousal (not present before the trauma), as indicated
by at least two of the following symptoms: (a) difficulty falling and/or staying asleep, (b)
irritability or outbursts of anger, (c) difficulty concentrating, and (d) hyperviligence and
exaggerated startle response. If the symptoms last less than three months, then it is
considered acute PTSD. If the symptoms last three months or more, it is considered
chronic PTSD. With delayed onset, the symptoms occur at least six months after the
stressor (American Psychiatric Association, 2000).
As revealed by this literature review, the process of colonization has had an
ongoing impact on the health and well-being of Aboriginal peoples. Virtually every
contemporary social pathology or health issue facing Aboriginal peoples can be attributed
directly to the fallout of colonialism (Midgely, 1998).

15
Impacts o f Canadian Social Policy on the Well-Being and Health o f Aboriginal Peoples
That the framework of colonial policies directed towards the Aboriginal peoples
of this country has severely weakened the social, economic, political, and cultural
foundations of Aboriginal societies (Adams, 1999; Chrisjohn, Young, & Maraun, 1997;
Pino, 1998), critically altering their way of life and engendering a legacy of racism and
oppression (Adams, 1999; Haig-Brown, 1994), is well documented in the literature.
According to RCAP (Canada, 1996a), Aboriginal peoples have a life expectancy
7 to 8 years shorter than non-Aboriginal Canadians; a higher incidence of low
educational attainment and welfare dependency; a greater prevalence of family violence,
physical and sexual abuse, and suicide; and elevated rates of ill health such as heart
disease and cancer.
Another disturbing consequence of the colonization of Aboriginal society is the
disproportionately high numbers of Aboriginal youth warehoused in federal and
provincial jails (Roberts & LaPrairie, 1996). In a judgment rendered on April 23, 1999
(Regina v Gladue), the Supreme Court of Canada observed that “prison has replaced
residential school as the likely fate of all too many modern-day Aboriginal Canadians”
(Canadian Strategy on HIV/AIDS, n.d). The court pointed out that although Aboriginal
peoples only make up approximately 3% of the Canadian population, they represent 15%
of the federal male penitentiary population and 16% of total provincial/territorial
sentences. According to Haslip (2000, p. 1), “the trend towards the over-incarceration of
Aboriginal offenders is even more pronounced” at the provincial level, particularly in the
Western provinces.
With respect to the health status of Aboriginal peoples. Health Canada’s (1999)

16
report, A Second Diagnostic on the Health o f First Nations and Inuit People in Canada,
deserves special attention. The report describes the overall health status of First Nations
and Inuit people living in Canada as much poorer than the non-Aboriginal population
(Health Canada, 1999). In 1997, as shown in Table 2.1, the prevalence of self-reported
chronic diseases in First Nations and Labrador Inuit people was higher than in the general
Canadian population (Health Canada, 1999).

Table 2.1
Chronic Disease
Age-adjusted prevalence
General
First Nations and
Chronic condition
Heart problems

Hypertension

Diabetes

Arthritis/rheumatism

Canadian

Sex

Labrador Inuit

Male

13

4

Female

10

4

Male

22

8

Female

25

10

Male

11

3

Female

16

3

Male

18

10

Female

27

18

Population

Sources: First Nations and Inuit Regional Health Survey and National Population Health Survey, as cited in
Health Canada (1999).

* “Due to limitations in the availability o f information on the Métis and the Non-status Indian
populations, the content o f this document relates primarily to First Nations and to a lesser extent to the Inuit
population. However, information is provided on the Métis and the Non-status Indian where data are
expressed for the total Aboriginal population.” (Health Canada, 1999, p. 4)

17
In 1996/97, First Nations and Inuit people from Eastern Canada, the Prairies and
the Western provinces had mortality rates up to almost 1.5 times higher than the 1996
national rate. As Figure 1 illustrates. First Nations and Inuit people were up to about 6.5
times more likely than the total Canadian population to die of injuries and poisonings
(Health Canada, 1999).

0

20
—

Canada

§

!I

BG First Nations

g

Saskatchew an

a

I

40

60

80

100

120

140

160

180

200

I------- 1--------- 1-------- 1-------- 1-------- 1-------- 1--------1-------- 1—

58

-

481

442

-

First Nations

Manitoba First
Nations

447

-

Population
Sources: Manitoba MSB Regional Office, Saskatchewan MSB Regional Office, British Columbia
Vital Statistics Vital Agency, as cited in Health Canada (1999).

Figure 1. Mortality rates, 1996/97.

In 1996, 54% of the Aboriginal population aged 15 and over did not have a high
school diploma, compared to 35% of the non-Aboriginal population (Health Canada,
1999). In 1995, the average employment income of Aboriginal people was $17,382,
about 1.5 times lower than the national average of $26,474 (Health Canada, 1999). The
rate of Aboriginal children who lived in low-income families was more than twice the
national rate, which may be partly explained by the larger number of single parent

18
families in the Aboriginal population (Health Canada, 1999). Approximately 44% of the
Aboriginal population was below Statistics Canada’s low-income cut-offs, compared to
20% of the total Canadian population (Health Canada, 1999). Aboriginal people appear to
be the largest population sub-group that is the most at risk of becoming homeless in
Canada (Health Canada, 1999). Risk factors for homelessness, which include high
unemployment, welfare dependency, poverty, substance abuse, physical and mental
health problems, and domestic and sexual abuse, tend to be more common in Aboriginal
communities (Health Canada, 1999). Data from Eastern Canada, the Prairies, and British
Columbia show that First Nations and Inuit people had a suicide rate in 1997 that was up
to almost three times higher than the 1996 rate for the total Canadian population (Health
Canada, 1999), as illustrated in Figure 2.

5

10

15

20

25

30

35

40

H ---------- 1----------1---------- 1--------- 1---------- 1----------1-----Canada

43

-

§

I

Cl. BO F irs t N a tio n s

I
s

S a s k a tc h e w a n

<D

F irst N a tio n s

Pi

M a n ito b a F irst

■ m

49

-

CL

34

N a tio n s

-

Population
Sources: Manitoba MSB Regional Office, Saskatchewan Regional Office, British Columbia Vital
Statistics Agency, Statistics Canada (1998).

Figure 2. Age-standardized suicide rates, 1996/97

19

While there is insufficient information in the literature on the racial and ethnic
origins of people living with HIV/AIDS, the Centre for Infectious Disease Prevention and
Control, Health Canada, as cited in Craig et al. (2003, p. 19), estimates that “in 1990 1%
of all reported AIDS cases involved Aboriginal people” and “by 1999 this proportion had
increased to 10.8%.” This is an alarming figure, considering that “only about 2.8% of the
general population” is Aboriginal (Craig et al., 2003, p. 19). Yet the Aboriginal
population “accounted for about 9% of all people with newly diagnosed HIV infection in
1999” (Craib et al., 2003, p. 19).
According to Health Canada’s 2003 Women’s Health Surveillance Report
(DesMeules et al., 2003, p. 55), “Aboriginal women now account for approximately 50%
of all HIV-positive test reports among Aboriginal people, compared with only 16% of
their non-Aboriginal counterparts.” In addition, a recent Vancouver study comparing HIV
incidence rates among Aboriginal and non-Aboriginal injection drug users (IDUs) found
the incidence of HIV infection among Aboriginal IDUs in Vancouver’s Downtown
Eastside to be twice as high as the incidence among non-Aboriginal IDUs (Craib et al.,
2003). The study found an elevated risk in equal measure among both the male and
female Aboriginal participants.
The high incidence of Aboriginal family violence is seen as one of the most tragic
results of the residential schools. According to Health Canada (2002), Aboriginal women
in Canada are three times more likely to have experienced spousal violence than nonAboriginal women. Moreover, the Saskatchewan Women’s Secretariat (1999) reported
that 8 out of 10 Aboriginal women have indicated that they contend with violence in their
homes.

20
Of all the manifestations of ill health among Aboriginal peoples, substance abuse
may be the most convincing illustration of the impacts of colonization. The 1991
Aboriginal Peoples Survey found that 73% of Aboriginal persons on reserves and in
settlements^ thought that alcohol abuse was a problem in their community (Statistics
Canada, 1993). And, according to Scott (1997), one in five Aboriginal youths has used
solvents, one third of users are under the age of 15, and over half began to use solvents
before reaching 11 years of age.
From a critical perspective, this literature review draws attention to the need to
rethink social work education and social work practice from a position of power over the
less fortunate minority or disenfranchised to a pedagogy and praxis premised on
indigenous knowledge that encompasses Aboriginal philosophical and healing methods,
which can be incorporated into contemporary approaches to mental health and social
work practices.

Focusing
Literature exploring “focusing psychotherapy” is reviewed here to demonstrate
the suitability of this traditional psychotherapy technique as a culturally sensitive mental
health intervention strategy for Aboriginal people. Focusing psychotherapy originates
from extensive research conducted by Dr. Eugene Gendlin (1981, 1987, 1996). For
Gendlin, persons apprehend the world moment-to-moment through their experiencing of
it. According to Gendlin (1997), a flow of experiencing is always ongoing in a living

^ Statistics Canada defines Indian Settlement as “a place where a self-contained group o f at least
10 Indian (Aboriginal) persons reside more or less permanently.. It is usually located on Crown lands
under federal or provincial jurisdiction” (Statistics Canada, 2001 Online Census Dictionary).

21
human being. Gendlin (1997, p. 3) refers to experience as:
...something so simple, so easily available to every person, that at first its very
simplicity makes it hard to point to. Another term for it is felt meaning or feeling.
However, feeling is a word usually used for [specific feelings] ... But regardless
of the many changes in what we feel—that is to say, really, how we feel—there
always is the concretely present flow of feeling (pp. 3-6).
Amodeo (2001) explains, Gendlin assumed that success in psychotherapy was
largely determined not by what the therapist did, nor by what the clients talked about, but
rather by how they talked. He revealed in his research that clients viewed as successful in
their therapy were in fact not highly verbal or analytical, but rather had allowed
themselves to experience and tolerate feelings that were vague, blurry, and unclear, and
had allowed these feelings to unfold in their own time and way (Amodeo, 2001).
Gendlin (1961, p. 234) contends that one can always turn one’s attention inside
and “tune in to,” “look at,” or “listen to” one’s experiencing. He coined the term “felt
sense” to depict the direct reference one makes to the phenomenon of experiencing
(Gendlin, 1961). He describes a felt sense as a bodily felt, implicitly rich “sense of some
situation, problem, or aspect of one’s life”; it is “the holistic, implicit, bodily sense of a
complex situation” (Gendlin, 1996, pp. 20-58).
Gendlin (1981) maintains that individuals encounter and act upon the world with
the whole of their bodies, and attending to the felt sense enables a person to draw upon
the wisdom of the body in assisting with personal difficulties and in being sensitively
aware in relationships. For Gendlin, then, psychotherapy begins when one makes direct
reference to one’s felt sense.

22
Drawing on his theory of experiencing and the experiential response, Gendlin
(1996) formulated what he believes a therapeutic response must do—that is, to make
contact with the client’s experiencing process. Gendlin calls this process “focusing.”
Gendlin (1996) also believes that people can be taught the focusing procedures outside of
traditional psychotherapy settings. As Greenstreet (1999) asserts, focusing is an
awareness skill that involves sensing a certain kind of inner experience:
Focusing involves turning attention to something called a “felt sense”—a kind of
body awareness that is subtle and (at first) unclear, such as an uneasy feeling in
the stomach or a fluttery feeling in the solar plexus, or a slight tightness in the
chest. These sensations are subtle enough that you can easily ignore them, and in
fact many of us do. (para. 2)
Focusing has also been used as a way to promote spiritual growth (Claxton, 1997;
Hinterkopf, 1998), as a means of strengthening personal relationships and communication
skills (Bierman, 1999; Johnson, 2002), as a technique for reducing stress and preventing
burnout (Gendlin, 1981), as a technique for tapping into creativity (Ikemi, 2000; Weiser
Cornell, 1996), and as a method for decision-making and overcoming procrastination or
writer’s block (Weiser Cornell, 1996). For this reason, focusing is widely used by experts
in the healing of trauma and Post Traumatic Stress Disorder, in that it allows individuals
suffering from trauma to be in contact with their bodily felt sense of a traumatic
experience as a safe observer, and always at their own pace (Gendlin, 1996).
Focusing has been especially well received in Aboriginal communities because of
its humanistic, person-centered approach to healing, which reflects the core values of
respect and non-interference.

23
The following structure can be suggested as an orientation frame for both a
research oriented and therapeutically oriented interview (Stelter, 2000, p. 71):
The interviewer and interviewee choose a concrete situation which is relevant for
the interviewee.
The interviewer helps the interviewee to “clear the space” by for example asking
the interviewee to close his eyes, breathe, and relax, and by asking him/her to see
and imagine him-/herself in the chosen situation.
The interviewee is trying to get a felt sense of the situation. It is very important
not to go inside the situation by judging or finding reasons for his/her behaviour.
The interviewee should just get a vague “internal aura” or “taste” of the situation,
e.g., a sensation of jumpiness.
The interviewee is trying to find a “handle” for the situation by letting a word, a
phrase, or an image come up from the felt sense itself. In our example it could be
“jumpy”.
•

The interviewer and interviewee try to find out how the word, phrase or image
resonates with the felt sense and try to develop a clearer picture of the situation.
Cox & Theilgaard (1987) suggest that the client can resonate about a metaphor
presented by the therapist. The metaphor has a mutative effect, if it fits the current
situation of the client.
In a normal research interview, the intensive work with metaphors and other
images would finish at this point, while a therapeutic dialogue would continue.
The therapist would ask questions like “What is the worst about being as you
described?”. The client would then develop answers which should grow out of the

24
felt sense itself.

Traditional Healing Circles
Aboriginal people had many ways of healing themselves before contact with nonAboriginal people, the European invasion of North America, and the imposition of
Western epistemology and systems of knowledge (Antone & Hill, 1990; Armstrong,
1986; Bopp, Bopp, Brown, & Lane, 1985). Some traditional healing practices are still
used today, including natural herbs, traditional ceremonies, song and dance, the vision
quest, prayer, the sacred sweat lodge, and the healing circle (Heinrich, Corbine, &
Thomas, 1990; McCormick et al., 1999). The fundamental philosophy underlying
traditional Aboriginal healing practices is the interconnectedness of the individual with
nature, family, community, society, and the universe (France, 1997; Garrett, & Carroll,
2000; O’Donnell, 1999). The seven teachings of love, honour, respect, caring, sharing,
humility, and truth form the basic principles of a healing intervention (Brown, 2001;
Green, 1997; Lee, 1996; McCormick, 1997; McCormick et ak, 1999).
Based upon Aboriginal worldviews, the healing circle reflects the inter­
relatedness and sacredness of all living forms (Hart, 1997; Nabigon, Hagey, Webster, &
MacKay, 1998). The four directions have special meanings, elements, powers, and spirits
that assist Aboriginal people in their healing journey of the mind, body, spirit, and
emotions (Ermine, 1995; Hart, 1997; Nabigon et al., 1998).
Circles, being intrinsically non-hierarchical and inclusive, represent respect,
equality, continuity, and interconnectedness (Absolon, 1993; Nabigon et ak, 1998). “The
image of a circle is recognized by many nations and territories; however, each nation and

25
culture may associate its own unique meanings with the circle” (International Institute for
Sustainable Development, 2000, para. 1). More specifically, the healing circle has its
philosophical underpinnings in the broader concept of the Medicine Wheel^, upon which
many Aboriginal communities depend for achieving balance (Hart, 1997). The medicine
wheel has been used by aboriginal North Americans for thousands of years (Dufrene,
1990). One of the main teachings of the Medicine Wheel is that balance between all four
elements of life, the physical, emotional, mental and spiritual is essential for maintaining
and supporting good health (Bopp et al, 1985, Canada 1996, Dyck, 1996; Voss et al.,
1999). It promotes the notion that the holistic needs of the individual have to be balanced
in order for the individual to reach his or her full potential (Baird-Olsen, 2000).
The most commonly used form of Aboriginal healing today, the healing circle is
used to facilitate group work in which Aboriginal people come together to share their
common and healing experiences and to further their healing journey (Heilbron &
Guttman, 2000; Latimer & Cassey, 2004). At the centre of the circle is the community,
symbolizing the importance of community identity, history, heritage, and culture. Each
person is of equal value to another, and has his or her roles and responsibilities within the
community (Calliou, 1995; Clarkson et al., 1992; International Institute for Sustainable
Development, 2000). Usually, an Elder or someone who has been taught by an Elder is
asked to facilitate a healing circle. A sweetgrass or sage ceremony—in which participants
are smudged with some of the sacred medicine—is often used to initiate the healing circle
(Hart, 1997; Nabigon et ak, 1998). It is also tradition for the Elder to say a prayer, and

^ Meanings o f cultural symbols such as the Medicine Wheel are fluid, as they vary by degree from
individual to individual (Pocock, 1988), as well as temporally.

26
then introduce himself or herself to the participants and share some experiences to
establish an atmosphere of sharing. A stone, stick, or feather is passed to each person in
the circle, moving to the right, and each person shares his or her story (Morrisseau, 1998;
Vogel, 1970).
Lambert (1993) notes that the healing circle is a useful tool in community healing
and development processes. Furthermore, Poonwassie and Charter (2001, p. 8) state that
“healing circles are powerful vehicles for healing and transmitting values.” For example,
both the British Columbia Healing Our Spirit and British Columbia First Nations AIDS
Society use the healing circle teaching to address the exclusion of and prejudice against
those who are infected and affected by HIV/AEDS (Marsden, Clement, & Schneider,
2004).
The healing circle is also a very positive tool for Canadian Aboriginal
communities striving to begin the process of healing and cultural revival (Canada, 1996a;
Hart, 1997). For example. Family Violence Initiative of the Aboriginal Women’s
Program, Department of Canadian Heritage, hosted a Learning Circle at the Odawa
Friendship Centre in Ottawa in March 2002, as a way to “share knowledge and
information; explore lessons learned from the work to date, and gather community-level
insight on the issues and direction for the future” (Jamieson & Semanyk, 2002, p. 4).
Any approach to improving the mental health and well-being of Aboriginal
peoples must consider the use of traditional knowledge and practices, and involve more
than the traditional mainstream services. A cross-cultural integrative approach is an
appropriate strategy for Aboriginal people to use to further their healing journey (Culley,
1991; Graveline, 2000; McGovern, 1998).

27
Integrative Approaches to Mental Health
European concepts of mental health have been identified as largely ineffective in
responding to the needs of Aboriginal people (McCormick, 1996; O’Neil, 1993; Trimble
& Fleming, 1990; Warry, 1998). It is well documented that Aboriginal people not only
avoid using mainstream mental health services (McCormick, 1996; Trimble & Fleming,
1990), but also experience an unusually high dropout rate when services are accessed
(Sue, 1981). According to Smye and Mus sell (2001);
Mental health programs and services designed in keeping with dominant cultural
(biomedical) views of mental health and illness ignore the unique cultural
identities, histories and sociopolitical contexts of the everyday lives of Aboriginal
peoples, putting them at risk of not having their health care needs recognized and
met. (p. 9)
Mignone, O’Neil, and Wilkie (2003, p. 26) suggest that “there should be
continued effort to adapt psychotherapeutic interventions to different First Nations
cultural realities, in particular to develop culturally sensitive and appropriate practices.”
Mignone, O ’Neil, and Wilkie (2003) also insist that it is equally important for the
integration of the mental health system with Aboriginal healers.
A notable example of a cross-cultural integrative approach is the Phoenix Indian
Rehabilitation Centre, which uses a standard 12-step-based A A counseling program
along with several traditional American Indian spiritual treatment modalities, including
participation in sweat lodges and talking circles, visits by American Indian spiritual
advisers, and attendance at local cultural events such as powwows (Gutierres, Russo, &
Urbanski, 1994, p. 1779).

28
Another cross-cultural integrative program is the Healing Forest Model of White
Bison. Based on the concept of the Medicine Wheel, the Healing Forest program grouped
the 12 steps of a standard AA program into four sets of three, associating each set of steps
with a seasonal character (i.e., spring, summer, fall, and winter). Watts (2001) explains
the significance of the four seasonally defined stages as follows:
Generally, steps associated with the east involve the process of coming to
recognize the Great Spirit as being there “to help us regain our responsibilities
and model the life of our forefathers” (Simonelli, 1993, p. 2). Steps associated
with the south involve letting in helpful advice by opening oneself to one’s place
in the circle of life, admitting weaknesses, and praying to the Creator for
intercession. The west directional steps involve regaining control via mediation,
as the individual gains strength through reliance on the Great Spirit’s assistance
and actively makes amends for weaknesses while practicing sobriety. The north
stage involves being there for others, as the individual maintains a life of no
longer being dependent upon alcohol or drugs and actively engages in sharing the
message of these steps with others, (p. 40)
The Alkali Lake program in British Columbia is an example of a social/health
initiative that has incorporated aspects of traditional healing such as the sweat lodge and
pipe ceremony as part of a purposeful movement to revive and relearn Aboriginal
spiritual ceremonies (Johnson & Johnson, 1993). The incorporation of these traditional
practices is thought to have had an influence on the overall improved sense of community
well-being (Johnson & Johnson, 1993).
Waseskun House, located in Montreal, is devoted to the healing of male

29
Aboriginal federal and provincial ex-offenders. The Waseskun House Program is rooted
in an inclusive approach to Native cultural tradition and a here-and-now awareness of
current global realities (Kelly, 2002). It takes an active and responsible approach to re­
integrating male ex-offenders into their communities of origin (Kelly, 2002). Using the
symbolism of the Medicine Wheel as a model for the developmental journey, and the
balance of the emotional, physical, mental, and spiritual aspects of human nature as a tool
for individual integration, community members are encouraged to examine their personal
life experiences in the context of the principles fundamental to a traditional Native
understanding of reality (Kelly, 2002).
Finally, the Stony Mountain and Rockwood Institutions program is one of a
growing number of treatment programs for Aboriginal and non-Aboriginal sex offenders.
The program integrates traditional practices such as healing rituals to help offenders
rediscover their culture, their spirituality, their identity and their pride, which
consequently requires a will to participate and an openness to integrating new practices
on the part of the therapists. One of the essential stages of this process consists of
approaching the Elders and integrating them into the working group as counsellors and as
providers of services such as healing rituals and counseling (Williams, Vallée, & Staubi,
1997).
It can be seen from this literature review that health and wellness for Aboriginal
people is seen within a holisitic and community lifestyle framework. The review also
suggests that Aboriginal people can greatly benefit from a closer liaison between the
Western and Aboriginal worldviews.

30
Chapter 3: Research Design

To explore the participants’ experience of the piloted integrated personal wellness
mental health program and how such experiences would help to inform models of
integrated mental health services for Aboriginal people, I needed to develop a research
methodology that fit the problem statement, research context, and objectives of the
research question (Patton, 1990; Riessman, 1994). In this chapter, I discuss the research
design, methodology, and methods employed in this study.

Case Study Design
A case study approach to qualitative inquiry is described as an in-depth, holistic
description and analysis of a “bounded phenomenon (i.e., case) such as a program, an
institution, a person, a process or a social unit” (Merriam, 1988, p. xiv). The paramount
objective of a qualitative case study is to understand the meaning of an experience. It is
an effort, Patton (1985) writes:
.. .to understand situations in their uniqueness as part of a particular context and
the interactions there. This understanding is an end in itself, so that it is not
attempting to predict what may happen in the future necessarily, but to understand
the nature of that setting, what their lives are like, what’s going on for them, what
their meanings are, what the world looks like in that particular setting— and in the
analysis to be able to communicate that faithfully to others who are interested in
that setting, (p.l)
Further, qualitative case study research is seen as an appropriate research

31
approach for dealing with critical problems of practice and extending the knowledge base
of education (Stake, 1995). For the purpose of this research, the type of case study design
used was formative in nature. The intent of the study is to contribute to the limited body
of knowledge concerning the integration of mainstream psychotherapy techniques and
traditional Aboriginal healing approaches in the construction of culturally relevant mental
health and clinical social work practice frameworks.

Locating the Case Study Design in Qualitative Inquiry
Qualitative research is a process of inquiry that explores a social or human
condition in a holistic manner (Stringer, 1996). Sherman and Read (1994, p. 1) assert that
qualitative research can be defined simply as “research that produces descriptive data
based upon spoken or written words and observable behaviour.” As such, it is more in
tune with the culturally specific oral traditions and non-positivist epistemological
worldview of Aboriginal society (Ross, 1996).
Thus, qualitative research design can serve to enhance the authentic voice of the
participants in the sharing of their stories, while also enriching the healing process
through the detailed descriptive and narrative richness of their experiences of survival
(Gilchrist, 1997). I wanted an approach that would allow my participants to share their
stories in a manner that took note of their importance. The participants were all given the
opportunity to “tell their story” about their experience or sense of the six-week personal
wellness mental health program. I wanted them to know they were being heard and that
what they said would be used to inform new options for Aboriginal mental health
services. My intention was realized, and one participant noted it this way in his interview;

32
“This process really helped me to overcome a lifetime of anguish and hopelessness.” He
further shared how this experience “opened up feelings” about himself and his sense of
being Aboriginal that he had “not eonsidered before.”
In addition to the appropriateness of the eultural fit, qualitative research has
emerged as a major influence in contemporary clinical practice and research (Maione &
Chenail, 1999). For example, in the development of family therapy, there have been a
number of influential elinical qualitative research projects in which researchers and
therapists have imaginatively, intuitively, rigorously, and relevantly explored the
application of metaphor in the study of clinical practice and theory (Andersen, 1991;
Bateson, 1972; Selvini-Palazzoli, Boscolo, Ceechin, & Prata, 1980). As my personal
approach to practice is that of a elinical-healer, with a heavy emphasis upon mindfulness
and reflection in my practice, it is essential for me to adopt a research approach that
allows me to bring my self into the inquiry process.
A third reason to situate my research in the qualitative paradigm is that the
research process itself is emergent; theory, methodology, and method may evolve in
response to and in the course of the research experience. The qualitative paradigm offers
me a diverse range of methodological options that can be considered to best reflect and
capture the learning opportunities available within the inquiry (Cresswell, 2003; Denzin
& Lincoln, 2000).
Finally, the qualitative paradigm is most congruent with the aims of Aboriginal
science. Aboriginal literature is highly critical of the (white) male-dominated positivistic,
rational, or quantitative paradigm because of its intent to generalize experience, find
universal truth, and minimize difference and eomplexity. By contrast, the aim of

33
qualitative research is to enhance understanding. This is compatible with the Aboriginal
epistemological worldview, which seeks to understand the lived experience of people in
all its complexity and diversity, and without any intention of uncovering a universal truth
about experience or phenomena. For example. Ermine (1995, p.103) states that
Aboriginal epistemology is based upon a paradigm “congruent with holism and the
beneficial transformation of total human knowledge.” Colorado (1988) further explains
that Aboriginal epistemology is a holistic and spiritual process whereby information is
gathered from the mental, physical, social, and cultural/historical realms. The metaphor
for information gathering is the tree, which exchanges and stores energy from nature. All
of science has a basis in the natural world and the foundation of that knowledge must be
strongly rooted in the individual’s origins—that is, understanding the interconnection and
interdependence of all things. In this way. Aboriginal science is a very personal journey
that ideally draws upon and results in balance, harmony, and peace.

A Formative Approach
The research was formative in nature. Participants were presented with the
opportunity to provide feedback throughout the six-week piloted program. This allowed
for opportunities to strengthen the program during the research process and to solicit
further feedback on changes that were made.

34
The Case Study Method
In this section, I provide a description of the process I used to conduct my
qualitative case study.

Defining the case.
According to Adelman, Jenkins, & Kemis, (1983), the decision to focus an
inquiry around an “instance” is what makes an inquiry a case study. In this research
design, the “instance” under inquiry was the experience of participants involved in a 6session integrated personal wellness mental health program.

Participants.
Chein (1981) explains that there are two basic types of sampling in case study
research: probability and non-probability. According to Chein, non-probability is the
sample method of choice in qualitative research. The difference between non-probability
and probability sampling is that non-probability sampling does not involve random
selection and probability sampling does (Merriam, 1988). Patton (1980) further explains
that since generalization in a statistical sense is not a goal of qualitative research,
probabilistic sampling is not necessary. Therefore, for the purpose of this study,
“purposive” or “criterion-based” sampling was used to select and identify research
participants.
One such purposive sampling strategy is unique-case selection (Goetz &
LeCompte, 1984), where selection is based on a “unique attribute of a population.” From
this standpoint, 1 approached several Aboriginal residents of Winnipeg with whom 1 had
ties as a member of the Aboriginal community. 1 met in person with the prospective

35
participants for periods ranging from 45 minutes to an hour, generally over tea, coffee, or
a meal. During this time, I learned more about who they were and they learned more
about both the research and me as a researcher, including why I was interested in the
topic and what I thought could be learned from conversations with individuals such as
themselves. All of these conversations were uplifting and informative. Out of 15 people
contacted, 6 agreed to volunteer as research participants. The participants ranged in age
from 25 to 65, and all had attended residential school or had been affected by an extended
family member who had attended residential school. Each participant was then invited to
complete a self-reporting mental health assessment^ to assess their personal struggles in
achieving personal wellness. (The results of this assessment are reported in Appendix A).
It is important to note that my intention here is not to suggest that the issues reported in
the self-assessment were directly or indirectly related to their experience with residential
school, but rather to provide some evidence that the participants involved in the study
were besieged by a variety of mental health issues affecting their sense of personal
wellness.

Data Collection Method
Data for this study were collected from two primary sources: conversational-style
interviews and a focus group. The idea of employing multiple data sources, known as
data triangulation, was used to strengthen the credibility (i.e., the convergent validity) of
the study (Clarke, James, & Kelly 1996; Denzin & Lincoln, 1998; Koch 1998).

^ The self-reporting mental health assessment is a non-scientific tool developed by Registered
Clinical Counsellor Shirley Turcotte and used as a self-measurement guide for clients who have
experienced some form o f trauma in their lives.

36
The Conversational Interview
In qualitative case study research, the main purpose of an interview is to
understand the world from the subjects’ point of view, to unfold the meaning of their
experiences, and to uncover their lived world (Kvale, 1996). A conversational-style, faceto-face interview guided by a standard set of open-ended questions (see Appendix B) was
used to interview the research participants (Monette, Sullivan, & Dejong, 1994).
Interview questions were formulated to assess the effectiveness of both the “focusing”
technique and “healing circle.” A non-scheduled format was used to allow for the
flexibility required to form a personal connection with each of the research participants
(Colorado, 1988; Gilchrist, 1997).
Interviews were conducted at the conclusion of the final session, at the location
where the program was delivered. Before the interview, participants were given the
opportunity to review the questionnaire and consent form, which outlined the purpose of
the study. A tape recorder was used for all of the interviews.
The conversational approach to the interview encouraged an open, interactive,
reflective, and engaged discussion, which is considered to be consistent with qualitative
inquiry (Kvale, 1996; van Manen, 2003). Eisner (1991, p. 183) states that “conducting a
good interview is, in some way, like participating in a good conversation: listening
intently and asking questions that focus on concrete examples and feelings rather than
abstract speculations...”
Following introductions, an initial 5 to 10 minutes was spent reviewing the
purpose and process of our conversation. This helped to establish a warm atmosphere,
encouraging the participants to talk about their experiences. A number of interview

37
techniques were used to elicit further commentary on selected aspects of the participants’
experiences (e.g., probing, reflection, silence). Flexibility was also needed. Many
participants valued the new insights and meanings that arose in their discussions of
various experiences. On average, the conversations lasted 30 to 40 minutes, concluding
when the participants indicated that there was nothing further to add.

The Focus Group
According to Patton (1990), focus groups can be used at any point in a research
program: as part of a needs assessment, during a program, at the end of the program, or
months after the completion of a program to gather perceptions of the outcome of the
program. A positive feature of this data collection strategy, according to Krueger (1994),
is that it provides a social forum, allowing participants to hear and consider other
opinions. Developing this emphasis on interaction, Kitzinger (1995, p. 299) writes that
“the idea behind the focus group method is that group processes can help people to
explore and clarify their views in ways that would be less easily accessible in a one to
one interview.” Focus groups are also an effective means of promoting dialogue and
exchange that can help participants clarify their own ideas and opinions on a subject
(Morgan & Krueger, 1993; Orbe, 1998). Bloor, Frankland, Thomas, and Robson (2001)
note that “focus groups provide a valuable resource for documenting the complex and
varying processes through which group norms and meanings are shaped, elaborated and
applied” (p. 17).
Stewart and Shamdasani (1990) summarize the more common uses of focus
groups: they include obtaining general background information about a topic of interest;

38
generating research hypotheses that can be submitted to further research and testing using
more quantitative approaches; stimulating new ideas and creative concepts; diagnosing
the potential for problems with a new program, service, or product; generating
impressions of products, programs, services, institutions, or other objects of interest;
learning how respondents talk about the phenomenon of interest which may facilitate
quantitative research tools; and interpreting previously obtained qualitative results.
According to Stewart and Shamdasani (1990), focus groups should grow directly
from the research questions that were the impetus for the research. When formulating
questions for the focus group, Stewart and Shamdasani (1990) suggest that the questions
be ordered from the more general to the more specific, and that questions of lesser
importance be asked early in the process (to build trust and safety of members), while
those of a greater significance should be placed near the end.
The focus group questioning guide for this study was based on the key themes
that emerged from the interview data. The focus group was conversational in nature and
framed by the opening invitation to participants to speak openly and freely about how
they experience the six-week program. The focus group lasted about two hours.
As the principal facilitator of the focus group, I was mindful of the role of the
facilitation process in relation to the nature and quality of the data collected (Vaughn,
Schumm, & Sinagub, 1996). Basch (1987, p. 415) points out how important it is for the
moderator to “create a non-threatening supportive climate that encourages all participants
to share views, facilitating interaction among members, and interjecting probing
comments, transitional questions and summaries without interfering too brusquely with
the dialogue.” As moderator, I paid close attention to issues of power and domination by

39
keeping track of who spoke and for how long. I facilitated interaction by inviting each
participant to make comments (e.g., “Is this similar to your experience?”). I also posed
probing questions to draw out different points of view (e.g., “How does this experience of
trust relate to your other experiences with mental health services?”). This allowed
participants to move back and forth between the whole and the parts in order to elaborate
meanings and to consider possible relationships between experiences on the fundamental
phenomenon of sense of community.
Following the conclusion of the focus group, participants were afforded an
opportunity to comment on their focus group experience. Overall, the participants
reported that they found the conversation thought-provoking and stated that they “gained
personally from their involvement.” The focus group was tape-recorded and transcribed.
As with the individual interviews, the focus group data was reviewed within 48 hours to
increase accuracy.

Data Analysis
Data analysis in qualitative research is an inductive process (Guba & Lincoln,
1989), meaning that the critical themes emerge out of the data (Patton, 1990). It is
defined by Bogdan and Biklen (1982, p. 145) as “working with data, organizing it,
breaking it into manageable units, synthesizing it, searching for patterns, discovering
what is important and what is to be learned, and deciding what you will tell others.” The
primary method used for data analysis was a grounded theory approach (Strauss &
Corbin, 1990) that involved a process of coding transcripts to generate categories.

40
In the present study a fully developed grounded theory approach was not utilized.
Rather, a method of thematic analysis (Lewis, 1995), which draws on principles of
grounded theory, was utilized to identify themes in individuals' accounts of their
experiences of the six-session Aboriginal mental health personal wellness program. In
other words, the grounded theory method was not used in an interpretative way to
develop a “theory,” but as an aid to identifying and organizing themes in participants’
accounts (Glaser & Strauss, 1967; Strauss & Corbin, 1990). The generated analysis is
grounded not only in participants' accounts, but also in researcher subjectivity, which
ultimately shapes the whole research process, including the analysis (Henwood &
Pidgeon, 1994). The open coding method of data analysis provides the opportunity to
“open inquiry more widely” (Berg, 1995, p. 236). Crang (1997, p. 186) describes the
coding process as getting as close to the material as possible and keeping notes that make
up “theoretical memos” to trace the development of new ideas and insights. Procedures
that were followed are outlined in more detail below.

Stage 1: Transcribing.
The audio recordings of the interviews were transcribed into text within 48 hours
of the interviews by two transcribers who have bachelor’s degrees and had agreed to
respect the anonymity of the participants by not identifying them in the text.

Stage 2: Getting to Know the Data
The interview transcripts were read several times by me and two other
independent reviewers to provide an overall idea of the content.

41
Stage 3: First Level Coding
Open coding was then used in a line-by-line analysis of the text. Thematic
statements or meaning units that seemed particularly revealing about the phenomenon
under investigation were isolated and inserted into Column 1 of the data analysis
worksheet (see Table 3.1). The thematic statements could be one or several statements.
The following guidelines, as outlined by Holsti (1969, pp. 99-100), were also adhered to
in the category/theme building process:
1. The categories should reflect the purpose of the research.
2. The categories should be exhaustive.
3. The categories should be mutually exclusive.
4. The categories should be independent in that “assignment of any datum into a
category [will] not affect the classification of other data.”
5. All categories should be derived from a single classification principle.

Table 3.1
Columns I, 2, and 3 o f the Data Analysis Worksheet
Column 1
Interview question
Can you describe your
experience as a participant in
this program?
-

Column 2
Meaning Unit
Actually I find the facilitator helpful
and friendly.
He knows what he is talking about. 1
like the fact that he is Aboriginal. He
seems to understand us.
I felt that I could trust him right away.
He is very respectful.

Column 3
Open Coding Themes
Facilitator
Trust
Aboriginal Facilitator

Stage 4: Second-Level or Axial Coding
The next stage of analysis involved re-examination of the categories identified in

42
Stage 3 to determine how they are linked, a complex process sometimes called “axial
coding” (Strauss & Corbin, 1990). This step enables the researcher to link subcategories
to a category in a set of relationships, and also enables further dimensionalization of
categories (Strauss & Corbin, 1990). Glaser and Strauss (1967) state that the lower-level
categories (or codes) emerge relatively quickly and that higher-level categories tend to
come later, when integrating concepts. As illustrated in Table 3.2, the initial list of
categories or themes changed as we worked with the data.

Table 3.2
Columns 2, 3 and 4 o f the Data Analysis Worksheet
Column 2
Meaning Unit
Actually I find the facilitator helpful and
friendly.
He knows what he is talking about.
I like the fact that he is Aboriginal.
He seems to understand us.
I felt that I could trust him right away.
He is very respectful.

Column 3
Themes
Facilitator

Column 4
Axial-Level Themes
Relationship

Trust
Aboriginal
Facilitator

Stage 5: Selective Coding—Bringing It All Together
During the selective coding process, all three interpretations of the data by the two
independent reviewers and me were brought together to form one case study record.
Following a creative and iterative process to discover the core categories, we reached a
consensus on five central themes: experience, relationship, spiritual connectedness,
empowerment, and self-awareness.

43
Stage 6: Checking It Out
The data analysis in the form of the constructed themes was then returned to the
participants in the form of a focus group to review for accuracy and enhance the
trustworthiness of the data.

Ethical Considerations
Qualitative research often involves the researcher exploring very personal
experiences of other people, and in so doing the researcher must ensure that the rights of
their human participants are not violated (LoBiondo-Wood & Haber, 1994). The proposal
for this study was submitted to and approved by the University of Northern British
Columbia’s Human Research Ethics Committee. All participants were provided with an
information letter (see Appendix D) that outlined the process and purpose of the study
and warned of potential risks. Participants were assured of the voluntary nature of their
participation and that complete confidentiality and anonymity would be maintained.
Participants were also presented with a consent form to be signed before their
participation in the face-to-face interview. The consent form indicated that consent could
be withdrawn at any time without penalty or need for explanation.

Methodological Integrity
Regardless of the research paradigm, it is now commonly accepted that the
quality of scientific research done within a paradigm has to be judged by its own
paradigm’s terms (Healy & Perry, 2000). For the purpose of this study, I chose to use
Lincoln and Cuba’s (1985) four criteria (credibility, transferability, dependability, and

44
confirmability) for trustworthiness in qualitative studies within a critical or constructivist
paradigm.

Credibility
The notion of credibility in qualitative research, the counterpart of internal
validity, depends less on sample size than on the richness of the information gathered and
on the analytical abilities of the researcher (Denzin & Lincoln, 1998; Patton, 1990;
Schwandt, 2001). It refers to the truth, value, or believability of findings as “known,
experienced, or deeply felt by the people being studied” (Leininger, 1994, p. 105). It
reflects the efforts made to address the issue of “fit” between respondents’ views and the
researcher’s representation of them (Ray, 1994; Sandelowski, 1995; van Manen, 2003).
Credibility was enhanced in this study by sharing with the participants the results
of the intensive data analysis process. Other procedures used to increase the level of
credibility in the current study included the judicious use of illustrative quotations, the
convergence of multiple sources of data (method triangulation) through the use of
interview and focus group data collection methods and the employment of two
independent second readers.

Transferability
Transferability (comparable with external validity) refers to the degree to which
particular findings from an interpretive study “can be transferred to another similar
context or situation and still preserve the particularized meanings, interpretations, and
inferences” (Leininger, 1994, p. 106). Transferability suggests that detailed, rich (or

45
“thick”) description is required in order to provide sufficient information to enable
reviewers to judge the applicability of the findings to other settings (Seale, 2002).
Congruent with the term transferability, the concepts of applicability and fittingness also
have been used in the literature (Sandelowski, 1986). I attempted to meet these criteria in
the detailed writing-up of the results of the study. This is commonly referred to as “thick
description” of methods and findings; it is important because it allows readers to make an
informed judgment about whether they can transfer the findings to their own situation
(Denzin & Lincoln, 1998; Patton, 1990).

Dependability
Dependability (comparable with reliability) refers to the extent to which people
not involved in the study can track the research process and determine which raw data
were used to reach corresponding conclusions (Erlandson, et al., 1993; Schwandt, 2000).
It also addresses the extent to which the research process is consistent across researchers
(Benner, 1994; Lincoln & Guba, 1985).
In this study, dependability was ensured through a trail of raw data, what Padgett
(1998) refers to as an “audit trail.” I kept detailed records of the data collection process
and analysis procedures, allowing interested people to reference exact quotes and
corresponding interpretations.

Confirmability
Confirmability is described as being parallel to objectivity. It is the need to show
that data, interpretations, and outcomes of inquiries are rooted in contexts and persons

46
apart from the evaluator and are not simply figments of the evaluator’s imagination. All
data must be trackable to its source, and the logic used to assemble the interpretations
into structurally coherent and corroborating wholes is both explicit and implicit in the
narrative of the case study.
Confirmability was achieved in this study through the researcher’s critical selfreflection about his assumptions, world views, biases, theoretical orientations, values, and
epistemological stances (Merriam, 2000). These biases were also moderated and checked
by having two independent readers.

Limitations o f the Research
Small Sample
In this case study, a small non-representative sample of 6 participants was
selected with whom I had ties to as a member of the Aboriginal community in Winnipeg.
While the sample of participants was intended to represent Aboriginal people who have
experienced the adverse affects of residential school, the sample was small and the
participants may have been uncharacteristic of the stakeholder group they represented.
Therefore, while the collection of thick data is theoretically useful in order to increase
comparison of the study context to other contexts (Caelli & Mott, 1997), this study makes
no claim that it is inevitable. For instance, van Manen (2003) writes that it is
inappropriate to ask for a conclusion or a summary of an interpretive qualitative study.
Instead, describing original experience is primal telling.

47
Researcher Bias
A further limitation of this study is the way in which my theoretical bias and
position as an Aboriginal person might influence this research. Despite the fact that
qualitative research allows the researcher to be an active participant in the study, all
scholars occupy a particular social location, and theories derived from that location might
not be inclusive of voices from the margins, where culture or ethnicity are defining
dimensions of the experience. Arbitrary formulations of pre-understanding or lack of
reflexivity during the research process could have led to potential bias in the findings. To
address the potential for researcher bias, the research design included a team of two
independent readers.
Another source of researcher bias was the multiple roles I played as therapist,
interviewer, and focus group facilitator.
Language
Another potential limitation of this study was that the interviews and focus group
were performed in the English language. This was an issue because many of the concepts
and traditional values that reflect the Aboriginal worldview are most effectively
expressed in Aboriginal languages.

48
Chapter 4: Data Analysis

This chapter presents the findings from the evaluation that emerged from the
interviews and focus group. This study has been driven by Aboriginal values and beliefs
and the analysis has been based on Aboriginal participants, which is, to the investigator.
Aboriginal research. Having the participants evaluate the program and give feedback
contributes to its cultural appropriateness. This method allows the participant’s voice to
be heard and put into action, where the program fits the participants—not the participants
fitting into the program.
In the first level of the data analysis process, five salient themes surfaced that
captured the breadth of the participants’ experiences of the six-session mental health
personal wellness program. In reviewing these findings, it is important to understand that
the Aboriginal worldview is one of an interconnected and interrelated world. As such, it
is not surprising that the themes that emerged in this review reflect that worldview.
The first theme, experience, speaks to the value Aboriginal people place on the
importance of “experiential” knowledge over “objectivist” knowing. This point is
illustrated by Bourgeois (1998), who writes:
The Anishinaabeg have no term for [the separation of] man/nature, or [this]
subject/object dichotomy in their language, because there is no nature, or
environment, as such, understood to be separate from the self. In my initial
research in the [Anishinaabemowin] dictionaries I did not find words for art,
philosophy, mind, and knowledge. There certainly is religion, art and philosophy
in Anishinaabe life. However, they exist as abstract nouns. What I am talking

49
about is a completely different worldview, a worldview where we relate and
interconnect everything with a manido (spirit) dwelling within everything, (p. 9)
The second theme, relationships, highlights the Aboriginal way of understanding
the world, through looking at the relationships among all parts of creation. Relationships
appear at the heart of Aboriginal knowledge. These relationships are symbolized through
sweat lodge ceremonies and healing circles that enable people to connect with all
creation. In Anishinaabe Philosophy: An Introduction, Rheault (1999) observes;
An underlying truth for the Anishinaabe is the inherent relationship, and belief in
a relationship, with Mother Earth. The Anishinaabe are physically and spiritually
bound in this relationship, and this relationship defines each person as child of
this Mother...the one fact that seems to distinguish the Anishinaabe from those
who live in a Western Euro-American way is that the Anishinaabe understand that
the umbilical cord was never cut. Like a fetus in its mother, we are constantly
drawing nutrition and life from our Mother. We cannot go anywhere without her,
and even in our most far reaching voyages we are dependent on the life our
mother provides for us; ask any astronaut. So what is it about the Earth Mother
that permeates Anishinaabe philosophies? In a word: circularity. We are witnesses
to the circularity of the seasons, of life and death and life again, to the cycles that
drive our very existence. The Circle of Life, the inter-connectivity of all Beings, is
the primordial worldview and it is the very essence of Anishinaabe-ness as well as
the foundation of Anishinaabe cultural and spiritual codes, (pp. 1-2)
The third theme, spirituality and connectedness, reflects the holistic nature of the
Aboriginal worldview. Central to this holistic approach is the assumption that balance is

50
the ideal to strive for and that all activity, human and otherwise, is directed toward this
goal (Kirmayer, Simpson, & Cargo, 2003; Scott, 1994). With respect to the self, the
person is made up of four equal parts (the physical, the emotional, the mental, and the
spiritual) and each of these parts must be nourished in order to live a healthy, happy, and
productive life (Canada, 1996a; Scott, 1994). As stated by Scott (1994), Aboriginal
culture advocates that “spiritual needs are every bit as important as hunger and thirst” (p.

152X
The theme of empowerment demonstrates the deep desire of Aboriginal people to
regain their voice and place in the world as equal citizens, not second-class citizens, in
their own homelands (Assembly of First Nations, 1994; Bopp et al., 1985). Through
empowerment. Aboriginal people are able to tell their stories as they have been witnessed
and experienced. When therapists share a small piece of their own story, this role models
empowerment and is important for development of a meaningful connection with the
people with whom they work.
Finally, the theme of self-awareness is further evidence that people can truly find
their own answers when they seek their own inner truths and indicates the power of
healing from within, with the integration of a non-traditional, non-intrusive, clientcentred psychotherapy with the healing circle means of self-healing is possible.

Experience
For Aboriginals, one of the most important gifts that a person can possess is the
gift of experience (Castellano, 2000; Colorado, 1988). One of the themes that quickly
emerged in the data analysis process was experience. It was quite clear that the

51
participants who volunteered to participate in the pilot program were doing so to add
another experience to their lifelong healing journey. It was important to all of the
participants that the therapist came from a place of experience as well, rather than a place
of “knowing” and telling. Participants often commented on the balance between the
therapist’s personal life experience and formal academic training. This balance gave
participants a sense of safety;
“Just knowing the person who did the focusing was educated and experienced
many traumas as well as having experience in this type o f field made me at ease
in this healing process, this is what our people need in order to heal.
It was vital for the participants to know the therapist’s direct experience with
focusing from an educational and personal point of view. From an Aboriginal
perspective, to be an effective counselor or therapist you are expected to come from
similar experiences and be well on your way with your healing journey and to share what
has worked for you in your healing journey. Several participants made comments about
the importance of bridging the Western way and the Aboriginal ways of healing to
integrate them in a balanced way. One group member concluded:
“Dealing with the mental, emotional, spiritual, and physical realms as an
experiential process using western and traditional methods adds to the healing
journey as they are all connected. ”
The therapist needs to aequire, through his or her own personal experience, the ability to
balance and integrate healing methods from Western therapies and traditional healing
methods.

The quotations from the participants used in Chapters 4 and 5 are taken largely from transcripts
o f the interviews and focus group, and are verbatim (i.e., have not been edited or corrected in any way).

52
In the healing process for many Aboriginal people, it is vital for them to own the
healing journey, as ownership of one’s experiences provides a sense of empowerment,
which is needed for a successful intervention. Many of the participants spoke about the
importance of their own experience over the course of the pilot program:
“My experience in the program was delightful, trusting and confidential. Gave me
a sense o f belonging to an important group and allowed me to share my story
with others. ”
“Experiencing this process offered me an opportunity to move forward in my
healing journey. ”
The experience of going through a healing program and sharing the information
on how it was beneficial to the participants links indirectly to community healing and
development. In many Aboriginal communities, sharing information through telling
stories of personal experiences is a way of healing.
Participants expressed a desire to experience something new and different to
assist them in maintaining a forward direction in their personal healing. Many times
during the program, participants who had sought therapy previously stated that they
noticed more of a difference in themselves as a result of the program than in other types
of therapy:
“This process offered me an opportunity to move forward and acknowledge my
own person as an observer than a critic enabling me to express myself. ”
The sharing of new information is vital for growth in the healing process for
Aboriginal people. How the information is shared in an experiential format, however, is
just as vital to the healing process. It is important to introduce new information in small

53
chunks and back it up with a personal example to relate it into real-life situations; this
creates a sense of connection and comfort for some Aboriginal people in a group setting:
“The process thinking carefully and communicating and our thoughts were clear
and understood and the new information was broken up into small pieces and this
added to my healing. ”
For many Aboriginal cultures, experiential learning, slowly and with limited information,
through the sharing of stories and working through them at the same time, is the most
practical way to incorporate theory and practice.

Relationships
Relationships with the earth, air, water and the creator are a crucial part of many
Aboriginal tribes’ healing processes and ceremonies. Similarly, relationship building is
vital in making a strong emotional connection during the healing process. Participants
talked a great deal about the value of the relationships they had built among themselves;
they also emphasized that they had met previously and developed relationships during the
initial contact with each other, which made it easier to establish a sense of safety within
the group:
“The experience in the group was very supportive it felt like I was part o f a
family. What really helped a lot was the group knew each other which made very
comfortable and very open to express yourself fully. ”
When a strong relationship is formed within a group, it takes the members’ healing to a
deeper level to access the core issues and to wholly deal with behaviours, emotions, and
psychological barriers, to release them through the healing process in a holistic manner.

54
When forming relationships to assist in a group healing process, it is important for
the therapist to form a link with the participants;
“The process met my needs because I need to go look in these spaces that I would
not he able to do so by myself. I was able to do so with the help o f our instructor
because he didn ’t leave me alone and also made sure I felt safe and was not
leaving the session in my teen state. I left in my adult state this made me feel a
connection to him. ”
When the therapist has established a strong bond with the participants, they are able to
take their healing to a deeper level, enabling them to go through the process in a positive,
respectful, trusting, and safe way:
“(therapist) walking with us through the Focusing issue was supportive, you
never left us alone when it was scary to share our felt sense and I was able with
your assistance to move beyond the scariness. ”
Walking beside the participants as they explore a past traumatic experience throughout
their healing journey deepens the relationship and the healing process.
Trust was another important factor in the relationship building, ensuring that
confidentiality was maintained throughout the process for the participants. Trust is a
catalyst for growth and healing for many Aboriginal people when they are sharing their
stories:
“the process o f letting the participants know that confidentiality is very important
was really important in establishing trust in the group. ”
Sharing of personal stories by each of the participants enabled all of the group
members to develop trust and open up with their own stories to further their healing

55
journey:
“I feel safe with my classmates to share my feelings as I listened and learned to
other’s stories. ”
Trust builds safety and plays a vital role in the healing process of Aboriginal
people. Such trust was broken many times and for many generations by governmental
authorities. Trust clearly has to be established when beginning to work with Aboriginal
people. With trust also comes safety. For generations, the safety of Aboriginal people has
been jeopardized through many thoughtless programs, interventions, and therapeutic
techniques. Many of the programs developed for Aboriginal communities have not been
mindful of the safety Aboriginal people feel in being in a trusting and empathetic
relationship as opposed to the objective arms-length approach of Western
professionalism:
“Bill walked us through it and made it safe in a kind, compassionate and
respectful way. ”
By connecting in a natural way, the therapist establishes a meaningful relationship
through which to assist the participants in their healing journey:
“Trust at all other levels by Bill.. ”
In many Aboriginal communities, helpers go above and beyond the call of duty to assist
in capacity development and societal healing.
Safety in Aboriginal communities is often established through sharing a part of
yourself with others. Helpers role model, showing that they are able to trust people in the
community they work with:
“And safety was given by Bill sharing some o f his experiences enhanced the trust

56
in the group. Also the tone was reassuring and a lot o f positive respectful
communication. ”
The sharing and engaging a small part of their personal experiences by therapists in an
Aboriginal community is a sign of respect.
Participants indicated that the physical environment further reinforced the sense
of safety that enabled them to move forward in their healing journey;
“The room was relaxing and group was trusting and this gave me the ability to
move forward in my healing. ”
The setting is therefore an important factor in creating a safe, nurturing place in which
healing can take place.
Participants placed a great deal of emphasis on sharing and listening to one
another’s stories:
“Share with another or other’s stories help me in my healing process. ”
The power of sharing in Aboriginal healing circles has moved mountains in the healing
journeys of many Aboriginal people and communities. The sharing of stories has the
ability to touch the lives of each participant in the group, allowing them to make a
personal connection to assist them in their own healing journey:
“Part o f my healing journey is wanting to help someone, who is in need, how
everybody is willing to help one another in the group. ”
The natural capacity of Aboriginal people to assist people through giving of self also
applies in the self-healing process, through the sharing of one’s story to assist others in
their healing process.
The participants’ ability to listen to one another as they share their stories is

57
another important aspect of the healing process:
“Sharing these words can generate strong positive feelings among those sharing
and assist others in their own healing. ”
Another participant reinforced the importance of reciprocal sharing in the healing process
for Aboriginal people:
“They listened and shared and this helped me learn more about myself to move
forward. ”
When people share their stories, a sense of connection and safety is created, allowing
others to open up to further their healing.
Support from other group members is another important factor in establishing a
trusting environment. Support makes it safe for participants to take risks to further their
healing journey:
“I felt safe and also a lot o f support from my group fo r me to move forward in my
healing journey. ”

Spirituality and Connectedness
In Aboriginal culture, one must have a connection with the Creator to be spiritual.
In counselling and group therapy, this connection with the Creator forms a vital link with
the therapist and the participants. Participants described how they felt a sense of
connection, and likened it to cultural appropriateness:
“There was a sacred rapport and the group was very compassionate and the
participant’s attitude was very important that enabled me to enhance my
healing. ”

58
The sense of sacredness that was created through the connection made the healing
journey of this participant deeper and more enriching.
Participants talked about the connection in many realms as important in their
healing journey, and culturally appropriate:
“It was also helpful to have someone who understands and connects with me
emotionally, mentally, and I found it culturally appropriate. ”
Another participant agreed that the multi-level connectedness formed a holistic balance to
their healing:
“It dealt with the mind body, spirit and emotions. Taking care o f it all to have
balance to move forward in my healing is important. ”
There was strong support from the participants for a holistic way of healing:
“Because we went around the medicine wheel. Dealing with the mental,
emotional, spiritual, and physical realms o f a person, which they have to be
balanced in keeping the body in a healthy and in a good way. ”
Conducting the program in a healing circle format fit the participants and provided a
holistic way of assisting in their healing process.
The strong sense of connection reveals that Aboriginal people can once again trust
in their own healing methods:
“1found it culturally appropriate as the group had a good sense o f connection. ”
“Respect in group. I was comfortable with group and to take that risk without
judgments and this allowed me to open up and deal with my past hurts when 1
allowed myself to connect with others. ”
“It dealt with the mind body, spirit and emotions. Taking care o f it all to have

59
balance to move forward in my healing is important. ”
A holistic integrated approach works well for Aboriginal people because that is
what they strive for throughout their lives. With the knowledge gained through this
integrated approach to the healing process, participants were able to approach all aspects
of their lives, as in a Medicine Wheel, which will help with other issues that may arise in
their lives in the future. Participants expressed the importance of sharing their knowledge,
wisdom, and experiences to assist others in their healing process and to build capacity in
our families, communities, and nations:
“Because we went around the medicine wheel. Dealing with the mental,
emotional, spiritual, and physical realms o f a person, which they have to he
balanced in keeping the body in a healthy and in a good way. ”
The Aboriginal way examines all the physical, emotional, spiritual, and mental realms to
seek out answers to assist in the healing process:
“Because this process o f Focusing is almost identical to the four elements in
aboriginal ways. ”
The group process focuses on the body, mind, spirit, emotions, and healing, which is
likened to Aboriginal traditional healing methods:
“The process o f focusing reminded me the four aspects o f life in the Aboriginal
way. Absolutely, I am sure when a native leader needs a dream or session in time
o f crisis he has given a message which is o f a similar process it seems. ”
One spiritual component of this process is in the therapist preparing spiritually,
emotionally, and physically before beginning the process with participants, as instructed
by Elders, to ensure safety and connectedness in healing.

60
There are many versions of the Medicine Wheel, depending on the region; it
differs from one First Nation to another. One participant linked this integrated process
and the Medicine Wheel to the internal and the external part of their healing process:
“Because it’s positive. Also to have a better knowledge o f focusing and the wheel
and connecting with the internal and external part. Take all the negative out and
not to take them home with this healing process. ”
With this connection we are able to examine how the external environment has affected
us from the inside and how we can heal our inner being so we can make a better and
healthier life for ourselves and our families.
The integrated process gave the participants the ability to connect their past with
their present to create a healthier future. Participants described the importance of story
telling about the past in their future healing:
“Yes, because we sat in a circle that was the past, present, future as we did in the
past. When we sat together as an extended family and began to make a strong
connection with one another by sharing some o f our stories we developed a sense
o f spiritual connection. ”
Establishing a connection between the past, present and future is a vital to the
effectiveness of Aboriginal healing.
The first thing the participants learned in the integrated process was how to
breathe, relax, and connect with ourselves, as was done in the past:
“What made it safe fo r me was the relaxing and breathing exercise during
clearing space. I was able to finally connect with myself as my ancestors done in
the past. ”

61
When we breathe, we are able to set aside many intrusive thoughts and feelings and
connect with our true self. When we connect to ourselves in this process in order to seek
answers and healing, it is similar to the vision quest or a sweat lodge ceremony:
“1found that it was culturally appropriate to the Aboriginal ways, such as being
almost identical to a vision quest and sweat lodge. ”
“Yes, it was similar because it’s like a vision guest as in the Aboriginal way, or
when you ’re in a sweat. ’’
The connection between the integrated process and Aboriginal spiritual healing is
quite clear. The integrated method also fits and can be used with other tribal ceremonies
for healing:
“The process in our healing journey was culturally appropriate because you
clear space when you are smudging yourself in the morning to begin your day. ”
Smudging and clearing space can easily be integrated and can complement one another if
used together, making this part of the healing process more culturally appropriate:
“To be able to smudge when and before we begin to clear space will make more
culturally appropriate. ”
This adds to the sacredness of the healing process. When we clear space through
smudging or the clearing space step, we clear out negative thoughts and feelings:
“Because you clear all bad feelings when you clear space and think about the
positive things in you’re life just like in a sweat lodge. ”
Elders tell us that we need to see our negative experiences and behaviours as learning
experiences, taking the negative of a story and turning it into a positive teaching to
correct our behaviours.

62
Using prayer along with the medicines can also make this process more culturally
appropriate for Aboriginal participants. We can begin the healing process with prayers
and tobacco to make it more culturally appropriate:
“Before we begin this process we can offer own prayers and tobacco to the spirit
fo r this process and ask the spirit to help you find the people you need, and trust
that they ’II come. ”
Praying and using the sacred medicines are key components in the healing of
Anishinaabe people and can also be integrated in traditional mental health practice to
make it more culturally appropriate.
One participant recalled that a similar method was used in the past:
“Because this focusing was done in many different ways in our culture. When you
smudge yourself you are breathing and flushing out all negative energy from your
body and mind. ”
The fundamental process is similar to ceremonies used in the past to let go of negative
hurts and emotions in order to aid in the healing process.
For along time, many Aboriginal people (including me) sought out ways of
healing in mainstream methods and found them ineffective and harmful. We were unable
to connect with the therapist, counselor, or psychologist. Aboriginal people often did not
continue in conventional therapies with non-Aboriginal professionals, as we did not fit
into their boxes of understanding from a psychological perspective. The integrated
approach is flexible enough to fit the needs of Anishinaabe people:
“Yes, the process o f culturally appropriate and was very good fo r my healing. ”
“People where they are - physically, emotionally, spiritually whatever that’s

63
needed. I have been looking at experiences that can assist in building up trust,
namely through acceptance o f self-revelations o f self to other’s, faith sharing or
sharing personal experiences and understanding o f one another, through sharing
o f feelings, ideas, beliefs and values. ”
A true client-centred method such as this approach will put the client and his or her
customs and traditions above those of the therapist.

Empowerment
For many decades, Aboriginal people’s voices have been masked or hidden by
various aspects of assimilation or colonization. The resurgence of traditional ceremonies
and healing practices has reawakened the voice of many Aboriginal nations. The result of
this reawakening through the healing process is the empowerment of Aboriginal people.
This research was designed for this purpose to listen and hear what the people
want and what they do not want in regards to assistance with their healing process. What
is appropriate for their healing journeys? One participant said:
“It’s always been our way to look after our own, that is why we need to be more
educated aboriginal people to look after ourselves. ’’
The ability of Aboriginal people to look after their own people was never an issue; it was
the perception of foreigners who were not accustomed to witnessing people of the earth
taking care of themselves in a holistic manner that was the problem.
The ability to connect in many ways is a common thread in these themes. Here a
participant describes the importance of sharing with one another:
“To fully meet the needs fo r our people we must be able to connect with our own

64
similar experiences, that’s how we survived as people it’s important to pass these
stories o f survival on. ”
The healing process should not be taught for personal gain, but to teach others to heal
themselves. That is what empowerment is about. Healing happens through a constant
connection with others throughout the healing journey:
“It made me feel good, it made me feel like I wasn’t alone, one day I hope to
teach others to help themselves. ”
When assisting people going through trauma healing, it is vital for the therapist to have a
strong connection with the people as they do their own work, to witness and share in their
healing journey. Sharing and experiencing the teachings and information enables
Aboriginal people to pass the information along to assist others in their healing process:
“We would carry that knowledge and that wisdom with us, wherever we walk. We
would .share with them and it would come from our spirit, from our own being,
from our own hearts, it was part o f our life, everyday life. ’’
This is the circle of sharing that is passed on to others and may assist them in their
healing process for generations to come.
The sense of empowerment that comes from people knowing that they have
choice and control in their healing process and in their everyday lives is the most
beneficial aspect in the counseling process:
“It is up to you to decide whether you agree or disagree or think something is
missing. The ideas presented are meant to be used as guides and learning how to
listen and to use what you need and leave the rest and teach others. ’’
The method that was taught to the participants gives people total control over their

65
healing process, as they are in full control of what and how they choose to deal with their
past issues. The therapist does not add or take away from their stories.
The shared experience of someone sharing their story and their voice is heard is
another form of empowerment. Others can benefit in their own healing journey from
hearing shared stories similar to their own:
“The experience in the group was very supportive. What really helped a lot was
the group knew each other which made very comfortable and very open to express
yourself fully and learn and heal from listening to one another’s stories. ”
This is a clear indication that sharing a story can benefit others in their healing journey.
Sharing can happen in many ways; one of them is through listening:
“They listened and shared and this benefited my healing. ”
Listening to stories is just as empowering as the sharing of stories in Aboriginal healing
practices. When Aboriginal people get together to share their stories in a healing circle
and learn from one another, the healing process can also contribute to capacity building
in communities.
Safety in sharing is another factor in empowerment. When people feel safe, they
are able to express themselves emotionally, spiritually, and physically, and more openly
and honestly, to aid in their healing:
“I feel safe with my classmates to share my feelings and this was important fo r my
healing journey. ”
When a safe environment is created, it allows participants to share their stories and
experiences and empowers them to move forward in their healing. Creating safety is vital
when working with a population that has been betrayed and disempowered by

66
governments for many generations; this enhances the healing process for many
Aboriginal people. When there is a feeling of safety in a group setting, there is support
for each group member:
''I felt safe and also a lot o f support from my grouping this healing circle. ”
Safety and support within a group greatly enhances participants’ ability to go further in
their healing process. The effectiveness of the healing process is enhanced through the
support of group members for one another when expressing their emotions:
“I felt very safe to express emotions and this was vital fo r me to gain trust and
move ahead. ”
When people are able to safely express their emotions, without being judged, the healing
process in a group setting may begin, thus creating empowerment.
Confidentiality is another means of providing safety and empowerment in the
group process. Acknowledging and discussing confidentiality establishes a safe
environment and allows people to share their stories in a trusting environment:
“The process o f letting the participants know that confidentiality is very
important and the participant’s attitude was very important created another level
o f safety. ”
When an atmosphere of confidentiality is maintained in the group, the expression of
emotions can be free and the healing can begin. Allowing people to fully express
themselves, without judgment or repercussion is true empowerment and healing.

Self-Awareness
An important part of healing is in achieving empowerment through finding voice.

67
along with having the control to observe, listen, and act on one’s own behalf. This is
when a sense of self-awareness occurs and catharsis happens, as one group member
illustrates:
“This process helped me in my healing journey. I was able to look somewhere
where I didn’t want to, it was painful. I was able to go back there at that time and
able to say I am okay and am here today. I am a survivor. I could breathe and
focus clearly. ”
True self-awareness comes with the re-visiting of the past and reframing it into a
positive-past perspective, incorporating it into current behaviours and making the
necessary positive changes for healing.
Once the empowerment of self-awareness begins, the sense of self-control for the
participant reemerges towards growth. The ability to look at oneself in an honest and
compassionate way without self-judgment and having a sense of control over one’s life is
a major part of the healing journey. As one group member shares:
“Facing the person that hurt me in my head and telling him, ‘he can’t hurt me no
more. ’ Made mg feel relief and at ease with what I did. That is one battle kicked
down the hill were all my other garbage is. ”
The courage of this participant to honestly look at what some one has done to him or her,
to re-evaluate the past and come to the conclusion that the past can never hurt him or her
again is where the healing of the old wounds takes place.
When people begin to address their past hurts, their emotional state alters and they
are more comfortable with and aware of their emotions, as this participant describes:
“What had changed fo r me was my emotional state has become more in control

68
and more at peace with my life. ”
Once people notice change in their emotions and perceptions of themselves and of the
past, they acquire a sense of being in more control over their lives, as they release their
past hurts and become more a peace with themselves. Another participant shares a similar
reaction to the healing process:
“Yes, the emotion I had dealt with during this process and find myself very
comfortable internally. ”
Being aware and being comfortable inside oneself is part of the healing and the
movement towards freedom from the past and personal growth.
Many people assume that healing has to be painful, because it involves dealing
with past wounds. However, this integrated process does not have to be painful, and one
does not have to relive painful memories. The process is gentle, compassionate,
respectful, and safe:
“It helped me look at something that was somewhat more painful than set out to
be and knowing that the past can never hurt me ever again was very helpful fo r
me I was able to move ahead. ”
The integrated method allows people to deal with and reach closure on past issues
in a more adult state. As one participant shared:
“Yes it was very helpful in my healing journey because it helped me put old
feeling away or close it. ”
The method can give participants control over their trauma memories to effectively deal
with past hurts and lay them to rest.
Self-awareness allows people to reflect and notice the changes from within, as

69
one participant states:
“The change was good. Because we use tools that were applied and show us how
to heal or take that block away and move in a forwarding a safe way. ”
The more in tune people are with themselves, the more progress they make in their
healing journey.
Seeking self-understanding allows for exploration of other life paths that people
might not have thought of before their healing journeys. The more we learn about
ourselves in the healing journey inward, the more we are able to get to the subconscious
issues where we are stuck in our lives:
“This process helped me get unstuck in my life through seeking my answers
inward. ”
Reaching an awareness of being stuck in life and using this method to find out where and
why we are stuck, and then finding out what we need to do, is an empowering mechanism
for the healing process:
“This process really assist me were I felt stuck in my life by looking at it and
seeing if it felt safe and to store it in a safe place and knowing that I am in full
control o f my healing. ”
Onee people know what to do with this stuck place, they are able to move in a forward
direction in their healing journey. Another participant shares a similar perception of
dealing with the stuck-ness in his or her life:
“Finding out that sometimes I was stuck in my life, by using the skills I learned
through basic skills focusing, I can help apply to daily routines and move forward
in my healing journey. ”

70
This is where many conventional therapies fail to address core issues, resulting in no
change in behaviours that would lead to a healthier way of living.
Self-exploration allows us to look and listen from within, as one group member
describes:
“1found that the whole process o f clearing space in focusing was very helpful fo r
me because it assisted to bring attention to my body and emotions and enabled me
to explore them. ”
Seeking wisdom from within is part of both the Aboriginal way of healing and focusing.
The closer we look within, the more we uncover from our past. One participant stated:
“1found it most interesting in how a group session can also help us as well
individually, by discovering the new stuff hidden in our sub-conscious self and
examine it. ”
Discovering the hidden events that lie beneath our consciousness is the path to holistic
healing and personal growth. The more we discover about ourselves, the more we are in
tune with ourselves, the Creator, and the Universe, and this is the magic of the Aboriginal
way of healing.
Many alternative therapeutic techniques have been used with Aboriginal people,
and many of them have little or no effect, as they are often based on talk therapy, not
holistic therapy, which comes from the heart:
“Yes it did, it came from the body, spiritual and emotional rather than coming
from just the head. ”
When working with Aboriginal people, it is vital to connect with them at the heart level
rather than the head level. Another participant reinforces the heart connection:

71
“Heart-to-heart communication made the difference in my healing process. ”
When the heart-to-heart connection is made through the therapist and the client, many
core issues can be resolved. Through the heart-to-heart connection, the client and
therapist are able to touch the core or internal issues that cause the client to be stuck in his
or her life, as participant hints:
“Yes, the internal feeling and the connection with the therapist I felt I didn’t know
existed before were still there, but now they are dealt with internally. "
Awareness of the internal issues is heightened and can be dealt with when connecting
heart-to-heart in a counseling session.
In some Aboriginal communities, family comes first, before self, but sometimes
we forget to take balanced care of ourselves and we get emotionally or physically sick:
“Connecting with self because sometimes we are so busy in taking care o f others
and not ourselves may lead to ill health mentally, physically, spiritually and
emotionally. ”
Family and community are important, but we need to remember that we can only help if
we are healthy physically, emotionally, mentally, and spiritually, as many Elders advise
people in the helping field. Once we have experienced a degree of healing through this
integrated method, we are able to use the method in our daily lives:
“We would carry that knowledge and that wisdom with us, wherever we walk. We
would share with them and it would come from our spirit, from our own being,
from our own hearts, it was part o f our life, everyday life. ”
Using this method in our everyday routine can dramatically enhance the healing process.
Self-awareness brings attention to our feelings and how we deal and cope with

72
uncomfortable places from the past:
“The healing journey took me to the felt sense with safety and time and honesty to
effectively deal with some o f my past. ”
Through deep self-awareness, we allow ourselves to become in tune with our body’s feltsenses and deal with the past. Once feelings can be established, a connection to the past
can occur that allows us to examine past issues:
“By understanding felt senses that needed attention. Attention to the loss in my
life, the disconnection. It helped to reconnect and feel!"
With the connection made with those past issues, we can begin working with what is
there:
“It aloud me to eliminate the glittering o f minor issues due to the process and
place focus on the felt sense stuff to move forward in my healing. ”
Being finely tuned to ourselves brings on deep healing of past hurts. When we deal with
those past issues, we are able to experience the growth and the shifts in our body and our
perception, and to realize how this process is beneficial to us:
“I realize because o f experiencing the process the beneficial aspects that have
received. ”
The benefits are priceless and gratifying for the participants in their healing
journey. Self-awareness is best summed up by this participant:
“To understand and explore myself I am able to grow more in my healing
journey. ’’
The ability to live today as a full adult, acting and reacting from a respectable adult place
inside, is the true result of Aboriginal healing and empowerment.

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Chapter 5: Discussion on the Research Findings

The purpose of this study was to conduct a formative evaluation of an Aboriginal
personal wellness program designed as an alternative approach to traditional mental
health interventions. In this chapter, the research findings are interpreted using the
therapeutic criteria (outlined in Appendix C) for both the focusing and healing circle
components of the personal wellness program.

Focusing
To understand the focusing method, one must first recognize that it involves
another way of knowing. Like Gestalt therapy, this method avoids reasoning and using
the mind to figure things out. The method involves focusing on the “felt senses.” “Felt
sense” is where body memories of traumatic events are stored and come alive through
sensory triggers. While the wisdom is not well understood or identified in Western
culture, it is the basis of Aboriginal culture (Bellrose, 1985). Gendlin (1996) believes that
by letting the body talk and listening to its wisdom, people can help themselves, a
concept not much different from the centuries-old Aboriginal sweat lodge.
Essentially, focusing is a self-awareness technique that seeks to help people
overcome self-criticism, overcome feelings of being stuck in life, deal with unsure
feelings, get what they are seeking from within themselves, better handle emotions, shift
out of old routines, and deal with past traumatic events. The following discussion will
examine focusing as an effective method for working with Aboriginal people in a mental
health context.

74
Overcoming Self-Criticism
The focusing process begins by bringing in self-compassion instead of selfcriticism, through the clearing and containing of negative emotions and thoughts to get to
the original self. This alone begins the process of release, because self-criticism is the
glue that holds the action block in place. Focusing can assist in modifying the negative
self-tapes that may arise from time to time from our childhood experiences, as explained
by one participant;
“This process offered me an opportunity to move forward and acknowledge my
own person as an observer than a critic that has held me hack. ”
Focusing assists in clearing any intrusive thoughts and feelings that one may
encounter in group sessions, allowing for clear thought processes to naturally occur in the
healing process, as another group member describes:
“Because you clear all bad feelings and think about the positive things in you’re
life that helps me in my healing journey. ”
Once people are able to clear out their critical thoughts and feelings, they are able to
process their past negative experiences and incorporate the new knowledge into their
lives today.

Overcoming Feelings o f Being Stuck in Life
A key element of the focusing process is the exploration of the feeling of being
“stuck” in life. Aspects of ourselves that we do not directly feel (felt sense), and that we
know only though their effects, are a crucial factor in the dynamics of stuck process. The
focusing technique encourages us to listen to the part of us that wants to change. After

75
spending time listening to the part that says, “I won’t,” participants are encouraged to
listen to the part that says, “I want to .. .and here’s why,” rather than focusing on the pain
and struggle of not being able to do what they want to do. Once participants go through
the focusing process, they are able to imagine that they are living a life where they have
the ability to live without the stuck-ness:
“This process really assist me were I felt stuck in my life by looking at it and
seeing if it felt safe and to store it in a safe place enabled me to move in a forward
direction in my life. ”
This place of unstuck-ness is where most people in therapy end their sessions, as most
therapists cannot take their clients any further in their healing journey.

Dealing with Uncertain Feelings
After listening to many hours of taped therapy sessions, Gendlin (1996)
discovered that successful therapy seemingly did not depend on the model of therapy
being employed, or even on the skillfulness of the therapist, but rather on something that
the clients did instinctively and organically within themselves that took them beyond the
limits of rational knowing into a realm of inner knowing. This is consistent with many
Aboriginal healing practices.
This inner knowing had its own reality and wisdom. Experience was registered in
a bodily-felt way, what Gendlin came to call the felt-sense, something like saying:
“This is what I think....and this is what my body thinks.”
Many body experiences can be released, and wisdom is gained when this occurs.
Focusing is about learning how to listen to what the body is saying so that there is a fit or

76
match between what we think and what we feel, as in the Aboriginal ways of healing.
When there is a match, the body immediately eases up, responding with a strong “Yes,
that’s it!” “That fits!” Conversely, when there is no match, the body does not react,
something doesn’t feel right, there is no connection. We often say “I knew it wasn’t right
all along.” So focusing is about learning how to listen to those vague or gut instincts out
of which so many of our crucial decisions are made. It is a process that validates our
finding out intrinsically, according to our own felt-rightness, what is appropriate and
fitting for us by learning how to recognize and affirm the body’s subtle signals and cues,
and how to be respectfully congruent in thought, feeling, and ultimately in action. This
comment from a participant is an example of this:
“the internal feeling I felt I didn’t know existed before were still there, hut now
they are dealt with internally and I can go on living my life. ”
The ability and self-power for one to safely go back and effectively deal with the past is a
great sense of empowerment.

Better Handling o f Emotions
There is a strong emphasis in focusing on the bodily potential for connecting with
the “spiritual” or the “transcendence,” which is very much aligned with the Aboriginal
tradition of seeking wisdom and knowledge from within themselves to aid in the healing
process. It is claimed that focusing will lead to spirituality because the personality at this
spiritual threshold will become aware of interwoven webs of personal fears and will be
guided to deal with these if and when the personality is ready, as opposed to forcing on it
any controlled spiritual ideals and methods, which in the long run could be manifested as

77
obstacles in themselves:
“I found that the whole process o f clearing space in focusing was very helpful fo r
me because it assisted to bring attention to my body and emotions and it assisted
me to rekindle my spirituality. ”
The cultural appropriateness of this method allows many Aboriginal people to deal with
their past traumatic events, allowing for healing in a forward motion in many
communities.

Shifting out o f Old Routines
The critical factor for change is not understanding a thought process or analyzing,
or replacing emotions and egotisms with better ones, but rather an experience of bodyshift or movement in bodily awareness on a given issue. This is seeing things in a new
way; it is an experience of inner release which has no particular way of being established
as a way:
“Because you clear all bad feelings and think about the positive things in you’re
life and this adds to my healing as I noticed my body changing inside. ”
Once able to clear out critical thoughts and feelings, people are able to process their past
negative experiences and incorporate the new knowledge into their lives.

The Healing Circle
Integrating the focusing methods within the healing circle was a smooth process,
as the values of both are very similar. The following discussion will examine the impact
of the healing circle, based on the criteria developed at the outset of the research, listed

78
below (and described in more detail in Appendix C), as an effective component of the
piloted personal wellness program. The program met the following criteria: safety,
cultural appropriateness, non-intrusiveness, meeting emotional needs, empowering
(voice), respect, and compassion.
Figure 3 is a model of the integration of the two approaches, illustrating the four
quadrants of the Medicine Wheel. The first quadrant represents the emotional impacts of
trauma and how Focusing and the Healing Circle is able to explore the emotions in a safe
and non-triggering way. The second quadrant captures the physical aspect of trauma and
deals with the bodily reactions to ensure they are no longer non-intrusive in the clients
physical response. The third quadrant is the spiritual journey inward in which the client
takes to be free of the past negative experiences. The last quadrant reconfigures the
client’s perception of the negative experiences and enables them to let go of the past and
become empowered for their future. The seamless joining of both methods fit together as
they are flexible enough to work in tangent to complement one another to meet the needs
for the client’s healing journey.

79

Focusing & The Medicine W heel

M en ta l
P.T.S.D.
Triggers
Memories / Flashbacks

E m otional
Trauma response
Loss / Grief
Anxiety
All emotions related to trauma

■
Spiritual
Inner vision quest
<!,uide on healing journey
with client
Spiritual connection with
Guide
Safe journey
Healing Journey

Physical
Body memories
Body Shifts
Physiological reaction / change
0 Physical harm

tfKWC) by fill T lp rp f "

frploUjForaef

Figure 3. Integrated medicine wheel and focusing model

80
Safety
The healing circle creates a safe environment where each story that a group
member shares is sacred (Heilbron & Guttman, 2000). A place of safety can allow people
to identify with and rectify behaviours that are detrimental to themselves and others. A
healing circle can provide this. In the circle, each person has the opportunity to share
without interruption. By being allowed to share without interruption, people are given a
sense of dignity and respect for their input. They have a sense of safety and distinction:
“I felt safe after the first session and this was truly beneficial fo r my healing and
was able to move forward. ”
Providing a feeling of safety is one of the most important criteria to meet when working
with Aboriginal people.

Cultural Appropriateness
As highlighted in the literature review, mainstream helping professionals often
find Aboriginal people passive, difficult to assess, and not forthcoming. These
characteristics, which are often interpreted as evidence of resistance, passive aggression,
opposition, depression, or withdrawal, are learned responses and stem from the
domination of Aboriginal people by European culture. The professional’s failure to
recognize this has led to errors in formulation, diagnosis, and treatment (Brant, 1990). In
contrast, one participant said:
“Because this focusing was done in many different ways in our culture. When you
smudge yourself you are breathing and flushing out all negative energy from your
body and mind. The sweat ceremonies are relaxing and incorporating focusing to

81
clear your mind. ”
This was a strong theme in the participants’ feedback.

Non-Intrusiveness
From an Aboriginal perspective, non-intrusiveness means that other people listen
with respect and without judgment, not contaminating or interfering with the story that is
being shared in the healing circle (Heilbron & Guttman, 2000). The non-intrusiveness of
the healing circle is illustrated in the following comment offered by one of the
participants:
“Respect in group. I was comfortable with group and to take that risk without
judgments and I was able to go forward in my healing. "
This criterion is vital to the well-being and health of the client in any therapeutic
situation.

Meeting Emotional Needs
Healing in the Aboriginal way examines all realms of human functioning in a
holistic manner. One of the many needs that the healing circle meets is the emotional
need, as one participant noticed:
“Because we went around the medicine wheel. Dealing with the mental,
emotional, spiritual and physical it was very traditional. That they have to be
balanced. Also to keep the body in a healthy and good way. ”
For effective therapy to take place, the clients attend therapy to resolve their issues and to
deal with their emotions in a cathartic environment.

82

Empowering (voice)
One of the key means of Aboriginal healing in a healing circle is the voice.
Listening to one another, sharing their stories, and hearing their authentic voice is healing
in itself, as described by one participant:
“I felt comfortable sharing; I felt heard what I experienced with our group as
others had also shared without being judged. ”
Once they get their voice back from the victimization, they are empowered and are able
to take more control over their lives and their environment.

Respect
The sharing of past hurts in a healing circle strengthens the individual and forms
more group cohesion, allowing for others to share their stories. The sharing of stories of
negative experience must be done in a respectful way to ensure the safety of the person
who is sharing. It is vital for this to occur in healing circles, as many Aboriginal people
have been and continue to be taken advantage of in places where healing occurs:
“Respect in group. I was comfortable with group and to take that risk without
judgments to be able to assist in my healing. ”
In many Aboriginal communities, seeking and obtaining respect is the way to
work towards healing and capacity development.

Compassion
Compassion and respect can be integrated with one another as they complement

83
one another in a healing circle. Together they form a catalyst for healing to take place
within a healing circle:
“There was a sacred rapport and the group was very compassionate and the
participant’s attitude was very important fo r me to further proceed in my healing
journey. ”
Compassion is the key component when working with Aboriginal people and their
communities towards healing.

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Chapter 6: Implications of the Research Findings

In this chapter, I present the participants’ reflections and my personal reflections
on our joint experience as learners in this research process. I then take the liberty of
sharing some personal reflections on what I think are important implications for social
work practice and social work education. These implications concern the need for
research by Aboriginal practitioners on Aboriginal issues, the need for greater numbers of
Aboriginal therapists, and the need for Aboriginal research frameworks of social work
education.

The Participants ’ Journey
The participants found that learning was meaningful through interactions with one
another in which they modified their ideas through reflection and action. Their shared
journey has brought them to a better understanding of themselves. The personal changes
that the participants experienced enabled them to develop a clearer perspective both on
their personal lives and on their collective existence in the world. In reflecting upon his
experience as a participant, one participant spoke of a hopeful future: “I feel stronger and
look forward to each new day now that I have a new way of thinking about things.”
Another participant said, “I am thinking more about what relationship means to me and
how. This process is really causing me to question who I am.”
As Freire (1970/2005) contends, social change will come about as individuals
realize their oppression, and transform their world as they transform themselves. In other
words, a shift in perspective is more than a change in political parties and their respective

85
ideologies. It is a shift in consciousness and a way of thinking. A shift in consciousness
involves a knowing inwardly or “to know with” (Goswami, 1995). To “know with” is a
community attitude of learning and working together, rather than competing to win over
others. On reflection, it is reasonable to suggest that as the six-week program unfolded,
the participants moved into deeper awareness of their inner selves.

My Journey
Although it was not my intention at the beginning of the study, the research has
been as much a personal journey as one that was focused on methodology. Like other
journeys in my life, it now makes a different sense to me as I reflect back on it.
As 1 moved through the research process, 1 did not always trust what 1 was doing.
However, 1 relied heavily on my intuition, which requires a certain amount of confidence
and trust in myself as well as trust in my methodology. 1 took solace in knowing that
qualitative inquiry shares this uncertainty. Hence, the analogy of “journeying along a
path” seems an appropriate metaphor for describing how this study progressed.
Through the conversations with my participants, 1 began to understand some­
thing about my “self,” in that “the other voice thereby becomes a moment in my own
understanding and self-understanding” (Jardine, Clifford, & Friesen, 2003, p. 176). For
example, when listening to participants’ experience of “showing up for others,” I
wondered about my own status as one-who-shows-up. In these moments, my participants
were teaching me about my self. It was in these moments that 1 recognized the
tremendous possibility of this integrated model.

86
Research on Aboriginal Issues by Aboriginal Practitioners
Clearly, further research of this nature needs to be conducted with, for, and by
Aboriginal people to ensure that their worldview is acknowledged and put into practice in
the healing process for their people (Hart, 1997). The prevailing view in our society is
that research is something that academics do. Furthermore, we often assume that research
must look a certain way. An Aboriginal approach to science reflects a clear shift away
from the ways in which research has been understood and organized in Western culture.
Once understood more as the object of research, Aboriginal peoples aie increasingly
being seen as researchers conducting research within Aboriginal knowledge traditions,
using Aboriginal methodologies as well as methodologies drawn from interaction with
non-Aboriginal intellectual traditions. In this context. Aboriginal research is more a
method of study than an area of study and derives its dynamic from traditions of thought
and experience developed among and in partnership with Aboriginal communities and
nations.
In addition to the need to recognize a paradigm shift in Aboriginal research, it is
important that Aboriginal communities be given the opportunity to decide what the
research priorities should be for their communities. Therefore, it is imperative that
“funders” demonstrate a commitment to changing these old patterns of research within
Aboriginal communities by allowing Aboriginal scholars, in consultation with these
communities, to set research agendas and to determine what areas need to be addressed.
The current targeted program areas for funding are not necessarily the top priority among
Aboriginal groups.

87
The Need fo r Greater Numbers o f Aboriginal Therapists
From my vantage point, there remains a disparity between Aboriginal and nonAboriginal conceptions of social work practice and mental health services. The current
approach, in which students learn a little about Aboriginal society and then use this
knowledge to make decisions on the peoples’ behalf, is not working. We need to
recognize this disparity, which has long been identified by Aboriginal people. For
Aboriginals, mental health must be considered in the wider context of health and well­
being. For many First Nations and other Aboriginal people, healing means dealing with
approaches to wellness that draw on the culture for inspiration and means of expression
(Gladstone, 1994, p.8). Hence, acknowledgment of the existing frameworks of healing
and knowledge within Aboriginal communities, and in particular those pertaining to the
resolution of mental health disorders, is needed. There must be an opportunity within the
assessment process to explore the extent to which the particular mental health issue is
symptomatic of the individual’s underlying cultural and/or spiritual issues. Cultural
congruence ensures that the client’s value system, life experiences, and expectations
about the therapeutic process will be integrated into the therapeutic process even when
the client is not fully conscious of these factors.
Participants interviewed in this study acknowledged that there was a lot of
cultural information for the non-Aboriginal practitioner to understand in order to work
effectively with Aboriginal individuals, families, and communities. They recognized that
the majority of non-Aboriginal practitioners with whom they had previous contact did not
fully understand their lived experiences. They suggested that properly trained Aboriginal
counselors or therapists would better understand their realities and have the insights and

88
skills to engage them in a healing journey.
Therefore, a high priority must be given to prepare and equip practitioners of First
Nation and Aboriginal backgrounds (as well as non-Aboriginal people) with the
knowledge, values, and skills required to promote holistic wellness within their families
and communities. It is also very important to provide these practitioners with the
foundation necessary to undertake advanced accredited courses of study and to develop
and demonstrate capacities for ongoing self-care, commitment to lifelong learning, and
the capacity to provide leadership in the field of mental health.

Aboriginal Frameworks fo r Social Work Education
The findings of this study suggest that effective social work practice with
Aboriginal people and communities must reflect a commitment to social justice, a critical
pedagogy of decolonization and a strength-based philosophy of personal, community, and
cultural capacity building. As articulated by McKenzie & Morrissette (2002):
The effects of colonization have continuing implications for Aboriginal social
work practice because these shape many of the initial meanings attached to the
roles of service user and social worker, particularly if that worker is nonAboriginal. In a sense, all of us carry the baggage of colonization, either as
victims or oppressors, (p. 35)
Such a commitment might include a strong recognition within the curriculum of the
historical and ongoing effects of colonization on Aboriginal people; a critical
appreciation of the importance of Aboriginal culture to the healing process; and an
understanding of the diversity of Aboriginal cultural expression and the way this diversity

89
affects people’s sense of identity and approaches to social work practice.

Conclusion
As an Aboriginal social work practitioner, this study was undertaken to advance
my understanding of the effectiveness and appropriateness of cross-cultural approaches to
mental health services for Aboriginal peoples. The information obtained from the study
has increased my level of confidence as a clinical practitioner committed to serving my
people and was informative in my quest to construct a mental health approach specific to
residential school survivors, their families, and their communities.

90
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Appendix A: Self-Reporting Mental Health Assessment

Symptom
Recurring

3-5 per week

1-2 per week

Per month

Not at all

Intrusive thoughts and images

ADEG

BCE

Recurring dreams/nightmares

DEG

ABCF

Flashbacks

BCDFG

AE

Anxiety attacks

ABC

DEG

Crying spells and tearfulness

ABEFG

CD

Feelings o f shame or embarrassment

B

A

DEFG

C

Guilt feelings (if only)

B

AE

DEG

C

Avoidance
Withdrawal

B

ACDF

Depression/diminished interest

B

ADE

CFG

Feeling o f detachment

AB

G

CF

Inability to recall specific events

B

DE

ACFG

BDE

CFG

DE

Disorientation, confusion

A

Restricted affect

ABD

Avoidance of thoughts o f trauma

BE

CEFG
ADG

CE
ABCDEFG

No sense of future in life
ADEF

G

C

Job difficulties

A

CDG

BEE

Sexual dysfunction

AB

DF

CEG

Numbness emotional/physical

B

ADG

CEE

Helplessness, loss o f control

B

ACDEF

G

AD

CFG

Fear

B

Arousal
Sleep disturbance

BE

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Anger/rage

E

Difficulty in concentrating

BE

AD

CG

F

Hyper vigilance

B

A

DEE

CG

A

BCDEG

F

B

AD

CFG

High startle response
Headaches

E

Muscle tension

BE

Nausea

ABCGDF

ACDFG
E

ADG

BCF

E

DF

CG

Difficulty in breathing

BE

AD

CFG

Cold sweats

B

ADEG

CE

Eating disturbance

AB

Increased alcohol use
Increased drug use

ABCDEFG
E

ABCDEG

Note: To maintain confidentiality, each o f the participant responses were coded and reported as follows;
Participant #1: (A); Participant #2: (B); Participant #3: (C); Participant #4: (D); Participant #5: (E);
Participant #6: (F); and Participant #7: (G).

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Appendix B: Interview Questions

1.

Can you describe your experience as a participant in this program?

2.

Which features of the program, if any, did you find most supportive to your
healing journey?

3.

Which features of the program, if any, did you find the least supportive to
your healing journey?

4.

Did you find this process culturally appropriate?

5.

Did this process assist you in areas that you felt that you were stuck in you
life?

6.

Did this process meet you needs? Please explain?

7.

What could be changed in this process to assist you more? What did you like
about this process?

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Appendix C: Therapeutic Criteria for Integrated Psychotherapy and Healing Circle
Aboriginal Personal Wellness Program

Focusing

o

How to deal with feeling stuck in your life

o

The ability to deal with your unsure feelings and how to get what you were
seeking from within yourself

o

Assisting in handling your emotions

o

Assisting in shifting you out of the same old routine

o

Assisting with self-criticism

Healing circle

o

Feeling safe to share your story

o

Culturally appropriate healing method

o Non-intrusive healing
o

Meeting your emotional needs

o

Finding your authentic voice

o

Respectful

o

Compassionate

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Appendix D; Information Letter and Informed Consent

Dear Participant
The purpose of this information letter and informed consent form is to inform you of my
thesis project and to outline your possible role in the study.
Researcher:

William Thomas, Master of Social Work Student
3660 Winslow Drive
Prince George, B.C. V2K 1W9

Supervisor:

Gerrard Bellefeuille, Social Work Professor
University of Northern British Columbia
(250) 960-6437

Thesis Title:

An Integrated Psychotherapy and Healing Circle Approach
To Aboriginal clinical Social Work Practice.

Purpose:
The purpose of this study is to implement and evaluate a six session (6 two hour sessions
over a period of six sessions) personal wellness Aboriginal mental health program. The
two hour sessions will guide you through a self-awareness process using a technique call
focusing within a traditional healing circle setting.
Goals of the Study:
When I graduate from the social work program, my intention is to offer this program in
my home province of Manitoba to Aboriginal persons seeking a culturally sensitive
alternative to mainstream mental health services.
Selection of Participants:
I am seeking Aboriginal individuals between the ages of 25 and 65 who either attended
residential schools or feel that they were personally impacted by a close family member
who attended residential school.
Voluntary Nature of Participation:
Your involvement is completely voluntary and you can choose to leave the study at any
time without consequence. In addition to agreeing to attend 6 two hour group sessions
over a period of six sessions, your involvement in the study will include participating in a
individual interview (confidential) and a focus group at the end of the program.

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Confidentiality and Security:
Please note that all information collected is highly confidential and cannot be traced to
the participants in the study. The interview responses will be coded to ensure there is no
identifying information, stored in a secure location and destroyed at the conclusion of the
research process.
Accountability of Findings:
I will meet with each participant to check the accuracy of the findings prior to writing up
the results of the study and make all recommended chances requested by group
participants.
Each group participant will be offered a copy of the final report. In addition, I will also
arrange a group meeting to discuss the results of the study.
Potential Risks:
There are no known risks associated with participating in this study. In terms of benefits,
I hope that the study will provide assistance in the participant’s healing journey and to
help shape more culturally sensitive approaches to Aboriginal social work/mental health
practice.
Contact Information:
If you have any questions about the study, please feel free to contact the researcher or her
supervisor at the numbers provided above.
Should you have a complaint or concern about the study you can contact Dr. Max Blouw,
UNBC Vice President Research at 960-5820.

Appendix E: Informed Consent
I understand the purpose of the research study.
I have read and received a copy of the attached information letter.
I understand that I am a free to refuse to participate or to withdraw from this study at any time
without penalty.
I understand that I have complete anonymity in that all data (e.g., survey and questionnaire
responses) are confidential and cannot be traced to the participants engaging in the study.
I understand that I will have an opportunity to ask questions and discuss this study with the social
work program.
I understand that I will remain anonymous in the written report.
The researcher has answered all of my questions about the study.
I agree to participate in this study.
Signature or Research Participant

Date

Printed Name of Research Participant

I believe that the person signing this form understands what is involved in the study and
voluntarily agrees to participate.

William Thomas
Principal Investigator

January , 2004
Date