Lewis Mehl-Madrona (M.D. Stanford University, Ph.D. Psychological Studies Institute) grew up in southeastern Kentucky and is a product of multiple cultures -- Lakota and Quebecoise on his father's side and Cherokee and Scottish on his mother's side. He completed his residencies in family medicine and psychiatry at the University of Vermont College of Medicine. He currently is Core Faculty of Clinical Psychology at the Union Institute & University in Brattleboro, Vermont, and practices family medicine with Brattleboro Primary Care and psychiatry with Otter Creek Associates. Along with his public speaking, producing DVD's and creating a training institute, Dr. Mehl-Madrona has written several books including Coyote Medicine and most recently Healing the Mind Through the Power of Story: The Promise of Narrative Psychiatry. I was fortunate to catch up with him between Sundances this summer, and he graciously agreed to contribute.

Please enjoy these thoughtful reflections on therapy from Dr. Lewis Mehl-Madrona:

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What is the role of religion or spirituality in your clinical practice?

Everything I do rests upon a foundation of my spirituality and its practice.  It doesn't emerge explicitly with every client, but it forms the basis for how I approach people.  My spirituality teaches that we are all inter-connected, that your suffering is my suffering, and that our survival depends upon each other. My belief in a supernatural realm supports my faith in people's ability to change.  I frequently ask the spirits to visit my patients.  I pray for my patients on a regular basis.  I ask for help from spirits.  I don't tell patients anything about this unless they are open to spirituality.  In those cases, we may pray together, we may ask for assistance from the spirits, and we understand that bigger forces are at work in influencing what will happen.  Research has shown that the majority of patients in the United States want their physicians to address their spiritual concerns, and when this is the case, I feel comfortable doing so.

How does your technique or theory differ from mainstream psychotherapy?

I'm not sure exactly what constitutes mainstream psychotherapy, so I'm going to guess that it's CBT and/or psychodynamic psychotherapy. From my elders, I have learned that story is what really matters, a similar insight to narrative therapy and to contemporary neuroscience, which shows that "storying" is the default mode of the brain, where we settle when we're not doing anything else.  I try to discover the stories which have formed the person to be who he or she is, the stories that are important to his or her identity, and the stories that he or she appears to be acting in the world.  When the story leads to suffering and pain, I hope to assist the person to change it.  For example, I have a client who believes he is the re-incarnation of Adolf Hitler.  He suffers greatly about this and wants to be punished.  I struggle to find ways in which he can experience kindness and compassion and believe that the Universe is a loving place.  In all that I have learned from the Elders, I know that the "Red Road" (the Native American pathway to spirituality) is a road from wisdom to compassion and that it is characterized by love.  I try to apply that to my psychotherapy.

A new client comes to therapy reporting his main problem is feeling detached from God. How would you proceed?

I'd conduct an interview to get a history of the problem as he or she perceives it. I'd need to know how he or she defines God.  Who is God and what kind of relationships does God have with people?  Within my Lakota spirituality, we have Dakuskanskan, or "That Which Moves Everything That Moves".  This is as close as we come to "God".  On a more local basis, we have the Wakantankan, or the Sky Spirits, who directly intervene in human affairs, the most powerful of which is the Sun.  Within Lakota spirituality, the Divine is within everything, including us.  The Lakota word for the part of the Divine that is within us is "nagiya"/  Most likely I would proceed by talking about how we humans are part of nature and that nature is within us and everywhere around us, that we are a part of nature.  It is impossible to escape Nature.  For nature based religions, it is impossible to be detached from God, because the Divine is within us all, because Nature is within us all and we are Nature.  We are not separate and apart from God as in some other religions in which God seems to be outside of Nature and the world.

What is the relationship between sin and psychopathology?

We don't actually believe in sin, so there's no relationship with psychopathology.  Actually, I don't really believe in psychopathology either.  Rather, I think there are good stories and bad stories.  "Bad" stories increase net suffering and generate friction and tension in their enactment.  "Good" stories reduce net, overall suffering and generate more kindness, compassion, and love.  Psychotherapy is the process of replacing "bad stores" with "good stories".  Furthermore, I would say that shame is the enemy of change and healing and that the story about sin promotes the idea of shame.  Mostly I believe that we do the best we can and that many forces work against us or for us and that many of these forces are even outside of our awareness.  Sometimes we make the "wrong" decision for lack of information or because our stories in which we have grown up, constrain us to behave in specific ways that may turn out to be harmful to others.  Rarely are people intentionally mean--spirited or cruel, though such people do exist.  Largely they do not come for help.  Mostly people struggle as best as they can and make mistakes and shouldn't be accused of being sinners.

Who or what is the primary agent of change in therapy?