Psi and Medicine Wheel, by WG

The Varieties of Religious Therapy (VRT) is a blog series where representatives from twelve belief systems discuss how they integrate faith with their approach to psychotherapy. This installment is an interview with a Native American healer, physician and psychologist. See the Introduction for a full description of VRT and the table of contents.

Native American spirituality encompasses the diverse beliefs and practices of hundreds of Native American tribes. Differences between tribes are great, but most share a common belief in the supernatural as experienced in connection with animals and the environment, visions, spirits, ancestors, the shaman and communal ceremony. Native American spirituality is not considered a religion by most adherents, but rather an integral part of all behavior and identity.

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?

Change happens within the relationship between the involved partners.  However, we each need to bring a receptivity to that relationship in which change occurs and we each have to be willing to do things that we haven't ever done (called behavioral experimentation).  The therapist is charged with creating novelty and doing interesting things.  Through dialogue, we have to negotiate what each of us is willing to do. I don't think we can escape some suffering, but we can learn how to suffer better, to carry our suffering in a noble way that inspires others, and, of course, to reduce our suffering through improved relationships with others, through the healing power of community, and through the help of the spirits.  So, I would say that the primary agent of change in therapy are the relationships that exist among everyone.  Change occurs through dialogue, which is speaking in order to listen.  Through dialogue we recognize the alterity of others and that we must work to understand what others mean.  We must recognize that we might be wrong about what we think and about our understanding and interpretation of others and that we must struggle to improve on this and through the struggle, change occurs.

What is the most difficult part of practicing psychotherapy while maintaining your beliefs?

My practice of psychotherapy is completely compatible with my beliefs. I have some difficulty fitting into the American mental health mainstream where money rules and what can be done is based on what makes the most money.  For example, when I worked in community mental health in New York State, what made the most money was 15 minute med checks.  I was told that "it's not your job to help people.  We have therapists for that.  Just write prescriptions".  I solved that by moving to Vermont where I can afford to see people for one hour visits.  Naturally I would make more than double the money seeing four people in an hour than one, but, in Vermont, I can afford to live on what I make for one person, and I can get so much more done in terms of helping with healing.  So my spiritual belief would say I should do all that I can.  The constraints of Vermont allow me to do so much more than the constraints of New York.  Listening deeply without judgment or interpretation is one gift I try to give people, and it usually takes longer than 15 minutes for them to complete a story (however, brief it is). I do work within the conventional medical system (though not all the time) and in that context, I must fit what I believe into 15 minute encounters.  Politically, I am doing what I can to change this.  I believe that patients would cost the health system less if we could give them all the time that they need when they need it, but this is yet to demonstrate.  I am seeking research funding to show this.

What is the most rewarding part?

I'm always rewarded by the privilege of being in relationship with another person and by hearing their stories unfold.  I think the relationship is a sacred trust and am honored to be included.  I'm so happy when people find a happier path to walk through life and suffer less.  I am rewarded by the sacred opportunity to listen deeply to another's story about his or her life.  Change is mysterious.  When it happens it is because we have all done our best to support the highest good for the person involved.  We have formed an interconnection among all of us involved to support the highest good.  We have struggled to hear and understand each other and have strived to support each others' highest good.

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About the Author

Ryan Howes

Ryan Howes, Ph.D., is a clinical psychologist, writer, musician and professor at Fuller Graduate School of Psychology in Pasadena, California.

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