Practice Briefs

Highlighting Indigenous Populations in Counseling

Introduction

The terms “Indigenous,” “Native American,” and “American Indian” have different meanings and can exist in different contexts. Indigenous is used to describe “descendants of the people who inhabited the Americas, the Pacific, and parts of Asia and Africa prior to European colonization” (UCLA Equity, Diversity & Inclusion, 2020). This is a broad term meant to include all Indigenous Peoples on continents around the globe. “Native American” and “American Indian” are terms used to describe the descendants of people who lived on modern day American soil prior to European colonization. The term “American Indian” is used by the U.S. government in legal contracts, and Federal Indian Law uses it in treaties and court action, like recognizing Indigenous national sovereignty (UCLA Equity, Diversity & Inclusion, 2020). There are also regional specifiers, including “Alaska Native,” “American Samoans,” and “Native Hawaiian,” that designate their cultural and historical differences from Native Americans who originated in the continental United States (Indian Affairs, 2017b).

Despite colonialism, Indigenous Peoples still exist around the world. In the United States, Native Americans live in all contexts, from metropolitan areas to rural areas to reservations. For the purpose of this brief, the term “Native American” will be used to indicate people from or located in the land now known as the United States, acknowledging that even this terminology might perpetuate generalization of Indigenous Peoples. When talking to, teaching about, or engaging in cultural understanding, it is imperative to use the specific term that said group prefers, to avoid stereotypes and promote cultural sensitivity (National Museum of the American Indian, n.d.).

A reservation is a piece of land where either a Indigenous nation was originally located, or the U.S. government forcibly placed Native Americans. This land is reserved for Indigenous Peoples and, by decree of the U.S. government, members of that nation have sovereignty over it. Indigenous national sovereignty allows Native Americans jurisdiction and authority to govern (Indian Affairs, 2017a; Ordway, 2021). Due to the sovereignty of each nation, which are recognized as distinct, self-governing political entities, membership to an Indigenous nation is based on that nation’s enrollment criteria (Huff & Coulter, 2019; Krakoff, 2013). These criteria vary widely by nation and are shaped by historical, cultural, political, and legal factors. For various peoples, including displacement and separation of families, “blood quantum” (a colonized measurement of Native blood in an individual), available funds, and negative stigma, not every Native American individual is enrolled in an Indigenous nation (Native Governance Center, n.d.). Enrolled membership varies in each individual nation. Furthermore, enrollment in a nation is a political classification, not a racial one, due to the political nature of the sovereignty of each nation (UCLA Equity, Diversity & Inclusion, 2020). Regardless of reservations and nation enrollment, there are also different levels of connectedness to nations and culture that are personal to each Native American individual, family, and community. The full range of Indigenous identity, or Indigeneity, and experience is not solely defined by enrollment status. Indigeneity is a culture, practice, and set of relationships to oneself, ancestry, land, and nation, which individuals maintain differing levels of connection shaped by personal experiences, histories, and circumstances (Fuller, 2025; Weaver, 2001).

Due to the history of colonization, genocide, residential schools, and child welfare agencies displacing Native American children, not all Native Americans have a direct connection to their culture or history. The continued legacy of colonization has shaped the historical and contemporary realities of Native American communities. Native Americans were often punished or killed for speaking their Native tongue or following Native traditions. The slogan “Kill the Indian, Save the Man” was meant to exterminate the Native identity and force assimilation (Rice, n.d.). This systemic violence fractured intergenerational transmission of knowledge and identity, resulting in a disruption of relationship with family, community, self, and land. Despite these conditions, Indigenous Peoples have maintained cultural continuity. However, Native Americans can have varying levels of relationships with their identity. Recognizing this historical context is essential to avoid defining Indigenous Peoples by their trauma, and to better understand systemic impacts.

Description

Both within and outside reservations, Native Americans disproportionately face mental health illnesses. According to the National Survey on Drug Use and Health, 19% of Native Americans experienced a mental illness in 2022, amounting to approximately over 827,000 people (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023; Mental Health America, 2022). Comparatively, Indigenous People report experiencing psychological distress 2.5 times more than the general population, within a month’s timeframe (Mental Health America, 2022). Several factors can be attributed to this inequality. In addition to the history of atrocities mentioned above, over 19.8% of the Native American population lives in poverty, higher than the national average (US Census Bureau, 2024). Native Americans begin to use alcohol and substances at earlier ages and have higher rates than other racial groups (American Psychiatric Association [APA], 2017). Native Americans have higher rates of posttraumatic stress disorder, suicide, and attachment disorders (APA, 2017).

Native Americans endure greater disparities when it comes to mental health (Mental Health America, 2022). There are many barriers preventing Native Americans from receiving counseling and mental health care. Due to the history of colonization and genocide, Native Americans are less likely to trust colonial institutions, which includes mental health care (Gone, 2022). Native Americans are typically more likely to search for help or care within their communities than to reach for outside, unknown services (Stewart & Gonzalez, 2023). In many areas, there is a lack of Native-specific resources or general resources available to Native Americans (Manson, 2000). Paired with economic barriers, like limited access to health insurance, Native Americans are faced with impediments to receiving care (APA, 2017). Furthermore, if a Native American were to engage in counseling services, there is a lack of culturally competent providers who understand the values, traditions, and relationship to Native American identity and who can provide culturally appropriate intervention strategies (Gone, 2022). Subjectively, Native American people might wrestle with a stigmatization of mental health in addition to mistrust of service providers (Mental Health America, 2022).

Assessment Strategies

While there is limited research in identifying causes of mental health issues in Native Americans, colonization has impacted the psychological landscape of this population. Centuries of genocide, introduction of disease, forced relocation, forced enrollment in residential schools, forced religion, and punishment for practicing culture have had lasting effects (Freeman et al., 2019). These historical consequences have had significant influences on Native mental health, communities, and healing practices (Freeman et al., 2016). Many of these atrocities have impacted the ability to pass down culture, language, and healing traditions, which has resulted in the loss of Native ancestors’ approaches to physical and mental healing. In some instances, Native communities have been able to preserve or reclaim cultural knowledge, healing practices, and teachings. But for the many contemporary Native Americans who have lost that knowledge to colonialism, their only option when in crisis is to engage in a Western, Eurocentric approach to mental health. With that in mind, healing within systems that have historically been oppressive and discriminatory can be challenging and complicated. Most often, assessment and intervention strategies are researched without marginalized populations in mind. Western and Eurocentric interventions and mental health systems were developed without considering Native American experiences. In some cases, these systems were weaponized against Native American populations (Bassett et al, 2012). Therefore, Western assessment strategies might not be helpful to use when attempting to assess or diagnose Native American clients. It is important to note that any suggestions in this article should be taken as generalizations, and working with specific nations should be done in community. Prioritizing Indigenous knowledge systems that use holistic frameworks can assist in recognizing and addressing psychological and communal wounds. Before utilizing Western assessment tools, consider contextualizing them by including cultural aspects or narrative methods that allow reflection of the client’s lived experience.

In addition to historical and cultural disruptions from colonialism, Native Americans face specific challenges and barriers within Western mental health systems that fail to reflect culture. Standardized diagnostic tools may overlook or misinterpret community, spirituality, or intergenerational influence in Native lives, as they have historically been rooted in Western health (Freeman et al., 2016). For example, in balancing a Native American’s individual connectedness to culture or nation and assimilation to Western world, counselors may find that the criteria in APA’s (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) is not complete enough to offer an accurate or helpful diagnosis. The complexity of cultural issues related to Western diagnoses cannot be understated. Counselors should consider culture when interpreting results of assessments and diagnoses.

Treatment Approaches

When working with Native American clients, it is important to understand that Native American identity is not homogenous. While there are several similarities of values and culture across Indigenous nations, the traditions and specific culture of each nation varies (Gray et al., 2019). Counselors can first address their own personal biases and work to understand the ways in which colonization has impacted personal and professional thinking and systems. Counselors who prioritize learning the history of Indigenous Peoples and the impacts of colonialism in their region can help foster cultural humility and safety (Reeves & Stewart, 2017). This also allows counselors to understand how historical context and trauma impact clients and mental health. Without doing so, counselors may inadvertently perpetuate the same colonial systems that have oppressed their clients in the first place.

Decolonizing ways of thinking allows counselors and clients to understand how Western mental health views might be harmful when conceptualizing presenting problems. For example, Western mental health diagnoses and assessments could impair the understanding of emotional expression for Native Americans (Reeves & Stewart, 2017). Adopting a social justice framework in working with Native American populations promotes relationships and collective goals toward effective treatments. Within this framework, there are several different intervention strategies in addressing Native American mental health: identity, community, spirituality, storytelling and strengths-based work, and advocacy. Non-Native counselors who want to implement the following intervention strategies must do so with cultural humility and must have the full consent of the client. To fully understand Native American cultures, clinicians are recommended to establish relationships with local Indigenous nations and see what resources are offered in local community (Thomason, 2012).

Intervention efforts that promote social support while also addressing historical oppression and inequality can be valuable to Native American clients (Burnette et al., 2017). Native American cultures are collectivist and place less significance on individual happiness (Beckstein et al, 2022). Therefore, community can play a helpful role in addressing mental health. Gray et al. (2019) found that connectedness with family and friends were protective factors for Native American youth against suicide attempts. This demonstrates the power of social support. The historical trauma of colonial disconnection can hinder the healing practice of connecting with community. Thus, the collective trauma that Native Americans have endured should also be met with a collective response (Reeves & Stewart, 2017). Western, Eurocentric mental health interventions emphasize individual happiness and well-being, providing a one-size-fits all approach. However, Native American cultures suggest more harmonious relationships among communities to be indicative of overall happiness (Beckstein et al., 2022). In congruence with Native American cultures, emphasizing community gatherings and social support within mental health treatment is advantageous.

Native American cultures emphasize spirituality in understanding and navigating life. Reeves and Stewart (2017) asserted that Native American ways of healing can assist clients in processing trauma. Many traditional Native American practices are integrated with spiritual significance. For example, smudging—the process of burning sage, tobacco, or herbs in order to cleanse mind, body, and spirit—is a traditional, spiritual practice that many Native American cultures still use today. Furthermore, integrating spirituality into counseling might be an entry point into a conversation about mental health and healing (Reeves & Stewart, 2017).

Native American culture and practices often utilize storytelling and strength identification (Hodge et al, 2002; Kennedy et al, 2022). These practices have been passed down through generations, even in the face of colonization. Storytelling allows the client space to focus on themes, values, and healing within the greater context of identity and community. Identifying strengths illustrates and highlights the resilience of Native American cultures. Counselors can include stories or narratives relevant to colonization and Native American cultural values and traditions to promote understanding and healing (Reeves & Stewart, 2017).

Cultural and Ethical Considerations

Native American identity has many elements including region, connectedness, knowledge, Western assimilation, relationship, and practice. Within this identity comes a sense of understanding about oneself, one’s position in community, and one’s perception of mental health. Research has indicated that youth who feel connected to their ancestry and nation have lower rates of suicide (Gray et al., 2019). Maintaining cultural ties to history and ancestry allows the individual client a sense of self and connectedness. In contrast, colonization asserts that Native identity is not to be embraced or practiced, making it a radical act for a client to connect with and learn about their Native American identity and its positionality within themselves and their community. Additionally, a client exploring their Native American identity can address current and historical traumas that might have impaired wellness. Connecting with oneself allows for better connection to community. Reeves and Stewart (2017) found that traditional Native American healing practices like sweat lodges, shake tent ceremonies, fire keeping, drumming, fasting, smudging, and spending time in nature contributed to a sense of pride in their Native American identity.

Advocacy

Within the greater context of the Western, Eurocentric mental health field, it is crucial for Native American nations and clients to be involved in and lead advocacy efforts. Efforts toward reconciliation and social justice goals can be done on an individual, community, and systems level. This can include more research regarding effectiveness of specific assessments and interventions for Native American populations, counselors and organizations acknowledging colonial traumas, and establishing relationships with local nations and supporting their collective recovery.

Conclusion

These intervention strategies highlight and weave in culturally relevant social and spiritual components that can greatly enhance the therapeutic relationship and therapeutic outcome for Native Americans. Recognizing the impact of colonization while engaging in cultural humility, decolonizing practice, and relational accountability can prepare counselors to support the wellness of Native American clients. Moving beyond cultural competence requires counselors, supervisors, and counselor educators to self-reflect on personal bias, learn about regional- and nation-specific histories, and scrutinize Western-centric norms. Accordingly, counselors can engage in systemic advocacy by advocating for inclusive research, funding Native-led mental health initiatives, building relationships with local nations and supporting local tr projects, and incorporating Native voices in curriculum development and policy reform. Culturally responsive care uplifts Indigenous voices, practices, relationships, and identity.

Resources

• Two Spirit and LGBTQ+ Advocacy Sheet, Northwest Portland Area Indian Health Board – https://www.npaihb.org/wp-content/uploads/2020/06/Two-Spirit-and-LGBTQ-Advocacy-Points.pdf
• StrongHearts Native Helpline – https://strongheartshelpline.org/
• WeRNative – https://inelda.org/our-resources/wernative/
• One Sky Center – https://www.oneskycenter.org/
• Indigenous Story Studio – https://istorystudio.com/

To Cite This Practice Brief:

Fuller, R. L. (2026). Highlighting Indigenous populations in counseling [Practice Brief]. Counseling Nexus. https://doi.org/10.63134/CCAP1413

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