Eduardo Duran on Psychotherapy with Native Americans

Eduardo Duran: Well, it started very early on. I had just gotten out of the military, and I was working in this community up in the mountains, pretty much by myself. I was in graduate school at the California School of Professional Psychology (CSPP) and was supposed to be developing a mental health program. People were coming to me for help, but I frankly didn't know anything about therapy. They weren’t easy clients—they had serious issues—and my supervisor was in the city, so I had to kind of start inventing stuff.

ED: It was a reservation up in the mountains. Very remote. The curious thing was that people assumed, “He’s an Indian guy, so he must know how to do this therapy thing.” At that point nobody else wanted to do it, so it was kind of up to me. So I started developing a needs assessment and came up with the usual stuff—there was a lot of depression, alcoholism, and those types of problems in the community.

When I took my report back to the Tribal Council they said, “Those are not our problems,” which really threw me. I could see with my own eyes that these were their problems. They completely rejected what I was doing and told me to go back and try something else.

At the same time people were coming to me for therapy and I was doing the best I could with my limited knowledge of cognitive behavioral therapy. But these folks were also telling me, “We don’t want this. We don’t want to talk about this stuff.”

Basically everything I was doing was being rejected. And here I was paying a lot of money to go to graduate school and it was not working with my clients.
 

ED: No they weren’t, and I was at my wit’s end. I went back to the Tribal Council with another report, and at this point I had switched over to using a qualitative methods approach and thought for sure I had the goods now. And they rejected it again. I had no idea what to do.

Then this old guy there says, “What you need to do is go up in the mountains and consult the spirits.” At that time, CSPP did not have a Consulting Spirits class. 

ED: I think you’re right. So I was like, “OK, now what? I don’t know how to do this.” I'd heard stories of ancient people and the burning bush and all that, so I went up into the mountains, and with nobody looking I just kind of walked around. 

ED: No. I was wandering around there like a dummy, hoping nobody saw me walking through the trees. I didn’t hear anything. Nobody talked to me. And no spirits came.

At the time I was sharing an office with a doctor and a nurse practitioner. It was actually an RV, an Indian Health Service RV, and we were so cramped. People just kept coming to me for help and I had exhausted my Western tool bag. What people wanted to talk about was their dreams and, of course, I didn't know anything about dreams. In grad school, they didn’t teach us anything about dreams.

So I would just sit there using the two techniques that I learned, that all psychologists need to know to be psychologists. The first one is when you have no idea what's going on—which is most of the time for me, anyway—you say, “Well, what do you think that means?” So I did that. And they said, “If we knew what it meant, we wouldn't be here talking to you, would we?”

So they took that one away from me, and all I had left was the deep-look-in-your-eye technique, and nodding “hmm.” Pretending that I knew stuff. Well, that bought me some space.

It was during this time that I started having the feeling that there were other people in the room.
 

ED: It sure was. And I couldn't very well acknowledge it with my clients who were coming to me for help. You know, because that’s against the rules. One of the rules of being a psychologist is, “Thou must not hallucinate in front of patients.”

ED: Actually, yeah. It was a very difficult time because I didn't have any context for this. But it happened that around this time, there was a particular traditional healer, or medicine man, that I had heard a lot of stories about. He arrived at my door one day to kind of just help or check me out or something. As he was talking, and using tobacco in the sacred way, I thought, “He's probably as good a guy as any to run this by.” I figured he’d say I was stressed out from working and graduate school and needed to take a break or something.

So I told him what I was experiencing and he said the exact opposite of what I wanted to hear: “The reason you're feeling that is because they are there.” I was like, “What?! Who's there? I don't need this.”
 

ED: Yeah. “Just go and take some time off. Take some nice anti-psychotic medication and all will be well.” He didn't do that. He told me that in most Native communities here and across the world where I've been, there's a very common saying that “everything you do affects seven generations.” And he said, “It's not just in one direction. In spirit time or dream time, it also can go backwards. So seven generations back, seven generations forward, which means a lot of the unborn ones are also being affected. You and me talking today, we're affecting seven generations of our ancestors and descendants.” Then he went on to explain that between the year 1870 and 1900, 80% of the Native people in the communities I was working with had been exterminated. By the military, through disease, complete tribes were wiped out.

He said that what was happening was because of the rules of natural law, that there needed to be healing, but it had to take place in a particular way. There had to be grieving and healing of the trauma, but because there had been no time to do that in the past, the energies or the spirits of the ancestors of the people I was working with were showing up in sessions. They needed to heal through their descendant here.

I mean, what do you do with that? 

ED: I sat with it in disbelief. But since nothing else I was doing was really making any sense to the people I was working with, I thought, “Well, I’ll try this. I'll tell some of these people what he said and just see what happens.” And it made perfect sense to the people I was working with. And it started helping me make more sense of the dreams, because a lot of the dreams involved trauma. Some of the people I was seeing had serious problems—addictions, violence, family dysfunction, all of that—and, to my surprise, using this frame to work through their dreams really started making people better. 

ED: They had experiences in their life where that had happened but, like me, they didn't have the context for understanding it. So, by me being able to talk about it, they were able to say, “Oh by the way, I've been seeing my great-great-grandpa appearing. But I can't tell people because they'll think I'm crazy.” And, of course, that was true.

ED: Exactly. In fact, I remember I was invited by the Federal Agency, the Indian Health Service, to give a report to them about what I was doing. So I gave a presentation about this—not like I’m talking to you; I tried to cover it up a little bit. And during my talk, these two guys in uniform from the Public Health Service came up to the podium and I thought they were going to congratulate me, but as they got to me, one of them whispered in my ear, “What the hell do you think you're doing?”

ED: And the other one said, “You're going to ruin your career before it starts.”

ED: One was and the other one wasn't. But they were high-ranking people in the Public Health Corps and in the Indian Health Service. They were high up on the food chain and had control over the money, so they could mess with me.

By this time I had already encountered my teacher, Terrence, who would play such a big role in my life, so I went up to see him, and he basically said, “Don't worry about that. Keep going. You’re on the right track.”

ED: Right before he went on to the spirit world, one of the things he told me was, “If everybody's liking everything you're doing, you're doing something wrong.” I really try to honor that wherever I go.

ED: Yes, and he was able to offer the container for me through all of it. In my meetings with him, he would kind of contain my psyche. My clinical supervisor could only do so much and I could only tell him so much if I wanted to stay in the profession.

ED: Oh yeah, I know Derald.

ED: I had an experience recently in New Zealand, reviewing a dissertation of a Maori man, where he talks about exactly this same phenomenon. In New Zealand, they’re in the beginning stages of this cultural competency training, and the Maori are pathologized in very much the same way that Native people here still are.

That’s why I write the stuff I write. There’s no other reason to write it. There's no money in academic publishing. But in the Western world, if it's published it's “true”; If you just say it, it's just anecdotal, right?
 

ED: It’s interesting. I did a talk for folks in the judicial system here in Montana—you know, cops and judges—and I thought, “This isn’t going to go well.” But I gave my talk and at the break, three or four officers came up and I thought they were really going to let me have it, but instead they said they were so relieved to hear me talk. They work with people who are locked up in jails and prisons, and they said that they were having these same experiences, of seeing people and thinking they were just going crazy. My stories gave them a context to understand their experiences and they were just very relieved. I was totally blown away by that. These were guys with guns and stuff.

So I think it’s more widespread than we think, but people stay closeted. What I do is validate it so they come out. The same with therapists. When I do these talks with therapists types, they don’t dare say it openly, but at breaks they’ll come and whisper in my ear that this has happened to them.

ED: Not at all. I'm working with this one brother right now who happens to be from a Jewish tradition. And he's experiencing these things in the room and seeing ancestors with the patients. He asked me, “What do I do with this?” And I told him, if it's going to help the patient, he’d better do something. He’s slowly allowing himself to go with the reality that he's experiencing.

All I'm doing is basically saying that it's okay to be human and to have a spirit. You have a soul, go with it. Because, that's what people really are needing at this point.
 

ED: There's a big movement with a lot of Native scholars from all over the world to respond to the evidence-based demand, since the only way you can get your practice to be considered evidence-based in a Western world is by using Western based empirical methods.

ED: Yeah. And it's also neo-colonialism, because if you set out rules that require everything to be validated through a certain filter, then what you're saying is that if it's not Western, it doesn't work. A lot of Native people all over the world, indigenous people, are really sensitive to that and say, “then we don't want it.” If you're using colonial methods to do the research, there's only one thing that's going to come out. You're going to come out with a colonial result. If we are to first “do no harm,” then this way of thinking and “validating” is unethical and immoral. It harms indigenous communities.

ED: There has to be another way of doing research, of getting “evidence-based” approval of more historical, traditional healing methods that have been in our communities for thousands of years. Why aren't those evidence based? It’s the colonial mindset that cannot accept them.

The very definition of the Western medical model is adversarial and pathologizing. In Native communities, it's all about relationships. We create relationships, even with the pathology itself. To the Native person it's not a matter of getting rid of the depression. It's a matter of making a relative out of it and learning something. It’s kind of an existential trip. Not unlike the Irvin Yalom’s work, actually.

ED: No, we moved all over. My dad worked construction, so we lived in places that weren't even places, up in the mountains.

ED: Yeah, I did. That's when I decided to go into the military, because that was too hard. Boy did I get that wrong.

ED: Yeah, I'm a veteran. The first day at boot camp I thought, “What the hell have I done? I should have stayed in the fields!”

ED: I thought, “This was a big mistake”—but it was too late. But the experience was valuable. Out of that I was able to get the GI Bill, which helped me get educated and get where I am today. 

ED: Not right away. The first college course I ever took was on the naval base. I didn't think I could go to college. I was told all along I couldn't. So I decided to try some classes on the naval base. I got B’s in the classes and thought, "Huh, maybe something is wrong here. Let me try another couple of classes." And I got A's in those. Then I thought, "I'm going to try the junior college, because this doesn't count." And I got A’s in those classes. By then I was like, “Somebody didn't tell me the truth here.”

ED: Yeah, so I kept going. But I got into trouble fairly early on, because I started saying stuff in class, especially psychology courses. One of my most momentous experiences was with this guy Jerome Sattler, a bigwig in assessment methods. I was in his class and started talking about how maybe assessment methods for Native children weren’t quite up to par. I'll never forget the last time I saw him I was at his door, and he closed the door, but as he was closing it he said, “You want to be a psychologist? Ha!” and he closed the door in my face.

ED: I thought I was done and that my career was over before I started, but there was a Native woman teaching there, Gwen Cooper, and she said, “Don’t worry, you can do this.” She pointed me in the direction of my graduate school and the rest is history.

ED: Yeah. The same thing happened in my Master’s program, in an assessment class, actually. I wrote a paper and the professor gave me a C. When I went to talk to him about it, he said, "It’s not because it’s not a good paper, it’s because you shouldn’t be saying what you’re saying in this paper." In that program, if you got two C’s you were kicked out, so I had to really learn early on to go underground and not say what I was thinking.

ED: I went underground and just pretended to be this nice white guy for the remaining time.

ED: That’s just what happens. A lot of Native students approach me and ask, “Where is there a program where we can study what you're doing?” And I tell them there isn’t one. You just have to go through it and hope you can keep your soul at the end of this. But a lot of them don't. If you pretend long enough, then you become it.

ED: Yeah. This is where Terrance really helped, because he wouldn’t let me become this middle American guy that just believed in that.

ED: It was really rough. Early on when I was doing the needs assessment, I had prepared this survey instrument, and I had sent it throughout the community. I thought, “Good, I'll have data so I can develop this program.” In that linear approach, you get the data, develop the program, implement and then evaluate. So I thought, “Voila, I'll cure this community in no time!”

Two weeks after the instruments went out in the community, they all came back to me and they were blank. I asked the community help workers, “Didn’t you guys take these out into the homes?” They said, “Yeah, but the elders said that the reason they hired you in the first place was because they thought your grandmother taught you better manners than this. What gives you the right to go around asking us a bunch of stupid questions like this?” Talk about cultural incompetence—I was the epitome of cultural incompetence. But I'm so blessed that they taught me. A lot of times Native people are very polite and they won't say things like that.
 

ED: Yeah, they would have pretended, and they would have paid me still, but nobody would have come. I would have just been wasting my time. I was very fortunate that they honored me enough to tell me the truth.

ED: Well, it was a mix. I got some of it, but because of the colonized way that it was treated, I had no real relationship with it. And I grew up in a very dysfunctional home with a lot of alcohol and violence, so those traditions were sort of on the periphery.

My grandparents followed a fairly spiritual way of being, were kind of models, but I didn't really know what it was that they were doing. They would take me to some of the ceremonial stuff, but there was often a lot of alcohol involved in that too, so there was a real contamination of the tradition with the dysfunction. So again, with the teachings of Terrance, I was able to finally see clearly through that.

ED: Yeah. That’s what I try to do with the people I see, because most of them are in the same situation where they're really struggling in between worlds—in between the religions and the loss of identity. By realizing who you are, your existence opens up and so much more becomes possible. If you don't know who you are, and there's no identity, it's real easy to kill yourself. If there's somebody there, it's a lot harder to commit suicide.

ED: Well, just being Native isn't the answer either. There are a lot of not just Native, but African-American, Latino and Asian psychologists who are being co-opted and internalize the oppression and that's even worse than being oppressed by a white person. Because you kind of expect it from the white person, but it’s a double hit when one of your own with internalized oppression does it to you.

But of course it can be done. Otherwise, it would be really hopeless and we should just shoot ourselves right now, right? But cultural competency training can't be a paternalistic, three-unit course where we learn little techniques to use with each culture—like not looking people in the eye as a sign of respect or whatever. There’s no list of stuff to make you culturally competent if everything coming out of your mouth is Westernese. That doesn't work.

I was invited to do a talk to a bunch of doctors and pharmacists and also a bunch of Native, traditional people about how to work in each other's worlds. I knew if I went in there and talked Westernese, then the Indians were going to shut down; and if I talked about traditional Indian stuff, then the doctors were going to shut down. So I came up with the idea of going back to the birth of the archetypes, where the female energy of the earth herself gives form to everything that is. The essence of my talk was that everything in Western medicine and Western philosophy, as well as Native philosophy and medicine, comes from the same source—that one great mother gave birth to all of it, and we then put the cultural flavor on it.

I gave examples of the ancient Greek doctor Asclepius, who is considered the first Western physician, and how he used the dreams of his patients to help heal them, in much the same way that Natives did and do.
 

ED: Yeah, exactly. He would take people into caves and wash them with water and steam, and that initial process was called a catharsis. Then they were taken into an inner chamber where they were supposed to have a healing dream. They would sit on this little stone couch, which was called a clinic, and they would have their healing dream. A lot of these dreams were recorded; you can look them up online.

For ancient Greeks, a medical doctor was a doctor of the body, of the mind, and of the spirit who was able, through dreams, to allow the patient to have their healing. That’s the root of Western medicine.

So I was talking about all this stuff and all the Indians were like, “Whoa, that's like what we do.” And the doctors were like, “We did that?” And I said, “Yeah, where did you lose it?”

Western medical models are pretty guy-oriented, built around antagonism. That’s why we have wars on sickness, wars on cancer, etc. The Native way is more female oriented, about relationship. Instead of saying, “You have a major depressive disorder,” which crystallizes the sickness, we say, “You are being visited by the spirit of sadness.” It’s a very different message to give the patient. They are more empowered, they feel they can actually move through it.

In English, there’s a noun-ing that happens that freezes you in space and time. If you say you are a woman, well, that's all you can be. But if it's woman-ing that’s happening, then guess what? Man-ning can also happen over there. 

ED: Yeah. Those energies can move. And what a way to live—you’re free to be whatever at any moment in time. I met this elder in Canada a couple years ago, and he told me that in his language there are no nouns.

ED: What do you do with that, right? But that's how he walks through the world, with no nouns; so everything's in movement. And in quantum theory we're finding out that that's really the way it is. The universe is really in movement, and nothing really exists, right?

In the Navajo tradition, there’s an idea of Changing Woman, where there’s no image that can be made of her because she is constantly changing, and because she’s constantly changing, she’s not anything. But if she’s not anything, she can be everything.
 

ED: Yes. I did the anger thing, where I critiqued and rejected white culture, but that didn’t work, they just got more dug in. And now it’s more that we can share these traditions in a way that will serve everyone.

ED: Oh, absolutely.

ED: Oh yeah, identity needs to be restored; without that they're going to be flailing out there. But initially I don't tell them that. We psychologists are supposed to be tricky right? That's the whole tradition. 

ED: Gain their trust, the therapeutic alliance and all that good stuff—again through their own dreams, their own process, it's restored. I’ll give you an example. I do dream groups, especially in substance abuse programs, and this one day I was leading a group and I was talking about the spirit of alcohol and how it’s an energy, and this young Indian guy rolled his eyes and said, “You sound just like my grandmother.” Which I took as a great compliment. He said, “We're modern people,” and I said, “Well that’s good. You don't have to believe this. I'm just offering another idea here.”

In my experience, patients in treatment for substance abuse have moments of being trapped in bed—they can't scream, they can't get up, and it's very terrifying. So two days later I came back to the program to do my dream group, and this guy was at the door waiting for me. He was ashen. “That thing happened to me. I couldn't get up and I couldn't cry. I couldn't move. I couldn't breathe, and it was really scary.” So here's where my psychologist manipulation came in. I said, “Well, gee, I wonder what happened?” He answered, “It was the spirit of alcohol.”

“I wonder what you could do about that?” I had already talked to the group about what to do. And he said, “Well, I could make an offering to the spirit.” I encouraged him to make an offering to that energy, whether it was alcohol or depression. He said, “How do I do that?”

See, so now his identity's starting to be turned. He’s doing the intervention, but he's also bringing himself back. And of course I always tease people. “What kind of Indian are you, anyway?”
 

ED: Exactly. So I said, “You use some tobacco, because that's the form of offering that is used by most Native people, and give the spirit of alcohol some of that and see what it does. It might accept it, it might not. I don't know.”

Two days later I come back for the group and he’s waiting for me at the door, looking worse than before. So I'm like, now what? And he said, “I put my offerings in this place, and they took them.” Whoever they are, they literally took the physical tobacco, and that really freaked him out. He’d been sober for a couple of months, so it wasn’t a hallucination or anything. So now he's realizing that he's moving in a whole other world. He's moving back into the Indian world.

I said, “Having a conversation with that energy, maybe it will let you go enough to where you can deal with what's bothering you, so that you don't have to use it anymore.” Because using alcohol as a Native person is abusing sacred medicine, and that a terrible accusation. That's like telling a Christian that they're blaspheming against Christ.

So I said, “Now you need to make amends to the spirit of alcohol. Because, as a Native person, it knows that you know better.” So now it's shifted the situation into a whole other place—and if nothing else, it’s weird enough to be interesting.
 

ED: He said, “Are you kidding?” I said, “You don't have to take my word, just do it and see what happens.” By doing these things, he started reconnecting himself to himself, and at the same time working on the addiction, so that now he’s lost his thirst for alcohol. Because the spirit of alcohol is also letting him go in that relationship. It’s like divorce. If you want to divorce somebody, you don't just walk away. You've got to go through a process. Here you've been married to this medicine, and now you just want to walk away. That's bad manners. It’s an interesting way of looking at things and it changes the way you think.

ED: During this process, their dreams get really intense to where the spirit of alcohol actually shows up, and it’s really terrifying for people. But now they're dealing with the real issue.

ED: Oh, sure, yes, if that's working for them. It says right there in the Twelve Steps that you need to make amends. So make amends to the medicine. AA founder Bill W. developed the Twelve Steps in part through a conversation with Jung, where he basically told him exactly what I'm telling you—that this is an energy, this is a spirit, and you're in a state of possession. You can look at the letter Jung wrote online. He also consulted with Native elders in developing the Twelve Steps. You can see the influence, but he westernized it so that it's more palatable.

ED: But if you look into the subtext, you can see Jung’s influence and that of the Native elders. A lot of these elders were present at his funeral. 

ED: Yes, exactly. 

ED: Well, I’ve trained quite a few interns over the span of my career and I basically let them dive into the work and then try to help move them away from the thinking function. For example, in supervision they'll come in with little yellow tablets ready to take notes. And I'll say stupid stuff like, “What's that for? You’re really going to take notes?” And then I try to deconstruct their thinking so that they can start moving down into their heart. I also ask them if they’re dreaming, and if their patients are dreaming, and basically immerse them into the Native worldview.

Of course, that can be really frightening. I've had interns almost lose it because they started hallucinating and seeing stuff when they were awake. I had to really contain that process for them, because it gets really scary once you start moving out of your Western-thinking paradigm. It’s foreign to the ego and the ego can start to disintegrate without proper containment.

I had a Jewish intern, actually, who was pretty non-identified with his Jewish culture, not practicing or anything. He was irreverent and would do things like bring pork to potlucks and laugh about it. He thought all this spirit stuff was crap.

One day he came to a Native ceremony. It was an all night ceremony and there happened to be a fire at the ceremony, and prayer and singing. And that night in the fire he said he saw God. It totally transformed him. He became ultra-Jewish, and even started rabbinical studies. It was a really interesting metamorphosis for him, like regaining his soul. Him being completely present to who he is allows him to be present for that Native person.

In another instance, a Korean woman from a very prestigious school was working with us, and we were going to have an all-night ceremony again. She was really worried that she might run into her clients at the ceremony and was struggling with the whole ethics side of things. I said, “Well, who knows?” I try not to contain it too much, because the ego needs to experience some unsettling.

So she decided to go, and she's sitting there in the teepee all night, and who walks in but the one family that she's been working with that's really difficult. They sit right next to her and since she doesn't know anything about the ceremony, they start helping her with the ceremony. It was such a tremendous transformation for her, and a tremendous validation for the family, because she was praying their way now. It really brought their relationship and the treatment to a whole new level.

ED: It took away that thinking function and at the end of it she was so grateful. Their work progressed quickly after that.

ED: Yeah. Absolutely. Since the ego's in complete control and knows everything, you can't go into other cultures, because then you’re just bringing your Westernese with you. But if you're a little big fragmented, maybe you'll be open to something else.

ED: I try. A lot of times I say stupid stuff to patients also, to confuse the ego.

ED: It was my pleasure, thank you.