COMMUNICATION STYLES OF WIND RIVER

NATIVE AMERICAN CLIENTS

AND THE THERAPEUTIC APPROACHES
OF THEIR CLINICIANS

Stacy AuCoin Lee, M.S.W., L.C.S.W. *

ABSTRACT
This article discusses the major themes that emerged from a
Smith College School for Social Work student's Master's
thesis, "Communication Styles in Wind River Native Ameri-
can Clients and the Therapeutic Responses of their Clini-
cians". The project explores differences in communication
styles between Wind River native people and Anglo-Ameri-
cans. Secondly, it seeks to discover therapeutic approaches
and styles that are effective with Wind River native people.
Semi-structured, exploratory interviews were conducted with
ten clinicians who worked with Native American clients on
the Wind River Reservation in Wyoming. The participants
included mental health care professionals and paraprofes-
sionals from the following professions: psychology, social
work, counseling, nursing, and community action.
The findings of the research revealed the importance of
understanding cultural differences in human interaction and
meaning making as conveyed in communication style. As
clinicians, these complex and often subtle differences play a
crucial role in our ability to establish a therapeutic alliance
and conduct sensitive, effective therapy. Many theoretical
models, such as psychodynamic, cognitive and behavioral,
family systems, ecological, constructionist, and narrative
theories support the successful approaches discussed in the
article.

Despite the large demand for culturally informed, effective therapy

among many Native American tribes, there is a dearth of informationin
the literature regarding such therapeutic approaches. This article

* Stacy AuCoin Lee, M.S.W., L.C.S.W. is a psychotherapist at Jackson Hole

Community Counseling Center in Jackson, WY.
Smith College Studies in Social Work, 68(1), November 1997.
58 STACY AuCOIN LEE

describes a recent study which explored communication styles of

Native American clients on the Wind River Reservation in Wyoming
and investigated the therapeutic approaches of their clinicians. A few
studies have been conducted and published regarding general charac-
teristics of communication styles and therapeutic approaches among
Native Americans, but no literature has been found which focuses
specifically on the Shoshone and Arapaho tribes. While the study
reported below has widespread applicability, it may be most helpful
to clinicians who are just beginning to work with Native American
clients, and to students and teachers of cross-cultural therapy. Fur-
ther studies are needed to explore effective, culturally relevant
therapeutic approaches at Wind River and among other tribes across
the country.
The study explored differences between Native American and
Anglo-American communication styles. Some of the communica-
tion style differences studied included: eye contact, listening/com-
fort with silence/interrupting, emotional expression, spiritual expres-
sion, concept of self, family, and problem description. The study also
explored the approaches and particular styles that clinicians utilized
in response to the communication style differences. At the 1995
Family Therapy Networker Annual Symposium, an Australian ab-
original woman from the Nunogee tribe told a story that expressed the
spirit of what this study tries to understand within the Wind River
Reservation. She stated:
A monkey from Europe came on a long journey to Australia.
This monkey had previously had a bad experience by nearly
drowning in water. He came along an Australian creek and
saw some fish in the water, splashing, playing around. With
good intentions, and wanting to save the fish from drowning,
the monkey quickly reached into the water and pulled the fish
out and tied them to a tree so they could breathe. But, alas,
the fish died. (White, Gollan, & Abdulla, 1995)
The story illustrates that understanding healing and communica-
tion may vary among different people, none being better or worse
than the others, but each being different. Clinicians must be open to
these differences and adapt their clinical approaches in therapy and
other social services. It also points to the importance of research on
multicultural therapy.
Native American clinicians as well as non-Native clinicians must
strive to attune themselves to Native American clients within the
clients' cultural context. Attunement to cultural differences may be
COMMUNICATION STYLÉS 59

difficult for those non-Native American clinicians who cannot step

out of their own cultural paradigm to listen to and understand Native
American clients. Stereotypical beliefs may also interfere with their
ability to help. For Native American clinicians, cultural attunement
toward clients may be complicated because Native American clients
are members of different tribes, which have different cultural beliefs,
and likely have assimilated differently within the Anglo-American
culture. The work may also stir up personal issues that require special
attention in supervision.
Communication styles are particularly important for clinicians to
understand because they powerfully affect people, often at an uncon-
scious level. Communication styles influence how we act, how we are
perceived by others, and how we regard other people. Without being
aware of it, we may make judgments about others based on their
culture's and family's style of communication etiquette.
A New Mexico study on Native American perspectives on healthcare
delivery systems for their families (Malach& Segal, 1990) illustrates
the significance of understanding communication patterns. The
research participants stated that "effective communication" was the
most important factor in improving the relationship between healthcare
providers and Native American families (p. 225).
Current studies about the cultural differences and communication
styles of Native Americans, and similar future studies are important
to inform clinicians about how best to work with their Native
American clients (Ainsworth, 1984; Albas, McCluskey & Albas,
1976; Dauphinais, Dauphinais & Rowe,1981; Dévore & Schlesinger,
1986; Edwards & Edwards, 1989; Greenbaum, 1985; Greenbaum &
Greenbaum, 1983; Herring, 1990; Joe, J. & Malach, S., 1992;
Kleinfeld, 1973; LaFromboise, 1994; Leap, 1987; Lewis & Ho, 1979;
Littrell & Littrell, 1983; Lockart, 1981; Lynch, 1992; Malach &
Segel, 1990; Red Horse, 1988; Sue, 1981; Swinomish Tribal Mental
Health Project, 1991; Tafoya, T., 1989; von Ruffler-Engel, 1988).
Most of these studies focused on cultural differences while a few
emphasized communication style differences. Very few looked at
therapeutic approaches in response to communication style differ-
ences, and no studies document Shoshone and Arapaho tribes. The
studies that did investigate communication style differences gener-
ated similar findings to this study. However, in the Wind River study,
nuances within communication style differences and therapeutic
roles were discovered that were not reported in other studies. These
findings promote a more complex and deeper understanding of the
60 STACY AuCOIN LEE

study issues and also corroborate the findings of past studies.

The Wind River study's findings corroborated past studies regard-
ing differences in eye contact, speaking and listening patterns, the
concept of self in relation, expression of emotion, and the importance
of family connection. This study also supported past studies which
found that non-confrontive therapeutic approaches and styles were
most effective. However, this study identified more details of the
non-confrontive style, incorporated additional features and nuances
within the therapeutic role, and synthesized these aspects into a more
comprehensive therapeutic style concept. The researcher in this
study coined a new term, "Halcyon Style", to name the complex
character of the therapeutic style revealed in the findings.
Some of the findings in this study call into question the accuracy
of one measurement used by Sue, Allen and Conaway (1978), who
measured success in therapy by the number of sessions and rate of
immediate return for next visit (see "Limitations of the Study"). All
of the cited studies as well as future studies of the issues have
implications for domestic policy. They provide information and
recommendations for improving how social services are adminis-
tered and the types of mental health services likely to be most helpful.

METHODOLOGY
Definition of Terms
For the purposes of this study, communication styles are defined
as the verbal and non-verbal forms of communication between at
least two people. They are assumed to vary among individuals,
families and cultures. The study looked at communication style
differences in some Wind River Native American clients, as per-
ceived by their clinicians. Through interviews, this investigator
examined the following aspects of communication style: eye contact,
silence, oral interruptions, touch, and physical distance, as well as
how clients speak of the self, their emotional "problems", family life,
and spirituality. The term "clinician" refers to professionals or
paraprofessionals in the mental health field. The ten subjects inter-
viewed for this study included social workers, psychologists, one
nurse, and one drug abuse prevention advocate.
"Native American" in this study refers to people who identify
themselves as Native American, American Indian, or as members of
an indigenous tribe in the United States. All interviews were con-
ducted with mental health workers affiliated with the Wind River
Reservation in Wyoming. The majority of the Native American
COMMUNICATION STYLES 61

clients referred to are members of the Arapaho or Shoshone tribes on

the reservation. Demographic information provided by the partici-
pants about their Native American clients served to increase under-
standing of client diversity.
During the literature search and the interview analysis it became
evident that a clearer definition of a particular and complex therapeu-
tic style was needed. To describe the relaxed, reflexive stance
associated with indirect therapeutic techniques, the researcher coined
the term "Halcyon Style" after the mythological bird the ancient
Greeks believed calmed the waves. In Greek mythology, Haley one
was a woman who threw herself into the sea when she discovered that
her husband, Ceyx, had drowned. She and her husband were both
changed into birds by the gods, and as long as both built and tended
their nest, the Aegean sea was tame (Mercantante, 1988). To this
researcher the image of a flying bird captures the complexity of a
particular therapeutic style. A bird can soar and glide smoothly and
calmly, but it also periodically needs to flap its wings actively to
remain in the air.
In this study, "Halcyon Style" suggests a calm, attentive, and
active therapeutic stance reminiscent of the birds Haley one and Ceyx
as they attended to their nest and flew calmly over the sea. A Halcyon
therapeutic style embodies a reflexive stance: a calm, gentle quality
that is non-confrontational and non-conflictual in relation to the
client. The other aspect of this style characterizes the techniques used
by a Halcyon therapist. For the most part these techniques are
indirect, although they are sometimes active as well. They use active
techniques such as drawing, storytelling, ritual, guided imagery, and
service follow-up for the client, and indirect techniques that thera-
pists externalize the clients' problems or feelings.

Participants
Four of the study participants were male and six were female. They
averaged 44 years in age, ranging from 34 to 58 years old. Their
educational backgrounds ranged from a B.S. degree and nursing
training, to a Ph.D. in psychology. Most of the participants worked
in the mental health field as psychologists, social workers, or coun-
selors. One participant was an advocate for a youth drug abuse
prevention program, and another was a nurse with clinical experience
and some psychology training.
Five participants identified themselves as Caucasian or White, two
as Native American from the Arapaho and Shoshone tribes and one
62 STACY AuCOIN LEE

as a "mixed blood", Anglo and Crow Creek Sioux and Cheyenne

River Sioux. One participant was Latina, and one was unsure about
her ethnicity, but indicated she was not enrolled in any Native
American tribe. The median number of years the participants had
worked with Native Americans was 12.5. The range was from 1.5 to
23 years. Three subjects worked in non-profit organizations. The
others worked in county, state, or federal agencies.
The participants' Native American clients came mostly from the
Shoshone and Arapaho tribes, although a few other tribes were
mentioned including Bannock, Cheyenne, Navaho, and Sioux. Most
(87.5%) of the clients lived on the Wind River Reservation. Recog-
nizing the diversity within tribal cultures and the various understand-
ings of the term "Native American", this study employed a diversity
measurement, the LaFromboise "Degree of Indianness" scale, which
attempts to measure assimilation into Anglo culture (LaFromboise,
1994). (Refer to Table I.) While imperfect, particularly in its ability
to capture fully the essence of diverse Native American tribal cul-
tures , the measurement did assist in characterizing numerous aspects
of the Native American clients with whom the study's participants
worked.

Table I: LaFromboise's Categories of "Indianness" or Assimilation Scale

Categories of "Indianness"/
Assimilation Description
Traditional The traditional person thinks and speaks in his or her
native language, knows little English, and probably
will not seek therapy.
Transitional The transitional person speaks both languages at
home and in the community. For the most part, this
individual questions traditional ways of being and
also questions the ways of the dominant society.
Marginal The marginal person is defensively Native American
Indian and has a difficult time coping with either
traditional ways or the dominant society. The
marginal person is caught between two worlds.
Assimilated The assimilated person has abandoned most of
traditional society and accepts dominant cultural
values.
Bicultural The bicultural person lives effectively in both
traditional and dominant societies. Instead of a dual
loyalty, he or she has multiple loyalties and can often
select roles that support themselves. The bicultural
person may have a better lifestyle than those who live
in only one world.
COMMUNICATION STYLES 63

As reported by the participants, the clients fell loosely into the

following categories: 36% were Marginal, 21.7% were Bicultural,
20% were Transitional, 15.1% were Assimilated, and 8% were
Traditional.
In terms of economic class, the participants indicated that 68.5%
of their clients were poor, 18.5% were working poor, 9.5% were
middle class, 3% upper middle class, and 0.5% were upper class.
Definitions of these categories were left up to each participant, and in
retrospect, it seems likely that some subjects had different views of
what each category meant. Clarification of the economic status is
recommended for future studies to strengthen the validity of the
demographic data.

Design and Procedure

The flexible research method and semi-structured exploratory
interviews used in this study allowed the researcher to delve beyond
the limits of impersonal questionnaires and discover new themes
woven into the research data. Interviews provide the opportunity to
gain a fuller, more nuanced sense of ideas as they are expressed
through body language, intonation, facial movements, pauses, as
well as words. Interviews also allow for clarification of meaning.
To insure high standards of validity and reliability, interviews
were audiotaped and transcribed. Thus, observations or results could
be reproduced under the same or similar conditions as during the data
collecting process. The investigator's own feelings and reactions, as
well as what the participants conveyed, were included in notes taken
during the interviews. Consent forms and demographic question-
naires were sent prior to the interviews. All interviews were tran-
scribed using the tapes and notes taken during the interview sessions.
Coding the results involved consideration of the context of the words
and phrases elicited during the interviews.
The data collection process was designed to construct a diverse
sample of clinicians who worked at the Wind River Reservation.
Word-of-mouth (snowball sample) was used to develop a list of
potential participants. In total, ten mental health care professionals
and paraprofessionals who work with Native Americans on the Wind
River Reservation in Wyoming were interviewed.

Ethical Issues
The reader should keep in mind that the researcher interviewed the
clinicians about their clients. As a result, the study findings are
64 STACY AuCOIN LEE

filtered through the lenses of the clinicians, most of whom (60%,

including the Latina therapist) were Anglo, and could mistake the
meanings of their interactions with clients in ways influenced by their
own culture. However, there was also real value in interviewing
clinicians, especially about their therapeutic approaches and reflec-
tions on the therapeutic work. It was important for this researcher to
keep Alpha and Beta biases in mind throughout the study. Hare-
Mustin (1989) describes, "Alpha bias as exaggerating differences
between groups of people", and "Beta bias as ignoring differences
when they do exist."
The use of confidentiality both in this study and in past research
about Native Americans was problematic for one Native American
clinician in the study. She was concerned that the study participants
could say anything they wanted and not be held accountable. She
asked that her name be included in the study to represent her
willingness to stand by her words. The researcher chose to accommo-
date her request in the ethics section of the Methodology chapter, but
did not include her name in the Findings and Discussion chapters
because they were organized according to themes identified in the
interviews. The same subject was also concerned that much past
research had never been shared with the community after completion.
Recognizing the validity of this concern, copies of this study were
distributed to all the participants.
Another clinician in the study was concerned about having partici-
pants define themselves as members of certain tribes, and rank
themselves on the assimilation scale. She felt very strongly that only
the tribal governing body can determine tribal membership for an
individual. She recommended that the researcher exercise caution
regarding possible misrepresentation, citing individuals who had
claimed tribal membership to receive grant money and academic
appointments or to sell jewelry and crafts as authentic native pieces.
For the purposes of this study, the assimilation scale, although
limited in value, was helpful in measuring some aspects of diversity.
The small sample size increased the possibility that findings may
not be representative of the clinicians who work with Wind River
Native American clients, or of the native population as a whole.
Accordingly, the results should not be generalized to all Native
Americans or to all Wind River native clients.
COMMUNICATION STYLES 65

FINDINGS
The findings were rich with nuance and complexity which cannot
entirely be conveyed in article format. However, some of the most
important themes are summarized below. The findings are divided
into two sections: Communication Styles and Therapeutic Ap-
proaches.

Communication Styles in Wind River Native American Clients

Eye contact. Generally, the participants indicated that eye contact
with their Native American clients was less direct and less frequent.
They also indicated that less eye contact can have multiple meanings,
including respect, deference to an elder, anger, and distrust. Most
participants indicated that less direct eye contact usually conveyed
respect and attention. They also indicated that eye contact style —
the degree of directness and frequency — also differs depending on
gender, age, cultural assimilation, and familiarity. One participant
described the complexity of this issue by stating:
It can be different for a woman conversing with a man, a
woman conversing with an older woman, a woman convers-
ing with a child, or depending on which tribe .... Older people
don't want you to look at them very often. So you might look
at them a few times, but you don't sit there and just stare at
them in the face very often because it's disrespectful .... I
have talked with men who are very traditional and find that
they don't even look at me at all, and we have to sit side by
side next to each other and talk to a wall, but that's okay ...
So, I just take my cue from other people ....
No differences between native and non-native therapists emerged
regarding this issue, but a Shoshone participant indicated that her
ideas about eye-contact styles have evolved over the years. She
stated:
Nowadays I think we [Native Americans] tend to look more
directly at the person we're talking to and then kind of glance
away and relieve that constant eye contact. And I think the
change in focus depends on the comfortableness of that
person. I don't feel comfortable just staring at someone just
constant, so I look away. And that is just me, but I do feel that
a lot of Indian people do the same.
66 STACY AuCOIN LEE

Oral patterns: listening, interrupting, use of silence. The partici-

pants indicated that their Native American clients were more com-
fortable with silence. One subject described silence for Native
Americans as a way of being with the other person. She stated:
Native American people are very comfortable with silence.
It is a respectful thing, whereas in the dominant culture we
feel we need to fill space up with talk. They don't, and they
feel that being there with someone is what is important —
this does not have to be talking. Just being there with
someone, sitting with them on the front porch and doing
whatever. Conversation is not necessary .... Many times I'm
counseling and someone starts telling their story, and they
take a pause and for me it stretches out into an unbelievable
pause.
The participants also described longer pauses occurring between
speaking—the switch-back cues were different in this way from
Anglo clients. One participant stated:
A length of time between sentences, for instance, when you
are conversing with another person in the dominant culture
... you wait for a beat of one (pause) — like that — and the
other person picks up the talking. With Native people, you
wait anywhere from three maybe four, possibly longer than
that, beats before another person starts talking. They con-
sider it very rude if another person just kind of jumps in.
Additionally, the participants indicated that one does not interrupt;
instead one person speaks and then the other person speaks. This
turn-taking style seems to allow more space for listening to each
other. A Native American participant attributed the comfort with
silence to valuing listening. She stated:
I generally have found Indian people ready to listen and to
perhaps have more of an interest in listening and becoming
aware of what's going on around them, as opposed to interest
in making a point of view known.
No differences between native and non-native therapists emerged
from the findings.
Expression of emotion. The participants explained that emotional
expression with a therapist was more subtle and restricted, but
present. They also noted that humor is often used as an adaptive
defense mechanism to defend against pain, discomfort, and intense
COMMUNICATION STYLES 67

feeling. It was found that the direct expression of a lot of intense

feeling is often considered indulgent and weak by many Native
Americans. A number of different reasons for this attitude were
cited; all of the reasons related to the tremendous amount of trauma
Native Americans have experienced throughout the generations.
Trauma can blunt or numb emotional expression. Also, individuals
can protect themselves from being overwhelmed by their intense
feelings by modulating the expression of those feelings. For such
individuals, suppressing emotion has an important adaptive function.
Cautiousness and restraint in expressing emotions can also signify an
adaptive distrust and wariness about being vulnerable with the thera-
pist. This is especially true if the therapist is Anglo. The participants
described this style of emotional expression as one that will also vary
according to gender, age, and the development of a trusting relation-
ship.
Spirituality and communication. The participants in the study
reported that spirituality is very important to their Native American
clients. However the topic is not often brought up directly until the
therapist and client have built a trusting relationship. This is espe-
cially true in regard to the more traditional spiritual activities or
beliefs. It was reported that spiritual beliefs and practices are quite
diverse. They include traditional beliefs and activities, as well as
rituals and practices derived from Catholicism, different Protestant
sects, the Jehovah's Witnesses, and idiosyncratic combinations of
any or all of the above.
The study revealed that the clinicians validated each client's
particular spiritual beliefs and practices because they believed them
to be an important part of healing for many of their Native American
clients. They cautioned, however, that one should not push for details
about practices, especially in regard to traditional ceremonies. Ac-
tive inquiry into such practices without a specific invitation to do so
is usually considered rude, obtrusive, and disrespectful of sacred
practices. Native and non-native therapists seemed to agree on this
matter.
Self in relation. The concept of self seems to be seen within the
context of relationships, such as the family, community, tribe, the
natural environment, and spiritual beliefs. The participants indicated
that their Native American clients seem to consider the individual
less important than the family and the group. They further described
clients as uncomfortable with calling attention to themselves in
68 STACY AuCOIN LEE

conversation, especially in regard to their strengths. It is considered

bad manners to attract too much attention to oneself. The native and
non-native therapists in the study seemed to agree on this issue.
Communication about family. The findings revealed that Wind
River Native American clients were very protective of their families
in conversation. Reportedly, clients were not easily engaged in
discussion about problems with other people in their family, even
when a family member was abusive. It is often considered disrespect-
ful and shameful to talk about another family member in a negative
way. There is a tremendous sense of shame and guilt for the entire
family when a member has done something wrong. The participants
reported that clients may minimize or play down problems they have
in regard to other family members. On this matter also, both native
and non-native therapists seemed to agree.
How problems are described. The findings indicated that prob-
lems were often expressed indirectly and that it often took time to
approach crucial issues. The study participants thought this style was
influenced by issues of trust, a need to test the therapist, and,
sometimes, respect for the therapist's ability to discover what the
client wanted to communicate without explicit description.
It was reported that oppression, prejudice, and bigotry are also
ongoing problems for clients. Participants indicated that anger about
bigotry may emerge in therapy and should be validated. One Native
American participant described a therapy group where anger about
bigotry and oppression were discussed indirectly when the group
members criticized General Custer. The participant had to counsel
her colleagues about the importance of General Custer as a useful
metaphor to work on anger for the daily prejudice to which the group
members were exposed.
Another way many of the Native American clients described their
problems involved attributing meaning to particular material objects
or environmental occurrences. Environmental phenomena were called
upon to explain problems or blessings that had significant meaning to
clients and their families. One participant described this tendency,
stating:
The person kind of interprets that [environmental thing or
event] as significant to them. For example, a Native Ameri-
can person could present with a problem around family
troubles, kind of a decrease in functioning of the whole
family, and [relate it to] that person having seen something
COMMUNICATION STYLES 69

in their environment (pause) like a spider crawling on the

wall and to them that meant a particular good sign .... Or a
particular noise, or event at home that had been caused by a
neighbor's ill will, or in-law's ill will toward them or toward
their family that had created this increased dysfunctioning
within their family. So, I might hear people describing
things in those terms in regard to what the problem is. And
I believe in those things and don't consider them schizo-
phrenic or anything like that. (Laughs.)
Problems were often defined in the context of family and tribe,
particularly, how individuals felt in relation to those entities. One
Native American participant described the value of interconnection
by stating that "there may be more of a tendency to speak about
oneself in terms of how they fit within the community." Another
participant stated:
So, it's good in one sense that people are interconnected in
that sense of belonging, hopefully, if things are going right.
Also, though, if people pass away, people experience a lot
more loss ... in that sense because of the connections. They
might experience grief and loss more frequently in the sense
of being closer to more people.
The findings of this study revealed many differences in communi-
cation styles between Wind River Native American clients and
Anglo-American clients. Differences included eye contact, oral
patterns of discourse, emotional expressiveness, expressions of spiri-
tuality , self representations, family relations, and personal problems.
Participants also suggested that issues such as racial and ethnic
distrust, oppression, individual and transgenerational trauma, educa-
tion, age, family role, therapy setting, diagnosis, and confidentiality
all influence communication styles among their Native American
clients.
Therapists, both native and non-native, reported similar findings.

Recommendations for Therapists

Don't stare. The findings indicated that the participants did not
use prolonged eye contact with their Native American clients. They
reported picking up on each client's own cues and then following suit.
They reported that less eye contact from a Native American client can
mean respect and thoughtfulness, rather than disrespect or weakness.
Individual meanings are discovered in the course of developing a
relationship with clients, a process that takes time. It was reported
70 STACY AuCOIN LEE

that eye contact tends to increase somewhat as a trusting relationship

develops, but is still less direct than in Anglo culture.
Both native and non-native therapists recognized differences be-
tween cultures regarding the level of intensity of eye contact, but
native therapists emphasized the importance of non-native therapists
respecting this difference.
Listen well. The findings emphasized that listening well was
important to clients. One participant stated:
People [her Native American clients] liked to be listened to
very much. They want someone to listen to them in a way that
is non-judgmental. I think everyone does, but there is a
cultural thing about just listening and waiting until
somebody's finished .... I think people want to feel like they
have been heard when they leave .... And all that kind of stuff
takes time, and if you try to put it all into a forty-five minute
time frame, it doesn't always work.

Another participant stated:

I think communication in the counseling session is most
effective when there is a hypnotic quality for both people
who are on the same wavelength. Somebody made the
comment that traditional Indian medicine men go into a
trance when they do their healing thing, and psychologists
put clients in a trance .... I think it's most effective when both
are in sort of a semi-trance in the sense we are talking about
being congruent in terms of feelings and on the same wave-
length in terms of exploring the problem together.
Another finding was that, sometimes, "active listening" was needed
to demonstrate interest and care for Native American clients. One
participant stated:
You definitely have to be an active listener and that is a big
quality of getting the response you want [getting the client
engaged in therapy]. I think you need to really try, when
you're listening to a client and getting information, to accu-
rately give them feedback from what you've heard and
describe the main points that you hear. So they know that
you're really here. And also just nodding and noticing that
and letting them know that you're with them somehow.
This more active listening stance does not challenge the earlier
recommendations. Rather, it illustrates the importance of sometimes
COMMUNICATION STYLES 71

needing to signal to the client, through nonverbal and reflective

verbal feedback, clear acceptance and understanding. It is still a non-
confrontational approach that can help foster a sense of rapport and
connection.
No differences were uncovered between native and non-native
therapists about this issue.
Emotional expression. Participants observed that it is acceptable
to explore expressions of intense emotion gently with Native Ameri-
can clients. Data revealed that the character of the emotional
expression was more subtle in Native American clients than in Anglo
clients. The participants reported that letting emotional expression
"flow naturally" was their approach; they didn't "push" their clients.
Humor was recommended as an effective tool in helping clients
regulate feelings. One participant described her use of humor by
stating:
In counseling, I always have to be careful to leave an
opportunity to make it light. It's like when it gets too heavy,
you just have to step back a little and lighten it up, joke about
this or that to let them know that you're still okay and you
still like them.
No differences between native and non-native therapists emerged
in regard to this matter.
Spirituality in therapy. The findings indicated that it is important
to understand and encourage the individual client's spiritual beliefs
and practices in the healing process. This did not mean, however, that
the clinician should push for information about specifics when they
were not shared spontaneously by the client. In fact, pushing for this
kind of information was described as very rude and unhelpful. This
principle seems compatible with the psychodynamic principle of
starting where the client is.
Participants reported a strong spiritual element to their clients'
concept of Wellness. One Shoshone participant described this by
stating:
Wellness is what spirituality has to do with and it's in four
sections: physical, mental, spiritual, and social. But I
always feel that with the Indians, rather than it being equal —
spiritual, physical, mental, and social — that the spiritual is
larger and overlaps the mental. I was thinking that the Wind
River Range of the Rockies has a great deal of medicine, and
it can heal us as a tribe. But how could you describe that?
72 STACY AuCOIN LEE

See, that's kind of a spiritual kind of thing that corrects and

controls, which comes from their [Native Americans at Wind
River] belief in the creator and ancestors ... [that] is ... the
best way to describe it. It's believing in things that are much
greater than we are and have powers much beyond what we
could ever have. And they are available to us if we just look
for them and accept them. That's my interpretation of what's
going on for us.
The use of ritual which incorporates spiritual beliefs into the
healing process was also reported to be important and effective. One
participant stated:
Experiential meaning and the use of ceremonies [is impor-
tant]. For example, one woman was talking about taking
back control over her life because it had just been blown
apart by tremendous tragedy. How to do that was coming
much more from an action, experiential kind of things, where
you go out and do things and those [activities] represent
[meaningful things] .It's like taking a letter or writing a letter
to someone who has died and then taking that letter and
putting it on the top of a nice bed of coals and watching the
flame, and watching then that energy being transformed
from something concrete to warmth and light .... That just
makes sense.
Native and non-native therapists seemed to agree in this area. One
might hypothesize that therapists from the same tribe as the clients
might be more comfortable in discussing spiritual experiences. How-
ever, no indication of this was revealed in this study.
Self in relation concept in therapy. Particular caution was ex-
pressed in regard to diagnosing Native American clients as co-
dependent because of the cultural differences between Anglo and
Native American concepts of independence and self. Native Ameri-
can clients hold cultural values of interconnection and of a life in
which the individual is a part of a system. A Sioux participant stated:
I guess I might worry that psychoanalytic types might make
a big deal out of that in terms of that ego boundary ....I have
mixed feelings about co-dependency as a diagnosis. I won-
der what that really means sometimes .... It is misused or
excessively used.
No differences between native and non-native therapists were
discovered in the findings. One native therapist did express concern
COMMUNICATION STYLES 73

about some non-native therapists with whom she worked who were
not as sensitive and understanding in their work with native clients on
this particular subject. Further study would be helpful in more fully
exploring possible differences.
Family contact and home visits. Again, caution was expressed
about using an Anglo version of individuality when working with the
family dynamics of Native American clients. One Sioux participant
used an example from her agency to illustrate this point. The case
involved an Arapàho grandmother who was attempting to work
outside the home for the first time in her life. Her sometimes
"irresponsible" adult children would leave their own children with
the grandmother at a moment's notice, causing her to be late or absent
from the new job. The grandmother's Anglo-American therapist
suggested that she distance herself from her family and get on with
her own life. The Sioux participant telling the story recommended
another more appropriate course of action aimed at preserving the
family connections. She said:
My approach was that [cutting off from family] is not going
to work, and that is not helpful for her in the long run as an
aging family member who is part of a community. And that
doesn't work for the kids and the grandkids in the long run
either. So my suggestion was around bringing in the house
some sort of day care waiting in the wings ... for when she
needed that. So, she could call upon those resources and
have that fall into place so that she could still get to work, and
she won't be stuck at the last minute trying to make last-
minute arrangements that would keep her from work. That
was a real difference [compared to the Anglo therapist's
approach].
Home visits were also found to be helpful. Reportedly, home visits
are deemed respectful to the client and the client's family. They were
also found to be helpful in terms of comfort, familiarity, and time
flexibility for the Native American clients at Wind River. The
findings from native and non-native therapists were similar in this
area.
The Halcyon Style
The frequent constellation of descriptors defining a therapist's
optimal style translated into what this researcher has termed the
"Halcyon Style" after the mythical bird Halcyone who calmed the
Aegean seas in its flight. The researcher defined Halcyon Style as a
74 STACY AuCOIN LEE

reflexive stance, a calm, gentle quality, non-confrontational and non-

conflictual, often including the use of indirect active techniques, such
as drawing, story-telling, the use of metaphor, and expressive art.
This approach is reminiscent of the mythical bird which gently glides
through the air, but occasionally needs to pump its wings actively to
continue to soar. These techniques often function to externalize the
problem. The Halcyon Style values the importance of taking time to
build a trusting relationship as opposed to acting aggressively and
authoritatively.
Mirroring communication styles are an important aspect of the
Halcyon Style. One participant described the importance of mirror-
ing to advance the discussion, and to establish acceptance and
respect. He stated:
A lot of good counseling technique is mirroring the way
somebody is talking to you, but I'm sure that it may come
across as somewhat unnatural if I do it too much. One of the
things I don't want to do is to appear something I'm not. lean
mirror things, but I never pretend I'm Indian ....
This technique resembles Self Psychological techniques in that the
therapist mirrors and validates the client in ways that build self-
esteem, self-knowledge, and self-acceptance (Baker & Baker, 1987).
The therapist becomes the client's selfobject.
This participant continued by saying:
[The therapist should be] more willing to listen, wait, don't
press it time-wise. If somebody is getting at a problem,
they're doing it somewhat indirectly. I think when I have a
better session, it's when I'm allowing them to get around to
it. The times I might have made a mistake is if I try to get
them into it too quickly.
Another participant clearly described important aspects of the
Halcyon Style — validation and non-confrontation — when he
described a confrontational clinician who was unsuccessful in his
work with Native American clients at Wind River. He stated:
There is a counselor ... [who] has a tendency to use confron-
tation, and it doesn't work; he just gets people upset. Might
even get them to leave angry, prematurely. I think [a
confrontational style] is a high-risk strategy, and I think that
in almost every case it would be ineffectual here. It would
not be effective and would be seen as being offensive, like
someone is playing superior .... Now if I were an Indian
COMMUNICATION STYLES 75

therapist, maybe there wouldn't be that gap, but even there I

think a more quiet, reflective style is going to be more
congruent across the lines.

The findings revealed examples of effective active and indirect

techniques that are part of the Halcyon Style. These techniques often
tended to externalize the problem. One participant stated:
I use a lot of drawings when I counsel. I use a circle a lot
because the circle is real meaningful to them [her Native
American clients]. So when I have them describe their
personality, I will use a circle and say, 'This is you, the
boundaries of your personality. What happens when some-
one crosses that boundary?' ... They relate to that real well.
Another participant stated:
[The] use of stories [is the] cornerstone of being heard and
understanding. When conveying a concept, if I use psycho-
logical terms or verbiage, I will miss the mark. But if I
respond using a story or metaphor, then they'll understand
because that is how for so many native people, they will
describe a situation.
These active, indirect techniques reflect cognitive-behavioral,
collaborative therapy, and narrative therapy principles (Andersen,
1993; White, 1989).
It is important to emphasize that the Halcyon Style includes some
forms of active, crisis-solving intervention because treating Native
American clients is likely to be crisis-oriented and intermittent. One
participant stated:
Indian clients do not generally participate in a long-term on-
going psychotherapy format. They may come several times
either through dealing with a crisis, and then feel like they've
had enough, and then they will disappear for a while and
resurface when another crisis or another issue comes up in
their life. So [being] really accommodating to those imme-
diate needs seems to be a clinical process. So formulating a
treatment plan that involves interventions for more than two
or three sessions generally doesn't pan out. It's really brief,
short-term interventions [that] tend to be the treatment of
choice.
The findings indicate, however, that the participant's therapeutic
relationship with Native American clients is often an ongoing, inter-
76 STACY AuCOIN LEE

mittent, long-term process. For the most part there were no differ-
ences between native and non-native therapists; however, it is also
possible, as one native therapist implied, that some confrontational
approaches may be more effective when the therapist and client have
the same tribal heritage. More research is needed to address this
question.
The clinicians in this study adapted their approaches in ways that
were attuned to the communication styles of their Wind River Native
American clients. Their approaches included an awareness ofcultur-
ally syntonic communication patterns, including a) eye contact, b)
discourse patterns, c) self-concept (including the client's larger
context; i.e., family, spiritual practices, the natural environment,
community, and tribe), and d) use of the Halcyon Style.
Further study is needed to establish whether or not there are any
significant differences in approaches among therapists of similar
tribal heritage. In this study a few subtle differences seemed to
emerge, although essentially approaches seemed similar. One differ-
ence may be that native therapists are sometimes able to use more
confrontive styles, perhaps because greater trust and comfort has
already been established through a bond of cultural familiarity.
However, one Anglo therapist indicated that some native clients
actively chose her because she was non-native. These clients seemed
to feel more comfortable disclosing issues to someone who was
removed from their community.

DISCUSSION
Content
In relation to therapeutic approaches, the study suggests variations
in theoretical frameworks, but common themes in terms of the role
and style of the therapist. The Halcyon Style captures the complex
constellation of descriptions of optimum therapeutic intervention.
Based on this study, no single integrated framework for treating
Native American clients has yet evolved. Self in relation interven-
tions are consonant with feminist and constructionist theories; mir-
roring is consonant with self psychology; the value of a reflective,
non-judgmental stance is consonant with psychodynamic theory;
active, behavioral techniques are consonant with behavioral theories ;
while other expressive techniques are consonant with a range of
psychodynamic and narrative therapies (expressing internal conflicts
in external forms). The clinicians in this study, however, did not refer
directly to any specific theory, and, for the most part, seemed to
COMMUNICATION STYLES 77

practice eclectically, drawing principles from a variety of theoretical

orientations.
While most approaches cited in the study focused on working with
individuals, the participants emphasized a keen appreciation of the
client's interconnectedness with family. Some therapists felt strongly
about conducting home visits and considered individual problems
within the context of family systems, but seldom practiced formal,
classic family therapy. The participants conveyed the view that the
most effective form of intervention involved family-focused, indi-
vidual practice, rather than any specific model of direct family
treatment.
One participant felt that "psychoanalytic types" especially, needed
to exercise caution in diagnosing co-dependency among Native
American clients. The comment was interesting because the idea that
"interdependence", or co-dependency is pathological is rooted in the
addictions field. Also, the family systems structural therapy model
pathologizes "enmeshment" and promotes separation among family
members as healthy. Feminist theory which promotes and encour-
ages individuation within a relational context, and values the connec-
tions within relationships seems more supportive of many Native
American clients' cultural value structure and environment. In the
feminist critique of separation-individuation and structural family
systems theory, health is defined in terms of the self in relation, a
definition that emphasizes individuation rather than separation.
The critical importance of providing opportunities to build trusting
relationships over time was repeatedly cited in the study, along with
the preponderant pattern of working with clients in intermittent crisis
work. These two factors together seem to suggest the need for
agencies to provide ongoing, consistent care for Native American
clients in time-limited treatment modules. For example, congruent
with the principles outlined above, clients should be able to reconnect
with past therapists to encourage and promote the development of
trusting therapeutic relationships over time, even when each specific
contact is crisis oriented. The study supports the view that long-term,
intermittent therapy should be valued and supported with Native
American clients.
Research Implications
This study describes communication style differences and effec-
tive therapeutic approaches between Native American and Anglo
clients on the Wind River Reservation. Further research on this topic
is needed, making use of larger samples and random sampling
78 STACY AuCOIN LEE

techniques. Drawing a sample from a more diverse population of

clinicians or directly from Native American clients would also be
useful. It is hoped that the current study will stimulate more research
on Native American communication styles and on the relevance and
effectiveness of various therapeutic approaches and techniques for
Native Americans of different tribes.
Sue, Allen and Conaway (1978) measured success by the number
of sessions and rate of immediate return for the next visit. They
indicated that therapy success was low for Native American clients.
The measurement they use may be conceptually flawed because this
study suggests that typically, Native Americans on the Wind River
Reservation use therapy in an intermittent, short-term, crisis-oriented
manner. Perhaps the return rates would be higher if a longer, more far
reaching measurement were used. Additionally, one needs to define
what successful therapy is for Native Americans of different tribes.
Length of treatment may not capture what is helpful for Native
Americans in therapy. It is this researcher's hope that future studies
will explore how better to measure success and effectiveness in
therapy with various tribes of Native Americans. Direct interviews
with Native Americans are needed to evaluate the effectiveness of
therapy and to learn why many Native American clients tend not to
come to therapy until they are in serious crisis.
Clinical Implications
Little research has been conducted on differences in communica-
tion styles between Native Americans and Anglo-Americans. Even
less has been done to determine effective and culturally sensitive
therapeutic approaches and techniques.
In therapy, clinicians often decide whether or not the behavior of
clients is "normal", "healthy", or "appropriate". These judgments
can be culturally biased and inaccurate if not made within the context
of the client's own culture and family. In subtle and unconscious
ways communication styles express people's cultural norms. If
therapists are ignorant of or insensitive to culturally shaped commu-
nication styles, misunderstandings that hinder therapy can occur.
Conversely, culturally sensitive communication styles can create an
atmosphere of trust and safety and provide the crucial building blocks
for therapeutic relationships and alliances.
Limitations of the Study
This study was undertaken as an exploratory thesis research project,
an approach with both benefits and limitations. The researcher's own
COMMUNICATION STYLES 79

cultural background as an Anglo woman must be acknowledged as a

source of potential investigator bias. Nevertheless, the difference
between the researcher's culture and tribal culture on the Wind River
Reservation did not foreclose her ability to see and interpret findings
accurately. Furthermore, interviewing clinicians (70% of whom
were non-Indian) rather than interviewing Native American clients,
increased the chance of bias and inaccuracy when identifying certain
aspects of client communication styles and the effectiveness of the
clinicians' interventions and techniques. Still, clinicians are better
equipped than most clients to describe their therapeutic approaches in
the context of communication style differences. The structure of the
study also provided many benefits including opportunities to explore
responses in greater depth, to clarify meaning, and to develop per-
sonal rapport that facilitated the collection of more candid informa-
tion.

CONCLUSION
The study describes communication style differences in Wind
River Reservation Native American clients, and the therapeutic
approaches used by their clinicians, as seen by the clinicians. The
findings revealed the importance of understanding cultural differ-
ences in human interaction and meaning making, as conveyed in
communication style. These complex and often subtle differences
play a crucial role in our ability as clinicians to establish a therapeutic
alliance and conduct sensitive, effective therapy. Findings empha-
size the importance of clinicians following the common psychody-
namic practice of expanding both their self-knowledge and their
understanding of how they use themselves therapeutically. The study
also emphasizes the importance of following the mantra: start where
the client is. Family systems, constructionist, ecological, psychody-
namic, and narrative theories are among the many different models
that support the successful approaches employed by clinicians in this
study. A major contribution is the recommendation that clinicians
who work with Native American clients find culturally syntonic ways
of promoting trust and respect within the treatment relationship.
Understanding and validating culturally influenced patterns and
rhythms of communication and meaning making, are essential com-
ponents in creating an effective and emotionally meaningful healing
relationship for Native American clients.
80 STACY AuCOIN LEE

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