Treating depression: towards an Indigenous psychotherapy

Abstract

There is a gap in the practice of psychotherapy that becomes clearly evident to non-\ud Aboriginal psychologists who find themselves in the position of having to provide\ud treatment to Aboriginal clients who present with the symptoms of depression. This is of\ud particular importance given the increase in the incidence of depression both nationally and\ud internationally. The problem stems from the reality that there is very little available by way\ud of psychotherapeutic interventions that are culturally suitable in the treatment of\ud Aboriginal clients who present with the symptoms of a depressed mood. A description of\ud depression is given, and current psychotherapies outlined. At the same time, Aboriginal\ud voices that explain Aboriginal culture and the expression of mental health is recognised\ud and discussed. This study acknowledges these two culturally different systems: western\ud psychological knowledge which often reflects individualistic, materialistic and secular\ud philosophical underpinnings; and Australian Aboriginal knowledge which is mostly\ud grounded in a philosophy that is communal, spiritual and ecological.\ud \ud This study aims to play a role in the continuation of the development of an\ud Aboriginal psychological intervention that may be implemented by non-Aboriginal\ud psychologists and that makes a contribution toward filling the present gap in\ud psychotherapy. To achieve this aim this study recognises that Aboriginal people around\ud Australia are the custodians of the knowledge relating to Aboriginal psychology and, as\ud such, provide the voices that express their own philosophy and culture. This study accepts\ud the invitation to learn from Aboriginal people and the site chosen to learn from is North\ud Queensland.\ud \ud The limitations of western psychotherapy in non-western and multicultural settings\ud are illuminated and current literature confirms that philosophy and culture are determinants\ud not only of human behaviour but also of psychotherapy. Contemporary western\ud psychotherapies and their theoretical and philosophical underpinnings are revisited so that\ud expression may be given to the salience of the manner in which western philosophy and\ud culture permeates western psychotherapy. By doing this, the gaze then moves toward\ud considering the ways in which mainstream western psychotherapy has tried, in the past, to\ud develop culturally appropriate treatments by indigenising psychotherapy. It also\ud acknowledges the implications for the therapeutic relationship. Subsequently, good reason\ud is given for acknowledging that other cultures have always had their own forms of\ud psychotherapies. This opens the portals to learn and listen to Aboriginal articulations about\ud their worldviews and culture. By doing so, justification is given to the hypothesis of this\ud study that Aboriginal psychology is determined by its own philosophy and culture and this,\ud by definition, determines a culturally appropriate psychotherapy. This leads to the research\ud question which asks Aboriginal people what it is that they do to help someone who is\ud suffering from depression.\ud \ud The data for this study was gathered over a two-year period (January 2002 –\ud December 2003) in North Queensland. Interviews were conducted with Aboriginal\ud Australians employed at an urban Community Controlled Health Service, Aboriginal\ud academics, Aboriginal people from a North Queensland urban community and elders from\ud that same North Queensland urban community. Because there are no Aboriginal\ud psychologists in North Queensland, an Aboriginal psychologist from another part of \ud Northern Australia was interviewed. On the advice of local Aboriginal consultants, a well regarded non-Indigenous psychiatrist who has worked for many years with Aboriginal\ud people in North Queensland was also interviewed. Indigenous research paradigms are\ud discussed and a qualitative research design is implemented. The author used a ‘free\ud association’ narrative and interview methodology and interpretive analysis to analyse the\ud transcripts. Justification is given with regard to how data was gathered for this study and\ud methodological issues are reviewed.\ud \ud The findings indicate that there is an Aboriginal psychology. It is grounded in a\ud theory of connectedness and relatedness to all things. Through the voices of the research\ud participants, recognition is given to Aboriginal philosophical thought and cultural\ud worldviews. Aboriginal voices explain the importance of connectedness and relatedness to\ud all things in their ways of healing. These findings offer a theoretical underpinning for the\ud development of an Aboriginal psychotherapy that is available to non-Indigenous\ud psychologists who treat Aboriginal clients. Examples of ways of applying a\ud psychotherapeutic intervention within an Aboriginal paradigm are given.\ud \ud Findings also indicate the importance of resolving the tensions arising from the\ud unconscious defence mechanisms brought to this encounter between Aboriginal\ud participants and the non-Aboriginal psychologist, all of whom are viewed as psychosocial\ud subjects. The concept of the ‘contact zone’ is applied to address these tensions within the\ud asymmetrical power in this relationship that stems from a shared history of colonisation\ud which places the non-Indigenous psychologist in the position of coloniser and the\ud Aboriginal participant in the position of the colonised.\ud \ud Conclusions drawn from these findings support the need to transform both\ud psychotherapy and the non-Aboriginal psychologist. Firstly, it builds on the works in\ud progress, both here in Australia and overseas, in that it responds to the need to rewrite\ud psychotherapy so that it is both inclusive of, and reflective of, a framework that is\ud grounded in Aboriginal philosophy, history and culture; and secondly, it responds to the\ud need to retrain non-Aboriginal psychologists who are working with Aboriginal clients. In\ud responding to these needs, non-Aboriginal psychologists are provided with greater\ud confidence in making a contribution toward filling the present gap in psychotherapy. It\ud offers the non-Indigenous psychologist a culturally appropriate treatment for depression\ud with improved sensitivity, respect, confidence and efficacy when working with an\ud Aboriginal clientele