Diné (Navajo) sandpainting ceremony

1. Introduction

Version followed: there is no clinical "version" of this practice. This guide is for the clinician who is not a hataałii. It follows what Diné people and their institutions publish: the Indian Health Service Traditional Cultural Advocacy policy (Special General Memorandum 94-08, 1994), Navajo Nation behavioral health programme descriptions (Navajo Department of Behavioral Health Services slide deck, 2016; Navajo Nation officials quoted in Indian Country Today, 2007), Navajo Nation Office of the President notice on Turquoise Care traditional-healing coverage (March 2026), and a published talk by a Diné medicine woman. It contains no ceremony, chant, design, procedure or images, and none should be added.

What it is. Diné (Navajo) sandpaintings (dry paintings; iikááh in Navajo, per a University of New Mexico reference page) are part of religious and healing ceremonies. A Diné medicine person (hataałii) makes them inside the ceremony, and each one is begun, used and destroyed within that ceremony. They are not art made for its own sake and not a therapy technique. [source: LibreTexts Cultural Anthropology 13.8; Tony Hillerman Portal, UNM] A Diné medicine woman describes the healing ceremony as "very private" and says she keeps it "very confidential". [source: Walking Thunder, Cultural Survival Quarterly, 2010]

Who holds authority. Religious and cultural authority belongs to the Diné people and to hatałii, who train through long apprenticeship. A Navajo Division of Health director contrasted federal interest in certification with Navajo communities' requirement of years of apprenticeship. [source: Indian Country Today, 2007] The Navajo Nation itself supports apprenticeship: its Navajo Traditional Apprenticeship Project, overseen by the Department of Diné Education, helps apprentices complete training as healing practitioners. [source: Navajo Nation Council press release, 2019] Diné organisations, among them the Diné Hatałii Association, Inc., work to stop people co-opting traditional healing. A Diné practitioner quoted by Stateline says the association licenses Native healers. [source: Stateline/Source NM, 2025] In its own 2020 public statement, the association describes itself as active since the early 1970s, made up of hatałii and herbalists who are caretakers of Diné ceremonial and herbal healing knowledge, incorporated under Navajo Nation business regulation, and offering cultural consultation and technical assistance to local authorities and other bodies. [source: Diné Hatałii Association statement, 2020] How it recognises individual practitioners is not set out in that statement. [uncertain] Under Medicaid traditional-healing coverage, each tribe and facility decides which services it offers. [source: Stateline/Source NM, 2025]

Restricted designs and commercial reproductions. Authentic ceremonial sandpaintings are rarely photographed, and medicine men seldom admit outsiders. Making an authentic painting only for display would be profane. Sandpaintings sold in shops and online are commercial pieces that contain deliberate errors or variations, because the ceremonial ones are sacred. [source: LibreTexts 13.8, citing Parezo 1983; Tony Hillerman Portal] So a commercial piece, book plate or museum piece is not the ceremony. It is not a template for a client activity either.

How change happens, as Diné sources frame it. Healing is understood in Diné terms. A Diné nurse scholar describes hózhó as a Diné wellness ideal and calls it "a complex and misunderstood wellness concept". [source: Kahn-John 2010, abstract] [uncertain: the common English gloss of "health, harmony and beauty" rests only on the title of a related Kahn-John publication.] The IHS policy recognises "the value of traditional beliefs, ceremonies, and practices" for body, mind and spirit. [source: IHS SGM 94-08] In psychotherapy terms, the clinician does not try to produce this change. The clinician's job is to protect the client's access to their own healing system and work alongside it. [synthesis]

Professional frame. No arts-therapy, counselling or psychology credential gives anyone, Diné or not, standing to make, imitate or interpret ceremonial sandpaintings. That standing comes only through Diné tradition. Art therapists (AATA/ATCB in the USA; HCPC/BAAT in the UK) and other licensed clinicians work under their own professional codes. Here those codes mean cultural humility, referral and coordination, not practice. [synthesis] Never offer "sandpainting therapy", sand-drawing exercises built on Diné imagery, or interpretation of a client's ceremony. These are appropriation. Diné organisations explicitly oppose people without traditional knowledge offering healing services. [source: Stateline/Source NM, 2025] No physical materials are used in the clinician's role, so there are no materials-safety issues. Do not bring sand, pollen or other ceremonial-type materials into sessions. [synthesis]

2. Framework

This is not a phased therapy. It is a way of working with Diné clients that runs alongside whatever treatment you provide. The "phases" below are stages of your care coordination, not ceremony stages. [synthesis]

Context of published services.

Navajo behavioral health services run a multi-systemic model that combines Western, traditional and pastoral (faith-based) healing. Traditional practitioners take part in intake and assessment, case staffing and treatment plans, traditional/cultural orientation and diagnosis, ceremonies and aftercare. [source: Navajo DBHS slide deck, 2016]
An earlier description of the Navajo traditional healing programme (started 1996 with SAMHSA funds, ongoing since 2000) set out a four-phase continuum. Officials compared its phases to residential, intensive day, outpatient and aftercare levels. Salaried traditional practitioners carried out diagnosis. Clients chose among interventions, Western treatment remained available, and family wishes were respected. A Navajo psychologist reported that about 60 percent of clients asked for traditional services. [source: Indian Country Today, 2007] [uncertain: current programme structure not verified]
In New Mexico, Turquoise Care (Medicaid) has covered traditional healing services for Native American members since March 2026. Services include herbs, prayers and ceremonies, are delivered through participating IHS and Tribal 638 facilities, and may happen in clinics, homes or ceremonial spaces. Patients may be referred to "certified traditional healers". The Navajo Nation reports being first to implement it. [source: Navajo Nation OPVP, 2026] Federal approval covered Arizona, California, New Mexico and Oregon. [source: Stateline/Source NM, 2025]
Chinle Comprehensive Health Care Facility was among the first IHS facilities with an Office of Native Medicine. Native healers on staff advise clinicians and administration. [source: IHS IPC case study, Chinle]

Stages of the clinician's role [synthesis, built on IHS SGM 94-08 duties]

Open the door (intake and early sessions). Goal: the client knows they are free to use traditional healing and that you respect it. Move on when the client has said whether they want this to be part of their care.
Connect (only if the client asks). Goal: the client reaches a practitioner or programme of their own choosing. Move on when the client, or family, has made contact or chosen not to.
Coordinate around ceremony. Goal: therapy, medical care and ceremony do not clash in timing, setting or expectations. This lasts as long as the ceremony and any period of observances the client describes.
Integrate afterwards, on the client's terms. Goal: help the client carry what they choose to share into their therapy goals, without asking about ceremonial content. This is ongoing.

There is no session count. The stages fit into ordinary sessions, and sometimes into a few minutes of one. A client can step out of any stage at any time. [synthesis]

3. Guiding principles

The client's right to practise their religion. IHS policy commits to "protect and preserve the inherent right" of AI/AN people to practise traditional religion, consistent with the American Indian Religious Freedom Act 1978. Practical meaning: offer access, never require it. [source: IHS SGM 94-08]
Tell clients they are free to use traditional healing. Staff must tell patients they are free to practise their native religion, including through a family member for minors or for patients who cannot ask themselves. Practical meaning: say so at intake, and say it again in a crisis or hospital stay. [source: IHS SGM 94-08]
No uninvited probing. Staff must avoid "uninvited probing or interference" in private beliefs, and patients who prefer not to talk about them must be respected. Practical meaning: ask whether, never what. [source: IHS SGM 94-08]
Do not dilute or change the practice. Avoid procedures that would interfere with, dilute or change traditional beliefs and practices. Practical meaning: no imitation exercises, no reinterpreting ceremony in psychological terms to the client. [source: IHS SGM 94-08]
Every effort when asked. When a patient asks for a native practitioner, staff make "every effort" to comply. That can mean contacting a practitioner or giving space or privacy for a ceremony in hospital. Practical meaning: treat a request for a healer like any other referral request, with follow-through. [source: IHS SGM 94-08; Rhoades 2009]
Complementary, not controlling. IHS support must not create dependency or take control away from traditional practitioners. The goal is a "complimentary interface" between the two systems [sic, as spelled in the policy]. Practical meaning: you coordinate, and the hataałii decides everything ceremonial. [source: IHS SGM 94-08]
Authority rests with Diné people. Each tribe and facility decides which traditional services it offers, and Diné bodies guard against co-opting. Practical meaning: refer to Diné-recognised practitioners and programmes, never to non-Native "shamanic" or "Native-inspired" providers. [source: Stateline/Source NM, 2025; synthesis]
Sacred material stays private. Ceremony is described as private and confidential. Sacred healing may be felt "too sacred" to discuss publicly. Practical meaning: write no ceremonial content in notes, letters, supervision, teaching or research. [source: Walking Thunder 2010; Rhoades 2009]
Commercial images are not the real thing. Sale pieces are deliberately altered. Practical meaning: do not use them as therapy props, décor for "cultural" rooms, or prompts. [source: LibreTexts 13.8; synthesis]
Cultural humility over cultural expertise. A Navajo psychologist called for more respect for "cultural competency" in Navajo health services. Practical meaning: the client and their community are the experts. Your role is to keep learning, not to explain Diné healing back to the client. [source: Indian Country Today, 2007; synthesis]
Respect a client's choice of path. Navajo services combine Western, traditional and faith-based (Christian, Native American Church) options. Practical meaning: do not assume a Diné client wants ceremony, or that they don't. Some follow other faiths or several at once. [source: Navajo DBHS 2016; Cronkite News 2020]

4. Intervention inventory

This inventory lists clinician actions only. None of them is a ceremony step, and you perform no part of the ceremony. Unless a source tag says otherwise, the steps are [synthesis] built on the duties in IHS SGM 94-08 and on the Navajo programme descriptions cited above.

4.1 Asking about traditional healing at intake

Purpose / when: Every Diné client, at intake and at reviews. This tells the client that traditional healing is welcome without assuming they use it. IHS policy requires telling patients they are free to practise their religion. [source: IHS SGM 94-08]
Steps:
1. Ask an open, optional question about healing resources: traditional, faith-based, Native American Church, Western, or none.
2. Make clear that no answer is needed, and that you will not ask about the content of any ceremony.
3. Ask only for what you need to coordinate care: whether they want it included, who they would like you to talk to (if anyone), and timing.
4. Record the preference, not the practice. For example: "client uses traditional healing; wants scheduling flexibility."
Example language (illustrative): "Some people I work with see a traditional healer, go to church, or both. You don't need to tell me anything about it. I'm only asking so I can fit around whatever matters to you. Is there anything like that you'd want me to know?"
Watch for: Hesitation or a polite closing-down. Accept it. Some clients worry that a clinician will judge or medicalise their practice. Some follow Christian or other paths and would find the assumption intrusive. It is working when the client brings up scheduling or healer contact unprompted later.

4.2 Telling the client (or family) they are free to use traditional healing

Purpose / when: At intake, at admission to residential or inpatient care, and in crises. The IHS policy covers requests made through a family member for minors or for patients who cannot ask themselves. [source: IHS SGM 94-08]
Steps: (1) State the freedom plainly. (2) Name who in your service can help arrange contact or space. (3) For a minor or incapacitated client, tell the parent, guardian or family the same. (4) Repeat it if the client's condition changes.
Example language (illustrative): "While you're with us you're free to see a traditional practitioner or have a family member arrange that. If you want help with space or timing, tell me and I'll sort it out."
Watch for: Staff who treat this as an exception that needs justifying. The policy treats it as a right. [source: IHS SGM 94-08]

4.3 Responding when a client says they are having, or want, a ceremony

Purpose / when: The client mentions an upcoming ceremony, says a healer has recommended one, or wonders aloud whether they should seek one.
Steps:
1. Acknowledge it with respect and without curiosity about its content.
2. Ask what, if anything, they need from you: time off from sessions, a letter for work or school that names no ceremony, help with travel or cost, or nothing at all.
3. If they are deciding whether to seek ceremony, keep to their values and leave the choice with them. Do not advise for or against.
4. Confirm any changes to therapy or medical care that should happen around it, and agree how you will reconnect afterwards.
Example language (illustrative): "Thank you for letting me know. I won't ask about the ceremony itself. What would be helpful from me around that time?"
Watch for: Your own urge to ask what the ceremony is "for" or what will happen. Hold back. It is working when the client tells you about practical needs and does not feel they have to explain.

4.4 Referral pathways when the client asks to be connected

Purpose / when: Only when the client asks for help finding a practitioner or programme. When asked, "every effort" should be made to comply. [source: IHS SGM 94-08]
Steps:
1. Ask first whether they or their family already have a practitioner. Family and community routes come first.
2. If not, offer Diné-run or Diné-recognised routes and let the client choose. Options include: Navajo Nation behavioral health services, where traditional practitioners take part in intake, assessment, treatment planning and aftercare [source: Navajo DBHS 2016]; IHS or Tribal 638 facilities with Native medicine offices or programmes, such as Chinle's Office of Native Medicine [source: IHS IPC case study]; and, for eligible New Mexico Medicaid members, Turquoise Care traditional-healing services through participating facilities [source: Navajo Nation OPVP 2026].
3. Check eligibility and cost. Medicaid traditional-healing coverage exists in Arizona, California (substance use only at the time of reporting), New Mexico and Oregon. Each tribe and facility decides which services it offers. [source: Stateline/Source NM 2025]
4. Make the referral the way the facility asks. Pass on only the minimum information, with written consent. One published example: at Fort Defiance Indian Hospital Board (Tséhootsooí Medical Center), the patient asks their medical provider, who starts the referral; the patient needs an established health record; the traditional and cultural service then meets the patient and family, makes its own traditional assessment and treatment plan, schedules an appointment, and gives an after-care plan. The same page lists services that facility does not provide, so check what a programme offers before you refer. [source: FDIHB Traditional & Cultural Services page] Navajo Nation Division of Behavioral and Mental Health Services outpatient centres combine clinical therapy with traditional Diné healing for Native Americans living on or near the Navajo Nation [source: University of Arizona Center for Rural Health directory]; its own referral procedure is not published in the sources used here, so ask the centre directly. [uncertain]
5. Follow up on whether contact was made, not on what happened.
Example language (illustrative): "Would you like me to find out how the Native medicine program at the clinic takes referrals, or would you rather go through your family?"
Watch for: Referring to non-Native "shamanic", "Native-inspired" or online "sandpainting healing" providers. Do not. Diné organisations work to stop healing being co-opted. [source: Stateline/Source NM 2025] If you cannot confirm that a provider is recognised by a Diné or tribal body, say so to the client and leave the choice with them. [synthesis]

4.5 Coordinating care with the traditional practitioner

Purpose / when: The client wants you and their hataałii, or the programme's traditional practitioner, to be in contact. Typical reasons: case staffing, timing, medication or admission questions, or aftercare. Navajo programmes build this into case staffing and treatment plans. [source: Navajo DBHS 2016]
Steps:
1. Get specific written consent covering who, what, and for how long.
2. Ask the practitioner how they prefer to communicate, and whether they want an interpreter or a Navajo-speaking colleague present.
3. Share only practical information: your role, the risks you are managing, and your scheduling needs.
4. Ask how you can support the client's healing. Do not ask what the ceremony involves.
5. Accept their judgement on all ceremonial matters. Raise clinical safety concerns plainly and respectfully, as you would with any co-provider.
6. Document the contact and any agreed actions, with no ceremonial content.
Example language (illustrative): "I'm [name], [client]'s counselor. They asked me to contact you. I'd like to make sure our appointments and any medical plans fit with the care you're providing. Is there anything you'd like me to know or avoid?"
Watch for: Treating the practitioner as a subordinate "cultural consultant", or the reverse, handing your own clinical duties to them. IHS policy calls for a complementary relationship that leaves control with the practitioner. [source: IHS SGM 94-08]

4.6 Scheduling around ceremony

Purpose / when: Before and during any ceremony period the client tells you about.
Steps:
1. Ask which dates to keep free. Ceremonies can run over several days, and travel and family obligations add time. [source: LibreTexts 13.8 on multi-day ceremonies; synthesis]
2. Pause or reschedule sessions without penalty. Waive late-cancellation fees for ceremonial absence.
3. Agree a simple contact plan for emergencies only, and a date to reconnect.
4. Write work or school letters that confirm a health-related absence and name no ceremony, unless the client wants it named.
5. If in-person ceremony is not possible, as during COVID-19 when in-person ceremonies were put on hold and some practitioners used Zoom, follow the client's and practitioner's arrangements. Do not suggest your own. [source: Cronkite News 2020]
Example language (illustrative): "Let's keep those days clear. Would you like a check-in afterwards, or should I wait to hear from you?"
Watch for: Billing or attendance policies that penalise ceremony. Fix those at service level (see 4.12).

4.7 Respecting restrictions after ceremony, as the client describes them

Purpose / when: After a ceremony, a client may tell you there are things they should or should not do for a time. No published source used here sets these out, and you must not look them up or guess at them. [uncertain; synthesis]
Steps:
1. If the client brings it up, ask only how it affects your work together. For example: whether to meet in person or by phone, whether certain topics or activities should wait, whether physical contact such as a handshake is fine, and how long this lasts.
2. Change your plans to fit: postpone exposure work, intense trauma processing, art or movement tasks, or anything else the client says conflicts.
3. Record only the practical adjustment, for example "client requested no in-person sessions until [date]."
4. Check with the client before restarting anything you paused.
Example language (illustrative): "You don't need to explain why. Just tell me what I should do differently for now, and for how long."
Watch for: Pressure from colleagues or protocols to keep to a fixed treatment schedule. The client's account of the restriction is enough.

4.8 Hospital, residential and inpatient accommodation

Purpose / when: The client is admitted and asks for a practitioner or a ceremony. IHS policy lists contacting a practitioner, giving "space or privacy within a hospital room for a ceremony", and, where necessary, paying for consultations from contract health funds. [source: IHS SGM 94-08; Rhoades 2009]
Steps: (1) Tell the nurse in charge or the facility's Native medicine or cultural liaison. (2) Arrange privacy and protected time: no rounds, no interruptions, and no photography. (3) Work through the practical arrangements with the practitioner and the client's family, following facility policy, and do not ask about ceremonial content. (4) Brief staff only on the practical needs. (5) Record that an accommodation was made, not what took place.
Example language (illustrative), to staff: "[Client] has a traditional practitioner visiting at 4 pm. Please hold non-urgent care and keep the room private until they're done."
Watch for: Staff curiosity, people dropping in, or phones in the room. Authentic ceremonial sandpaintings are rarely photographed, and outsiders are rarely admitted. [source: LibreTexts 13.8]

4.9 Documentation, confidentiality and restricted knowledge

Purpose / when: Every record, letter, referral, supervision discussion and case presentation.
Steps:
1. Record the preference, the referral, the coordination, the scheduling and the practical adjustments, and nothing ceremonial.
2. If the client tells you ceremonial content unprompted, do not write it down. Note only that the client discussed their traditional healing.
3. Leave out details that identify the client's practitioner from records shared outside the care team, unless the client agrees.
4. In supervision or teaching, present only the coordination issues. Never present ceremony content.
5. Do not photograph, record, draw or describe any ceremonial object or design, even if a client offers you a picture.
6. If you plan research or publication involving Diné clients, get Navajo Nation Human Research Review Board (NNHRRB) approval before you start, in addition to any university or hospital IRB. Its application asks for support letters and resolutions from the sites involved (for example a health board resolution for an IHS facility), offers no expedited review, states that all data collected belong to the Navajo Nation, and requires conference abstracts and final manuscripts to be submitted to the Nation for review before presentation or publication. [source: NNHRRB IRB application, updated 2024]
Example language (illustrative): "I'm going to keep that out of your notes. Those are things that belong to you and your family."
Watch for: Electronic record templates that ask you to specify the "type" of traditional treatment. Use the most general option. [synthesis] Under Medicaid waivers, data collection is a federal requirement. Panellists have discussed ways to protect the sacredness of ceremonies, and the details are still being worked out. [source: Stateline/Source NM 2025]

4.10 Integration in therapy after ceremony, on the client's terms

Purpose / when: After the ceremony, if the client wants to link what it meant for them to their therapy goals.
Steps:
1. Invite the client to share only what they choose, and say plainly that they can keep things to themselves.
2. Reflect their words, and do not translate their experience into psychological constructs. For example, do not call it "exposure", "catharsis" or "symbolic work".
3. Ask how you can support what their healer recommended, without asking what that was.
4. Update the treatment plan with the client's own goals.
Example language (illustrative): "Is there anything from that time you'd like to bring into our work, or anything you'd like me to keep in mind?"
Watch for: Offering your own symbolic readings, or asking for designs or meanings. It is working when the client sets the agenda and the alliance stays intact.

4.11 Supporting family and community involvement

Purpose / when: Family often arranges or takes part in traditional healing. In Navajo programmes, family wishes are respected and aftercare can include family support. [source: Indian Country Today 2007; IHS SGM 94-08]
Steps: (1) With consent, include family members the client names in planning that touches on ceremony. (2) Respect family decisions on ceremonial matters. (3) Hold your duty of care to the client, and note if the client's wishes and the family's wishes differ.
Example language (illustrative): "Who in your family would you like involved in planning this, if anyone?"
Watch for: An adult client feeling pressured into or out of ceremony. Explore this privately with them. [synthesis]

4.12 Avoiding appropriation in your own practice and service

Purpose / when: At all times, including with non-Native clients and in group or arts-therapy programmes.
Steps:
1. Do not run, advertise or teach "Navajo sandpainting therapy", "sand mandala healing in the Navajo tradition", or sand activities based on Diné imagery.
2. Do not use commercial sandpaintings, prints or book images as prompts, props or "healing" décor. They are deliberately altered for sale and are not ceremony. [source: LibreTexts 13.8; Tony Hillerman Portal]
3. If a client, Native or not, asks for such an activity, explain why you won't do it and offer something from your own discipline instead, or a Diné-recognised referral if they are Diné.
4. Check service policies for barriers: fees for ceremonial absence, rigid attendance rules, record fields.
5. Build relationships with local Native medicine offices or tribal programmes through official channels.
Example language (illustrative): "Those paintings belong to Diné ceremony and to medicine people who train for years. It wouldn't be right for me to copy them. Here's what I can offer instead."
Watch for: Workshops, CPD courses or online "Native healing" offerings led by people without tribal recognition. Diné organisations oppose this kind of co-opting. [source: Stateline/Source NM 2025]

4.13 Your own learning and consultation

Purpose / when: Ongoing cultural humility.
Steps: (1) Learn from Diné-published and Diné-authored sources, such as Kahn-John's work on hózhó, and from your local Native medicine office. Don't expect clients to teach you. (2) Where your service has one, use a cultural consultant. Rhoades describes patients who could explain tribal religious reasons to a cultural consultant but not to their physicians, with good outcomes. [source: Rhoades 2009] (3) Notice your assumptions about "traditional" versus "modern" Diné identity.
Example language (illustrative) [synthesis], to a colleague or supervisor: "I want to understand how to support Diné clients better. Could we look at what the Native medicine office publishes, rather than me asking my client to explain?"
Watch for: Collecting cultural "facts" to use on clients. Learning is for your stance, not for technique.

4.14 Children and young people

Purpose / when: A minor, or their parent or guardian, raises traditional healing.
Steps: (1) Tell the parent or guardian the child is free to use traditional healing, as IHS policy provides for minors through family. [source: IHS SGM 94-08] (2) Get the young person's assent where they are developmentally able, and include their views. (3) Coordinate scheduling with school, with the family's consent. (4) Keep normal safeguarding and mandatory-reporting duties. Taking part in ceremony is not, in itself, a safeguarding concern. [synthesis]
Example language (illustrative), to parent: "If your family wants a traditional practitioner involved, we'll make room for that. Tell me what you need from us."
Watch for: Staff misreading cultural practice as neglect. Educate staff, and escalate concerns only on ordinary safeguarding grounds.

4.15 Keeping traditional and Western care side by side

Purpose / when: The client is using ceremony alongside medication, psychotherapy, or medical treatment for physical illness.
Steps: (1) Do not present ceremony as a substitute for medical care, or medical care as a substitute for ceremony. Navajo programmes keep Western treatment available alongside traditional care. [source: Indian Country Today 2007; Navajo DBHS 2016] (2) If a medical need clashes with ceremonial timing, for example an admission date, help the client, practitioner and medical team agree a plan together. (3) Continue risk monitoring as usual.
Example language (illustrative) [synthesis]: "You're seeing your healer and taking your medication. Both matter. Is there anything about the timing of either that we should plan around?"
Watch for: Either system being framed as "the real treatment". Listen to how the client frames it.

5. Handling problems

The published sources do not address most clinical difficulties. Everything below is [synthesis] unless tagged otherwise.

The client won't discuss traditional healing. This is their right. IHS policy says patients who prefer not to discuss their beliefs must be respected. [source: IHS SGM 94-08] Do not take it as resistance. Leave the door open once, then drop the subject.
The client shares ceremonial details and you feel you should record them or ask more. Listen, don't probe, and don't write them down. If the client seems to regret sharing, reassure them that it stays with them.
A colleague asks you to "find out what the medicine man is doing". Decline. Explain the no-probing duty and the policy that control stays with traditional practitioners. [source: IHS SGM 94-08] If there is a real safety question, such as interactions with prescribed medicines, the client can choose to raise it with the practitioner, or you can raise it through consented coordination (4.5).
Ceremony and urgent clinical need clash (for example acute suicide risk, or a medical procedure). Safety comes first, and you can still respect the ceremony. Keep up standard risk assessment and safety planning. With consent, involve the practitioner and family in planning. Push to accommodate ceremony within the clinical setting rather than cancel it (4.8). [source: IHS SGM 94-08 on space and privacy; synthesis]
Ruptures caused by a clinician's cultural misstep (for example a probing question, showing a commercial sandpainting image, or calling ceremony "alternative therapy"). Name it, apologise briefly, say what you'll do differently, and don't make the client take care of your discomfort. Check in at the next session.
Non-attendance after ceremony. Don't treat it as disengagement. Send one low-pressure contact. The client may be observing restrictions or family obligations (4.7).
The client is torn between traditional, Christian or Native American Church paths, or the family is divided. Navajo services themselves include traditional, faith-based and Western components. [source: Navajo DBHS 2016] Explore values and choices without favouring a path. Refer to the relevant faith or traditional resource the client chooses.
The client cannot find or afford a practitioner. Check coverage: Turquoise Care in New Mexico, and waivers in Arizona, California and Oregon. [source: Navajo Nation OPVP 2026; Stateline/Source NM 2025] Ask local IHS or Tribal 638 facilities about Native medicine programmes. The number of traditional healers is widely seen as declining, and waiting may be unavoidable. [source: Rhoades 2009] Keep providing your own care in the meantime.
A non-Diné client asks you for "Navajo sandpainting healing". Decline and explain why (4.12). Offer methods from your own discipline instead.
You hold dual roles, for example a Diné clinician who is also in training under a hatałii. Keep the roles separate. Do not perform ceremony within your clinical role or bill for it under your clinical licence. Seek guidance from your professional body and the relevant Diné authorities. [uncertain: no published guidance on this is known]
Your service lacks policy. Use IHS SGM 94-08 as a model: tell clients they are free to use traditional healing, accommodate requests, give space and privacy, don't probe, and support without controlling. Develop service procedures in consultation with tribal programmes. [source: IHS SGM 94-08; synthesis]

Sources

Web pages and documents:

Books cited:

Parezo, N. J. (1983). Navajo Sandpainting: From Religious Act to Commercial Art. University of Arizona Press. (Cited via LibreTexts 13.8.)

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