Alaska Native healing

1. Introduction

Version followed: the tribal-doctor model of Southcentral Foundation's (SCF) Traditional Healing Clinic within the Nuka System of Care, Anchorage, as SCF publishes it. Alongside it: the Yukon-Kuskokwim Health Corporation (YKHC) Calricaraq system of care and the Qungasvik youth programme as Yup'ik community frameworks, and the DSM-5-TR Cultural Formulation Interview (CFI) for the psychotherapist's own assessment.

"Alaska Native healing" is not one therapy. It names the living healing knowledge of many distinct Alaska Native peoples and the tribally run health systems that now deliver some of it. These include SCF's Traditional Healing Clinic in Anchorage, the Maniilaq Association Tribal Doctor Program in northwest Alaska, and YKHC's Calricaraq in the Yukon-Kuskokwim Delta. [source: https://www.southcentralfoundation.com/services/traditional-healing/] [source: https://anchoragemuseum.org/exhibits/extra-tough-women-of-the-north/women-of-the-north-profiles/della-keats-trailblazer-of-the-tribal-doctor-program] [source: https://www.yk-health.org/images/3/31/Calricaraq_System_of_Care.pdf]

The psychotherapist does not practise this healing. Tribal doctors do, recognised by Elders' councils, and so do community members whom Tribes and Elders recognise. The therapist's work is culturally responsive assessment, collaboration and referral when the client wishes, and support for integration.

How change is understood, as these institutions describe it:

SCF frames health as "physical, mental, emotional and spiritual wellness" of a Native community. Care addresses mind, body, spirit and family, and the customer-owner's own goals guide it. [source: https://www.careinnovations.org/wp-content/uploads/Traditional-Healing-Overview_Southcentral-Foundation-Site-Visit-9.13.18.pdf]
YKHC's Calricaraq describes Yup'ik ancestral principles (nutemllaat, which it calls "our ancestral health care system") as a way of living that keeps health and balance. Healing (mamilleq) follows awareness and understanding (ellangneq) of historical trauma and its impacts. [source: https://www.yk-health.org/images/3/31/Calricaraq_System_of_Care.pdf]
Qungasvik's guiding idea is that "Yup'ik culture is prevention." [source: https://www.niaaa.nih.gov/health-professionals-communities/native-air/prevention-alcohol-misuse/qungasvik]

These are the communities' own accounts. They are reported here as such, neither endorsed nor dismissed.

2. Framework

There is no session protocol. The framework is the care pathway that tribal health organisations publish, plus the therapist's parallel work.

Who holds authority

SCF tribal doctors. A tribal doctor must meet several criteria, including "certification by the Traditional Healing Elders' Advisory Council." SCF has a tribal doctor apprentice role and, from 2017, a Tribal Doctor Training Program. [source: https://www.careinnovations.org/wp-content/uploads/Traditional-Healing-Overview_Southcentral-Foundation-Site-Visit-9.13.18.pdf] A 2017 article in Stanford Social Innovation Review, hosted by SCF, reports three things. Only Alaska Native healers are appointed. "A council of elders decides" who is appointed. Tribal doctors hold the same status as medical doctors. [source: https://www.southcentralfoundation.com/wp-content/uploads/2017/05/SSIR-Summer-2017.pdf] Council membership and selection procedures are not given in the cited sources. [uncertain: not verified]
Maniilaq Association (northwest Alaska). The Tribal Doctor Program dates from the 1970s, and the Iñupiaq healer and midwife Della Keats (1907–1986) helped found it. It restarted after a pandemic pause and, as of January 2025, had one full-time tribal doctor. [source: https://www.adn.com/arctic-sounder/2025/01/24/tribal-doctors-remember-traditional-healer-on-della-keats-day/] [source: https://anchoragemuseum.org/exhibits/extra-tough-women-of-the-north/women-of-the-north-profiles/della-keats-trailblazer-of-the-tribal-doctor-program]
YKHC Calricaraq. Delivery starts with an invitation from the Tribe and planning with the Tribe. Elders are named as holders of the knowledge. [source: https://www.yk-health.org/images/3/31/Calricaraq_System_of_Care.pdf]
Qungasvik. The programme is "Tribally directed." Communities nominate local cultural experts, and Elders take part in planning and delivery. [source: https://www.niaaa.nih.gov/health-professionals-communities/native-air/prevention-alcohol-misuse/qungasvik]
Governance. SCF is tribally owned and operated. It took over the whole primary-care system in 1998 under a compact with the Indian Health Service (IHS). [source: https://www.southcentralfoundation.com/wp-content/uploads/2017/05/SSIR-Summer-2017.pdf]

SCF Traditional Healing Clinic pathway (as published)

Entry by referral. Referrals come from a primary care provider or from OB-GYN, pediatrics, behavioral health or internal medicine. Appointments are for eligible beneficiaries. A new referral is needed every six months. [source: https://www.careinnovations.org/wp-content/uploads/Traditional-Healing-Overview_Southcentral-Foundation-Site-Visit-9.13.18.pdf] SCF's public page says: "For a referral to the Traditional Healing Clinic, please contact your primary care provider." [source: https://www.southcentralfoundation.com/services/traditional-healing/]
Identifying needs and goals. The clinic identifies the customer-owner's needs and goals. The services offered depend on the individual tribal doctor's skills. [source: https://www.careinnovations.org/wp-content/uploads/Traditional-Healing-Overview_Southcentral-Foundation-Site-Visit-9.13.18.pdf]
Services. These are traditional counselling (reflective listening and dialogue), traditional physical care ("Healing Hands" bodywork and "Healing Touch", which SCF describes as a biofield energy therapy), talking circles, a healing garden, and cultural classes taught by staff who share knowledge from Elders. [source: https://www.southcentralfoundation.com/services/traditional-healing/]
Reasons for referral. In SCF's data, referrals were for pain (54%), behavioral health and counselling (26%), other medical reasons (8%) and customer-owner request (7%). Reasons people come include grief, a new diagnosis, substance use support and unexplained symptoms. [source: https://www.careinnovations.org/wp-content/uploads/Traditional-Healing-Overview_Southcentral-Foundation-Site-Visit-9.13.18.pdf]
Format. Outpatient, Monday to Friday, alongside other SCF services. [source: https://www.southcentralfoundation.com/services/traditional-healing/]

Session counts and lengths are not published. [uncertain: not verified]

Calricaraq delivery (as published). A 3-day community gathering, then follow-up gatherings, healing circles and training. Training moves from buy-in, to awareness and understanding of historical trauma, to traditional healing (Calricaraq). A facilitator manual was published in March 2015. [source: https://www.yk-health.org/images/3/31/Calricaraq_System_of_Care.pdf]

The psychotherapist's parallel phases [synthesis, built on the CFI and the pathways above]

Phase A, orientation and assessment (sessions 1–3). Run the core CFI and the relevant supplementary modules. Learn which people, community and tribal health organisation the client belongs to, and ask about past and current traditional help. Move on once you have a shared cultural formulation and the client's stated preferences.
Phase B, collaboration (when the client wishes). Get consent for referral through the organisation's own pathway, usually the primary care provider at SCF, and agree what will and will not be shared. Move on once the referral is made or the client declines.
Phase C, parallel care. Continue psychotherapy, which may be adapted CBT, ACT or solution-focused work. Bring in what the client chooses to share from traditional care, and review safety and risk.
Phase D, review. Revisit the CFI help-seeking questions. At SCF, the six-month referral renewal is a natural review point. End or step down with the client's plan for community supports.

3. Guiding principles

Community authority. Tribal doctors are certified or appointed by Elders' councils, and community programmes start with the Tribe's invitation. In practice: never act as, or substitute for, a tribal doctor or Elder. Refer only through legitimate pathways. [source: https://www.careinnovations.org/wp-content/uploads/Traditional-Healing-Overview_Southcentral-Foundation-Site-Visit-9.13.18.pdf] [source: https://www.yk-health.org/images/3/31/Calricaraq_System_of_Care.pdf]
Customer-ownership. SCF patients are "customer-owners" who choose their care team. In practice: the client sets the goals and decides whether traditional healing is part of their care. [source: https://www.southcentralfoundation.com/wp-content/uploads/2017/05/SSIR-Summer-2017.pdf]
Relationship-based care. Nuka care rests on "trusting, accountable, long-term personal relationships." In practice: prioritise continuity and trust over speed, and expect assessment to take more than one meeting. [source: https://www.southcentralfoundation.com/wp-content/uploads/2017/05/SSIR-Summer-2017.pdf]
Wholeness. Care covers mind, body, spirit and family. In practice: ask about the physical, spiritual, family and land-based parts of the client's life, not only symptoms. [source: https://www.careinnovations.org/wp-content/uploads/Traditional-Healing-Overview_Southcentral-Foundation-Site-Visit-9.13.18.pdf]
Two ways known side by side. Calricaraq distinguishes kass'artaq, the structured Western approach of referral, assessment, diagnosis and treatment, from yugtaq, a therapeutic way of life drawing on Elders' knowledge. It calls failure to understand the difference "a huge barrier" to integration. In practice: name which way you work in, and do not fold the client's traditional understanding into a diagnosis. [source: https://www.yk-health.org/images/3/31/Calricaraq_System_of_Care.pdf]
Cultural humility, not competence. Humility is a lifelong commitment to self-reflection that "promotes a curious and other-oriented interpersonal style." In practice: treat the client as the expert on their culture, and examine your own assumptions. [source: https://bhinstitute.uw.edu/wp-content/uploads/2025/05/TeleBH-2025-Session-05-Wellness-Approach-to-Culturally-Informed-Services-Alaska-Natives-Forscher-05-16-2025.pdf]
Historical trauma as context. Calricaraq names historical trauma and unresolved grief as root causes of domestic violence, substance use, suicide and losses. In practice: include colonisation, epidemics, schooling and loss of language in the formulation, without reducing the client to it. [source: https://www.yk-health.org/images/3/31/Calricaraq_System_of_Care.pdf]
Strengths and culture as protection. In practice: map protective factors, such as Elders, subsistence activity, language and family roles, as actively as risks. [source: https://www.niaaa.nih.gov/health-professionals-communities/native-air/prevention-alcohol-misuse/qungasvik]
No extraction or reproduction. In practice: do not record, teach or reproduce ceremonies, songs, prayers or healing methods, and do not ask the client to explain them in detail unless they choose to. [synthesis]
Heterogeneity. Alaska Native peoples differ in language, region and religion, and many are Christian. Napoleon describes widespread conversion after the epidemics. In practice: never assume a client wants traditional healing, or that they do not. [source: https://ua.pressbooks.pub/writingalaska/?p=115] [synthesis]
Safety and medicines. In practice: questions about plant remedies or medication go to the prescriber and, for traditional remedies, to the tribal doctor. The therapist gives no advice on starting, stopping or combining either. [synthesis]

4. Intervention inventory

These are the psychotherapist's own interventions. Tribal doctors' and Elders' healing methods, ceremonies, songs, prayers and plant preparations are deliberately left out. They belong to those who hold them.

4.1 Cultural humility and self-examination

Purpose: to reduce the clinician's bias and the power imbalance before and throughout care. It is especially important for non-Native clinicians and in settings with a history of mistrust. [source: https://bhinstitute.uw.edu/wp-content/uploads/2025/05/TeleBH-2025-Session-05-Wellness-Approach-to-Culturally-Informed-Services-Alaska-Natives-Forscher-05-16-2025.pdf]
Steps:
1. Before first contact, write down what you assume about Alaska Native clients, traditional healing and Christianity in Alaska Native life.
2. Learn the history the client's region names: epidemics, schooling and suppression of language. Napoleon's Yuuyaraq and Calricaraq's historical-trauma training are community-authored starting points.
3. After sessions, note moments where you steered toward Western categories.
4. Take this to supervision or consultation with Alaska Native colleagues. [synthesis]
Example language (illustrative): "I'm not from your community, and I'll get things wrong sometimes. Please tell me when I do."
Watch for: over-confidence that a training course has made you "competent". Also watch for the opposite: deferring so much that you stop doing your clinical job. It is working when the client corrects you openly.

4.2 Locating the client: people, place, system

Purpose: to learn which community, language, region and tribal health organisation the client belongs to, because pathways differ (SCF, Maniilaq, YKHC and others).
Steps:
1. Ask how the client describes their people and home community, and where they live now.
2. Ask which tribal health organisation they use, if any, and whether they are an SCF customer-owner.
3. Ask about languages spoken and preferred.
4. Ask about religious affiliation without assuming it. [synthesis]
Example language (illustrative): "Where's home for you, and who are your people? Which clinic or health corporation do you usually go to?"
Watch for: pan-Native assumptions. It is working when you can name the specific organisation and pathway that applies to this client.

4.3 DSM-5-TR Cultural Formulation Interview (core)

Purpose: to clarify the problem from the client's and their network's point of view: its meaning, possible sources of help, and what they expect from services. APA describes it as "designed to be used by any clinician providing services to any individual in any care setting." [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]
Steps: Follow the official 16 questions across four domains: (1) the cultural definition of the problem (Q1–3); (2) cultural perceptions of cause, context and support, covering causes, stressors and supports, and the role of cultural identity (Q4–10); (3) self-coping and past help seeking, including barriers (Q11–13); (4) current help seeking, covering preferences and the clinician–patient relationship (Q14–16). Use the APA form; it may be reproduced for clinical use with your own patients. Use it to inform decisions, not as the only basis for diagnosis. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] How long it takes is not stated on the APA forms. In the field trial, later interviews "required less time." [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/] A figure in minutes is [uncertain].
Example language (illustrative): "How would you describe what's been happening, in your own words? How would people back home talk about it?"
Watch for: long silences, which may be reflection rather than resistance. Do not hurry them. [synthesis] It is working when the client's own terms for the problem appear in your notes and formulation.

4.4 CFI supplementary modules

Purpose: to go deeper where the core CFI shows it is needed. There are 12 modules. Those most relevant here are Spirituality, Religion and Moral Traditions; Cultural Identity; Explanatory Model; Coping and Help-Seeking; Social Network; Older Adults; School-Age Children and Adolescents; and Caregivers. Modules can be given at the first evaluation, later in care, or repeatedly. The Informant Version (17 questions) is for a family member or friend. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
Steps:
1. From the core CFI, note which subtopics the client opened up; the core form shows which module expands each subtopic.
2. Offer the matching module in a later session, with the client's agreement.
3. Use the Informant Version only with the client's consent. [synthesis on sequencing]
Example language (illustrative): "You mentioned your grandmother's teachings and church both matter to you. Would it be all right to spend some time next session on that side of your life?"
Watch for: turning the modules into an interrogation. It is working when the client brings up spiritual or family material without being asked.

4.5 Exploring the explanatory model (Kleinman)

Purpose: to learn what the client believes about the name, cause, timing, course, severity, treatment, consequences and feared outcome of the problem. Source: Kleinman, Eisenberg and Good, 1978. [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf]
Steps: Ask, in your own words, the eight questions:
1. What do you call the problem?
2. What caused it?
3. Why did it start when it did?
4. What does it do to you, and how does it work?
5. How severe is it, and will it last a short or a long time?
6. What treatment should you receive?
7. What are the chief problems it has caused?
8. What do you fear most about it?
Record the answers verbatim where you can, and compare them with your own formulation openly.
Example language (illustrative): "What do you think started this? And what kind of help do you think would actually work for it?"
Watch for: answers in spiritual, ancestral or historical terms. Record these as the client's understanding, neither correcting nor endorsing them. [synthesis] It is working when treatment goals visibly reflect the client's model.

4.6 Asking about traditional healing and tribal doctors without judgement

Purpose: clients may already use, or want, tribal doctors, Elders' counsel, talking circles, church or plant remedies. At SCF, about 7% of Traditional Healing Clinic referrals come at the customer-owner's own request. [source: https://www.careinnovations.org/wp-content/uploads/Traditional-Healing-Overview_Southcentral-Foundation-Site-Visit-9.13.18.pdf]
Steps:
1. Normalise the question.
2. Ask what help they have sought, what helped, and what did not.
3. Ask whether they want traditional healing to be part of the current plan.
4. Do not ask for details of methods or ceremonies. [synthesis]
Example language (illustrative): "Some people I work with also see a tribal doctor, an Elder, or their church. Is any of that part of how you look after yourself? Would you like it to be part of the plan?"
Watch for: fear of being judged for using traditional or church help, or for not using it. It is working when the client discloses parallel help freely.

4.7 Cultural concepts of distress: normative experience versus disorder

Purpose: to avoid pathologising culturally normative experiences, and to avoid missing illness.
Steps:
1. Ask how the experience, such as dreams, visits from deceased relatives, or spiritual experiences, is understood in the client's family and community.
2. Ask whether others in the community would see it as normal.
3. Check the diagnostic exclusions. DSM-5-TR dissociative identity disorder (possession form) and dissociative trance both exclude experiences that are a normal part of broadly accepted cultural or religious practice. In ICD-11, 6B62 Trance disorder and 6B63 Possession trance disorder require the state to be involuntary, unwanted and outside accepted practice. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://www.findacode.com/icd-11/code-1807490186.html] The exact DSM-5-TR wording is [uncertain].
4. Look for markers of disorder: distress, functional decline, disorganisation, risk, and the family's or community's own judgement that something is wrong.
5. With consent, consult an Alaska Native colleague, Elder or cultural broker the client trusts. [synthesis]
Note: the DSM-5 glossary removed older "culture-bound" labels, including pibloktoq, which was historically applied to Arctic peoples. [source: https://revistapsiquiatria.pt/index.php/sppsm/article/download/139/69] Do not use such labels.
Example language (illustrative): "When you hear your late grandfather, how would your family understand that? Is it something that worries you, or something that comforts you?"
Watch for: distress or impairment that the community itself sees as illness. That warrants full assessment, whatever the cultural frame. It is working when diagnosis and cultural meaning are recorded separately and both are respected.

4.8 Referral and collaboration with tribal doctors

Purpose: to connect a client who wants it with community-sanctioned traditional healing, through the organisation's own pathway. In a Psychiatric News report, psychiatrists at the Alaska Native Medical Center referred some patients to Native healers as a complementary, "culturally appropriate" choice. Some patients combined the two. Others found traditional healing unhelpful and reconsidered the options the psychiatrist had discussed. [source: https://psychiatryonline.org/doi/10.1176/pn.38.22.0013]
Steps:
1. Confirm that the client wants a referral and what they hope for.
2. At SCF, referrals go through the primary care provider. Behavioral health is also a listed referral source, and a new referral is needed every six months. [source: https://www.careinnovations.org/wp-content/uploads/Traditional-Healing-Overview_Southcentral-Foundation-Site-Visit-9.13.18.pdf] [source: https://www.southcentralfoundation.com/services/traditional-healing/]
3. Elsewhere, ask the client's own tribal health organisation whether it has a tribal doctor or traditional healing programme, as Maniilaq does. Do not refer to unaffiliated individuals offering "Native healing". [synthesis]
4. With consent, share only what the client approves.
5. Keep psychotherapy going in parallel, and agree how you will hear back from the client.
Example language (illustrative): "The Traditional Healing Clinic takes referrals through your primary care provider. Would you like me to let your provider know you're interested? What would you be comfortable with me saying?"
Watch for: referral used to offload a difficult client, or the client feeling pushed toward "culture" they did not ask for. It is working when the client experiences the two kinds of care as joined up, not competing.

4.9 Consent, confidentiality and small-community privacy

Purpose: to protect the client where everyone may know everyone. Tribal leaders in the Qungasvik trial judged direct suicide and alcohol assessments "culturally incongruent and stigmatizing", with possible harm in small communities. [source: https://www.niaaa.nih.gov/health-professionals-communities/native-air/prevention-alcohol-misuse/qungasvik] Telehealth can offer privacy and reduce stigma. [source: https://bhinstitute.uw.edu/wp-content/uploads/2025/05/TeleBH-2025-Session-05-Wellness-Approach-to-Culturally-Informed-Services-Alaska-Natives-Forscher-05-16-2025.pdf]
Steps:
1. Explain confidentiality and its limits.
2. Get specific written consent for each information-sharing route (tribal doctor, Elder, family, church).
3. Ask whether the client knows the interpreter, cultural broker or helper personally.
4. Keep written notes free of sacred details the client shares. [synthesis]
Example language (illustrative): "In a small place, privacy matters a lot. Who, if anyone, do you want me to talk with, and about what?"
Watch for: reluctance that is really fear of gossip or of relatives finding out. It is working when the client sets the limits clearly and keeps attending.

4.10 Preparing a client for touch-based traditional care

Purpose: SCF's traditional physical care includes hands-on bodywork ("Healing Hands") and "Healing Touch". [source: https://www.southcentralfoundation.com/services/traditional-healing/] Clients with trauma histories may want to think through touch beforehand. The therapist does not give or describe the touch.
Steps:
1. If the client raises it, explore what touch means for them and any trauma triggers.
2. Affirm their right to ask questions, to set limits, and to stop at any time.
3. Encourage them to tell the tribal doctor what they need.
4. Afterwards, ask how it felt, and process any distress. Touch is never sexual. Any boundary violation is a safeguarding matter (see 4.19). [synthesis]
Example language (illustrative): "Before you go, is there anything about being touched that we should think through, so you can tell the tribal doctor what you need?"
Watch for: dissociation or freezing when touch is described. It is working when the client goes in with a clear sense of their own limits.

4.11 Integrating traditional counselling and talking-circle experiences

Purpose: to help the client connect what they gain in traditional counselling or talking circles with their therapy goals. SCF describes its talking circle as a confidential, non-judgemental sharing ceremony. [source: https://www.southcentralfoundation.com/services/traditional-healing/] The therapist does not run or reproduce talking circles unless the community has sanctioned it.
Steps:
1. Ask open questions about what was meaningful.
2. Respect the circle's confidentiality; do not ask what others shared.
3. Link insights to the client's goals in their own words.
4. Note any distress that came up for follow-up. [synthesis]
Example language (illustrative): "You don't need to tell me what happened in the circle. Is there anything you took away from it that you'd like to bring into our work?"
Watch for: the therapist claiming credit, or reinterpreting the experience into therapy jargon. It is working when the client describes the two as fitting together.

4.12 Working with historical trauma and unresolved grief

Purpose: to place the client's distress in its historical context when the client finds that useful. Calricaraq lists historical trauma and unresolved grief among root causes, and its training begins with awareness of them. [source: https://www.yk-health.org/images/3/31/Calricaraq_System_of_Care.pdf] In Yuuyaraq: The Way of the Human Being, Yup'ik author Harold Napoleon traces how the epidemics of the "Great Death" (including the 1900 influenza) left survivors orphaned and guilt-ridden, followed by a culture of silence. Young people were told "to pretend it didn't happen." He likens the result to post-traumatic stress and argues that it needs speaking, not suppression. [source: https://ua.pressbooks.pub/writingalaska/?p=115]
Steps:
1. Ask about family history of losses, schooling, relocation and language loss, only as far as the client chooses.
2. Offer a historical-trauma frame as one possible lens, not a diagnosis.
3. Connect it with present patterns (silence, numbing with alcohol, family conflict) while keeping personal agency in view.
4. Pair it with strengths and survival.
5. Point to community-authored resources and programmes if the client wants more. [synthesis]
Example language (illustrative): "Some people find it helps to see what their family carried from earlier generations. Would that be useful for you, or would you rather stay with what's happening now?"
Watch for: fatalism ("it's all history, nothing can change"), or feeling blamed. It is working when the client can hold both the history and their own choices.

4.13 Linking to community-led programmes

Purpose: to support community-level healing that the therapist cannot provide.
Programmes:
- Calricaraq (YKHC): community gatherings by Tribal invitation. [source: https://www.yk-health.org/images/3/31/Calricaraq_System_of_Care.pdf]
- Qungasvik: for Yup'ik youth aged 12–18. It has 18 community-created module outlines built around 13 protective factors and is delivered by community cultural experts and Elders. [source: https://www.niaaa.nih.gov/health-professionals-communities/native-air/prevention-alcohol-misuse/qungasvik]
- SCF's Family Wellness Warriors Initiative: a faith-based training and education programme addressing domestic violence, child abuse and neglect, which incorporates Native spiritual practices. [source: https://www.southcentralfoundation.com/wp-content/uploads/2017/05/SSIR-Summer-2017.pdf]
- SCF cultural classes: for example, beading and formline design. [source: https://www.southcentralfoundation.com/services/traditional-healing/]
Steps:
1. Learn what is available in the client's region.
2. Ask whether they are interested.
3. Help with practical barriers.
4. Review the effects in session. [synthesis]
Example language (illustrative): "Southcentral runs cultural classes, and some people find that being with others and making something with their hands helps. Is that something you'd want to look into?"
Watch for: a faith-based programme that does not fit a client's beliefs. It is working when the client takes part by choice and reports a stronger sense of connection.

4.14 Culturally adapting the therapist's own evidence-based work

Purpose: to keep effective psychotherapy while making it fit. A clinic serving Alaska Natives describes several adaptations:
- CBT: storytelling, linking cognitive restructuring to Indigenous knowledge, and exploring how cultural identity shapes thoughts.
- ACT: culturally relevant values, resonant metaphors, and including spirituality.
- Solution-focused techniques: compliments, scaling, the miracle question, exceptions and homework.
[source: https://bhinstitute.uw.edu/wp-content/uploads/2025/05/TeleBH-2025-Session-05-Wellness-Approach-to-Culturally-Informed-Services-Alaska-Natives-Forscher-05-16-2025.pdf]
Steps:
1. Use the client's explanatory model (4.5) to choose the frame.
2. Invite metaphors from the client's life (land, seasons, subsistence, family roles) rather than supplying them.
3. Check that homework fits seasonal subsistence demands and village life. [synthesis]
Example language (illustrative): "When you think about the person you want to be, are there people, teachings or times out on the land that show you that?"
Watch for: tokenism, such as adding "cultural" decoration without real change. It is working when the client uses their own metaphors between sessions.

4.15 Telehealth and rural practicalities

Purpose: to keep access possible across long distances, limited roads, bad weather and big swings in daylight. [source: https://bhinstitute.uw.edu/wp-content/uploads/2025/05/TeleBH-2025-Session-05-Wellness-Approach-to-Culturally-Informed-Services-Alaska-Natives-Forscher-05-16-2025.pdf]
Steps:
1. Agree back-up contact routes for connection failures.
2. Check the privacy of the client's location; shared homes are common. [synthesis]
3. Plan for seasonal changes in availability.
4. Know the local emergency and health-aide contacts. [synthesis]
Example language (illustrative): "If the connection drops, should I call you back on this number? Is there a private place you can talk from?"
Watch for: missed sessions caused by logistics rather than lack of engagement. It is working when sessions happen reliably and privately.

4.16 Working with family and Elders

Purpose: care at SCF is framed around family as well as the individual, and Elders are named as keepers of knowledge. [source: https://www.careinnovations.org/wp-content/uploads/Traditional-Healing-Overview_Southcentral-Foundation-Site-Visit-9.13.18.pdf] [source: https://bhinstitute.uw.edu/wp-content/uploads/2025/05/TeleBH-2025-Session-05-Wellness-Approach-to-Culturally-Informed-Services-Alaska-Natives-Forscher-05-16-2025.pdf]
Steps:
1. Ask whom the client wants involved.
2. Use the CFI Informant Version or a family session only with consent.
3. Approach an Elder only through the client or the community's own channels, never on your own initiative.
4. Let Elders speak without interruption, and do not ask them for sacred knowledge. [synthesis]
Example language (illustrative): "Is there someone in your family, or an Elder, whose advice you'd want included? How would you like to go about that?"
Watch for: family members speaking over the client, or using cultural authority to silence disclosure of harm. It is working when involvement strengthens the client's own voice.

4.17 Interpreters and cultural brokers

Purpose: for clients whose first or preferred language is an Alaska Native language, or who want a broker.
Steps:
1. Offer a trained interpreter, and check that the interpreter is not a relative or close acquaintance unless the client prefers that.
2. Brief them on confidentiality.
3. Debrief afterwards about cultural meanings. [synthesis]
Example language (illustrative): "Would you rather talk in Yup'ik with an interpreter, or in English? Is there anyone you'd not want interpreting?"
Watch for: the interpreter answering for the client. It is working when the client's own words come through.

4.18 Questions about plant remedies and medicines

Purpose: tribal doctors may use plants. SCF has a healing garden, and the Maniilaq tribal doctor is reported to use tundra plants. [source: https://www.southcentralfoundation.com/services/traditional-healing/] [source: https://www.adn.com/arctic-sounder/2025/01/24/tribal-doctors-remember-traditional-healer-on-della-keats-day/] The therapist gives no advice on remedies or medicines.
Steps:
1. Ask neutrally what the client takes, both prescribed and traditional.
2. With consent, tell the prescriber about traditional remedies so they can check interactions.
3. Never advise starting, stopping or changing a medicine; route the question to the prescriber and, for traditional remedies, to the tribal doctor. [synthesis]
Example language (illustrative): "That's a good question for your provider and the tribal doctor together. Would you like me to let your provider know you're using it?"
Watch for: a client stopping prescribed medication because they believe the two are in conflict. It is working when prescriber and tribal doctor both know the full picture.

4.19 Safeguarding and suicide risk

Purpose: suicide, violence and substance use are named in Calricaraq's list of root concerns. [source: https://www.yk-health.org/images/3/31/Calricaraq_System_of_Care.pdf] Standard risk duties still apply alongside cultural care.
Steps:
1. Carry out standard suicide risk assessment and safety planning, including lethal-means counselling (safe storage or removal), and draw on cultural and family protective factors.
2. Know your mandatory-reporting duties for child and elder abuse and domestic violence in Alaska. Know the federal Indian Child Welfare Act implications in child matters. [uncertain: not verified]
3. Report any harmful act, including sexual or non-consensual touch or any practice that delays urgent medical care, whoever does it. [synthesis]
Example language (illustrative): "Sometimes people feel so low they think about ending their life. Has that been happening for you? Who and what keeps you here?"
Watch for: your own reluctance to ask directly out of cultural caution. Asking is still required. It is working when the safety plan names people and practices the client actually draws on.

5. Handling problems

The cited sources give little problem-specific guidance. Except where cited, everything below is [synthesis].

The client is stuck or says little. Silence and indirectness can be respectful communication. Slow the pace, use fewer questions and more reflection, and offer side-by-side activities or telehealth if face-to-face is hard. Recheck the CFI questions on the clinician–patient relationship: perceived racism, language barriers. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] (illustrative) "Take whatever time you need. There's no rush here."
Mistrust of Western services. Distrust of government systems and Western health care is described as an ongoing effect of historical trauma. [source: https://bhinstitute.uw.edu/wp-content/uploads/2025/05/TeleBH-2025-Session-05-Wellness-Approach-to-Culturally-Informed-Services-Alaska-Natives-Forscher-05-16-2025.pdf] Name the history openly, be reliable in small things, explain your limits on confidentiality honestly, and let the client set the pace. (illustrative) "It makes sense to be careful with services, given what your family has been through."
The client asks you to do traditional healing, or a ceremony. Decline clearly and warmly. Explain that this belongs to tribal doctors and Elders, and offer the referral pathway (4.8). Never improvise or borrow a practice. (illustrative) "That isn't mine to do. What I can do is help you get to the people who hold it."
The client rejects traditional healing, or belongs to a church that discourages it. Respect this fully, and do not frame culture as the "real" treatment. Many Alaska Natives are Christian. [source: https://ua.pressbooks.pub/writingalaska/?p=115] Explore the client's own sources of meaning.
Conflict between the two ways of knowing. For example, the client's explanatory model differs from your diagnosis. Calricaraq treats understanding the difference between kass'artaq and yugtaq as the basis for integration. [source: https://www.yk-health.org/images/3/31/Calricaraq_System_of_Care.pdf] Lay out both side by side and let the client decide how to combine them. Write down agreed and unagreed points.
Traditional healing "didn't work". As in the Psychiatric News account, revisit the options without saying "I told you so". [source: https://psychiatryonline.org/doi/10.1176/pn.38.22.0013] Ask what was helpful, even partly, and whether the client wants to continue both.
Non-adherence: missed sessions or referrals not followed through. First rule out logistics: travel, weather, subsistence seasons, connectivity, and SCF's six-month referral renewal. [source: https://www.careinnovations.org/wp-content/uploads/Traditional-Healing-Overview_Southcentral-Foundation-Site-Visit-9.13.18.pdf] Then explore ambivalence.
Overwhelm during historical-trauma work. Return to grounding and present-day safety and pause the historical material. Strengthen supports (family, Elders, community programmes) before going on. Watch for numbing with substances, which Napoleon links to suppressed trauma. [source: https://ua.pressbooks.pub/writingalaska/?p=115]
Rupture after a cultural mistake (wrong assumption, a pan-Native generalisation, mispronouncing a name). Acknowledge it plainly, apologise without over-explaining, ask what would be better, and repair through behaviour. (illustrative) "I got that wrong. Thank you for telling me. How should I have asked?"
Unaffiliated "Native healers" or appropriated practices. If a client is approached by someone offering Alaska Native healing outside tribal or community recognition, help them check with their tribal health organisation or community. Do not endorse or refer to unaffiliated individuals.
Possible harm linked to any helper. Examples: sexual or non-consensual touch, pressure to stop medication, delay of urgent care, or exploitation. Follow safeguarding and reporting duties as for any provider. Inform the tribal organisation's own complaint routes with the client's knowledge, where safe. Cultural framing never overrides safety.
Small-community dual relationships. The client may know the interpreter, the tribal doctor or other clients. Ask early and offer alternatives such as telehealth or a different interpreter. [source: https://bhinstitute.uw.edu/wp-content/uploads/2025/05/TeleBH-2025-Session-05-Wellness-Approach-to-Culturally-Informed-Services-Alaska-Natives-Forscher-05-16-2025.pdf]
Possible psychosis versus normative spiritual experience. Use 4.7. Get a cultural consultation with consent, assess risk and functioning, and involve psychiatry when there is disorganisation, danger or marked decline, while respecting the client's meaning.
Therapist over-reach or romanticising. Bring it to supervision. You are a guest in the client's cultural world; the tradition is not a technique for you to use.

Sources

Web sources

Books and papers cited

Napoleon, H. Yuuyaraq: The Way of the Human Being. Alaska Native Knowledge Network, University of Alaska Fairbanks. The edition year is [uncertain]: the reprint page shows a 1996 cover and a 2005 copyright credit.
Kleinman, A., Eisenberg, L., & Good, B. (1978). Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88, 251–258.
Lewis-Fernández, R., Aggarwal, N. K., Lam, P. C., et al. (2017). Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: mixed-methods results from the DSM-5 international field trial. British Journal of Psychiatry, 210(4), 290–297.
American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision (DSM-5-TR).

← Previous · XI-101Talking and healing circles Next · XI-103 →Mexican curanderismo