A Return to “The Clinic” for Community Psychology: Lessons from a Clinical Ethnography in Urban American Indian Behavioral Health

Community psychology (CP) abandoned the clinic and disengaged from movements for community mental health (CMH) to escape clinical convention and pursue growing aspirations as an independent field of context‐oriented, community‐engaged, and values‐driven research and action. In doing so, however, CP positioned itself on the sidelines of influential contemporary movements that promote potentially harmful, reductionist biomedical narratives in mental health. We advocate for a return to the clinic—the seat of institutional power in mental health—using critical clinic‐based inquiry to open sites for clinical‐community dialogue that can instigate transformative change locally and nationally. To inform such works within the collaborative and emancipatory traditions of CP, we detail a recently completed clinical ethnography and offer “lessons learned” regarding challenges likely to re‐emerge in similar efforts. Conducted with an urban American Indian community behavioral health clinic, this ethnography examined how culture and culture concepts (e.g., cultural competence) shaped clinical practice with socio‐political implications for American Indian peoples and the pursuit of transformative change in CMH. Lessons learned identify exceptional clinicians versed in ecological thinking and contextualist discourses of human suffering as ideal partners for this work; encourage intense contextualization and constraining critique to areas of mutual interest; and support relational approaches to clinic collaborations.     

Identifying effective mental health interventions for American Indians and Alaska Natives: a review of the literature

The pursuit of evidence-based practice (EBP) within the mental health professions has contributed to efficacious clinical intervention for individuals struggling with mental health problems. Within the context of the EBP movement, this article reviews the treatment outcome literature for mental health interventions directed specifically toward American Indians and Alaska Natives experiencing psychological distress. Fifty-six articles and chapters pertaining to the treatment of Native Americans with mental health problems were identified, though the vast majority of these did not systematically assess outcomes of specified treatments for Native American clients under scientifically controlled conditions. Of just nine studies assessing intervention outcomes, only two were controlled studies with adequate sample sizes and interpretable results relative to the identification of EBP among American Indians and Alaska Natives. The advantages and limitations of EBP for treatment of Native American mental health problems are discussed.     

“We Never was Happy Living Like a Whiteman” : Mental Health Disparities and the Postcolonial Predicament in American Indian Communities

In the context of increasing attention to disparities in health status between U.S. ethnoracial groups, this article examines the dilemma of divergent cultural practices for redressing disparities in mental health status in American Indian communities. Drawing upon an ethnographic interview with a tribal elder from a northern Plains Indian reservation, a prototypical discourse of distress is presented and analyzed as one exemplar of the divergence between the culture of the clinic and the culture of the community. Situated in the context of continuing power asymmetries between tribal nations and the U.S. federal government, the implications of this cultural divergence for the efforts of mental health professionals, practitioners, and policymakers are identified as a predicament that only the conventions and commitments of a robust community psychology have the potential to resolve.     

Is psychological science a-cultural?

The history of psychological science, as it has intersected with ethnoracial, cultural, and other marginalized domains of group difference, is replete with disinterest, dismissal, or denigration of these diverse forms of psychological experience. This has led some to wonder whether psychological science is a-cultural, or even anti-cultural in orientation. Assessment of this provocative proposition first requires exploration of three composite questions: (1) What is culture?, (2) What is science?, and (3) What is psychological science? Based on brief consideration of these composite questions--which are remarkably complex in their own right--I argue that psychological science is not, has never been, and indeed cannot in principle be a-cultural. Instead, like all forms of knowing, psychological science emerges at particular historical moments to achieve particular goals that are motivated by particular interests. Throughout much of the history of psychological science, these goals and interests were tied to ideologically suspect agendas that contemporary psychologists are right to repudiate. The interesting question becomes whether psychology's knowledge practices can be disentangled from this earlier ideological contamination to furnish the discipline with viable methods. I propose that psychological science can in fact be so disentangled; nevertheless, the resulting methods are never adopted or deployed outside of culturally constituted interests, objectives, and motivations, thereby requiring ongoing critical engagement with the subtexts of disciplinary knowledge production. In fact, there seem to be important ways in which psychology's scientific aspirations hobble disciplinary inquiry into the human condition that has motivated multicultural psychologists to consider alternative paradigms of inquiry.     

How to Assess a Model's Testability and Identifiability

Formal definitions are given of the following intuitive concepts: (a) A model is quantitatively testable if its predictions are highly precise and narrow. (b) A model is identifiable if the values of its parameters can be ascertained from empirical observations. (c) A model is redundant if the values of some parameters can be deduced from others or if the values of some observables can be deduced from others. Various rules of thumb for nonredundant models are examined. The Counting Rule states that a model is quantitatively testable if and only if it has fewer parameters than observables. This rule can be safely applied only to identifiable models. If a model is unidentifiable, one must apply a generalization of the Counting Rule known as the Jacobian Rule. This rule states that a model is quantitatively testable if and only if the maximum rank (i.e., the number of linearly independent columns) of its Jacobian matrix (i.e., the matrix of partial derivatives of the function that maps parameter values to the predicted values of observables) is smaller than the number of observables. The Identifiability Rule states that a model is identifiable if and only if the maximum rank of its Jacobian matrix equals the number of parameters. The conclusions provided by these rules are only presumptive. To reach definitive conclusions, additional analyses must be performed. To illustrate the foregoing, the quantitative testability and identifiability of linear models and of discrete-state models are analyzed. Copyright 2000 Academic Press.     

The sounds of dominance.

A study was conducted to determine the effects of vocal cues on judgements of dominance in an interpersonal influence context. Physical measures of human vocal cues and participant ratings of dominance were obtained from videotapes of actors delivering short influence messages. After controlling for linguistic and visual content of messages, results indicated that mean amplitude and amplitude standard deviation were positively associated with dominance judgments, whereas speech rate was negatively associated with dominance judgments. An unexpected interaction revealed that mean fundamental frequency (F₀) was positively associated with dominance judgments for male speakers but not significantly associated with dominance judgments for female speakers. F₀ standard deviation was not significantly associated with dominance judgments. Results support the conclusion that dominance judgments are inferred from multiple sources of information and that some vocal markers of dominance are more influential than others.     

American Indian Historical Trauma: Community Perspectives from Two Great Plains Medicine Men

The field of community psychology has long been interested in the relations between how community problems are defined, what interventions are developed in response, and to what degree power is distributed as a result. Tensions around these issues have come to the fore in debates over the influence of historical trauma (HT) in American Indian (AI) communities. After interviewing the two most influential medicine men on a Great Plains reservation to investigate how these tensions were being resolved, we found that both respondents were engaging with their own unique elaboration of HT theory. The first, George, engaged in a therapeutic discourse that reconfigured HT as a recognizable but malleable term that could help to communicate his “spiritual perspective” on distress and the need for healing in the reservation community. The second, Henry, engaged in a nation-building discourse that shifted attention away from past colonial military violence toward ongoing systemic oppression and the need for sociostructural change. These two interviews located HT at the heart of important tensions between globalization and indigeneity while opening the door for constructive but critical reflection within AI communities, as well as dialogue with allied social scientists, to consider how emerging discourses surrounding behavioral health disparities might be helpful for promoting healing and/or sociostructural change.     

Psychological‐Mindedness and American Indian Historical Trauma: Interviews with Service Providers from a Great Plains Reservation

The concept of historical trauma (HT) was developed to explain clinical distress among descendants of Jewish Holocaust survivors and has since been ascribed new meanings to account for suffering in diverse contexts. In American Indian (AI) communities, the concept of AI HT has been tailored and promoted as an expanded notion of trauma that combines psychological injury with historical oppression to causally connect experiences with Euro‐American colonization to contemporary behavioral health disparities. However, rather than clinical formulations emphasizing psychological injury, a focused content analysis of interviews with 23 AI health and human service providers (SPs) on a Great Plains reservation demonstrated strong preferences for socio‐cultural accounts of oppression. Reflective of a local worldview associated with minimal psychological‐mindedness, this study illustrates how cultural assumptions embedded within health discourses like HT can conflict with diverse cultural forms and promote “psychologized” perspectives on suffering that may limit attention to social, economic, and political determinants of health.     

Teaching Tradition: Diverse Perspectives on the Pilot Urban American Indian Traditional Spirituality Program

Many urban American Indian community members lack access to knowledgeable participation in indigenous spiritual practices. And yet, these sacred traditional activities remain vitally important to their reservation‐based kin. In response, our research team partnered with an urban American Indian health center in Detroit for purposes of developing a structured program to facilitate more ready access to participation in indigenous spiritual knowledge and practices centered on the sweat lodge ceremony. Following years of preparation and consultation, we implemented a pilot version of the Urban American Indian Traditional Spirituality Program in the spring of 2016 for 10 urban AI community participants. Drawing on six first‐person accounts about this program, we reflect on its success as a function of participant meaningfulness, staff support, mitigated sensitivities, and program structure. We believe that these observations will enable other community psychologists to undertake similar program development in service to innovative and beneficial impacts on behalf of their community partners.