A Critical Ethnography of the Compatibility of a Culturally Modified Dialectical Behavior Therapy with Native American Culture and Context

Abstract

Purpose: Describe the Suquamish cultural influences on defining living a life worthwhile and to describe the compatibility of a culturally modified Dialectical Behavior Therapy (DBT) with a Native American community's culture and context. Background: Native Americans experience serious psychological distress, suicide, and substance abuse at higher rates than other racial groups. Studies using DBT found a significant decrease in parasuicidal risk behavior and substance abuse. However, research has not demonstrated that DBT is efficacious or compatible within the Native American culture. Specific Aims: 1) Describe the Native American cultural influences on defining living a life worthwhile. 2) Describe the compatibility between Healthy and Whole, a culturally modified DBT intervention with Native American culture. Methodology: Critical ethnographic study with in-depth interviews (13) and participant observations (10 months) was conducted. Sample was tribal members and clinicians exposed to the Healthy and Whole and tribal members who are identified as knowledgeable regarding tribal tradition. Analyses included semantic domain, taxonomic, and theme analysis for aim1 and compared DBT curriculum to results of aim 1 to accomplish aim 2.Findings: An intergenerational cycle of relational trauma was initiated by structural cultural genocide with systematic abuse and neglect of Native Americans especially children. Relational trauma of abuse and neglect is the source of a variety of maladaptive behaviors. These maladaptive behaviors lead to relational trauma in the next generation. A dual process of maintaining and revitalizing Suquamish cultural values coupled with skills taught in a culturally modified DBT intervention, Healthy and Whole, help Suquamish members live more worthwhile lives and recover from intrapersonal trauma. Implications: Healthy and Whole is a community approach to healing from relational trauma. Healthy and Whole approach to DBT may help other indigenous people live more worthwhile lives and recover from relational trauma and break the cycle because Suquamish cultural values are collectivist and many indigenous peoples share similar values and histories of historical trauma.