Moving from Colonization

toward Balance and Harmony:

A Native American Perspective on Wellness
David R. Hodge, Gordon E. Limb, and Terry L. Cross

At best, mainstream mental health services are often ineffective with Native American clients,
and, at worst, they are a vehicle for Western colonization. As such, the authors explore the
notion of abandoning the Western therapeutic project and rebuilding the helping process on
the basis of indigenous knowledge foundations.To this end, they discuss a Native perspective
on wellness that emphasizes balance among the interconnected areas of spirit, body, mind,
and context or environment. From this perspective, mental health is a product of balance
and harmony among these four areas.The authors conclude with a discussion of the practice
implications of this relationally based perspective in which practitioners target interventions
toward improving balance and harmony.

Key words: American Indians; cultural competency;

Native Americans; practice perspectives; spirituality

C urrent mental health practices appear to

be largely ineffective in terms of meeting
the needs of many Native Americans (Gra-
ham, 2002; Weaver, 2004). According to nationally
representative survey data (N = 134,875), Native
Americans are significantly more likely to indicate
that they have unmet needs in the area of mental
health care than are white Americans (Harris, Ed-
lund, & Larson, 2005). Conversely, the perceptions
of unmet mental health care needs among African
Americans, Asians, and Hispanics are usually lower
than those of white Americans—often significantly
lower (Harris et al., 2005).The high level of unmet
needs among Native Americans calls for some type
of explanation.
In what might be considered the conventional
hypothesis, the higher perceived need among Na-
tive Americans is related to the existence of higher
rates of mental health challenges in this population.
Indeed, a substantial body of research indicates that
the prevalence rate of mental health challenges
among Native Americans is significantly higher
than it is among white Americans and many other
populations (Beals et al., 2005; Harris et al., 2005;
Kulis, Napoli, & Marsiglia, 2002; Stiffman et al.,
2006; Weaver, 2004). Thus, perceptions of unmet
need are posited to exist because of the magnitude
of the challenges and the scarcity of resources. The
solution, according to this view, is to increase access
to professional service providers so that mental health
challenges can be met.
This hypothesis, however, is based on the premise
that Native Americans lack sufficient access to pro-
fessional service providers.Yet according to recent,
nationally representative data, Native Americans
are just as likely as whites Americans to use mental
health services (Harris et al., 2005). This is true for
those experiencing one or more health symptoms
as well as for those with serious mental illness. For
instance, among Native Americans with serious
mental illness (n = 161), roughly 61 percent had
used mental health services (Harris et al., 2005).
In absolute terms, this was the highest percentage
of service usage among the groups surveyed.These
data suggest that the high level of perceived unmet
mental health needs cannot be attributed solely to
lack of access to mental health services.
An alternative, critical viewpoint posits that the
problem lies not with the degree of access but with
the services themselves. Professional mental health
services are often perceived by Native Americans
to be ineffective (Graham, 2002; Weaver, 2004).
One recent survey of tribal members living on four
reservations (N = 965) assessed the effectiveness of
various types of services commonly used to address
mental health and substance abuse problems (Walls,

Hodge,
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 Johnson,Whitbeck, & Hoyt, 2006). Of the 21 types
of services assessed, those provided by professional
service providers were perceived to be the least ef-
fective. Services provided by off-reservation social
workers, the most numerous providers of mental
health services in the United States, were perceived
to be the least effective of all.
In short, perhaps the reason so many Native
Americans report unmet mental health needs—
despite receiving relatively high levels of mental
health services—is simply because the provided
services do not meet their needs.The service models
are simply ineffective.Yet, as implied earlier, much of
the existing scholarship on Native Americans sup-
ports, either implicitly or explicitly, existing Western
models of service delivery.
This article provides an alternative viewpoint,
positing that the Western therapeutic project is in-
consistent with many Native American cultures and
often serves as a form of Western colonization. We
suggest abandoning this value-informed project and
rebuilding the helping process on tribal knowledge
foundations. In keeping with this goal, we offer a
relationally based Native perspective in which well-
ness results from the complex interplay of spirituality,
physical status, cognitive and emotional processes,
and environment. Before proceeding, however, the
diversity of perspectives that exists among Native
Americans should be noted.
Native American—A Constructed
Concept
It is important to recognize that terms such as “Na-
tive American” and “American Indian” are linguistic
devices designed to denote contemporary descen-
dents of a wide variety of tribal nations. Over 550
American Indian tribes are currently recognized
by the federal government (Fuller-Thomson &
Minkler, 2005). In addition, many other tribes are
recognized only by state governments, and still
others are working to obtain official governmental
recognition. Each tribe, whether recognized or
not, is informed by a culturally unique worldview
(Trujillo, 2000; Whitbeck, 2006).
Although Native Americans commonly affirm a
number of values (Cross, 1997; Jackson & Turner,
2004), no single Native perspective exists among the
4.3 million people who self-identify as American
Indian or Alaskan Native in the United States (U.S.
Census Bureau, 2000). In this article, we present
one Native perspective that has broad resonance
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among many Native Americans. Before delineating
this perspective, we discuss how mainstream mental
health services can oppress Native clients, in spite of
good intentions on the part of practitioners.
Therapy as Colonization
In practice settings, it is widely accepted that
the theoretical perspective brought to the table
influences how problems are conceptualized and
addressed (Tjeltveit, 1999). Practitioners using a
cognitive perspective may be more likely to view
problems as stemming from unhealthy schemas and
recommend interventions that emphasize salutary
thoughts. Alternatively, those operating from a be-
havioral theoretical framework may be inclined to
believe that altering patterns of behavior is the best
way to help clients ameliorate problems.
Although it is commonly accepted that values
inform direct practice, less thought is typically
given to the values that animate the larger,Western
therapeutic project (Coates, Gray, & Hetherington,
2006). Debate exists about the efficiency of various
therapeutic modalities (Chambless & Ollendick,
2001; Hepworth, Rooney, Rooney, Strom-Gottfried,
& Larsen, 2006), but the effectiveness of the larger
therapeutic enterprise is typically assumed.Therapy
is viewed as the appropriate means to address mental
health needs across cultures and populations. Put dif-
ferently, psychotherapy is implicitly understood to be
a neutral, scientifically based vehicle through which
mental health problems are best ameliorated.
All human constructions, however, are informed
by certain sets of values. The therapeutic project is
informed by and reflects the values of the Western
Enlightenment worldview from which it emanated
(Cross, 1997, 1998; Gray, 2008; Jafari, 1993; Red
Horse, 1997;Voss, Douville, & Little Soldier, 1999).
It is important to note that not all westerners ac-
cept the premises of the Enlightenment, which
have come under considerable criticism from some
members of the dominant secular culture (Lyotard,
1979/1984). Nevertheless, Enlightenment values
continue to guide the trajectory of the therapeutic
project.
To be clear, we are not talking about individual
practice modalities but therapy as a larger enterprise.
This project entails numerous assumptions about
the nature of reality. Included among these are the
assumption that “good mental health” is an end
worth pursuing; various assumptions about what
constitutes both good mental health and dysfunction;
Social Work  Volume 54, Number 3  July 2009
 and assumptions that the discussion and exploration
of problems benefits those who suffer, problems
can be isolated and interventions targeted to the
localized problem, outcomes in a specific area can
be monitored and measured, and secular licensed
professionals are best suited to guide people through
the healing process.
Because some degree of consensus exists regarding
these assumptions among mental health profession-
als, the underlying values are rarely questioned. To
service providers who have been socialized to accept
them, the prevailing norms seem correct, true, and
appropriate. Although it is recognized that various
therapeutic modalities shape practitioners’ under-
standings, the values that inform the larger profes-
sional framework are unconsciously accepted. After
years of professional training, the professional mental
health paradigm is implicitly assumed to reflect the
world as it is rather than one particular understand-
ing of reality (Gone, 2004; Kuhn, 1970).
The suppositions that inform many Native
worldviews differ from the Enlightenment world-
view that serves as the foundation on which the
Western counseling project is constructed (Frame,
2003; Miller, 2003;Trujillo, 2000). At a foundational,
suppositional level, a clash in values exists in many
areas. Native understandings of wellness are typically
not entertained as legitimate options within the
Western therapeutic project. The array of options
presented to Native clients fails to resonate with
them because such options tend to fall outside the
parameters of Native worldviews. Consequently,
many Native clients experience therapy as oppressive,
because their worldviews are effectively marginalized
by mainstream mental health theory and practice
(Coates et al., 2006).
Native clients are subtly encouraged to adopt a
culturally foreign worldview through their engage-
ment in the counseling process (Gone, 2004). In
essence, therapy functions as an agent of coloniza-
tion (Coates et al., 2006). The only options on the
table, the only options deemed legitimate within
the therapeutic project, are foreign ones. Because
practitioners sincerely believe in the worth of the
larger project, they encourage Native clients to
engage the options sanctioned by the therapeutic
project. Thus, despite good intentions on the part
of practitioners, culturally different Native clients
are subtly coerced into adopting norms derived
from a Western, Enlightenment worldview (Yellow
Bird, 2004).
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To be clear, adapting therapy with multicultural
techniques—for example, matching clients on the
basis of gender, factoring in level of acculturation,
or tailoring communication style to match that of
the client—in and of itself, does little to mitigate the
colonization (Gone, 2004). Such techniques func-
tion to repackage the counseling project in more
palatable dress while leaving its central colonizing
function intact. The fact must be faced that profes-
sional therapy is a thoroughly enculturated project.
As such, it is time to consider revaluating or even
abandoning this project and rebuilding the helping
process on an indigenous knowledge foundation
(Walls et al., 2006). We discuss the parameters of
such a Native perspective on helping in the fol-
lowing section.
Before proceeding, it is important to note that
space constraints preclude discussion of all of the
issues raised in the foregoing discussion. Take, for
instance, the issue of what constitutes good men-
tal health. Characteristics viewed as markers of
psychopathology in the dominant secular culture
may be understood as indicators of well-being in
many Native American settings (Cross, 2001). For
example, communicating with the Creator or other
metaphysical dimensions of the spiritual world can
signify health and well-being in many Native tribes.
Conversely, in the context of the dominant culture,
such events are often construed as indicators of
psychopathology, with hearing a voice external to
one’s self commonly understood to be a marker of
schizophrenia (American Psychiatric Association,
2000).
Although we acknowledge the importance of
such issues, we limit the present discussion to a Na-
tive perspective on wellness, drawn primarily from
the work of Cross (1997, 1998, 2001), supplemented
by those influenced by his work (Coates et al., 2006;
Graham, 2002; Limb & Hodge, 2008) and other Na-
tive American scholars. Central to this relationally
based perspective are the interrelated concepts of
spirit, body, mind, and context.
A Native Model of Wellness
Spirit, Body, Mind and Context
In the Native model, in contrast to the dominant
secular culture, spirituality is perceived to be central
to wellness (Gilgun, 2002; Lowery, 1998). At the core
of one’s existence is the spiritual (see Figure 1). We
are not so much humans on a spiritual journey as
spirits on a human journey—a journey in which
Harmony 213
 Figure 1: Native Model of Wellness

Context

Mind

Body

Spirit

(Physical)

(Cognitive & emotional processes)

(Environment)

our spirits will continue to exist in the hereafter
(Cross, 2001).
In addition to the human spirit, spirituality also
includes transcendent dimensions (Gesino, 2001;
Weaver, 2005). People are in relationship with the
Creator and with what might be called positive
and negative spiritual forces. These forces are la-
beled differently by various traditions. Examples of
negative forces are signified by such terms as “bad
luck,” “evil spirits,” “ghosts,” and “the devil” (Cross,
1997). Although typically unseen, these forces are
real and influence people for both good and bad in
this material dimension of existence.
During their human journey, people exist in a
physical body. As is the case with our spirits, many
factors also affect our physical condition (Graham,
2002). Included among these are genetics, age,
nutrition, sleep, physical fitness, and substance use
(Cross, 1998). Although some characteristics, such
as genetic makeup, are more difficult (if not impos-
sible) to change, others, such as nutrition or physical
fitness, can be changed with relative ease.
Interconnected with both the spirit and the body
is the mind (Coates et al., 2006). It is important to
emphasize that “mind” in this context represents a
broader understanding than is typical among western
mental health professionals (Graham, 2002). In addi-
tion to purely cognitive components like memory,
it also includes intellect, judgment, experience, and
affect (Cross, 1997). As such, the concept includes
the notion of personality but goes beyond it.
People are not isolated beings but, rather, exist
in a particular context. Included in this context are
climate, work, family, community, culture, and his-
tory (Cross, 1997). As part of their journey, people
are born into a particular family that exists in a
community that has a unique culture and history.
In turn, this context or environment shapes people
in various ways (Weaver & Brave Hart, 1999). For
instance, trauma, unemployment, and crime typically
have a negative impact, whereas Native traditions,
family members, and tribal elders often have a posi-
tive influence.
With this being said, it is also important not to
romanticize Native cultures, as some members of
the dominant culture have done (Weaver, 2005).
As is the case with all cultures, Native cultures
have strengths and weakness. Although belief in
a transcendent spiritual reality is often an asset, it
can also be a limitation. For example, some Native
clients can understand the notion of bad luck in a
deterministic manner that functions to unduly limit

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 choices that would be legitimate within a given tribal
context. Balance is central to evaluating cultures and
to promoting wellness.
Balance as the Key to Wellness
As implied in the previous section, spirit, body,
mind, and context are interconnected (Coates et
al., 2006; Gilgun, 2002). Consequently, change in
one area influences other areas (Lowery, 1998). For
example, the sudden onset of unemployment may
produce a sense of sadness and anxiety, which is
augmented by bad spirits. In turn, this state may result
in a loss of appetite and sleep, further exacerbating
an already precarious mental state. Although some
Western perspectives would see a linear connection
between unemployment, sadness and anxiety, and
loss of appetite and sleep, within a Native context
these events are conceptualized in a more circular,
spherical manner in which each event is viewed in
relationship to the others.
Health and well-being are the result of the
complex interplay among our spirituality, physical
status, cognitive and emotional processes, and envi-
ronments (Cross, 2001). When all four areas are in
balance, we are said to be healthy. This relationship
is depicted in Figure 2. As can be seen in the figure,
Figure 2: Balance and Harmony as the Pathway to Wellness
Spirit
Ceremonies
Rituals
Dreams
Prayer
Context
Family
Elders
Culture
Traditions
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each area has equal weight. Wellness occurs when
each area is functioning in harmony with the other
areas. Although balance and harmony are related,
intertwined constructs, they can be distinguished
(Cross, 2007).
Balance is a natural state that results from the
normal processes of stimuli and response, drive and
drive satisfaction, and complex system interactions.
Some degree of balance occurs naturally among
the areas depicted in Figure 2, with or without
intervention.Without intervention, balance may be
functional but not necessarily optimal. For example,
children in an alcoholic family may develop coping
strategies that maintain some form of balance in
their given situation but also leave them vulnerable.
As long as humans survive, some form of balance
exists naturally.
Harmony, conversely, requires effort. Harmony
results from the active pursuit of more optimal or
positive balance.This process entails the use of self-
discipline and some forms of cultural, spiritual, or
mental practices or therapeutic interventions, such as
those depicted in Figure 2 (for example, ceremonies,
memorials). Ideally, the process creates a condition in
which each of the quadrants generates positive en-
ergy. The energy of the whole system then becomes
Body
Nutrition
Sleep
Exercise
Recreation
Mind
Storytelling
Reminiscing
Remembering
Memorials
Harmony 215
 greater than the sum of its parts.When in harmony,
people thrive, are resilient beyond expectation, and
contributes in a synergistic manner to those around
them with their energy.
A number of practice implications flow from
this understanding of wellness. As stated earlier,
people are usually able to maintain some form of
balance and, thus, are able to function in a generally
healthy manner. Health and wellness, however, are
not always preserved as people move through life.
In such cases, some Native American clients will
encounter mental health professionals (Gone, 2004;
Limb & Hodge, 2008).
Implications for Mental
Health Professionals
Mental health professionals are typically trained
to isolate problem areas in human functioning, for
which interventions are then developed.The prob-
lem is commonly thought to exist with or within
the person in some sense. A practitioner working
from a cognitive perspective, for instance, attempts
to correct a client’s unproductive thought patterns
(Ellis, 2001). The problem, from this perspective, is
with the client, specifically her or his schema.View-
ing the problem as residing with the person can foster
a milieu in which the person becomes completely
identified with the problem, as occurs when people
are called “schizophrenics” (Hodge, 2004).
The Native perspective discussed in this article
calls for a completely different way of addressing
problems. Rather than treating the person, the healer
treats the balance (Cross, 1997). The problem lies
not within the person but in the lack of balance
and harmony among spirit, body, mind, and con-
text. Adjusting the balance among these four areas
restores wellness.
Healers focus on understanding challenges
through the complex relationships among spirit,
body, mind, and context. Rather than using a lin-
ear cause-and-effect framework, healers approach
challenges using a relational, intuitive framework in
which all variables are understood to be intercon-
nected (Graham, 2002). Because of the interrelation-
ship among variables, changing one area results in
changes throughout the larger system.
Four sample interventions in each of the four areas
are listed in Figure 2. It should be noted that these
interventions are illustrative and may not be relevant
to all Native Americans. Although the concepts of
spirit, body, mind, and context are likely to hold
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broad resonance across tribes, interventions designed
to promote balance and harmony will vary consider-
ably from tribe to tribe and person to person.
With these cautions in mind, these sample in-
terventions are relatively representative of the types
of practices that might be used to foster wellness.
In some cases, the nature of the intervention is
readily apparent. A case in point would be a client
needing better nutrition, extra sleep, more exercise,
additional recreation, or some other type of inter-
vention designed to restore harmony in the realm
of the body.
In the areas of mind and context, the interventions
may be more unfamiliar. Storytelling, reminiscing,
remembering, and memorializing are traditional,
mind-oriented interventions that can engender
wellness by selectively emphasizing certain experi-
ences, values, and feelings. For instance, reminiscing
about past events in which problems were success-
fully overcome can help bring harmony to the
mind by instilling hope that present difficulties can
be overcome.
As noted, the person exists in a given context,
which typically includes family, elders, culture,
and traditions. Each environmental factor can be
understood and operationalized as an interven-
tion. Health can often be enhanced, for instance,
by restoring family unity, consulting the wisdom
of elders, or reconnecting individuals with their
culture or traditions.
Although not listed as such, it should also be
noted that more traditional therapeutic interventions
might also be used in the areas of mind and con-
text. A cognitive intervention, for example, might
be used to address unproductive thought patterns.
In some cases, a traditional therapeutic perspec-
tive might be used in conjunction with one of the
more traditional tribal interventions to enhance its
effectiveness. For instance, operating from a systems
perspective, a structural intervention might be used
with a family.
Given the intertwined nature of many of these
interventions, they are often best conducted with
other tribal members. For example, clan members
can often facilitate the process of storytelling, in-
creasing the significance of the exercise. Likewise,
reminiscing with tribal elders may help clients to
reconnect with their traditions while enhancing
their resilience. Incorporation of tribal members
into the process is particularly important in the
area of spirituality.
Social Work  Volume 54, Number 3  July 2009
 Perhaps the most complex set of interventions
occurs under the rubric of the spirit. Spiritual inter-
ventions are often intensely private affairs (Trujillo,
2000). Many tribal ceremonies and rituals are not
open to outsiders. Similarly, the sharing of dreams or
prayers is often proscribed outside of tribal circles.
Although this area is of foundational importance,
any discussion of spiritual matters must proceed ten-
tatively and with the utmost caution because of the
sacred nature of many Native spiritual practices.
As implied in the foregoing, spiritual, psycho-
logical, contextual, or physical interventions might
be used to promote balance and harmony. Because
restoring balance is the crucial issue, it is important
to emphasize that interventions are not necessar-
ily aimed at specific problem areas. Rather, healers
attempt to understand the interplay among inter-
dependent systems, and they design interventions
accordingly.
This understanding of healing differs dramatically
from that held within the Western therapeutic proj-
ect. For instance, using the linear, cause-and-effect
framework of mainstream mental health, a problem
such as chemical dependency is typically addressed
by developing psychological interventions that
address the mind (Blazer, 2003; Ellis, 2001; Long-
abaugh et al., 2005). As we have noted, the use of
such interventions is not necessary proscribed from
a Native perspective. In some cases, a cognitive in-
tervention may be appropriate. The problem is not
with the intervention in and of itself but with the
larger linear, cause-and-effect framework.
In contrast, Native perspectives typically affirm
a more circular, holistic approach. Addictions, for
example, may be the product of an unbalanced
relationship with the Creator. In such situations,
a cognitive intervention that addresses the mind is
unlikely to be effective. Rather, the best way to ad-
dress substance abuse may be a spiritual intervention
that restores harmony between the individual and
the Creator. A renewed spiritual connection with
the Creator, manifested in the form of a dream, may
play a critical role in recovery from chemical de-
pendency (Lowery, 1998). Once balance is restored,
the problem is ameliorated.
The interconnected nature of problems is often
difficult for mainstream mental health profession-
als to understand because of years of socialization
that have privileged Western scientific knowledge
claims over spiritual knowledge. As Cross (2001)
observed, the Western therapeutic project has of-
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ten pathologized religious beliefs and categorized
spiritual phenomena as dysfunctional. Indeed, woven
into the Enlightenment worldview at a basic, pre-
suppositional level is an antireligious bias (Gellner,
1992; Gray, 2008).
Yet for many Native Americans, spirituality is
critical to wellness and healing (Gone, 2004; Stone,
Whitbeck, Chen, & Johnson, 2005). For instance,
in one chemical dependency project, many Native
women linked their decision to stop using substances
to a spiritual experience, such as a dream, a vision,
or a transcendent voice encouraging them to stop
using (Lowery, 1998). Restoring harmony with
the spiritual realm played an instrumental role in
recovery (Lowery, 1998; Stone et al., 2005).
Implementing a Native perspective in mental
health settings will typically require a collaborative
effort. Social workers are required by the NASW
Code of Ethics (NASW, 2000) to remain within
their areas of professional competency. Given their
socialization into the Western therapeutic project,
they are unlikely to have the knowledge, skills, or
training to work with Native clients in the manner
delineated in this article.
Consequently, it will usually be necessary to form
working relationships with specialists in Native
spirituality and culture. As mentioned earlier, each
tribe has a distinct worldview, and, consequently,
collaborations should reflect this reality (Whitbeck,
2006). Although the basic concepts presented in this
article are widely affirmed among Native Ameri-
cans, they are operationalized in various ways. For
instance, spirituality may be expressed within con-
texts as varied as Catholicism, indigenous settings,
Pentecostalism, the Native American Church, or
some combination of these (Gone, 2004).Thus, col-
laboration may entail working with medicine men,
pastors, elders, priests, teachers, or other individuals
with specialized knowledge.
To identify individuals with whom to collaborate,
practitioners should consult their clients (Weaver,
2003). Given the diversity of potential collaborators,
social workers must be careful not to favor certain
types of associations that are based on their prede-
termined notions of what constitutes an appropriate
collaborator. As experts on their own life circum-
stances, clients are ideally situated to suggest the most
appropriate collaborator to meet their needs.
Before such conversations can occur, however, it
is usually necessary to spend some time establish-
ing trust (Jackson & Turner, 2004; Weaver, 2003).
Harmony 217
 Initially, clients may assume that non-Native prac-
titioners buy into the assumptions of the Western
therapeutic project. Hesitancy is to be expected in
such situations. Consequently, it may take some time
to develop sufficient rapport to ensure that clients
feel comfortable exploring alternative methods of
addressing problems.
Conclusion
Social work is a profession ethically committed
to providing effective services (NASW, 2000). Yet,
despite good intentions, the services provided by
mental health professionals have failed to adequately
address the needs of Native Americans (Harris et
al., 2005). As currently constructed, the Western
counseling project delivers services that are often
ineffective and function as a vehicle for coloniza-
tion (Coates et al., 2006; Gone, 2004; Walls et al.,
2006).
In light of this situation, it is time to consider
transforming service provision, rebuilding it upon
Native understandings of reality (Whitbeck, 2006).
Instead of dressing secular Western frameworks
up in culturally competent garb, it is time to
construct Native practice modalities from the
ground up. New helping models—built on a Na-
tive presuppositional foundation rather than an
Enlightenment presuppositional foundation—must
be constructed.
Fortunately, openness to such innovations may
be growing. As implied earlier, the philosophical
cracks in the Enlightenment foundation on which
the Western counseling project rests are increasingly
recognized across cultures (Ermarth, 1998; Lyotard,
1979/1984). Professional interest in spirituality and
nonmaterial understandings of reality is growing
(Cnaan, Boddie, & Danzig, 2005; Hodge, 2006). A
new era in which diverse worldviews are regarded as
being on a par with the dominant secular worldview
may be emerging.
Toward this end, we have sketched out one
Native practice perspective in this article. Other
perspectives representing different Native under-
standings, however, are needed. As noted earlier,
no single Native perspective exists (Trujillo, 2000;
Whitbeck, 2006). Different tribes, operating from
different presuppositional foundations, will con-
struct different helping models. It is our hope
that future professional discourse will expand its
understanding of diversity sufficiently to include
such models.  British Journal of Social Work, 38, 175–196.
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David R. Hodge, PhD, is assistant professor, School of Social
Work, Arizona State University, and senior nonresident fellow,
Program for Research on Religion and Urban Civil Society,
University of Pennsylvania, Philadelphia. Gordon E. Limb,
PhD, is associate professor, School of Social Work, Brigham
Young University, Provo, UT. Terry L. Cross, ACSW,
LCSW, is executive director, National Indian Child Welfare
Association, Portland, OR. Address correspondence to David
R. Hodge, School of Social Work, Arizona State University,
Mail Code 3251, 4701 West Thunderbird Road, Glendale,
AZ 85306-4908.
Original manuscript received April 30, 2007
Final revision received December 18, 2008
Accepted February 3, 2009

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