A clinical psychologist’s journey into working with Indigenous clients

Josephine Tan, PhD. C.Psych, (Canada)

When I started my career as an academic and professional clinical psychologist, working with Indigenous peoples was the furthest thing from my mind.  Today, most of my part-time private practice consists of Indigenous clients who fly in for appointments from remote parts of the province of Ontario in Canada. I am often asked what I did to end up working with Indigenous clients.

There was no prescribed path that I took because no such path existed during my student days, which were in the 1980’s and 1990’s.  However, I was cognizant of differences among cultural groups despite clinical psychology treating all groups at that time as no different from the dominant group.  Since then, psychology has undergone substantial shifts; today, culture is recognized as one of the central influences on human behaviours and functioning.

My journey into cultural clinical psychology began when I signed up to be a psychological service provider with the Canadian federal health plan for the Indigenous peoples of Canada.  Several years later, I would also sign up with the Indian Residential School (IRS) Resolution Health Support program which provides mental health assistance to former students of the Indian residential school system and their families.

The residential schools, which started in the 1800’s with the last school closing down in 1996, was an assimilation tool of the federal government, which removed Indigenous children from their families to prevent the intergenerational transmission of their cultures. The schools were mismanaged, resulting in the abuse of many of the children in the schools by staff and in the alienation of children from their loved ones who could nurture and help them develop their identity and sense of belonging.  A comprehensive account of the residential school system and its effects can be found in A national crime: The Canadian Government and the residential school system by Milloy (1999).

The IRS program was set up by the Canadian government under the terms of the Indian Residential School Settlement Agreement (IRRSA) which was signed in 2006 by the federal government, representatives of the residential school survivors, the Assembly of First Nations, representatives of the Inuit people, and churches.  The IRSSA also set up the Truth and Reconciliation Commission (TRC) to document and preserve the experiences of survivors, and to facilitate reconciliation between the survivors, their families, and communities and the non-Indigenous society.

In 2015, the TRC produced a six-volume report which contained Ten Principles for Reconciliation and 94 calls to action.  In a recent visit to Canada, the UN Special Rapporteur on the Rights of Indigenous Peoples noted that whereas progress has been made in Canada to protect and promote the rights of Indigenous peoples, there are still ongoing human rights abuses and violations that are linked to the intergenerational trauma arising from the residential schools and structural discrimination, and that more needs to be done to follow through on the TRC recommendations (Calí-Tzay, 2023).

Working with Indigenous peoples has been one of the most rewarding aspects of my career, and proven to be a great learning experience as well.  I learned to view the client as one who is linked to family members and the extended kinship system, instead of as an isolated individual as taught by mainstream clinical psychology.  Many of the clients’ problems could not be reduced to singular terms, such as depression or anxiety. Rather, they were consequences of colonization that led to the disintegration of families, poverty, substandard living conditions, low access to education, employment, and the medical system, and much more.

My work as a therapist extended to seeking resources and advocating for my clients. Some of my clients would also access traditional healing and consult with Elders, and I learned how to complement my psychological work with the other Indigenous interventions.

I also found that “getting better” for my clients went beyond symptomatic improvement. It involved improved relations with others, greater stability in the clients’ lives, fewer crises, and enhanced sense of coping. For some clients who went further in their healing journey, it was seen in their pride in their culture and their Indigenous identity, and their giving back to their peoples in the form of helping others.

It would be a great mistake to assume that all Indigenous peoples are the same. For example, there are three groups of Indigenous peoples in Canada, namely First Nations, Inuit, and Métis; they have different history and experiences with colonization.  Some First Nations are highly Christianized while others continue with their traditional spiritual beliefs.  A vanishingly few still speak their languages and strive to keep their languages alive by teaching it to the young and to non-Indigenous peoples who wish to learn. There are some First Nations individuals who are completely Westernized and have lost their connection to their cultural heritage and language, and they are perfectly fine with it.  Working with them in therapy would be like working with a non-Indigenous client.  Some First Nations individuals have lived on reserves and no where else; some First Nations individuals grew up in urban settings and have never seen a reserve before. The ways of living on reserves and in cities are vastly different, leading to different lived experiences and perspectives, opportunities and challenges.  Therefore, there is no one “right” way to work with Indigenous clients as the work is dependent on the client’s history and current circumstances.

My clinical work with First Nations has also informed my teaching and research. My doctoral course on cultural issues for clinical psychologists has evolved over the years to include Elders and traditional healers as invited speakers. My research increasingly adopts a cultural lens. I now seek out research studies from various countries to compare their findings. I am interested in decolonizing psychology that is being carried out in different parts of the world.

Interestingly, my work with First Nations has led me to connect more strongly with my Asian cultural roots.  There are many aspects of the First Nations culture that resonates with my heritage, not the least of which is the importance of kinship, the way everyone relates to each other, the sense of self within a collective, and the sense of responsibility that one has to the collective. I imagine that my own heritage has made it easier for me to understand and accept the First Nations culture.

As we commemorate and celebrate the International Day of World’s Indigenous Peoples on August 9, the call for greater understanding between the Indigenous and non-Indigenous peoples in Canada becomes even more urgent if we are to make progress on the TRC recommendations to address the social injustice that continues to affect the Indigenous populations.  It is up to the non-Indigenous society to reach out to the Indigenous communities if we want to learn.  It is a journey that is waiting for many of us to take.


Calí-Tzay, J. F. (2023).  End of Mission Statement from the United Nations Special Rapporteur on the Rights of Indigenous Peoples.  Retrieved from https://www.ohchr.org/sites/default/files/documents/issues/indigenouspeoples/sr/statements/eom-statement-canada-sr-indigenous-2023-03-10.pdf

Milloy, J. S. (1999).  A national crime: The Canadian Government and the residential school system.  University of Manitoba Press.

Cover Photo by Andreas Wagner on Unsplash

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