when working with Maori clients? Getting practical How do we honour Te Whare Tapa Wha when working with Maori clients? Getting practical Workshop New Zealand College of Clinical Psychologists Conference March, 2011 Lisa Cherrington Te Ara Whatumanawa/ Psycho-Oncology Service, Massey University Photocopy pikitia What has been passed down to you from forebears – personality, tikanga, understanding, Maori gifts

Overview Part 1: Assessment (1hr) What is Te Whare Tapa Wha (TWTW)? 2) Case study – Meet Pearl Part 2: Reflecting on practice using Te Whare Tapa Wha (45mins) 3) Hua Oranga (Maori Mental Health Outcomes Measure) (Kingi, 2002) 4) Self-Reflective questions

WHAT IS TE WHARE TAPA WHA (TWTW)? A Maori model of health/ well-being developed by Mason Durie in 1980’s Holistic view of well-being that states in order to be at one’s optimal health, all area’s need to be in balance and working order Each dimension is integrated, intertwined Several presentations at this session Themes developed into four main dimensions- the emphasis being on wairua as starting point 1982 – Rapuora – Maori Women’s Welfare League Kaumatua emphasized wairua as being starting point for health

TE WHARE TAPA WHA Compared health to four cornerstones of health All four necessary to ensure strength and symmetry BRAINSTORM – If you were to research these area’s, keeping in mind indigenous psychology, what would you be interested in? Themes and Key aspects – break into groups of 4

The capacity to communicate, to think and to feel (Durie, 1998) Te Taha Hinengaro The capacity to communicate, to think and to feel (Durie, 1998) often refers to psychological processes – thoughts/ feelings/ behaviour/ cognitive functioning/ thinking styles –Hine (female) – conscious part ngaro (hidden ) – subconscious (Pere, 1991) Mental, intuitive and feeling So what might this mean

Te Taha Tinana (physical health and environment) The capacity for physical growth and development (Durie, 1998) Good physical health is necessary for optimal development (Durie, 1998) Sacredness of the body - Tapu and noa emphasis Taha tinana is turning to nature for herbal compassion, utilising rituals for physical appeasement, keeping the soul and body intact (Te Roopu Awhina Tautoko, 1987) Practical issues – income, housing, food Body functions/ rituals kept separate from other activities – food and body, ‘sitting on tables’, teatowels and clothes separate, toenail clippings. Excellent hygiene standards in comparison…. Durie questions about body image different – less wahine with anorexia nervosa. Been my experience. Increasingly a new generation of wahine, sporting, image focused where this will change Non-verbal communication Clients often abusing their body – drugs, eating, smoking. He tapu te tinana….

Te Taha Whanau (family and relationships) The capacity to belong, to care and to share (Durie, 1998) Refers to family, extended family and sense of belonging and connection with Individuals are part of wider social systems (Durie, 1998) Identity/ whakapapa/ connection Interdependence a strength Gang culture – a whanau Muru – taking away person’s belongings Family taking over from parents where child abuse occurs Family is primary support system for Maori – care and nurturance in physical terms but also culturally and emotionally Identity and purpose – interdependence Development goals clash ie with teenager development – goal is to strive for independence Whanau support at interviews

Te taha wairua (spirituality) Te taha wairua is probably the most difficult area to define, assess and understand – yet it is the most important area and intertwined with every other taha Refers to spiritual well-being, not just religion - Beliefs in a non-physical dimension or force (Kingi, 2002) The capacity for faith and wider communion (Durie, 1998) Health is related to unseen and unspoken energies (Durie, 1998) A relationship also with the environment, ancestors Individual inter-generation continuum – what do you think that means? Past, present and future – co-exist – very important concept amongst Maori. Need to understand past. When look at I nga ra o mua…the past Look at psychology definitions….of indigenous and psychology

Na Heather Delamere Thomson Wairua Na Heather Delamere Thomson “Koro, what is wairua?” the child asked, eyes wide “Wairua, my moko is what gives us life Handed down to us from a time past At the moment of your beginning You shared with me the wairua of your tipuna: For I am your link with the past And you are my link to the future The aroha of the whanau has wairua And their words, their laughter, their tears The marae, tangi, waiata and whakapapa Have a wairua that strengthens us, gives us pride

So too the sunrise and sunset The soft summer rain, the raging storm, The song of the birds in the trees, The waves on the beach The mist rising from the bush The moonlight on the water And the embracing darkness of the night To sit quietly in the wharenui or the urupa And feel the presence of your tipuna is to feel wairua Your arms around my neck, your breath on my cheek, Fills me with a special wairua For there is wairua in all things that give meaning to life To love, to the future

So moko, open your mind, Let your heart love Your eyes see Your ears hear Your hands feel Give of yourself, my moko For in giving, you receive And the wairua grows.” Na Heather Delamere Thomson

Case study 1: Pearl Hei mahi: Exercise 1 Read through case study and allocate identified issues into each taha Physical environment – pollution of tribal waterways Turangawaewae – cultural, social and economic significance – MARAE Level of Access to marae – a measure of well-being Taonga tuku iho – te reom intellectual and philosophical traditions, cultural heritage – intellectual and cultural property rights Social Policy emphasis

TE TAHA WHANAU Clinical: Cultural: Argued that the perspectives would override clinical priorities ie whare tapa wha extended focus for health beyond the individual…how could diabetic regain health if the land injustices remained? Ie sociological, economic and political agendas override clinical resource Was taha wairua any practical value if it could not be measured? NO Clinical/ cultural issues Identity as a Maori Tuakana/ teina Kuia/ kaumatua Obligations to whanau Whakapapa Whanau, hapu, iwi connections Whakawhanaungatanga – sense of connection with family, medical staff Whanau beliefs about cancer Support from whanau – appropriate? Expectations of whanau, ability of whanau to communicate with clinician’s Involvement with other groups/ associates (gangs, sports, church, Maori)

Te Taha Hinengaro Clinical: Cultural: Mana ake Cultural/ clinical issues: Use of te reo to communicate Beliefs about cancer, what’s causing it? Understanding/ comprehension about medical treatment process Feelings of isolation/ disconnection in medical system Beliefs about tikanga, tapu/ noa, wairua Whakama Pouri Lack of motivation to engage in treatment process

Te Taha Tinana Clinical: Cultural: Group activity: to each draw one triangle of what that represents to them. Will discuss more Cultural/ clinical issues Western medicines vs rongoa/ karakia Sense of tapu about own body parts Hospital environment – eating, washing, toileting in same place Shelter and food Accessing medical system at a very late stage Urban vs rural/ turangawaewae

Te taha wairua Clinical: Cultural: Clinical/ cultural issues Beliefs and connection with spirituality and /or religion Tapu and noa Makutu, mate Maori – what’s causing cancer? Use of and beliefs in tohunga, rongoa, karakia, moemoea, purakau, taonga, tohu Tangihanga Life’s purpose Connecting with spirituality – how do they do this? What makes them feel centred, uplifted in some way (ie listening to music, going to the ocean, laughing with their children)

Part 2: Reflecting on practice using Te Whare Tapa Wha Hua Oranga (Maori Mental Health Outcomes Measure) (Kingi, 2002) Developed a Maori mental health outcomes measure based on Te Whare Tapa Wha Through consultation/ hui with key stakeholders identified components within each taha as a way to evaluate outcomes of interventions Clinician, whanau and tangata whaiora forms Useful questions to ask ourselves when working with Maori

(this intervention – assessment process, therapy session etc) As a result of … (this intervention – assessment process, therapy session etc) …are you/ is your client/ is your relative… - More able to set goals for yourself/ him/herself (Te taha hinengaro) - More able to move around without pain and distress (Te taha tinana) - More able to communicate with your whanau? (Te taha whanau) As a result of this intervention do you feel stronger in yourself as a Maori person? (Te taha wairua) Environment Scoffed at our tradition of planting a new tree after chopping one down, referred to as Maori and their gods. Everything in the universe has a divine right…. How might you investigate this taha? What questions would you ask?

The capacity for faith and wider communion * Personal contentment Te taha wairua The capacity for faith and wider communion * Personal contentment As a result of this intervention do you feel more content within yourself? identifying what might assist with feeling more content, more at peace * Spirituality As a result of this intervention do you feel healthier from a spiritual viewpoint? (Kingi, 2002) - Imagine if sessions at were held on a mountain top, at the river, at the beach - spiritual practises - karakia, prayers, rituals of significance for client, church - creative processes – singing, drawing, writing, building

Hei Mahi: Reflecting on practice Consider Pearl. Identify a treatment plan based on te whare tapa wha Taha Hinengaro: Taha Tinana: Taha Whanau: Taha Wairua:

Does your plan: Enhance her capacity to communicate, think and feel? Enhance her capacity for physical health and development? Enhance her capacity to belong, to care and to share? Enhance her capacity for faith and wider communion? In particular: Does she feel more valued as a person? Is she stronger in herself as a Maori person? Is she more content within herself? Healthier from a spiritual view point?

HOW DO WE HONOUR TE WHARE TAPA WHA WHEN WORKING WITH MAORI CLIENTS Ask yourself these questions when assessing, planning and treating (or in self-reflective review) Have I/ will I/ will the intervention/ has the intervention enhanced his/her: capacity to communicate, think and feel? capacity for physical health and development? capacity to belong, to care and to share? capacity for faith and wider communion? Pearls final words….