The journey of reconciliation continues: Impact of APA’s apology to Indigenous Peoples

When leaders from APA publicly apologized for psychology’s contribution to the harms suffered by Native people, many Native and non-Native psychologists were moved to tears. It was June 2023 at the annual convention for the Society of Indian Psychologists (SIP), and the hundreds in attendance were experiencing the culmination of a years-long effort to change the way APA takes responsibility for its impact on Indigenous persons and communities.

The field of psychology has caused significant harm to First Peoples, including American Indian, Native American, Native Hawaiian, and Alaska Native people, by providing ideological support for the colonial framework of the boarding school system that forcibly separated children from their families and inflicted cultural eradication. Much psychological research with First Peoples has been exploitive, conducted without any attempt to know or empathize with the Indigenous people being studied. In many cases, APA’s inaction also caused harm. It was not until 2000 that the association began formally opposing destructive policies of adoption and foster care placements of American Indian and Alaska Native children.

The apology journey began in 2020 when Sandra Shullman, PhD, APA’s 2020 president, created a work group with four other non-Native psychologists and two Native psychologists who served as advisers. “Too often we put the responsibility on people of color to apologize to themselves, but I wanted the dominant culture to listen and learn at a deep level through this process,” said Shullman. They built relationships with tribal elders who were members of SIP, and over time this increased trust, and elders began sharing traumatic memories that have had ripple effects through generations. For example, they talked about personal experiences of being separated from their families, taken to boarding schools, and prevented from returning home. In some cases, relatives were taken to mental institutions even though they did not have mental health conditions—and staff in these institutions were cruel and inhumane. “They shared their deepest hurts with us,” Shullman said. These exchanges informed the work group’s 46 recommendations to begin the process of reconciliation by advancing health, growing the workforce, increasing training for clinicians about Indigenous culture, and learning new research methodologies.

Now, a year after APA issued the formal apology, Indigenous psychologists are cautiously optimistic that the suggested remedial actions are creating momentum for this change, including more public awareness about the harms of colonialization, increased advocacy for policies that protect Native American rights, and better collaboration between APA, SIP, and Indigenous psychologists.

The authors of the apology hope the recommendations will help APA maintain a commitment to the following: more active listening, following more and steering less, advocating more and complying less, including more and ignoring less, and collaborating more and commanding less. In other words, APA needs to treat ethnic psychological associations as independent self-governing entities. APA also needs to respect Indigenous ways of dealing with psychological difficulties because they have their own holistic healing and treatment approaches, in addition to theories based on Indigenous ways of knowing and understanding.

“Though much more still needs to be done, I am seeing changes in APA that give me hope that we can be partners in healing,” said SIP President-elect Mark Standing Eagle Baez, PhD, a member of the Coahuiltecan Nation and an associate professor of counseling and clinical psychology at Bemidji State University in Minnesota.

Eight recommendations in the apology focused on changes needed in the research arena, with goals to publish more research by Native American psychologists, conduct more studies in collaboration with tribal councils, and develop assessment tools that have been created in Native settings. Alex Pieterse, PhD, associate editor of The Counseling Psychologist, says that journal editors have an important role in implementing the recommendation to “elevate psychology’s understanding of and regard for research centered on Native persons, people, and communities.” Pieterse helped edit a special issue of The Counseling Psychologist that will publish in October 2024 with articles centered on Indigenous perspectives on psychological health and well-being.

The impetus for the special issue was a study conducted by Candice Keyes, PhD, MPH, a psychologist practicing at a tribal medical center in Oklahoma, exploring how language impacts therapy for Indigenous patients. The study participants were members of the Kickapoo Tribe of Oklahoma, and Keyes found that many struggled with commonly used English words such as “trauma” and “stress” because these words could not easily be translated into their Indigenous language (Keyes, C. M., et al., Vol. 52, No. 1, The Counseling Psychologist, 2023opens in new window). “Introducing these Western psychological constructs could be another act of colonialization because they utilize Western schools of thought that may not align with the Kickapoo holistic worldview,” said Keyes. The participants also described how their language was a gift from their ancestors to survive, and they felt joy, pride, and happiness speaking it. They reported that using the tribal language helped them combat isolation, depression, and death.

For Pieterse, the study sheds light on the importance of disseminating more research focused on Indigenous populations. “Our understanding of trauma is based on an individual’s symptoms, but for Native Americans, trauma may be based on history or groups,” said Pieterse. “Typical interventions may not be applicable.”

Leaders in APA and SIP are discussing the importance of creating a digital historical archive to record the effects of colonialism. “The archive would safeguard against denialism or the rewriting of history,” Baez said. “It could increase public awareness and serve as a precaution against future transgressions.”

The archive could include the work of Indigenous psychologists who continue to uncover the health consequences of oppression of Native people, which includes those who identify as Native American, American Indian, Alaska Native, and Native Hawaiian. Stephanie Fryberg, PhD, a psychology professor at Northwestern University and founding director of the Research for Indigenous Social Action and Equity Center, found evidence that American Indian and Alaska Native people are largely invisible in modern American culture, with more than 67%–80% of non-Natives holding the bias that Native people are people of the past, rather than living among us now. Nearly 90% of references to Native people in K–12 state standards depict them in a pre-1900 context (Shear, S. B., et al., Theory & Research in Social Education, Vol. 43, No. 1, 2015opens in new window). Studies suggest that the public also minimizes Native Americans’ experiences of racism, especially compared with other marginalized groups. Polls show that 75% of Native people report that their group experiences discrimination, while only 33% of Americans believe that Native Americans do. By contrast, 92% of Black people report that they experience discrimination, and 80% of Americans believe that Black people do (Lopez, J. J., et al., Social Psychological and Personality Science, Vol. 13, No. 3, 2021opens in new window).

“When we are omitted from society, the public is more likely to minimize our experiences of discrimination,” said Fryberg, who is a member of the Tulalip Tribes in Washington State. To explore the effects of this discrimination, she recently studied 20,000 Indigenous North Americans. The data collected across three surveys showed that participants who were more sensitive to the omission and misrepresentation of their group reported poorer psychological well-being, such as lower life satisfaction and higher anxiety, depression, and suicidality. “As a society, we need to stop rendering Indigenous people as invisible,” said Fryberg, who presented the data in a conference keynote address at the Society for the Psychological Study of Social Issues. “As psychologists, we need to be conscious about allowing Indigenous people to share their stories and their experiences as Native Peoples in this country.”

Research shows that Native Americans also have higher rates of chronic pain than other racial or ethnic groups in the United States (Jimenez, N., et al., The Journal of Pain, Vol. 12, No. 5, 2011opens in new window). Oklahoma psychologists Joanna Shadlow, PhD, a member of the Osage Nation, and Jamie Rhudy, PhD, are investigating the mechanisms of this pain disparity. In a recent 5-year study with more than 300 participants, they found that Native Americans developed chronic pain at 3 times the rate of non-Hispanic Whites, even after controlling for age, sex, income, and education. The experiences of discrimination and psychological trauma predicted increased perceived stress, and this stress predicted pain-related anxiety and catastrophizing (fear and worry about pain). These factors, in turn, decreased the body’s natural ability to dampen pain and together predicted chronic pain onset (Pain, Vol. 163, No. 5, 2022opens in new window). “We studied individuals who had no pain at the outset, and it was shocking how much more quickly Native Americans shifted from being healthy to developing chronic pain,” said Rhudy, who is director of the Psychophysiology Laboratory for Affective Neuroscience at the University of Tulsa.

Psychologists are also shedding light on how the natural environment affects cognitive function in Native Americans. The Akwesasne Mohawks, who live along the St. Lawrence River in upstate New York and the Canadian provinces of Quebec and Ontario, live downriver from three former aluminum foundries. They were exposed to polychlorinated biphenyls (PCBs) and pesticides for decades. Gayle Skawen:nio Morse, PhD, a professor of counseling and community psychology at Russell Sage College in New York, and her colleagues found that the mixture effects of these toxicants in the Mohawk people were significantly associated with decreased cognitive performance for executive function in people who were middle-aged and older. This group, which included people ages 47 to 79, had 2 to 9 times higher concentrations of PCBs and certain pesticides in their bloodstream than the younger groups (Sasaki, N., et al., International Journal of Environmental Research and Public Health, Vol. 20, No. 2, 2023opens in new window).

“Many people in health care do not consider this exposure to have an impact,” said Morse, who was a consultant for the apology work group. “Psychologists need to be aware that the damage to the Native American environment affected their bodies and their ability to rely on the environment for sustenance.”

Indigenous psychologists have also been encouraged by APA’s willingness to partner with them in advocacy efforts, including support for the Indian Child Welfare Act (ICWA). This federal law affirms the rights of tribes, pueblos, and nations to protect Native American children from unlawful removal and establishes placement preferences that keep Native children with Native families. The law was challenged in 2022 by the state of Texas and non-Native adoptive parents who claimed that the ICWA was unconstitutional. APA partnered with SIP and several state psychological associations to submit an amicus brief citing research that showed placing Native American children with Native American families promoted healthy psychological development—and placing them with non-Native families increased the risk of adverse outcomes for these children. The U.S. Supreme Court cited the amicus brief in its decision to uphold the ICWA.

Kee Straits, PhD, an Indigenous psychologist based in Albuquerque, New Mexico, is eager to see APA increase awareness in the psychology community about the ICWA. Mental health professionals are often involved in decisions about child safety, child removal, and where children should be placed in foster care and adoptions. Indigenous child-rearing values and norms have historically been viewed as unhealthy for children, said Straits, who was adopted into a non-Native family when she was 18 months old.

“In Native households, extended families often live under the same roof and share rooms, but non-Native professionals may base safety assessments on nuclear family norms and unconsciously judge this as chaotic and unsafe,” said Straits, a clinical and community psychologist at TLC Transformations. In some traditional practices, grandparents are in the role of primary caregivers for children, and these clan relationships may challenge Western concepts of family in placement decisions, said Straits. She urges psychologists to determine if a child has ties to a tribal nation at the outset of a removal investigation and placement process. “Alert the tribal nation of the situation and collaborate with that community to make decisions,” she said.

Straits also encourages psychologists to learn the history of the ICWA, which was enacted in 1978 after a congressional investigation found that over a third of Native children had been removed from their homes between the 1950s and 1970s. They were typically placed in non-Native families, boarding schools, and other institutions with no ties to their tribal communities. Under the ICWA, the placement preferences for Native children are as follows: First preference is with the child’s extended family, then to other members of the tribe, and then to members of another tribe. Straits and other Indigenous psychologists are advocating to include education about the ICWA in graduate teaching programs and clinical settings serving Native children and families.

APA is also now a liaison member of the Committee on Native American Child Health (CONACH), an American Academy of Pediatrics initiative focused on issues facing American Indian and Alaska Native children. APA participates in legislative briefings and consultation site visits in the Indian Health Service areas to learn about the needs in each community. This year, APA plans to involve psychologists in congressional visits through its partnership with CONACH.

Baez and other Native American psychologists commend tangible evidence of APA’s commitments to “following more and steering less” and “listening more and talking less.” At the opening of APA’s 2023 annual convention, Indigenous psychologists led a prayer to the Four Directions (east, north, west, south). During the blessing, everyone in the audience turned in unison in each direction as the prayer was read. “I was in awe that Native and non-Native psychologists were doing this together,” Baez said. “Even though we will face obstacles in the reconciliation process, the prayer was a reminder that we can overcome the stumbling blocks in every direction.”