Julie Smith-Yliniemi, Krista M. Malott, JoAnne Riegert, Susan F. Branco

Faith and Indigenous healing ceremonies offer spiritually oriented interventions that maintain client wellness or mitigate client existential, biopsychosocial, or spiritual distress. Mental health practitioners of all identities may ethically apply ceremony-assisted treatments with Native and non-Native populations. Three such interventions are described in this article, drawn from Indigenous traditions as practiced personally and professionally by the first and third authors. Directives for use, including populations appropriate for application, adaptations, ethical considerations, and culturally responsive competency considerations, are included.

Keywords: Indigenous, healing ceremonies, ceremony-assisted treatments, Native, culturally responsive

Across time and cultures, humans have engaged in rituals as a means for fostering healing, resilience, grounding, and connection to something larger than oneself, to ultimately create and sustain meaning and health in life (Dallas et al., 2020; Ingerman, 2018). A ritual or ceremony entails enacting a sequence of behaviors or ideas relating to symbols and meanings (La Fontaine, 1985). Healing ceremonies are spiritually oriented rituals that seek to return a person to wellness or to maintain one’s physical, spiritual, or emotional health, particularly in the face of perceived threats or losses (Crouch, 2016; Kumar et al., 2023). Such traditions often stem from religious, cultural, or ethnic roots and are commonly performed to signify celebrations or other important events (Kumar et al., 2023). These acts also offer spiritual coping as a means to address difficult existential, biopsychosocial, or spiritual situations (Crouch, 2016; Mathew, 2021); to elicit healing narratives or conversations regarding trauma; and to honor feelings of frustration, fear, anxiety, and guilt (Crouch, 2016).

Indigenous healing and ceremonial practices are part of community wellness and healing traditions for Native tribes across the North American continent (Causadias et al., 2022; Saiz et al., 2021). Such practices are passed down by the generations, despite having been forced underground for a period when the U.S. government outlawed Native American cultural practices (Irwin, 1997). Indeed, colonizers have sought to suppress and erase the Indigenous knowledge and practices of colonized communities around the world throughout history.

Scholars have recently recognized the efforts of Indigenous communities across North America to reclaim the many traditional practices to which they had been denied access because of the violence of colonization (McCormick, 2021). This healing movement is embodied in the United Nations Declaration on the Rights of Indigenous Peoples (United Nations, 2008), emphasizing the rights of Indigenous people to maintain their cultural, spiritual, and health traditions and practices (Kumar et al., 2023; McCormick, 2021). In turn, ceremony-assisted treatments can be used by and with persons of all Indigenous roots to enact healing and sustain wellness and survivance (e.g., resistance and thriving in the face of oppression; Vizenor, 1993).

Because of the efficacious nature of healing rituals, mental health practitioners of all identities have sought to apply traditional practices with Indigenous clientele and in addressing a variety of symptoms of client distress (McCormick, 2021). Non-Native American mental health practitioners have drawn upon Indigenous rituals such as smudging and drumming to address myriad forms of presenting distress across tribal groups (Blackett & Payne, 2005). Examples of issues addressed through such rituals include chronic pain (Greensky et al., 2014), distress from discrimination and colonization (Lu & Yuen, 2012; West-Olatunji et al., 2008), and substance use (Spillane et al., 2021).

In light of the universal practice around making meaning through ritual, certain Indigenous interventions may also be considered for adaptation with non-Native clientele, albeit with caution and an ethical mindset (Rathod et al., 2019). Currently, however, there are limited guidelines around the ethical implementation of ceremony-assisted interventions for non-Native practitioners, particularly for work with non-Native clientele. Such guidelines are essential to mitigate harmful acts of appropriation born from colonization and the continued exploitation of Indigenous communities and their practices on the North American continent (Meade et al., 2022).

Consequently, considering the importance and power of ritual and ceremony as a healing and wellness practice, we offer recommendations for non-Native and Native practitioners to ethically explore and incorporate ceremony-assisted interventions into practice with Native and non-Native clientele. We provide an overview of relevant provisions of the American Counseling Association’s ACA Code of Ethics (ACA; 2014) and, through examples, outline how practitioners can implement ceremony-assisted treatments while avoiding cultural appropriation.

Next, we present three ceremony-assisted treatments, including smudging, drumming, and a letting-go ceremony. Such traditions stem from Indigenous origins and are applied by authors Smith-Yliniemi and Riegert in both professional and personal settings. Suggestions for use, including appropriate populations and areas of distress, are included. We address ethical considerations in promoting respectful and culturally sensitive use of each practice, to share traditions with broader populations while seeking to maintain the cultural integrity of said practices.

Regarding language use in this article, we will interchangeably apply the terms Native, Native American, Indian, and Indigenous to refer to persons who are indigenous to Turtle Island (i.e., the lands recognized by the dominant normative population as North America). Reference will be made to Creator, to indicate a universal reference by Indigenous communities of a spiritual presence greater than oneself. In addition, drawing from the preferred naming conventions of tribal communities, the terms Ojibwe and Anishinaabe will be used interchangeably in referring to Smith-Yliniemi’s and Riegert’s origins. However, we recognize that Indigenous people on Turtle Island are a diverse group of tribes or nations with their own languages, traditions, cultures, and naming conventions (National Museum of the American Indian, n.d.). Consequently, different tribes or Indigenous communities may choose different terminologies and for unique reasons, and many will likely take differing stances from those put forth in this article.

Practitioner Positionality
     As the authors, we collectively identify as counselor educators. We each approach the directives in this article with multiple intersecting identities and critical lenses with which we seek to understand and make meaning of the world and our work. We attempt to embody cultural humility, responsiveness, and antiracist and decolonizing frameworks. We recognize that counseling as a practice has historically applied a pathologizing and therefore harmful lens toward clientele and, in particular, toward communities whose identities have been minoritized by dominant normative systems (Malott et al., 2023). Hence, to counter this deficit-based narrative, we ascribe to a strengths-based perspective and recommend practitioners do likewise (White et al., 2020). We encourage Native American practitioners seeking to “remember what they already know” about Indigenous practices as they return to their ancestral roots. In light of these points, we will transparently and authentically share the identities and frameworks we bring to this work.

Julie Smith-Yliniemi identifies as an Anishinaabe ikwe, an Indigenous woman, who grew up on a Native American reservation in the Midwest. Additional heritage includes Scandinavian descent. Intersectionalities include being a mother, wife, daughter, cisgender, temporarily able-bodied, and a person who engages in her traditional Native American ceremonial practices. Her personal and professional lens is grounded in humanistic and relational–cultural theories.

Krista M. Malott identifies with multiple intersecting identities that profoundly shape her lens, some of which include being White, U.S.–born, cisgender, female, temporarily able-bodied, spiritually agnostic, and a member of a transracially adoptive family. She principally assumes humanist, systemic, antiracist, and intersectional lenses, which shape her worldviews and her approach to her work.

JoAnne Riegert identifies as an Anishinaabe ikwe who lives and works on a Native American Indian reservation in a rural community. Her ancestral heritage also includes French Canadian and German descent. Her familial roles include being a grandmother, mother, sister, daughter, niece, and aunt. She is steeped in the Native American community and her worldview originates from this perspective. Her theoretical foundation incorporates restorative justice practices and relational-cultural theory.

Susan F. Branco identifies as a Latina, South American–born, transracial adoptee, cisgender female, able-bodied, descendent of the Guahibo tribe, and connected to the Anishinaabe culture through marriage. She is an active member of the adoptee community and is working to reculturate and reclaim her lost cultural and Indigenous heritage. Her clinical and scholarly work revolve around relational-cultural and liberation theories.

Ethical Application and Considerations

For the purpose of this article, we approach the concept of adaptation with a collectivist perspective, whereby we eschew an ownership concept of healing practices by any one cultural group. Consequently, as counselor educators and mental health practitioners, we collectively suggest that some Indigenous ritual or ceremonial healing practices may also be adapted for clients of non-Native identities, and by practitioners of all cultural identities, albeit while keeping certain points in mind—for example, if undertaken with respect and sensitivity, awareness, and guidance, and with the understanding that every person has origins to some tract of land and a spiritual connection to earth and self. This perspective is not true, of course, for all Native interventions, and not all Indigenous people will adhere to this stance. Attending to ethical guidelines can reduce the risk of appropriation, whereby cultural knowledge is used without proper and respectful acknowledgement to the cultural creators (Lalonde, 2021). Ethical guidelines may also increase cultural appreciation, adaptation, and acknowledgement, along with respectful attribution to the creators of certain interventions without stereotyping (Han, 2019; Hiratsuka et al., 2018; Meade et al., 2022).

To further attend to issues of ethics and harm in drawing on Indigenous healing ceremonies, non-Native counselors may refer to Meade et al.’s Checklist for Counselor Practitioners (2022). Meade and colleagues (2022) cited the need for practitioners to acquire cultural knowledge to more ethically implement ceremony-assisted practices, beginning with researching the “origins of the clinical intervention” (p. 103). We encourage practitioners to consider relevant ethical standards (ACA, 2014) as a starting point in the journey to Indigenous practice implementation and adaptation. We will denote suggested ethical standards after each ceremony-assisted treatment description.

Ceremony-Assisted Treatments

In the following sections we describe three specific healing rituals premised on Indigenous ceremonial treatments as means for supporting clients in healing or in sustaining wellness in a private (i.e., individual client) setting: smudging, drumming, and a letting-go ceremony. We detail when and how (and with whom) such practices could optimally be applied. A case example is used to illustrate application of each ritual with clients, with directives for the cultural adaptation of each. Considering the right and essential need for Indigenous peoples to protect their lands, traditions, and ceremonies (Drissi, 2023; United Nations, 2008), each ritual includes directives according to ethical use of its application, including consideration around appropriation and reverence for land and material use, when applicable.

     Smudging is an act of burning a traditional medicinal plant with the purpose of cleansing the body, mind, or spirit; renewing energy within and around individuals in a particular space or with a certain object; or calling for help in opening oneself to a new experience (Borden & Coyote, 1991). Some people incorporate smudging into their daily lives, while others apply it as needed. For instance, if a person is in the presence of someone who is giving off negativity or energy that is not welcoming, they may leave and smudge themselves to cleanse themselves of the negativity. At other times, if a person receives a gift or buys something new, they smudge that object in order to cleanse it. Cleansing a space to bring positive energy is also a common use of smudging. Hence, if someone moves into a new or different home, or is using a specific space for a ceremony, they might walk around the space, smudging it.

Smudging may invoke positive energy for a specific event. For instance, both in-person or virtual meetings can be started with a smudge. Smith-Yliniemi smudges each morning as a way to start her day positively. A counselor could begin sessions with a smudge, if the client desires to do so, along with personalizing or adapting the ceremony according to the client’s expressed needs or wants.

Smudging is a ceremonial process with a purpose, a beginning, and an end, with different teachings according to different tribal or community norms. Examples of smudging materials include cedar, sage, and sweetgrass. Those materials can be purchased or found in nature. In Smith-Yliniemi’s Anishinaabe community, sage is used, and it is gathered within a natural setting, with the act of gathering as part of the ceremonial process. Grown in the wild, sage differs according to the ecosystem in which it resides. Smith-Yliniemi’s community typically picks sage annually during the summer months when it is grown and ready, typically found in ditches and usually in patches. The person picking the sage will offer tobacco to Mother Earth and to the sage plant prior to picking it, to give thanks.

Traditional tobacco has been used for spiritual and medicinal purposes within communities for generations. It is central to culture, spirituality, and healing (National Native Network, n.d.). To offer tobacco, a person takes a pinch of loose-leaf tobacco from a bag or jar and places it in the palm of their left hand. The left hand is typically used because it is closest to our hearts. One then closes their hand with the tobacco secured in the fist and prays to Mother Earth and gives gratitude for the healing medicine offered by sage; they also ask the sage to help all who smudge with it. After the prayer, the tobacco in the left hand is gently placed next to the sage plants intended for harvest.

One of the Anishinaabe Original Instructions from Creator is to take only what one needs, so that there is enough for others. Individuals typically pick enough sage for those who are unable to do so, such as elders or those affected by an impairment. The sage is cut or picked from the stem of the plant, leaving the root intact; in this way the sage is able to regrow each year. Once picked, the sage is hung upside down to dry, a process that can take several weeks depending on the heat and humidity. It is then bundled and stored in a dry place to be used throughout the year.

Although smudging can be used at any time of the day, it is often done in the morning. To smudge, a small amount of sage is taken off the bundle and rolled into a small ball. It is usually placed in a shell or a special bowl and then lit with matches. The teaching Smith-Yliniemi received is that, when smudging, the smoke from the burning sage is initially taken into the hands and placed over the heart while asking Creator to open one’s heart to the experience they are about to have, as a new beginning. That beginning may entail the opening of the day, a counseling session, an event related to a life transition, or something else. In this way, a person asks for help to open their heart to a new experience.

Next, the smoke from the sage is smudged (fanned or wafted) toward the throat area while asking Creator to help with one’s words—to formulate loving and respectful words and thoughts and to know when to use them thoughtfully. Hence, one smudges the throat to reduce impulsivity and increase thoughtfulness and deliberation in speaking. Next, the ears are smudged while asking Creator to help the person hear what they are meant to hear, as so much of what one hears can cause undue worry. Hence, smudging the ears allows others’ words not meant to be heard to dissipate. In this way, Creator helps people to better hear only that which promotes learning and growth or the calming of our minds.

Next, the eyes are smudged while asking Creator to help one see what they are meant to see, including the best in others—knowing that all persons have flaws and wounds from living in a world full of chaos and worry. Additionally, the person asks to look beyond the physical, to use a lens that Creator intends. Seeing in this way allows one to live in a more peaceful manner. The person then smudges their head while asking Creator to help them with healthy thoughts and the ability to welcome a positive mindset. Consequently, through this ceremony, a person seeks spiritual and physical healing through the cleansing of any negative feelings, thoughts, or energies. They ask Creator to help them to be present and open to a more positive, healthy, and compassionate way of being toward themselves and others.

Counselors or clients of any identity can smudge if it is something they feel called to do and it makes them (or their clients) feel better. As the process is used by Indigenous communities around the world, anyone can have their own smudging routine. Some groups use smudging in association with ceremonies, as a means to feel connected to something they have lost, such as their culture and ways of being, or to address loss from war, genocide, intergenerational trauma, or colonialism. Smudging can be used as a precursor to a “welcome home” ceremony for Native American clients who were adopted and do not know their culture well or urban Indians lacking direct connection to their reservation or tribe. The ritual serves as an opening process that clears the space of any negative energy before enacting that ceremony. Smudging in this way brings in positive energy and allows attendees to be fully present and with open spirits, hearts, and minds. In turn, the welcome home ceremony acts as a coming-together process that helps individuals feel a part of their cultural community, as a symbolic rebirth of their connection to their culture.

Smudging can cleanse one’s mind, body, and spirit, bringing the person to the here and now, and therefore it can help with depression, trauma, anxiety, or substance abuse. In turn, researchers have cited smudging to have significant meaning for individuals in regard to myriad issues, from physical health issues (Greensky et al., 2014) to mental health recovery (Spillane et al., 2021) to connecting employees to one another and to their work setting through the ritual itself (McPhee et al., 2017).

Ethical Considerations
     In considering the ethics of applying smudging with clients, there are several points to keep in mind. First, for non-Indigenous practitioners, it is essential that ethical standard C.2.a. Boundaries of Competence (ACA, 2014) is considered. This states that practitioners, at minimum, read about and, ideally, receive training or experience with the practice of smudging. Such services could be advertised as one intervention available to specific populations, similar to the way other modalities are advertised (e.g., via the practitioner’s website, written materials, and verbally). Mentions of smudging should include its traditional origins and meaning, in order to educate potential clients about the nature of the intervention. Potential areas of learning include understanding the historical roots and practices of smudging, recognizing the impact of colonialism and contemporary culture on the practice (McCormick, 2021), and attending to personal bias and values per standard A.4.b. Personal Values (ACA, 2014).

In addressing issues of cultural appropriation, practitioners should avoid use of the intervention solely for profit, aligned with standard A.4.a. Avoiding Harm (ACA, 2014). When using the intervention, they should clearly credit the source and origins of the practice for their clients. Regarding materials, they should also be mindful to avoid taking more sage than necessary, to allow others access to the plant. Ideally, counselors would consult, learn, and draw from local cultural protocol and original persons/elders/tribes of their area. They would also keep in mind that what is acceptable in one community is not the same in others, and that although some Indigenous persons believe that Indigenous medicines are there to help people of any and all identities, others believe such practices should be maintained as sacred and exclusive to their community. Hence, one should seek out protocols and perspectives in their local community, aligned with ethical standard C.2.e. Consultations on Ethical Obligations (ACA, 2014).

Finally, if smudging with clients whose ancestors may have used the practice, such as African Americans, it is important to gauge their cultural awareness regarding their identities. Perhaps encourage research around ancestral African ceremonial practices or research such histories collaboratively. Explore their perspectives and emotions around what is discovered; what has been lost to colonialism, enslavement, genocide, and other historical traumas; and how they wish to proceed with smudging as a practice in collaboration with the counselor. A decolonizing counseling framework could be drawn upon for processing deep-seated trauma and corresponding emotions stemming from colonization impacts (Millner et al., 2021). In so doing, counselors will attend to ethical standard A.2.c. Developmental and Cultural Sensitivity (ACA, 2014).

Adaptation Possibilities
     As an intervention, smudging is suitable for adaptation. If not using sage, counselors can still engage in the act of cleansing a space. Some clients may be interested in burning a different herbal medicine that is meaningful to them. Some may be interested in using incense or oils to cleanse themselves or the space they are in. Adaptations, in turn, can be made in collaboration with each client, to honor their own cultural norms and practices.

Smudging: A Case Example
     Kiah, a 15-year-old Indigenous youth, sought out her school counselor, who was non-Indigenous. The client had been struggling with identity issues since hearing that there was going to be a school-sponsored powwow at the end of the school year. Some of her friends asked her if she would be dancing, as they knew she was Native American. However, she moved from the reservation to the city over 10 years ago and didn’t know much about her culture or dancing. As a result, she was feeling disconnected and anxious about who she was as a Native American.

In an effort to support Kiah, the school counselor researched and read articles regarding Native American identity and also reached out to the school district’s Native American education director in order to glean ideas on how to effectively work with the student. The director advised the counselor to engage Kiah in an activity that included her memories of living on the reservation while asking her what she may want to reconnect to.

During this activity, Kiah remembered her grandmother having a shell on her kitchen table, a distinct smell, and feelings of calmness in her home. Working collaboratively, the student and counselor recalled that her grandmother would engage in the ceremonial practice of smudging each day, and Kiah realized this was something she would like to do in reconnecting to her culture. The Native American education director shared the smudging teaching with the student and helped procure sage from a local Native American–owned shop. The student relearned this ceremonial practice and planned to regularly practice the new ritual as a way to stay grounded in and connected to her identity.

     The goals of drumming are to find rhythm in one’s life again; to help people celebrate, grieve, and heal; and to feel connected to Mother Earth as one was once connected to their mother’s womb (Rojiani et al., 2022). Many Indigenous people believe that drumming represents the heartbeat of Mother Earth. The act of drumming connects the drummer with the earth. It is a practice that is both intimate and ceremonial. Drumming has been shown to enact multiple positive outcomes in clients, with examples including positive identity development (Rojiani et al., 2022); stress reduction and empowerment (Maschi et al., 2013); coping with societal oppression (McKinley, 2023); and anxiety reduction, decreased self-stigma, and the improvement of mood (Mungas & Silverman, 2014; Rowe et al., 2023).

Drums can be made from different animal hides; in the Midwest region, they are often made with deer hides. Drums can be made or bought, with kits accessible online. Drumming music can come from any origin. Oftentimes, Indigenous songs originate from someone’s dream and then are gifted to a person or group. One example is that of an elder who once dreamt a specific song for a women’s ceremony, and then gifted the song to Smith-Yliniemi and Riegert. The elder sang the song to them, and it was their responsibility to learn the song and sing it at that certain monthly ceremony from then on, which has been done for the past decade. The drum is considered a sacred living object, as an animal gave their life so that humans could benefit and heal. Consequently, caring for a drum should occur regularly and is considered a ritualistic ceremonial experience, whereby the keeper has the responsibility to acknowledge its life and treat it with great respect and honor.

The act of drumming includes tapping the instrument with a drumstick or hand. One or multiple individuals can drum. Drumming can be used in ceremonies. In some communities, behavioral health departments offer ceremonies to community members as a way to heal and connect with their Indigenous roots. As an example of the use of drumming in counseling, when Smith-Yliniemi engaged in group trauma therapy with adolescents, she would use drumming as a way to connect members. They would begin with a smudge and then one person would choose a song and either drum and sing individually or ask the group to join if they happen to know the song.

Individuals of all identities can drum, as the practice is not exclusively Indigenous (e.g., there are music therapy degrees that incorporate drumming for all). Anyone can drum, as it comes from within; one doesn’t have to be a musician or take lessons. Drumming can be used with myriad client issues, including depression, oppression, anxiety, affect regulation, substance use, and identity strengthening. As noted in the prior paragraph, drumming can connect members of a group to enhance social interest (Sperry et al., 2021) or create a sense of belonging and humanization (Craddock et al., 2022).

Ethical Considerations
     In considering the ethics of applying drumming with clients, there are several points to keep in mind. First, like the above directives with smudging, for non-Indigenous practitioners, it is essential that practitioners adhere to standard C.2.a. Boundaries of Competence (ACA, 2014) and read about, research, and study—and ideally receive training or experience with—the practice of drumming. Potential areas of learning include understanding the historical roots and practices of drumming, recognizing the impact of colonialism and contemporary culture on the practice (Quarshie, 2023), and use of drumming in contemporary healing practices (Rojiani et al., 2022; Rowe et al., 2023), all of which support adherence to standard C.2.b. New Specialty Areas of Practice (ACA, 2014). In addition, counselors can describe the practice, meaning, and impacts of drumming both in advertising and verbally with clients.

Adaptation Possibilities
     When drumming with clients whose ancestors may have used the practice, such as African Americans, similar to the suggestions for smudging, it is important to explore their awareness of their identities and roots, encourage research around their ancestors’ ceremonial practices, or research such histories collaboratively. Explore their perspectives and emotions around what is discovered; what has been lost to colonialism, enslavement, genocide, and other historical traumas; and how they wish to proceed with drumming as a practice in collaboration with the counselor.

Drumming: A Case Example
     Zane, a non-Indigenous, African American client sought counseling because of feeling depressed following several failed romantic relationships. Zane explained to the counselor that he had a recent “aha” moment when he realized he kept breaking up with his partners because he didn’t know who he was. His insight came after watching a movie on African American history and realizing he wasn’t sure of who he was, where he was from, or any cultural practices of his African American ancestors. Zane asked, “How am I supposed to know what I want in others when I don’t even know myself”?

The counselor explored with Zane what parts of the movie called him to his “aha” moment. He explained that it was a part in which African ceremonies were taking place and that the drumming had immediately brought him to tears. Throughout the next few sessions Zane and his counselor explored his African roots, and he ordered a drum kit so that he could make his own drum. Zane also reached out to a local African organization and began attending a bimonthly community event that promotes African culture and song. Over time and across the counseling sessions, Zane’s mood appeared to significantly improve. He began to discuss additional ways of researching his identity and to also consider the implication of these explorations on his dating choices going forward.

Letting-Go Ceremony
     A letting-go ceremony is a ritual that allows a person to process and/or release thoughts, emotions, or memories around beliefs or experiences in order to bring about healing and a sense of peace and to make room for new ways of being or engaging in the world (McCormick, 2021). It is often believed that one cannot simply talk their way through a trauma, but that they must spiritually and physically release it as well. Using tobacco ties is one traditional way to release a trauma, as a symbol of letting go, freeing oneself from the human experience, and returning the trauma back into the earth. It is a metaphor for no longer having to carry a certain burden.

Tobacco is considered a sacred medicine that represents the earth and is used for myriad purposes in Indigenous communities (National Native Network, n.d.). A tobacco tie can be created by placing a small amount of tobacco on a cloth and folding or tying the corners to create a small ball or sachet. It can be connected to a chain of ties, as well. The ties are released or given to the earth or sky, through laying them near the roots of a tree or placing them in a fire.

The process itself can be ceremonial, implemented with fasting or praying. The idea is an offering to the spirit world meant to impact the here and now in the physical world and to release some of the pain associated with an event (Wilson & Restoule, 2010). When the client and counselor practice the ceremony together, both are able to let go of part of the pain. The collective connection of healing helps to ease some of the traumatic experience.

In an example of using tobacco ties in group counseling, Smith-Yliniemi would often invite a medicine person to be part of the closure process for trauma groups. The medicine person would instruct group members to make a tobacco tie for each trauma they wanted to release from their bodies and their lives. These ties would then be used in a sweat lodge ceremony in the final session of a 10–12 week group.

The idea of symbolically “giving over/letting go” or releasing something as a means for healing is a universal act and therefore can be drawn upon and applied by counselors and clients of any identity. However, the ceremony would look different according to the client’s identity and wishes. Letting go allows one to release thoughts or beliefs that keep them held to the past—hence, it allows people to stay more focused in the present moment, which could apply to many topics. Common letting-go issues include grief, traumas, and depression, as well as negative and harmful thoughts, feelings, habits, and experiences. Ultimately, we could not think of any issue that necessarily would not benefit from a spiritual and/or physical ceremonial process of “letting go.” The client, of course, must be amenable to the idea of letting go; hence, the counselor should collaboratively determine client readiness for letting go and explore client reluctance, if it does arise, as a natural part of the process.

Ethical Considerations
     Individuals of any identity can engage in letting-go ceremonies, and likely the best practice is to initially draw upon clients’ own cultural practices specific to letting go in line with standard E.5.b. Cultural Sensitivity (ACA, 2014). However, if they are unaware of any such practice in their own community, counselors may adapt a letting-go ceremony as described here to meet the client’s need. Because letting-go ceremonies can be particularly emotionally laden for both the client and counselor, we encourage counselors to monitor their own wellness and to be mindful of counselor impairment, as noted in ACA ethical standard C.2.g. Impairment (2014).

Adaptation Possibilities
     If a person does not use tobacco as part of the letting-go ceremony, other elements of nature can be used instead. For example, a person can use a stone. A stone/rock is known as a “grandfather” in many Indigenous cultures. They have been on the earth the longest and have helped humans for many generations, carrying wisdom and strength. As a symbol of letting go, a person could find and hold a grandfather (rock) in their hand, releasing their pain from the human experience back into the earth through the rock, symbolizing that we do not have to carry the pain within us, but that we can release it to Mother Nature, who serves as a caregiver to us all.

Letting-Go Ceremony: A Case Example
     Lisa, a non-Indigenous client, came to counseling to address the trauma of losing an unborn child. During the sessions, the counselor and Lisa explored the impact of this trauma. Together, they decided to engage in a letting-go ceremony as a means for healing. As a first step, the counselor gave credit to the origins of the letting-go ceremony and explained to the client how and from whom the intervention was learned.

In preparation for the ceremony, the counselor obtained the necessary items, while also tending to their own emotions to ensure that the ceremony was delivered in a healthy and therapeutic way. The counselor prepared the meeting space to ensure that it was free of distractions. A blanket was laid on the floor with a sacred altar or centerpiece, on which both the counselor and Lisa placed items that were meaningful to them. Elements of the natural world were also part of the altar—examples of potential elements include a stone, tree leaves, a small dish of water, and even an electric candle to represent fire.

In addition, objects that represented other important people in the client’s life could be present, such as a small picture or an item that belongs to a significant person. That object signifies that one does not carry the challenges in their lives alone, that there are other humans who helped to guide one along the way. In this case, the centerpiece objects were selected collaboratively by the counselor and Lisa with the intention of providing support during the letting-go ceremony.

Next, the counselor offered a small piece of cloth (4” by 4” square) to Lisa, while keeping a piece of the material for themself. In this cloth, Lisa and the counselor placed dried herbs and natural earth medicines brought specifically for the ceremony. They then tied their individual bundles of herbs with a small string and held them in their left hands, which are closest to the human heart. Importantly, only a small amount of dried medicine (one teaspoon) was used for the cloth tie.

Next, a song was played. (Other options include reading a poem or offering several moments of silence.) The counselor explained to Lisa that the particular moment was spent intentionally in sending any energy from the traumatic experience into the tied cloth. After some time passed and the client signaled that they felt ready, the counselor brought the session to a close. The altar was disassembled while both participants continued to hold their ties.

At the end of the session, the counselor explained that the cloth tie that held the medicine and the energy from the ceremony can be placed on the earth, left at the base of a tree, placed in the woods, or even put near a body of water. The implication and healing properties of the ceremony were that the energy and emotions from the loss are now part of the tie and part of the earth, so that Lisa did not have to carry them all individually. The counselor also explained that a letting-go ceremony was not a one-time practice, and that throughout Lisa’s life, she now had the knowledge to practice letting go as needed.

Competency and Cultural Responsivity Considerations

We have identified methods by which practicing counselors can begin to implement ceremony-assisted treatments. Suggestions for obtaining more information about ceremony-assisted experiences include reaching out to and collaborating with one’s local Indigenous community and seeking out a knowledge expert. It is important to offer a gift to the person who is sharing their knowledge. Gift giving in this way aligns with the spirit of the 2014 ACA Code of Ethics preamble, which asserts the importance of honoring and “embracing a multicultural approach in support of the worth, dignity, potential and uniqueness of people within their social and cultural contexts” (p. 2). ACA ethical standard A.10.f. Receiving Gifts may also be relevant for giving gifts to those from whom one learns. Making a gift to recognize the importance of honoring cultural norms around gifting is certainly in keeping with the reasons and values behind this standard. Gift giving in this instance could entail any tangible item given with thoughtful consideration from one’s heart to the heart of the person from whom they seek wisdom. Examples include plants from the earth (dried or fresh), an object with a meaningful phrase, something useful (such as towels/blankets), or a handmade item. The gift item itself is not as important as the intention behind it—as an expression of love and respect and the sharing of gratitude for the opportunity to be open and learn from wisdom keepers. The experience of earnestly seeking, listening, and developing deeper understanding creates an opportunity for the growth of cultural humility (Tham & Solomon, 2023). Additionally, practitioners are building cultural responsivity as they adopt customs and traditions with awareness of the cultural origins.

Once knowledge of the healing ceremony is learned, practitioners should also offer the earth a gift of natural essence (a stone, small berry, dried herb, or small amount of water), as the counselor now holds this wisdom and has a responsibility to honor the earth and the person who gifted it to them. This connection and reciprocity between the natural and human world are a continual exchange of gratitude. It is essential that practitioners give due credit to the contributors of newly learned practices and traditions (Meade et al., 2022). In service delivery, sincerity is honored while using our own language and understanding.

In considering competency, ethical standard C.2.b. New Specialty Areas of Practice cites the need for counselors to take steps to ensure competence in applying new techniques, and always with the lens of “protecting others from possible harm” (p. 8). Additionally, counselor commitment to ongoing learning is emphasized in ethical standard C.2.f. Continuing Education (ACA, 2014). Hence, learning should not be considered as a singular universal practice; rather, practitioners should seek to learn in the moment from the knowledge keeper and engage in ongoing consultation, learning, and interaction with the wisdom holders. Continual practitioner reflection and the eliciting of client feedback—to determine the meaningfulness and impact of such interventions—is also essential to determining counselor effectiveness. These steps align with ethical standard C.2.d. Monitor Effectiveness (ACA, 2014), stating the importance of counselor action in monitoring the effectiveness of the work they do.


Ceremony-assisted treatments are powerful sources of healing and health for clientele. Ritual is essential for all humans, as a means for healing and for the maintenance of one’s physical, spiritual, and emotional health (Hewson et al., 2014)—albeit in ways that are uniquely shaped by personal culture and experiences (McCormick, 2021). We hope that the interventions included in this article can be used to enhance client mental health and health care needs.

Essential directives noted in this article include the importance of consulting with Indigenous healers within (or in approximation to) readers’ own contexts, to consider the ethical application of Indigenous-origin healing practices. We suggest seeking out and receiving education around such interventions, their histories, and the communities from which they originate to gain further understanding and respect for the practices. Those working in school systems may want to work collaboratively with an Indigenous education director in the ethical provision of ceremony-based interventions in their setting or to advocate for hiring such professionals for settings that lack an expert. Readers can also refer to the Association for Multicultural Counseling and Development’s Native American Concerns Group as a resource for Native counselors as well as for professionals counseling Native populations.

We reiterate that the perspectives around the use of and appropriation of Indigenous practices differ within and across Indigenous communities. Meade et al.’s (2022) Checklist for Counselor Practitioners reminds practitioners to remain vigilant to their own intersecting identities and to adhere to ethical practices in order to avoid harmful cultural appropriation. We attend to several of these recommendations by acknowledging and sharing our intersecting identities and offering guidance on ethically adapting the interventions to all clients.

Finally, going forward, when sharing these healing teachings, we encourage readers to maintain an awareness of the deep roots of these practices—stretching back and beyond seven generations—as a way to honor the ancestors who came before us and who have persisted in the face of great tragedy. We recognize the oral traditions that have allowed these teachings to be passed across the generations and ask readers to mindfully and respectfully pass on such teachings (orally or in writing) for seven generations more. In this way, future communities will know the healing practices that have aided Indigenous people for thousands of years, and they can adapt such practices in ways that heal and bring balance and wholeness to each unique community. Ultimately, we hope that counselor awareness of such factors will ensure that these teachings are shared in a mindful, loving, and honorable way.

Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.



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Julie Smith-Yliniemi, PhD, NCC, LPCC, is an assistant professor and Director of Community Engaged Research at the University of North Dakota. Krista M. Malott, PhD, LPC, is a full professor at Villanova University. JoAnne Riegert, PhD, LPCC, is a mental health professional from the White Earth Indian Reservation. Susan F. Branco, PhD, NCC, BC-TMH, LPC, LCPC, ACE, is an associate professor at Palo Alto University. Correspondence may be addressed to Julie Smith-Yliniemi, 1301 N Columbia Rd, Suite E-2, Grand Forks, ND 58202, julie.smithyliniemi@und.edu.