CBT and Sweat Lodge Ceremonies in Conversation on Psychological Healing Practices
ABSTRACT: Both CBT and Sweat Lodges are healing practices that have value in a twenty-first century context. However this paper demonstrates that cultural sensitivity requires that Sweat Lodge Ceremonies not be exported out of their context in native communities, and that standard CBT should not be used in Native American contexts with clients who are not fully acculturated to Euro-American culture.
This paper seeks to provide a detailed summary of Cognitive Behavioral Therapy (CBT) and the Native American Practice of Sweat Lodge Ceremonies and then to provide a format in which to explore commonalities, differences, and unique perspectives in how these very different healing practices engage the relationship between healer and help-seeker, define the process by which healing occurs, and the strengths and limitations of each method before inserting personal reflections about the theological, cultural, and personal implications of the usage of each of these practices as a treatment method. This paper will defend the argument that while both CBT and Sweat Lodges are healing practices that have value in a twenty-first century context, cultural sensitivity requires that Sweat Lodge Ceremonies not be exported out of their context in native communities, and that standard CBT should not be used in Native American contexts with populations that are less than fully acculturated to euro-american mainstream culture.
Basic Theory and Process of Healing in CBT
Essential to the examination of the contrasts and similarities of these two healing practices is a basic understanding of how CBT and Sweat Lodge operate within their cultural contexts. CBT, like many therapeutic orientations, is a combination of several earlier theoretical frameworks (Hays, 2006). CBT includes elements of both Cognitive Therapy and Behavior Therapy. Liese (2014) explained that in CBT, the therapist focuses on helping clients identify and gain mastery over maladaptive thoughts, feelings, and behaviors. The therapist and client work together as a team in which the therapist brings expert knowledge of psychological patterns of change and the client brings expert knowledge about themselves (Wills, 2009). Hays (2006) stated that a CBT therapist assists the client to recognize unhealthy, negative, or unrealistic cognitive patterns, she continued by explaining that the therapist facilitates change by helping the client to develop more helpful thoughts and behaviors in the area of problem solving, social skills, and cognitive restructuring. Cognitive restructuring, a key concept in CBT, refers to a client’s learned ability to replace unhealthy thoughts with healthy thoughts; Hays phrased this process as, “changing the way they feel by changing the way they think” (2006). CBT is used in many clinical settings. Essential elements to a successful outcome include a therapist trained in CBT, a client presenting a maladaptive thought, feeling, or behavior stemming from a cognitive distortion, and a desire on behalf of that client to change or improve that thought, feeling, or behavior. According to Gone (2011), as an Evidence Based Therapy CBT is frequently funded for public health programs on Native American reservations, so may enter contexts shared by participants of sweat lodge ceremonies.
Basic Theory and Practices of Sweat Lodge Ceremonies
Garrett et al. (2011) reported that the Sweat Lodge ceremony is a native practice common among many North American indigenous groups, although similar practices and ceremonies can be identified among the traditions of indigenous people groups throughout the world (p. 319). Multiple sources confirm that common elements to the North American indigenous groups practice of sweat lodge ceremonies include conducting the ceremony in a dedicated building or hut that is completely dark, using a heated rocks to heat the building to a temperature that induces heavy sweating, and spiritual themes such as honoring a great spirit, purification of self, and a righting of balance (Garrett, et al., 2011; Livingston, 2010; Bruchac, 1993). Sweat Lodges approach the process of recovery by seeking to use the sweat lodge as a place for a person to experience realignment of their soul with the earth, and bring elements of self which are dis-eased back unto the sacred circle which represents wholeness and unity with the earth (Garrett et al., 2011). The ceremony promotes healing via the pursuit of harmony for both the individual and the community via sweating, talking, chanting, praying, and silent meditation in the sacred space (Garrett et al., 2011, p. 319).
According to Bruchac’s (1993) book, Sweat Lodge practitioners claim that the effectiveness of the sweat lodge ceremony is accomplished through multiple methods: physical, emotional, and spiritual. He explained that healing of the body, mind, and spirit are accomplished through one ceremony and that according to Native American beliefs, these elements of a person cannot be treated separately (p. 107). Livingston (2010), a physician of Cherokee/Creek heritage, stated that the Sweat Lodge heals through the physically detoxifying benefits inherent in sweating and via the herbs used in the ceremony infused into the steam and inhaled.
Mentally, the sweat lodge can bring healing to a participant by helping the person reconnect to their community and heritage (Livingston, 2010). The sweat lodge provides an intimate bonding experience for the participants, the connectedness of which can improve mental well being (Livingston, 2010). Bruchac (1993) stated that spiritually, the Native American tribes practicing Sweat Lodge ceremony believe that the process of sweating is giving back to the earth, and that by giving back to the earth the participant will restore a balance which has been offset, thus impacting the participant’s health. The context for sweat lodges is within native groups. In recent years an increasing number of non-native persons have led sweat lodge ceremonies, some with deadly consequences (Livingston, 2010).
Healing through a Sweat Lodge ceremony requires a few essential elements for success. According to Bruchac (1993) the participant must have fasted prior to the ceremony. Livingston (2010) stated that for both the participant’s safety and to preserve the sacredness of the ceremony the participant must be fully sober and not under the influence of drugs or alcohol. The participant must enter naked and with solemnity (Bruchac, 1993). For a successful outcome, the lodge and a competent guide must be available. These elements may seem obvious, however as Bruchac (1993) reported in his book on Sweat Lodges, until the 1930’s native persons in the United States were forbidden by law to practice this ceremony, and sweat lodges were burned or destroyed by officials of the federal government upon discovery (p. 28).
Comparing and Contrasting CBT and Sweat Lodge Ceremonies in the Areas of Healing Process, Recovery, and Role of Healer
Although both CBT and Sweat Lodge practitioners seek to help participants live healthier, fuller lives, CBT and Sweat Lodge practitioners view the healing process and the goal of healing very differently. For a CBT practitioner, success is achieved when the client no longer exercises the undesirable behavior but according to Garrett and Carroll (2000) for a sweat lodge leader the idea of success or recovery may be a more abstract concept, and considered a lifetime process rather than an accessible goal, even if specific symptoms are eliminated. CBT and sweat lodges differ significantly in how they view the process of healing. While CBT defines recovery as symptom reduction or remission achieved via altering a person’s cognitive thought patterns, sweat lodges are part of an integrative practice of healing mind, body, and soul.
In both CBT and sweat lodge ceremonies the relationship between healer and person seeking healing play significant, though very different, roles. In CBT, the practitioner (therapist) and person seeking healing (client) are in a two-person relationship. The therapist and client and meet at specified times for a specified amount of time (Moorey, 2007, p. 312). Multiple sources confirmed that the CBT sessions will be very structured and the client will be assigned homework between sessions (Liese, 2014, p. 238; Wills, 2007, p. 114; Moorey, 2007, p. 317). The therapist generally helps the client feel at ease, but a very distinct, very western, power differential remains in which the therapist is the expert and the client is the submissive person in the relationship- seeking the wisdom of the healer. According to Avaline (2007), the therapist and patient do not engage with one another in significant ways outside of the therapeutic setting and the therapist intentionally avoids a personal relationship with the client (p. 527). Unless the therapy is being offered by a government-funded program, money is generally exchanged, further emphasizing the power-based divide between therapist and client. Additionally, in contrast to relational models of therapy which empathize empathy, disclosure of emotions, and the therapist meeting a client’s emotional needs, strict adherents to CBT therapy only engage relationally to the degree required to establish a therapeutic alliance and participation of the client in the therapy (Neill, 2015). A CBT therapist attends to cognitive distortions and observable behavior, circumventing many opportunities to develop an emotional or relational alliance with the client (Neill, 2015).
In contrast to the clearly defined boundaries between therapist and client in CBT, in a Sweat Lodge ceremony ceremony the practitioner (called a guide) and the person seeking healing (the participant) are in relationship with one another in a larger context. Livingston (2010) stated that their one-on-one relationship occurs in the context of the small group of persons with whom they are entering the sweat lodge- and this group of persons exists in close connection with the community or tribe supporting their ceremony. While the leader of the sweat lodge ceremony may hold a higher status in the tribe and receive elevated respect for leading the sacred sweat lodge ceremony, the concept of unity inherent in this Native American ritual emphasises that the healer and participant are in a much closer, less power defined relationship than are the therapist and client in CBT. (Garrett et al., 2011, p. 324) Additionally, while a CBT therapist is paid for their services, Smith (1993) stated that the sweat lodge leader almost always, within the native tradition, performs the ceremony for no charge.
Strengths and Weaknesses of CBT & Sweat Lodges
Both CBT and Sweat Lodge Ceremonies have strengths and weaknesses. Due to the lack of clinical research surrounding the efficacy of Sweat Lodge Ceremonies the strengths will be outlined based on claims made by Native American Sweat Lodge practitioners. Among the strengths of CBT is the fact that it is a low cost, effective treatment for many disorders across a wide range of disorders (Beck, 1993). Novins (2011) stated that because CBT takes place over a few meetings, it is cost effective, thus increasing desirability for managed health care providers and for self-pay clients. Wills (2009) explained that because the CBT therapist helps teach the client tools to retain and practice new cognitive patterns, CBT has the potential for long term effectiveness (p. 113). Without a motivated client and a supportive environment, however, these gains may potentially be temporary. According to Wills (2009) some longitudinal studies of CBT indicate favorable long term outcomes. (p. 113) Novins (2011) adds that because the results of CBT are easily tested and quantifiable, public servants and grant writers may find it easier to access public or private funds for implementing this therapy. Since accessibility is the first step to effective mental health care, the quantifiable nature of CBT may actually improve the therapy’s ability to help people simply by improving its appeal to mental health funding administrators and thus, improving availability to clients. An additional strength of CBT is the potential for the method to be practiced by the client on themselves on new cognitive distortions that come to light after the therapeutic relationship has terminated, as Beck (1979) explained when he wrote “The sense of mastery from solving one problem frequently inspires the patient to approach and solve other problems that he has long avoided” (p. 232).
Strengths of Sweat Lodges can be identified through publications from native practitioners. As a practice of a marginalized people group, Sweat Lodge ceremonies lack the impressive funding that managed healthcare has invested in researching the effectiveness of CBT, but anecdotal evidence suggests strengths in several areas including the low cost of the ceremony, high cultural/traditional value, and the fact that even if not effective at healing for a specific individual, sweat lodges have an extremely low risk of adverse effects when practiced well. An article in Journal of Alternative & Complementary Medicine by Livingston (2010) stated the “narrative traditions show the benefits of the old ways, and the apparent sterling safety record of indigenous leadership is impressive.” Indirectly supporting the effectiveness of a sweat lodge is research by Pierce (2000) indicating that connections within a community, such as those created in tribal ceremonies, significantly reduce the risk of lapses in sobriety for recovered addicts. Because of this link between sweat lodge ceremonies and a feeling of cohesion with community, sweat lodges may play a part in developing an ongoing support network for a client, resulting in sustained improvement in mental functioning.
Limitations of CBT include the hyperfocus on an individual’s cognitive patterns, rather than a valuation of a whole person who has physical, emotional, spiritual, and relational components (Neill, 2015). Additionally, as Van Der Kolk (2006) points out, CBT fails to address the emerging neurological evidence that disorders such as PTSD are deeply linked to physical experience. Limitations of Sweat Lodge ceremonies include the limited availability both in the individuals it is available to as well as in conditions or disorders which can be treated. Additionally, Garrett et al. (2009) points out there are several psychological disorders which disqualify a candidate from participating in a Sweat Lodge ceremony when he stated “people who suffer from any condition such as claustrophobia or posttraumatic stress disorder are encouraged to avoid such a ceremony, which might trigger uncomfortable reactions to being in a dark, closed space for an extended period of time” (p. 323).
Theological Reflections on CBT and Sweat Lodge Ceremonies
The spiritual part of a person is not addressed equally in both of these healing practices. CBT fails to acknowledge the role of spirituality in a person’s sense of wholeness, while Sweat Lodge ceremonies emphasize spiritual matters over the physical or mental. CBT is a therapeutic framework which provides little space in the theory for integration with a Christian worldview. While christians value the human as both body and soul, as cognitive belief structures and physical bodies existing in union with the spiritual being, and view an individual’s emotional life as emanating from spiritual conditions and not merely cognitive believe structures, CBT tends towards a reductionist view of mankind that views the human as a purely biological being, and invests only in curing the outwardly observable behavior. CBT falls short in addressing issues of human suffering originating from the tension between God’s call on our lives and the fallen state of man. I believe CBT can have great value within the toolkit of a Christian therapist, as a method to help provide relief to a person suffering acutely from a number of pathologies, but due to the failure to address the role of spirituality and identity in behavior and meaning making, CBT is an insufficient orientation from which to operate exclusively. If one looks closely, one can see many subtle similarities to Christian theology in the Native American spirituality behind Sweat Lodges. Native American spirituality, like Christianity, names that humans are both sacred and of the earth. Most subsets of Native American spirituality recognize a Creator that is present, and identifies that relationship with this being is essential to healthy mental functioning.
Sweat Lodges and CBT in 21st Century Culture
The sources cited above indicate that both CBT and Sweat Lodges have a place in 21st century culture, within their cultural contexts. It must be noted, however, that successful outcomes for both CBT and Sweat Lodge ceremony are heavily dependant upon cultural conditions being met by both the practitioner and the person seeking healing; because of this fact it may be concluded that each of these healing practices cannot be effectively exported into the cultural environment in which the other was developed. Whitt (1999) argues that the Native American Sweat Lodge ceremony cannot be adapted and marketed in mainstream 21st century contexts because the act of reducing this complex and sacred ceremony of a minority culture to a formula which can be marketed and sold by members of a majority culture is equal to cultural imperialism. Such cultural imperialism, she continues eloquently, “secures and deepens the subordinated status of those cultures” (Whitt, 1999). Additionally, Livingston (2010) points out that Sweat Lodges are more likely to cause physical harm to participants when practiced outside the indigenous context. CBT cannot be effectively used in low-acculturated Native American populations because CBT requires that a patient ascribe to the belief that cognitive thoughts shape behavior (Hays, 2006). For a collectivist culture or a culture that ascribes the cause of mental illness to being out of balance with the earth instead of the result of cognitive distortions, a practitioner attempting CBT may find very that clients do not respond well to the treatment (Hays, 2006). CBT presents additional challenges in Native American communities ascribing to traditional belief systems which do not have a word for “I” or a clear concept of division of self and others necessary for successful CBT (McDonald & Gonzalez, 2006). Several sources pointed out that some native people groups within the United states have rejected all modern psychotherapy on the basis that, in denying their belief structure, western psychotherapies are a form of colonialism (Novins, 2011; Whitt, 1999). In these communities, CBT has no role unless multiculturally competent practitioners can sufficiently adapt the therapy to use native beliefs as the basis for change.
As an alternative to exporting Native american Sweat Lodge ceremonies out of their context in an attempt to serve 21st century Euro-American clients, mental health practitioners wishing to offer the benefits of Sweat Lodge therapies to their non-native clients may instead explore alternative therapies using individual elements of Sweat Lodges. For example, one recent study by Colmant (2005) showed that interpersonal group therapy conducted in a 145° F sauna resulted resulted in significantly better outcomes in therapeutic factors including altruism, interpersonal learning, and group cohesiveness.
Author’s Personal Reflections & Conclusion
In the opinion of this author, CBT is an excellent approach for a therapist to be able to implement in appropriate and helpful contexts. I selected CBT as my therapeutic orientation to research because of its wide applicability and many sources indicating outcomes including relief of symptoms within a short period of therapy. As a person who recognizes the role of the body and soul, not just cognitive belief patterns, in mental health I do feel this therapeutic orientation would be limiting to practice exclusively, however in a culture where many clients are acutely suffering and may not financially have the option of ongoing holistic therapy, CBT appears to be one way to attempt to alleviate acute suffering in many cases. Through my research on Sweat Lodge Ceremonies I came to a greater respect for this practice and a belief that sweat lodge ceremonies should not be exported from native cultures.
Both CBT and Sweat Lodges can be best understood via examination of the process of healing believed to be at work, the context in which the treatment is administered, and the essential elements of a successful outcome. After defining and exploring the differences and similarities between these healing practices in the areas of the relationship between healer and participant, the strengths and limitations, integration with a Christian theological framework, integration into a 21st century context, and a brief exploration of the unique cultural subtext surrounding Native American healing practices, evidence was presented to support the claim that while both CBT and Sweat Lodges are healing practices that have value in a twenty-first century context, cultural sensitivity requires that Sweat Lodge Ceremonies not be exported out of their context in native communities, and that standard CBT should not be used in Native American contexts with clients who are not fully acculturated to majority culture.
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