The healing constellation: A conceptual framework for treating trauma among Athabaskan women in Alaska

Wendy Hanford Arundale
Dept. of Psychology, Union Institute and University
July, 2013


The majority of Alaska Native women---including Athabaskan women---seeking treatment for substance abuse or mental health problems have experienced some form of trauma, often with an intergenerational component. Over the past 25 years, our understanding of how trauma affects all areas of a woman's life has grown significantly. As Herman (1992) reminds us in her pioneering work, Trauma and Recovery, trauma often results in a disconnection from the community, from social support systems, from memories, and sometimes even from the self. Nevertheless, trauma treatment for Alaska Native women has been slow to reflect these growing understandings in an organized way. The traditional separation of mental health and substance abuse treatment has further hampered treatment efforts. Until recently, treatment strategies tended to focus on just a few elements. When only some aspects of a woman's distress are considered, treatment may be unnecessarily prolonged or fail completely. For optimal treatment, a broad conceptual framework and approach to treatment are essential. Just as constellations guided early travelers, the Healing Constellation, which is just such a framework and approach, can help guide effective treatment of Athabaskan women suffering from trauma. The Healing Constellation prompts practitioners to examine and recognize a wide variety of factors that may contribute to a trauma survivor's distress. The framework's complexity provides a variety of entry points, as well as places to start again if initial efforts fail. The framework also offers some insurance against narrowly focused 'magic bullet' approaches. This dissertation describes the Healing Constellation, which is shaped like a safety net, laying out a theoretical and research-based rationale and discussing pertinent aspects of the following elements, which are like the stars in the constellation: (1) the nature of trauma, including complex trauma; (2) intergenerational trauma; (3) local sociocultural and historical context; (4) the therapeutic alliance, including multicultural competence issues; (5) substance abuse; (6) the relationships between trauma and substance abuse; (7) the neuropsychology of trauma; (8) attachment theory as it relates to trauma; (9) assessment; (10) conventional therapeutic approaches such as cognitive-behavioral and group therapy; (11) psychopharmacology of trauma; and (12) traditional approaches to healing, especially the use of narrative. Implications for research and policy are also discussed.