How do we honour Te Whare Tapa Wha

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

Overview Part 1: Assessment (1 hr) 1) What is Te Whare Tapa Wha (TWTW)? 2) Case study – Meet Pearl Part 2: Reflecting on practice using Te Whare Tapa Wha (45 mins) 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/ wellbeing 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

TE WHARE TAPA WHA

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

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

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

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

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

TE TAHA WHANAU Clinical: Cultural:

Clinical: Te Taha Hinengaro Cultural:

Te Taha Tinana Clinical: Cultural:

Te taha wairua Clinical: Cultural:

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

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)

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: 1. Enhance her capacity to communicate, think and feel? 2. Enhance her capacity for physical health and development? 3. Enhance her capacity to belong, to care and to share? 4. 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 WHEN WORKING WITH MAORI CLIENTS Ask yourself these questions when assessing, planning and treating (or in selfreflective review) Have 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….