We report on the incorporation of a North American aboriginal procedure called “the talking circle” into primary care in areas serving this population. Communication is regulated through the passing of a talking piece (an object of special meaning or symbolism to the circle facilitator, who is usually called the circle keeper). Twelve hundred people participated in talking circles in which 415 attended 4 sessions and completed pre- and postquestionnaires. Outcome measures included baseline and end Measure Your Medical Outcome Profile version 2 forms. Participation in at least 4 talking circles resulted in a statistically significant improvement in reported symptoms and overall quality of life (p < 0.001 and effect sizes ranging from 0.75 to 1.19). The talking circle is a useful tool to use with Native Americans. It may be useful as a means to reduce health care costs by providing other alternative settings to deal with stress-related and other life problems.


Talking circles, peacemaking circles, or healing circles, as they are variously called, are deeply rooted in the traditional practices of indigenous people. In North America, they are widely used among the First Nations people of Canada and among the many tribes of Native Americans in the US. Healing circles take a variety of forms, but most basically, members sit in a circle to consider a problem or a question. The circle starts with a prayer, usually by the person convening the circle, or by an elder, when an elder is involved. A talking stick is held by the person who speaks (other sacred objects may also be used, including eagle feathers and fans). When that person is finished speaking, the talking stick is passed to the left (clockwise around the circle). Only the person holding the stick may speak. All others remain quiet. The circle is complete when the stick passes around the circle one complete time without anyone speaking out of turn. The talking circle prevents reactive communication and directly responsive communication, and it fosters deeper listening and reflection in conversation. It also provides a means for people who are prohibited from speaking directly to each other because of various social taboos to speak and be heard. Healing circles are often called hocokah in the Lakota language, which means a sacred circle and is also the word for altar. The hocokah consists of people who sit together in a talking circle, in prayer, in ceremony, and are committed to helping one another and to each other’s healing. Hocokahs may participate together in purification and other ceremonies and usually camp together when traveling to larger gatherings, such as the sun dance. Healing circles have been used for recovery from alcoholism in aboriginal communities, especially when the traditional spirituality of those communities are perceived to conflict with the assumptions of Alcoholics Anonymous (AA).

The talking circle process is a unique instructional approach that can be used to stimulate multicultural awareness while fostering respect for individual differences and facilitating group cohesion. The creation of the talking circle is often credited to the Woodland tribes in the Midwest North America, who used it as a form of parliamentary procedure. “The symbol of the circle holds a place of special importance in Native beliefs. For the North American Indian, whose culture is traditional rather than literate, the significance of the circle has always been expressed in ritual practice and in art. The lives of men and women, as individual expressions of the Power of the World move in and are nourished by an uninterrupted circular/spiral motion. This circle is often referred to as the Medicine Wheel. Human beings live, breathe and move, giving additional impetus to the circular movement, provided they live harmoniously, according to the circle’s vibratory movement. Every seeker has a chance to eventually discover a harmonious way of living with their environment according to these precepts.” Traditionally, many Native American communities have used the talking circle as a way of bringing people of all ages together for the purposes of teaching, listening, and learning. Talking circles were a traditional form of education from early childhood through adulthood and provided a way to pass on knowledge, values, and culture. This method of education instilled respect for another’s viewpoint and encouraged members to be open to other viewpoints by listening with their hearts while another individual speaks. Today, talking circles are used throughout the country in tribal inpatient and outpatient drug and alcohol centers, group homes, adolescent prevention and intervention programs, prayer circles, tribal and public schools, and college-based English as a Second Language programs. They effectively foster respect, model good listening skills, settle disputes, resolve conflicts, and build self-esteem. Talking circles as a psychological technique provide a cathartic impact of publicly sharing problems or concerns. This group intervention/activity provides participants with a structure that promotes self-exploration in an empathic and supportive atmosphere. In addition, talking circles have been compared in relevance to Network Therapy, which mobilizes members of the family and extended family into maximizing their resources and coping mechanisms.

The object used to designate the speaker is considered sacred. In many Native American cultures, this object is often viewed as having a symbolic meaning to its owner. It is suggested that the group facilitator or instructor (for the first talking circle) bring an object that is symbolic to him or her. Members of the group can bring personally significant objects to use in subsequent talking circles. The convener sets the framework for the activity by clarifying the use of the talking circle as an educational group activity versus a therapeutic group format (which would require an agreement for participant confidentiality). The facilitator clarifies and models appropriate use of self-disclosure, such as staying within the topic, especially in educational settings. Furthermore, the facilitator/instructor identifies, models, and monitors the emotional content level in personal disclosures.

The circle process establishes a very different style of communication. Rather than aggressively debating and challenging each other, which often involves only a few of the more assertive individuals, the circle process establishes a safe nonhierarchical place in which all present have the opportunity to speak without interruptions. Rather than active verbal facilitation, communication is regulated through the passing of the object. The talking stick or other object fosters respectful listening and reflection. It prevents one-to-one debating or attacking. After brief opening comments by the circle keeper about the purpose of the talking circle, a listing of ground rules, and a request for additional contributions to the ground rules, the circle keeper says a few things about the talking object and then passes it to the person on the left, clockwise. Only the person with the talking piece can speak. If others jump in with comments, the circle keeper reminds them of the ground rules and refocuses on the person with the talking object.

Healing circles have also been used for reconciliation justice within the criminal justice system and are then often called peacemaking circles:

“Peacemaking circles use traditional circle ritual and structure to create a respectful space in which the crime victim, victim supporters, offender, offender supporters, judge, prosecutor, defense counsel, police, court workers, and all interested community members can speak in a shared search for understanding the event at issue; participants also identify the steps necessary to address the harm caused by the offense and to prevent future occurrences. The peacemaking circle process typically involves several steps that lead to the sentencing. An application by the offender to the circle process is followed by the creation of a support system for the offender and a support system for the victim. Other steps are a healing circle for the victim and healing circle for the offender. These steps are then followed by the sentencing circle. After the sentencing circle, there may be follow-up circles at appropriate intervals to review progress on the sentencing agreement. The circle process is not simply a process for finding more appropriate justice; it is an exercise in building community, because it brings community members together in a forum that allows exploration of the underlying causes of crime and encourages each community member to offer gifts or capacities to the process of finding solutions and implementing them. The circle process allows full expression of emotions and channels the energy of those emotions toward positive solutions. In the circles, decisions are based on consensus, and everyone involved must agree that the decision is one with which they can live. Circles draw on the life experiences of all the participants to understand the problem at hand and to devise workable solutions.”

Healing Circles Are Elements of Native American Spirituality

The healing circle/talking circle is an element of North American aboriginal spirituality, which has historically been an underlying concept that permeates every aspect of Native American life. This spirituality is closely connected to the natural world, with land and community having the highest possible meaning and being places for honoring and communicating with spirits.

Native American spirituality is circular in nature, encompassing the 7 sacred directions of West, North, East, South, Sky, Earth, and Center. “West, North, East, and South are viewed as the sacred quadrants of the universe. Each quadrant contains special meanings, elements of power, spirits, and sacred teachings. The spiritual essence of all life forms—plant, animal, and human—resides in these four directions.” The fifth direction, Sky, is the upward direction that represents (in Lakota) Wakantankan, the sky spirits, many or one. Earth, the sixth direction, represents the Mother, the source of all life. The seventh direction, Center, is responsible for the connection and unification of all the sacred directions. Center is the spiritual essence of self, so that every living entity is also a Center. All of these directions in unison represent the Sacred Hoop, or Medicine Wheel. When the 7 sacred directions are in harmony and balance, the Sacred Hoop is whole. Similarities exist between talking circles and support groups and 12-step groups.

This article reports a “case study” of implementing this culturally appropriate healing tool within conventional primary care to learn whether outcomes could be improved. A total of 1211 people participated in talking circles in which 415 people attended 4 sessions and completed baseline and end Measure Yourself Medical Outcome Profile version 2 (MYMOP2) forms. These talking circles focused on drugs, alcohol, and mental health in the respective communities and how community members could work together to solve these problems.

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