5 Learning to Listen: A Literature Review of Approaches to First Nations Counselling in Australia

Katelyn Wallace


Mental health service engagement and outcomes for Indigenous Australians continues to be impeded by lack of therapist cultural competency and lack of cultural safety for First Nations clients. While Australian accreditation authorities in counselling and psychology require cultural competency for either professional accreditation or ethical practice, mental health outcomes for Indigenous Australians remain significantly worse when compared to other Australians, suggesting cultural competency and safety are not well understood or implemented by non-Aboriginal mental health providers. Indigenous voices in Australia and abroad recommend the incorporation of Indigenous cultural practices and holistic approaches to health and healing that incorporate family, community, Country and spirituality as a pathway to greater cultural safety and thereby engagement with counselling services. This paper provides a chronological literature review of First Nations counselling approaches in Australia from the 1970s to the present and suggests directions for further research into First Nations perspectives on the cultural safety of counselling practices that incorporate dadirri, an Indigenous Australian deep listening practice, in outdoor therapeutic settings.


According to Flick (2010), the origins of research questions lie in “the researchers’ personal biographies and social contexts” (p.98). Before embarking on a review of the literature related to counselling First Nations clients, it is essential that I as the researcher, first articulate those aspects of my personal biography and social context that have shaped and driven this research. For the past six years I have worked as an educator in First Nations contexts, first as an Indigenous Education Coordinator at a secondary school for four years, followed by two years of teaching in a remote Aboriginal community in North Queensland. As a non-Indigenous person working in community, I, like many others, have struggled with the cultural mismatch of the institution I represented and the young people I was employed to teach (Mahood, 2016). It has been my suspicion that this cultural mismatch I experienced first-hand is not limited to the sphere of education, but likely extends to other realms, including health and mental health.

Research by Fredericks (2010) has shown that Aboriginal people often experience rural health services as lacking cultural safety and unwelcoming to Aboriginal peopleAboriginal people often experience rural health services as lacking cultural safety and unwelcoming to Aboriginal people..  A study by Kendall and Barnett (2015) identified key factors that impacted the use of health services by Indigenous Australians, including historical experiences, cultural competency and appropriate communication, and collective and holistic health models. The conclusion drawn from this study was that principles of cultural competency and cultural safety were not well understood, nor effectively impended by non-Aboriginal health services (Kendall and Barnett, 2015). According to a study by Fan (2007), this lack of therapist cultural competency and cultural safety for clients is the primary barrier preventing Indigenous Australians from accessing mental health services.

Lack of cultural safety in therapeutic spaces for First Nations peoples is highly concerning considering current statistics about Indigenous mental health. First Nations peoples in Australia are nearly three times more likely to suffer acute psychological distress, and twice as likely to die by suicide or be hospitalised for a mental health condition (Edwige et al., 2021). These rates are also higher for young people (Edwige et al., 2021).

This paper seeks to provide a review of the research literature on approaches to counselling First Nations clients in Australia. This review will highlight gaps in the research pertaining to (1) First Nations client perspectives of counselling, and (2) effective evidence-based strategies for enacting culturally safe and responsive counselling for First Nations clients. This paper will then outline the potential negative impacts of a continued failure to deliver culturally safe and responsive counselling for First Nations clients. Finally, potential research directions will be suggested for exploring First Nation’s perspectives on counselling practices that incorporate aspects of Indigenous knowledge systems and spirituality through dadirri ‘deep listening’ in the context of natural, outdoor therapeutic spaces. This literature review will conclude with a summary of the possible benefits of this research for First Nations clients, the community, and the counselling profession.

History of First Nations Counselling Approaches

1970s and 1980s

Prior to the 1990s, there were exceedingly few research publications pertaining to therapeutic interventions with First Nations clients, reflecting the minimal mental health services available to Indigenous Australians at the time (Fan, 2007). Most of the research was published in either the Aboriginal and Islander Health Worker Journal or in The Aboriginal Child at School. Papers published in the 1970s and 1980s largely focussed on alcohol rehabilitation programs (Cawte,1977; Budby, 1984; Daniele, 1985; Dwyer, 1989). Papers by Marika (1985) and Brand (1985) examined the role of the church in counselling Aboriginal people, also specifically targeting the issue of alcoholism.

In the late 1970s, the need for a First Nations presence in schools to address educational and vocational inequality was identified and initiatives to train Aboriginal community education counsellors were trialled in Queensland in Brisbane (McIntyre & Clark, 1976; Pettit, 1978; Clark, 1981), Innisfail (Jones, 1985), Atherton (Department of Education, 1988), and Magnetic Island (Department of Education, 1989). A parent counselling program was initiated with the same aim in Charters Towers (Krista, 1979).

In 1976, Kahn, Henry and Cawte published a study titled Mental Health Services by and for Australian Aborigines, which examined the impact of an Aboriginal community mental health clinic where mental health services were provided by five Indigenous behavioural health workers. Then in 1979 the National Aboriginal Mental Health Association was formed by Uncle Cyril Hennessy and others, who framed a Declaration of Mental Health specific to Aboriginal people (Hennessy, 1988, p.5). The Declaration and the association’s recommendations for an Aboriginal led mental health service made to the then Fraser government were ignored (Hennessy, 1988), however Aboriginal mental health workers and activists continued to advocate for such a service, most notably Cliff Fua, Cyril Coaby, Cyril Hennessy, Marion Kickett, Eva Kennedy, and Josie Sailor (Fua, 1988, p.41).

Apart from the efforts of the above First Nations pioneers in Aboriginal Mental Health, the mental health needs of First Nations peoples were largely overlooked (Hennessy, 1988) and counselling services provided to Indigenous Australians were mostly limited to alcohol rehabilitation programs.


The 1990s saw continued efforts to train First Nations counsellors (Fua & Hahn, 1991; Howlett, 1993), such as through the development of a Certificate IV in Aboriginal Social Emotional Wellbeing (McGuire, 1999). Aboriginal counsellors, health workers and activists continued to advocate for Aboriginal led counselling services and the inclusion of traditional approaches in addressing Aboriginal mental health (Dudgeon & Grogan, 1993; Collard & Garvey, 1994; Plumber, 1996; Tsey, 2000). Some small headway was made in the provision of culturally relevant counselling, such as the use of yarning circles in therapeutic contexts by Atkinson (1994) and Kids Help Line (Kids Help Line, 2000).

In the early 1990s, the Royal Commission into Aboriginal Deaths in Custody (RCIADIC) (1987-1991) put the spotlight on the wellbeing of incarcerated Indigenous peoples (Collard & Garvey, 1994). The RCIADIC recommended that there be a significant expansion of Aboriginal mental health services, built upon a foundation of community consultation (Australian Government, 1991, 264a), and that counselling services be provided to offenders (94b), Aboriginal inmates (152b), and the family members of Aboriginal people who died in custody (5).

Then, the 1997 Bringing them Home Report on the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from their Families also made recommendations that emphasised the need for counselling services that specifically addressed the preventative and primary mental health needs of First Nations communities, recommending all government-run mental health services employ First Nations mental health workers and community members acknowledged for their healing skills, and work in partnership with local Indigenous services (Wilson, 1997, 33b).

Whilst the RCIADIC and the Bringing them Home Report impacted public policy and opinion about the importance of Indigenous mental health, scholarship relating to the then relatively new concept of transgenerational trauma was also emerging. The work of Judy Atkinson throughout the 1990s and early 2000s was critical in turning the tide of scholarship towards an examination of the impacts of colonization on therapeutic work with First Nations clients (Fan, 2007). Atkinson’s book Trauma trails, recreating song lines: the transgenerational effects of trauma in Indigenous Australia helped generate further national discourse on the topic. Possibly in response to the increased recognition of the impacts of colonisation on Indigenous mental health, the late 1990s also saw an increase in studies focusing on grief in Aboriginal clients (Hunter, 1998; Swan, 1998).


The 2000s saw a significant increase in research on the topics of Indigenous mental health and culturally appropriate counselling for First Nations clients (Vicary & Andrews, 2001; Vicary, 2002; Westerman, 2004, McLennan & Khavarpour, 2004; Monahan & Twining, 2007). Case studies of Indigenous clients began to emerge (Spiller, 2005) and studies began to target specific conditions in Indigenous populations such as Schizophrenia (Parker & Milroy, 2003), PTSD (Wilson et al. 2007), and suicide prevention (Deane et al., 2006). Moreover, researchers began to pay attention to the use of different therapeutic approaches with Aboriginal clients, such as narrative therapy (Denborough et al., 2006; Bacon, 2007) and positive psychology (Craven & Bodkin-Andrews, 2006). Studies examining the psychological impact of the Stolen Generations continued to grow (Fredericks, 2006; Young, 2009), and a new capacity for critical self-reflection about colonial power dynamics in counselling also emerged (Bowers, 2008). The need for therapists to examine their own values and practice in light of the specific needs of Indigenous clients was also becoming apparent in papers like ‘Changing Practices, Changing Paradigms: Working Effectively with Indigenous Clients’ by Burke (2007) and in Richard Chenhall’s (2006) critique of individual psychotherapy as a modality for counselling First Nations clients for whom mental health is intrinsically tied to social connectedness to family and community.

Counselling targeting Indigenous educational and vocational outcomes evolved and became part of the research and academic discourse in the field of careers counselling (Crump, 2001; Craven & Marsh, 2004; Chesters et. al, 2009; Diemer & Ortega, 2010; Bodkin-Andrews et al., 2010). Low engagement rates of First Nations youth with mental health services were also targeted through studies identifying barriers and engagement strategies (Stathis, et al., 2006; Melder & Simmonds, 2008). One study of a culturally appropriate model of engaging Aboriginal youth in mental health services had a 97% success rate when trialled with a mix of urban (N=43) and rural (N=86) Aboriginal youth (aged 13-17) (Westerman, 2010). The model incorporated discussions of the client’s family, mob, country, and spirituality and addressed common cultural barriers such as eye contact, non-verbal expression, language use and age and gender differences between the client and counsellor (Westerman, 2010). Studies also emerged examining the relationships between Indigenous spiritualities and mental health (McLennan, 2003) and how the incorporation of Aboriginal and Torres Strait Islander spirituality can be used as a healing resource in therapy (Wanganeen, 2001).

Partnership models between Aboriginal health workers and non-Aboriginal service providers developed further (Mushin et al., 2003; Fuller, et al., 2005), as did Two-Way models combining First Nations practices with Western therapy (Pratt, 2007; Nagel et al., 2009), including the use of yarning circles in group therapy (Towney, 2004; Bowers, 2010). Qualitative studies suggested Indigenous-specific support groups had a positive effect on social emotional wellbeing (McCalman et al., 2010). Acknowledgement of the need for community consultation and perspectives on mental health also grew during this period (McLennan, 2003; Hillin et al., 2008). The critical need for First Nations perspectives within the research on First Nations counselling in Australia would not be realised until the next decade, and while the 2000s undoubtedly demonstrated a noteworthy leap in critical reflexive practice in the counselling profession in Australia, most studies were still carried out on First Nations peoples, not by or with them.

2011- Current

The past decade has seen an increased focus on First Nations people in the counselling and psychology professions, with studies conducted on the development of counselling qualifications for First Nations communities (Connelly & Coulter, 2011) and on the experience of Indigenous psychology students (Harris et al., 2012; Cameron & Robinson, 2014). These developments are reflective of the recent emergence of the field of Australian Indigenous psychology (Wall, 2013). Leading Australian Indigenous researchers and psychologists such as Dr Lorraine Muller and Professor Pat Dudgeon represent part of a global movement of Indigenous psychology built on principles of self-determination and utilizing the resources within one’s own culture to support transformation (Dudgeon, 2017). For instance, Professor Dudgeon’s (2018) research on Australian Indigenous healing practices explores the restoration of women’s traditional therapeutic practices and Dr Muller’s work has focussed on educating non-Indigenous service workers in Indigenous practices and ways of working with people within a decolonising framework (Muller, 2014).

This past decade also saw a steady stream of studies from the field of educational psychology aimed at improving academic outcomes (Liem and Bernardo, 2013; Craven et al., 2016; Mooney et al., 2016) and school wellbeing (Miller & Berger, 2021) for Indigenous students.

Studies on the social-emotional wellbeing of Aboriginal and Torres Strait Islander people increased (Calma et al., 2017), and became more specific to particular populations including women (Baker, 2012), men (McDonald & Haswell, 2013), children (Marmor & Harley (2018), youth (Skerret et al., 2018), incarcerated peoples (Rose et al., 2019), Indigenous correctional officers (Trounson et al., 2022), and urban, rural, and remote populations (Tomyn et al., 2016). As available data has increased with time, more cross-sectional and meta-analyses have also been conducted, providing valuable research insights relating to PTSD (Nasir et al., 2021), malignant grief (Merritt, 2011), and other common mental health disorders in First Nations communities (Nasir et al., 2018).

Research into therapeutic interventions included studies on family-based interventions to address substance abuse (Munro & Allen, 2011; Calabria et al., 2014), strengths-based psychology (Kilcullen et al., 2018), and the use of new assessment tools specifically designed for First Nations clients, such as the Westerman Aboriginal Symptoms Checklist – Youth (WASC-Y) mental health screener (Stathis et al., 2012).

It is important to note that this research into therapeutic interventions with First Nations clients is overwhelmingly qualitativeResearch into therapeutic interventions with First Nations clients is overwhelmingly qualitative.. In a systematic review of empirical psychotherapy research on Indigenous clients in Australia, New Zealand, Canada and the United States, Pomerville et al. (2016) found that of 44 studies there were only two instances of controlled outcome trials (p. 1023). It was noted that the works in the review promoted the incorporation of cultural practices into therapy and this seemed to have a positive impact on client retention, however, there was insufficient data to draw conclusions about the role of cultural practices in therapy or their effects (Pomerville et al., 2016). Pomerville et al.’s findings about improved client retention when therapy included cultural practices is however supported by the research into Aboriginal perspectives on mental health services. In a systematic review of Aboriginal participant perspectives of 33 social emotional wellbeing programs across Australia, Murrup-Stewart et al. (2019) found that Aboriginal participants wanted services to be holistic, culturally safe, and to integrate culture through Indigenous staffing and relevant cultural activities (p.171).

Certainly, the last decade has seen several notable experiments in combining Indigenous cultural activities with Western therapeutic models, such as incorporating family therapy with Dreaming stories (Neden, 2011), and combining narrative therapy with Aboriginal art (Davis, 2017). The efficacy of these approaches is however unknown, as are the First Nations client’s perspectives on the cultural appropriateness of these approaches. This apparent gap in the research literature regarding the effectiveness of cultural practices when integrated with Western psychotherapies has also been identified by Toombs et al. (2020), who noted that there have been no controlled clinical trials evaluating the effectiveness of psychological treatments for First Nations clients that integrate Indigenous cultural and spiritual healing. In response to this gap, Toombs et al. (2020) have designed a protocol for a randomised control trial with the stated aim of developing and evaluating the efficacy of an Indigenous model of mental healthcare. The randomised control trial will assess the effectiveness of a transdiagnostic cognitive-behavioural therapy that was co-designed with an Australian Indigenous community with 110 First Nations adults with depression (Toombs et al., 2020). The study appears to be one of the first of its kind and hopefully signals a new direction in research towards empirically validating Indigenised and culturally relevant models of therapeutic intervention.

Perhaps one of the most salient developments in the research of the last and current decade has been the deepening of inquiry into post-colonial models of counselling (Dudgeon & Walker, 2015; Goodman & Gorski, 2015; Coe, 2021). Scholarly debate has largely moved the goalposts from away notions of cultural competency in counselling (Wendt & Gone, 2012) towards cultural responsiveness (Smith et al., 2020; Hutton & Sisko, 2020) and cultural safety (Curtis et al., 2019; Freire, 2022). Where cultural competency emphasises the need for mental health providers to learn the cultural customs of their clients, cultural safety is about acknowledging the barriers to effective practice arising from power imbalances in clinical and therapeutic contexts (Curtis et al., 2019). Cultural safety places the power in the hands of the client to determine whether a therapeutic encounter is culturally safe by examining the culture of the clinician and clinical environment rather than the culture of the patient (Curtis et al., 2019).

Critical Analysis

Research into First Nations counselling has changed dramatically over the decades, as have actual counselling practices. From the 1970s and 1980s when very little research was conducted on the topic and when almost no mental health services, except for alcohol rehabilitation programs, were tailored for First Nations peoples, to the present day, when publications and studies on the topic exceed the scope of this paper. While more recent studies on counselling services for First Nations clients tend to express a clear preference for the incorporation of cultural practices, there is a lack of research on the clinical effectiveness of combining cultural practices with Western models of therapy. This presents limitations to counsellors working with First Nations clients who are also required to use evidence-based practice. Without empirical evidence to guide counsellors on effective ways to include cultural practices in therapy, there is significant risk that culturally responsive practice will continue to be poorly understood and applied (Kendall & Barnett, 2015). For non-Indigenous therapists, fear of unethical or culturally inappropriate practice, which may be warranted due to the risks it would pose to the client, the therapeutic relationship, and the profession at large, may also prevent the counselling profession from progressing into the realm of effective multicultural counselling.

Growing self-reflexivity within the counselling profession and the increase in decolonising discourse and practice has led to an increased awareness of the importance of listening to the voices of First Nations peoples on matters that affect them. How mental health services are delivered ought to be a key area of listening, and while some research has been conducted into First Nations perspectives about counselling services, overall, there is a dearth of literature on the topicHow mental health services are delivered ought to be a key area of listening, and while some research has been conducted into First Nations perspectives about counselling services, overall, there is a dearth of literature on the topic.. What the research is however clear on is that Aboriginal and Torres Strait Islander peoples access mental health services at a significantly lower rate than the non-Indigenous population, despite being at much higher risk of psychological distress and suicide (Edwige et al., 2021). The research is also clear that a primary barrier to First Nations peoples accessing mental health services is lack of cultural safety (Fredericks, 2010). Because cultural safety is defined not by the therapist or non-Indigenous ‘expert’, but by the Indigenous client, it is imperative that research into culturally safe and responsive counselling is aimed at listening to the client’s perspective (Sharmil et al., 2021).

Future Research Directions and Benefits

I propose a research project that examines First Nations children and youth’s perspectives of the cultural safety of counselling that incorporates the deep listening practice of dadirri in a natural, outdoor setting. Dadirri is a Ngan’gikurunggurr word for deep listening and quiet still awareness (Ungunmerr, n.d.). As a practice, dadirri bears some similarity to grounding exercises commonly used in counselling to centre the client in the present moment through engagement with the senses, but dadirri also possesses a contemplative dimension in its emphasis on listening with the whole of the self to both the self and to Country (Ungunmerr, n.d.). Comparisons can be made between dadirri and the counselling process more generally, as both are essentially practices of deep listening (Ungunmerr, n.d.), and these points of similarity may serve as a strong foundation for combining these practices in an authentic and complimentary way.

Dadirri is ideally practiced outdoors, and this is one reason for my research proposal’s inclusion of an outdoor therapeutic setting. Another reason for this proposed setting change is that outdoor settings provide a more culturally neutral environment for the therapeutic encounter, which may, it is hypothesised, increase the cultural safety of First Nations clients. Not only is Country a critical resource in the spiritual and mental wellbeing of First Nations peoples, but the symbols and processes of historically colonizing and neo-colonizing institutions such as schools and medical centres are less visible to the client and counsellor outdoors. This provides the opportunity for a different kind of therapeutic encounter in a space that does not automatically reinforce the power differences already at play if the counsellor is non-Indigenous.

The research approach known as participatory action research-dadirri-ganma developed by Sharmil et al. (2021) would serve as a guide in constructing and conducting the research within a decolonizing framework. The aim of Sharmil et al.’s 2021 study was to develop an authentically representative research process, which was achieved through yarning (consulting) with senior Elders of the community to co-design a research process that combined a Western approach (participatory action research) with the Aboriginal methodologies dadirri (deep listening) and ganma (two-way knowledge sharing) (Sharmil et al., 2021, p.1).

This primary research would be carried out as a cohort study, interviewing a group of First Nations school children who have received counselling within the usual context of the school counsellor’s office without the use of dadirri, and interviewing another group of First Nations school children from the same school who have received counselling from the same counsellor using dadirri in a natural outdoor setting. Follow-up interviews at 1- and 2-year intervals would be carried out to examine the longer-term impacts of the counselling, also allowing for possible changes in client perspectives over time.

The potential benefits of the proposed research are manifold. The proposed study would be a step towards addressing the lack of research about First Nations clients’ perspectives of their counselling experiences, particularly pertaining to cultural safety, the use of cultural practices within counselling, and the therapeutic environment. This is important if the counselling profession in Australia is truly committed to listening to its clients and delivering effective multicultural practice.

This study could also help pave the way for further research into the use of other First Nations practices within counselling, such as the two-way knowledge sharing process, ganma. While the proposed study focusses on First Nations children and youth, the findings of the research could be used to hypothesise similar effects for First Nations adults and could serve as an impetus to carry out similar studies with adult populations.

According to Dr Miriam Rose Ungunmerr, the leading proponent of dadirri, dadirri is a healing practice needed by the entire nation, not only Aboriginal people (Ungunmerr, n.d.). While the proposed study focusses on client reports of the cultural safety of their counselling sessions, data gathered about the client’s perspectives of the effectiveness of the therapy may also be used to hypothesise the possible effects of using dadirri and an outdoor setting in counselling non-Indigenous clients. This study may also provide an opportunity for the emergent field of ecopsychology to intersect respectfully with Aboriginal and Torres Strait Islander culture, creating the basis for a uniquely Australian ecopsychology that may more broadly promote reconciliation and healing within the collective Australian psyche.

Lastly, but most importantly, this research could have far-reaching implications for how effectively counselling services in Australia address the needs of First Nations children and youth. It is highly unlikely that the mental health of First Nations people will improve without mental health services that are adequately equipped to provide culturally safe care. And culturally safe care will not happen without deeply listening first to what Aboriginal and Torres Strait Islander clients say they need from mental health care providers. This research aims to do just that, and thereby seeks to be part of a broader shift within the counselling profession in Australia towards a stance of true cultural humility.


Approaches to counselling Aboriginal and Torres Strait Islander clients have changed significantly over time. The counselling profession clearly does not exist outside of its broader social context, and as could be expected, a chronological review of the literature on approaches to First Nations counselling in Australia mirrors Australian society’s changing attitude to First Nations peoples and cultures more generally. As society has become more aware of the impacts of colonisation on First Nations peoples, so has the counselling profession. As post-colonial discourses now begin to move beyond the halls of academia and the margins of activism into places of work, healthcare, and schools, it is critical that these discourses do not stop short at words, and that these words do not impair our capacity to listen. The proposed research into First Nations children and youth’s perspectives on the cultural safety of the counselling they currently experience, versus the cultural safety of counselling sessions that incorporate dadirri deep listening in a natural, outdoor therapeutic space could be of significant benefit to not only the mental health outcomes of these children and youth, but also to the counselling profession and wider Australian community.


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