Diné (Navajo) sandpainting ceremony

Domain VIII · Creative & expressive arts therapies · Navajo Nation

What it is

Diné (Navajo) sandpaintings (dry paintings; iikááh in Navajo, per a University of New Mexico reference page) are part of religious and healing ceremonies. A Diné medicine person (hataałii) makes them inside the ceremony, and each one is begun, used and destroyed within that ceremony. They are not…

Format

• An earlier description of the Navajo traditional healing programme (started 1996 with SAMHSA funds, ongoing since 2000) set out a four-phase continuum. Officials compared its phases to residential, intensive day, outpatient and aftercare levels. Salaried traditional practitioners carried out…
• Open the door (intake and early sessions). Goal: the client knows they are free to use traditional healing and that you respect it. Move on when the client has said whether they want this to be part of their care.

Who practises it, and how they are trained or regulated

• In New Mexico, Turquoise Care (Medicaid) has covered traditional healing services for Native American members since March 2026. Services include herbs, prayers and ceremonies, are delivered through participating IHS and Tribal 638 facilities, and may happen in clinics, homes or ceremonial spaces. Patients may be referred to "certified traditional healers". The Navajo Nation reports being first to implement it.…
• Who holds authority. Religious and cultural authority belongs to the Diné people and to hatałii, who train through long apprenticeship. A Navajo Division of Health director contrasted federal interest in certification with Navajo communities' requirement of years of apprenticeship. The Navajo Nation itself supports apprenticeship: its Navajo Traditional Apprenticeship Project, overseen by the Department of Diné…
• Professional frame. No arts-therapy, counselling or psychology credential gives anyone, Diné or not, standing to make, imitate or interpret ceremonial sandpaintings. That standing comes only through Diné tradition. Art therapists (AATA/ATCB in the USA; HCPC/BAAT in the UK) and other licensed clinicians work under their own professional codes. Here those codes mean cultural humility, referral and coordination, not…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Either system being framed as "the real treatment". Listen to how the client frames it.
• Staff who treat this as an exception that needs justifying. The policy treats it as a right.
• An adult client feeling pressured into or out of ceremony. Explore this privately with them.
• Billing or attendance policies that penalise ceremony. Fix those at service level (see 4.12).
• Collecting cultural "facts" to use on clients. Learning is for your stance, not for technique.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.