This chapter proposes a way of understanding pastoral diagnosis as a process of discernment that seeks to bring into dialogue alternative ways of knowing, while at the same time being grounded in a larger interplay between knowing and unknowing, which brings a unique experience to the engagement with human distress. The idea of pastoral diagnosis that developed in the 20th century had its roots in the worldwide pattern of religious interpretive systems in general and more particularly in the centuries-old practice of pastoral care from the Judeo- Christian tradition. Implicit in pastoral diagnosis is not only a way of conceptualizing human distress but also a way of engaging human distress with a particular focus on experience. The pastoral experience implied in the process of pastoral diagnosis with its inclusion of various ways of knowing engages the primary, raw, affective aspects of “core-consciousness” that often underlie human distress.

This chapter provides an overview of traditional Native American spiritualities and life ways as systems of faith, then discusses the role and influence of Christianity, and, finally, offers implications for pastoral counseling with Native people from a culturally based perspective. In terms of faith and belief, Christianity has had the greatest influence on Native Americans. Essentially, cultural competence is critical in pastoral counseling with ethnic and spiritually marginalized groups such as Native Americans due to historical struggles, mistreatment, and a resulting potential for mistrust. Pastoral counselors must avoid making assumptions about the cultural identity of Native American clients without gathering information about both the individual’s internal and external experiences. Both verbal and nonverbal cues offer pastoral counselors a sense of a Native American client’s level of acculturation. Pastoral counselors might get involved with working on large social issues that will then indirectly affect the experience of Native American clients.