Tromba and bilo spirit possession (Madagascar)

Domain XI · Traditional medicine & indigenous healing · Madagascar (Sakalava; Bara)

What it is

Tromba and bilo are not therapies. They are living Malagasy spirit traditions, each with its own authorities, and a psychotherapist does not practise them.

Format

• This is a framework for the psychotherapist's culturally responsive work alongside the tradition, not a protocol of the tradition itself. Phases, session counts and transition criteria are. The CFI content is as APA publishes it.
• Engagement and cultural assessment (sessions 1-2, individual, optionally with an informant). Goal: the client's own account of the problem, its cause and the help already sought. Use the core CFI and, as needed, the Informant Version. Move on when you can state the client's explanatory model in…

Who practises it, and how they are trained or regulated

• Protestant healing, which many clients use alongside or instead of tromba: in the Fifohazana revival, lay "shepherds" (mpiandry) are commissioned by the Malagasy Lutheran Church after training and run toby healing communities under church supervision.

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

• politeness masking distrust. Working when the client can tell you when something you said felt dismissive.
• the client hiding remedies from the doctor or medicines from the healer. Working when every prescriber has the full picture.
• fear of losing community support if they disclose. Working when the client is safe and still connected to the supports they value.
• your own questions implying that only one cause is real. Working when the client explains the spirit's role and also says what they want from you.
• the urge to explain the experience away, or to romanticise it. It is working when the client corrects you freely and brings up spirit matters without being prompted.

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.