Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 018
Guide XI-018

Javanese jamu and Indonesian dukun

700Java, Indonesia
A 36 · L 55 · M 916 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: jamu as described in the UNESCO Representative List entry "Jamu wellness culture" (Indonesia, 2023, Decision 18.COM 8.b.33) and as regulated by Indonesia's food and drug authority BPOM (Regulation 25/2023); dukun as described in Indonesian ethnography (Arini, Alimi and Gunawan 2016, building on Geertz's Javanese typology) and in Indonesian traditional-health law (PP 103/2014 and its ministerial regulations); the psychotherapist's own work follows the DSM-5-TR Cultural Formulation Interview (CFI) and Kleinman's explanatory-model approach.

This entry is not a psychotherapy. It covers two living Indonesian healing traditions and the psychotherapist's culturally responsive work alongside them. A psychotherapist does not make jamu, prescribe it, or act as a dukun. Your role is to understand what these traditions mean to the client and family, assess safely, collaborate when the client wishes, and safeguard where harm occurs. [source: UNESCO ICH; APA CFI]

  • Jamu. UNESCO describes jamu as "a form of herbal medicine and treatment" practised in Indonesia since the eighth century. It is grounded in a hot–cold balance: hot illnesses are treated with cold-natured remedies and the reverse, so that health is a balance of hot and cold in the body. Its stated aims are boosting immunity and maintaining health. UNESCO links it to values of confidentiality, trust and social ties, and tags it with concepts including holism, happiness, family and women workers. [source: UNESCO ICH]
  • Dukun. "Dukun" is a broad Indonesian and Javanese term for many kinds of practitioner, not one role. Geertz's study of a Javanese town listed 13 types, as summarised by Arini et al. These include birth attendants (dukun bayi), massage practitioners (dukun pijat) and prewangan healers who work with supernatural helpers (rewang). Other dukun, such as suwuk healers, work mainly through prayer. [source: Arini et al. 2016; Geertz 1960 via Arini et al. [uncertain: not verified]] The same word also appears in dukun santet, a person locally believed to practise harmful sorcery. Accusations of this kind were central to the 1998 Banyuwangi killings. [source: Brown, Inside Indonesia]
  • How change happens, as the traditions hold it. In jamu, health means restoring hot–cold balance and strengthening the body. [source: UNESCO ICH] In dukun healing, as Arini et al. describe it using Turner's ideas, illness puts a person in an in-between state, and healing returns them to social life. Success depends on trust and on cocog-cocogan, the felt fit between healer and patient. [source: Arini et al. 2016] These are attributed accounts; this guide neither affirms nor dismisses them.
  • How change happens in your own work. Clients engage, and harm is avoided, when the clinician understands the client's own model of the problem and where they seek help. That understanding becomes part of the formulation and the plan. [source: APA CFI; Kleinman et al. 1978 via Dinos et al. 2017]

2. Framework

2a. The traditions and who holds authority

  • Jamu as cultural heritage. UNESCO names the bearers as jamu makers and the people who make, distribute, cultivate and consume the ingredients. People of all ages take jamu. Most makers are adult women, who often grow their own herbs and tailor recipes to each customer's age, lifestyle and health concerns. Knowledge passes informally within families and among neighbours. Some practitioners are self-taught, and jamu is also taught in universities. [source: UNESCO ICH]
  • Jamu as a regulated product. BPOM (Badan Pengawas Obat dan Makanan) registers obat bahan alam (natural-ingredient medicines) in three main categories [source: BPOM Reg. 25/2023, Arts. 1–2]:
    • Jamu: based on traditional knowledge or Indonesian cultural heritage.
    • Obat Herbal Terstandar (OHT, standardised herbal medicine): safety and efficacy shown in preclinical testing, with standardised raw materials.
    • Fitofarmaka: safety and efficacy shown in both preclinical and clinical testing.
    Registrants must guarantee their products contain no bahan kimia berkhasiat obat (pharmacologically active chemicals, "BKO"), and labels must be "lengkap, objektif, dan tidak menyesatkan" (complete, objective and not misleading). [source: BPOM Reg. 25/2023, Arts. 9, 68] BPOM has withdrawn adulterated products. In 2015 it withdrew 54 traditional medicines containing BKO, mostly paracetamol and phenylbutazone, and it reported 115 distribution cases taken to court over the previous two years. [source: BPOM 2015]
  • Traditional health services and healers. Under Health Law 17/2023, traditional services are either skill-based or herbal-based (Art. 160). PP 103/2014 (Art. 7) sorts them into empiris (benefit and safety shown by experience), komplementer (scientifically proven) and integrasi (combined with conventional care). Empirical healers (penyehat tradisional) register with an STPT (Surat Terdaftar Penyehat Tradisional), and the STPT can be cancelled as a sanction. Traditional health workers hold an STRTKT registration and an SIPTKT practice licence. [source: Hukumonline 2024] Which specific dukun roles register in practice is [uncertain: not verified].
  • Authority within dukun practice. In Arini et al.'s Kediri study, suwuk ability is learned from experienced teachers and passed to disciples through a pledge of mutual obligation. Prewangan ability is inherited through descent. Standing comes from clients' respect and trust. Some Islamic reform movements reject prewangan practice as religious deviation, and its clientele has fallen as a result. [source: Arini et al. 2016] Islamic teachers (ustad) may perform ruqyah (Islamic exorcism), which is a separate, religious route. [source: Anjara et al. 2021]
  • Who you defer to. On jamu product safety, defer to BPOM and the client's prescriber or pharmacist. On a healer's legal standing, defer to Indonesian health authorities. On the meaning and legitimacy of a dukun's or religious healer's work, defer to the client, their family and the healer, and to religious authorities the client recognises. [synthesis]

2b. The psychotherapist's working framework [synthesis, built on APA CFI]

The CFI does not prescribe phases. The structure below is this guide's own synthesis. The CFI can be used at the first evaluation, later in care, or repeatedly. [source: APA CFI Supplementary Modules]

  1. Engagement and cultural assessment (sessions 1–2, within the normal intake). Goals: give the core CFI, start an informant interview if family is involved, and screen for safety, including pasung or restraint, sorcery-accusation risk and medical red flags. Move on once you can state the client's own name for the problem, their causal ideas and their help-seeking map. APA gives no time for the core CFI; field-trial estimates of 15–20 minutes are [uncertain].
  2. Explanatory model and help-seeking map (sessions 2–3). Goals: use the supplementary modules as needed (Explanatory Model; Spirituality, Religion and Moral Traditions; Coping and Help-Seeking), take a jamu and herbal-product history for the prescriber, and identify any dukun, kyai, ustad or ruqyah involvement. Move on once the client confirms your summary of their model.
  3. Collaborative formulation and plan (around session 3). Goals: write a two-model formulation, decide with the client whether and how to coordinate with healers, religious leaders or the prescriber, and record consent. Move on once the plan is agreed and consent is documented.
  4. Parallel care and active treatment (ongoing). Goals: deliver your evidence-based treatment for the presenting disorder, keep reviewing traditional help-seeking without judgement, and monitor safety.
  5. Integration and review. Goals: help the client make sense of healing experiences, repeat CFI modules when meaning or help-seeking changes, and plan relapse prevention that includes the client's cultural resources.

Format: individual sessions, with family or informant sessions when the client agrees. Use a trained interpreter or cultural broker when you do not share the client's language, whether Indonesian, Javanese or another regional language. [synthesis]

3. Guiding principles

  • You are not a practitioner of the tradition. Never offer jamu, rituals or spiritual diagnoses. Your expertise is assessment, psychotherapy and coordination. [synthesis]
  • The client's model comes first. Elicit their words for the problem before using diagnostic terms, and record those words in the notes. [source: APA CFI; Kleinman via Tanenbaum handout]
  • Attribute; neither affirm nor dismiss. Speak of spirits, santet and rewang as the client or tradition holds them ("in your family's understanding…"). [synthesis]
  • "Dukun" covers many roles. A birth attendant, a massage practitioner, a prayer healer and an alleged sorcerer are different. Ask which one is meant. [source: Arini et al. 2016]
  • Mixing care is common and rational. Patients often see doctors for check-ups and dukun for cures, and choose healers for trust and results. Expect parallel help-seeking, and do not frame it as non-compliance. [source: Arini et al. 2016; Anjara et al. 2021]
  • Religious identity shapes help-seeking. Many Muslim clients stopped seeing shamans because it felt against their faith, and prayer and ruqyah may be preferred. Explore without assuming. [source: Anjara et al. 2021]
  • Safety from adulterated products. Some jamu products have contained undeclared drugs. Pass the client's product information to the prescriber or pharmacist, and never advise on medicines yourself. [source: BPOM 2015; BPOM Reg. 25/2023]
  • Cultural normativity is not an automatic exemption. A broadly accepted possession or trance practice is not a disorder. Distress, impairment and involuntary, unwanted states still need assessment. [source: DSM-5 via PMC9199574; ICD-11 6B62/6B63]
  • Safeguarding overrides cultural deference. Shackling (pasung), chaining, forced "treatment" and sexual violence in healing settings are abuses, whatever their framing. [source: HRW 2016; Pergub DIY 81/2014]
  • Sorcery accusations carry lethal risk. A belief that someone is a dukun santet can endanger the accused. Assess risk to both the client and the accused. [source: Brown, Inside Indonesia]
  • Consent and confidentiality govern every contact with healers. Contact a healer or religious leader only with the client's explicit, specific consent. UNESCO notes that jamu culture itself values confidentiality and trust. [source: UNESCO ICH; synthesis]
  • Fit matters (cocog). Clients may judge any helper, you included, by felt compatibility. Name the working relationship openly. [source: Arini et al. 2016 for the concept; application is synthesis]
  • Humility about scarce services. Indonesia has roughly one psychiatrist per 300,000–400,000 people, so healers and families often carry the load of care. Work with this reality. [source: HRW 2016]

4. Intervention inventory

Every intervention below is the psychotherapist's own culturally responsive work. None of it involves preparing, recommending or giving jamu, or taking part in dukun healing. Example language is illustrative wording, not text from the sources.

4.1 Cultural humility and self-examination

  • Purpose: to catch your own assumptions, whether dismissive ("superstition") or romanticising ("natural therapy"), before they reach the client. Do this before the first session and keep doing it throughout. [synthesis]
  • Steps:
    1. Write down what you assume about jamu, dukun, Javanese spirituality and Islam in Indonesia, and where those assumptions came from.
    2. Mark which assumptions came from media coverage of sorcery or "black magic" and which from sources.
    3. Notice your reaction to herbal products and to spirit explanations. Decide in advance that you will attribute these, not argue them.
    4. Plan consultation with a colleague who has Indonesian cultural knowledge, or with a cultural broker. [synthesis]
  • Example language (illustrative, to yourself or in supervision): "Am I treating the client's account of santet as a symptom before I have assessed it?"
  • Watch for: urges to correct the client's model; curiosity that feels voyeuristic about spirit practices. It is working when your notes record the client's terms neutrally and the client tells you more over time.

4.2 Core Cultural Formulation Interview (DSM-5-TR)

  • Purpose: to understand the problem from the perspective of the client and their social network: what it means, sources of help, and what they expect from services. Use it at intake with every client, not only those who "seem cultural." APA says it is designed for any clinician, with any individual, in any setting. It supports clinical judgement and is not the sole basis for diagnosis. [source: APA CFI; APA DSM-5-TR Section III]
  • Steps (16 questions in four domains; paraphrase rather than reproduce):
    1. Cultural definition of the problem: how the client describes the problem and what troubles them most.
    2. Cultural perceptions of cause, context and support: what they think caused it, what makes it worse and what helps, and how their background or identity bears on it.
    3. Self-coping and past help seeking: what they have tried, including healers, religious help and products such as jamu, and what got in the way.
    4. Current help seeking: what they want now, and anything about you or the service, such as language or experiences of discrimination, that could affect care.
    5. Note which supplementary modules to add (see 4.4). The core form shows which module expands each subtopic. [source: APA CFI; APA Supplementary Modules]
  • Permission: clinicians may reproduce the CFI for use with their own patients. Translating or modifying it needs APA permission. [source: APA CFI] An official Indonesian translation is [uncertain: not verified].
  • Example language (illustrative): "People understand problems like this in different ways. In your own words, how would you describe what is happening?" / "Some people in Indonesia see a doctor, a dukun, an ustad, or take jamu, or several at once. What have you tried so far?"
  • Watch for: short, guarded answers about healers (fear of judgement); answers in religious terms that you pass over. It is working when the client gives their own term (for example, banyak pikiran, "thinking too much") and names helpers outside the clinic.

4.3 CFI Informant Version with family

  • Purpose: to gather the family's view when relatives are involved in decisions or care. This matters where family consent and family choice of healer are common. The Informant Version has 17 questions: Q1 covers the informant's relationship to the client, then the same four domains follow. [source: APA CFI Informant Version]
  • Steps:
    1. Get the client's consent for a family interview and agree what may and may not be shared.
    2. Interview the informant separately where possible.
    3. Compare the client's and family's models, and note where they differ (for example, the client says "stress" and the family says "spirits").
    4. Bring the differences back to the client with care. [source: APA CFI Informant Version; steps 1, 3 and 4 are synthesis]
  • Example language (illustrative): "You know [client] well. What do you think has been happening to them, and what has the family done to help?"
  • Watch for: the family speaking for the client; hints of restraint or confinement at home (see 4.13). It is working when you can state both models and the client agrees with your summary.

4.4 CFI supplementary modules relevant here

  • Purpose: in-depth assessment of particular areas. The modules can be add-ons to the core CFI or standalone tools, and can be used at the first evaluation, later in care, or repeatedly. [source: APA Supplementary Modules]
  • Modules to consider:
    • Explanatory Model: when causes involve spirits, santet or hot–cold imbalance.
    • Spirituality, Religion and Moral Traditions: when Islam, kejawen or other religious identity shapes the problem or help-seeking. [kejawen as a term: synthesis [uncertain: not verified]]
    • Coping and Help-Seeking: to map dukun, ustad, ruqyah and jamu use.
    • Cultural Identity: language, region, ethnicity, religion.
    • Immigrants and Refugees: for migrant workers, students or diaspora clients.
    • Patient–Clinician Relationship: when trust or fit (cocog) is in question.
    • Social Network, Psychosocial Stressors, Caregivers: when family carries the care. [source: APA Supplementary Modules for the module list; matching modules to situations is synthesis]
  • Steps: choose one or two modules per session, give them conversationally, and summarise back. [synthesis]
  • Example language (illustrative): "You mentioned prayer has helped more than anything. Can we spend some time on the part faith plays in this for you?"
  • Watch for: fatigue from long questioning; it is better to spread modules across sessions. It is working when the module changes your formulation or plan.

4.5 Kleinman explanatory-model questions

  • Purpose: a short, flexible alternative or supplement to the CFI Explanatory Model module, useful in brief or medical settings. [source: Kleinman, Eisenberg and Good 1978 via Dinos et al. 2017; Tanenbaum handout]
  • Steps (eight areas, paraphrased): ask what the client calls the problem; what caused it; why it started when it did; what it does to them and how it works; how severe it is and whether it will be short or long; what treatment they think they should receive; the main problems it has caused; and what they fear most. [source: Tanenbaum handout]
  • Example language (illustrative): "What do you think started this, and why now?" / "What worries you most about where this is going?"
  • Watch for: several co-existing models (for example banyak pikiran, weak faith and santet all at once, as Anjara et al. found among Yogyakarta patients). Do not force a single cause. It is working when the client's fears become explicit and you can plan around them. [source: Anjara et al. 2021]

4.6 Mapping help-seeking: dukun, religious healers and family

  • Purpose: to know who else is helping, what they advise, and whether that advice supports or conflicts with treatment. Use at intake and whenever symptoms change. [synthesis; grounded in CFI Domain 3]
  • Steps:
    1. Ask in a normalising way about each kind of helper: doctors, dukun (and which kind), orang pintar ("clever person", a common term for shamans), ustad or kyai, ruqyah, family elders, and jamu makers or sellers. [source: Anjara et al. 2021 for orang pintar, ustad, ruqyah; Arini et al. 2016 for dukun types]
    2. For each, ask what they said the problem was, what they advised, what the client found helpful, and what costs or demands were involved.
    3. Ask specifically whether any helper advised stopping medicines or medical care, or recommended confinement.
    4. Record the map without evaluative language.
  • Example language (illustrative): "Many people I see have also visited a dukun or an ustad. Have you? What did they say was going on?" / "Did anyone suggest stopping the medicine from the doctor? I ask so the doctor and I can work with it, not to criticise."
  • Watch for: shame (Anjara et al. found some clients stopped seeing shamans because it felt against their faith, or because shamans seemed to be after money); a healer's demands for large payments; advice to stop psychiatric care. It is working when the client volunteers new contacts with healers unprompted. [source: Anjara et al. 2021]

4.7 Jamu and herbal-product history (for the prescriber)

  • Purpose: to make sure products the client takes are known to the medical team, given BPOM's warnings about adulterated products. This is information-gathering and routing only. You do not give advice on any medicine or herb. [source: BPOM 2015; BPOM Reg. 25/2023]
  • Steps:
    1. Ask whether the client takes jamu or other herbal products. Ask whether it is home-made, from a seller, or packaged, and what it is meant for (for example health, energy, pain or sleep).
    2. For packaged products, ask the client to bring the pack or a photo showing the name, category label (jamu, OHT or fitofarmaka) and BPOM registration number, for the prescriber or pharmacist. [source: BPOM Reg. 25/2023 for categories; bringing the pack is synthesis]
    3. Pass the information to the prescriber or pharmacist with consent. Do not judge safety yourself.
    4. If the client reports new symptoms after a product, such as stomach pain, black stools, rash, jaundice or swelling, route them urgently to medical care. BPOM lists bleeding, Stevens–Johnson syndrome, hepatitis and kidney failure as risks of the undeclared phenylbutazone it found, and liver damage for paracetamol. [source: BPOM 2015]
    5. Never advise starting, stopping or changing any medicine or jamu. [synthesis]
  • Example language (illustrative): "Jamu is part of many families' routines. Could you bring the packet next time so your doctor knows everything you're taking? That helps keep everything safe together."
  • Watch for: the client hearing the question as criticism of their heritage; reliance on painkiller-type jamu for chronic pain, which may hide undeclared drugs. It is working when the prescriber has the full list and the client keeps telling you about products.

4.8 Working with idioms and cultural concepts of distress

  • Purpose: to use the client's idiom as a bridge rather than translating it straight into diagnosis. DSM-5-TR describes cultural concepts of distress as idioms, explanations or perceived causes, and syndromes, revised to avoid stigmatising or generalising language. [source: APA DSM-5-TR Section III]
  • Indonesian idioms reported in Indonesian studies (not DSM-5-TR glossary entries):
    • banyak pikiran ("thinking too much"), the most common explanation among Yogyakarta primary-care patients;
    • spirits or jinn entering a person with an "empty mind" or who is daydreaming;
    • santet (sorcery sent by envious others);
    • weak religious practice or distance from God;
    • kesurupan (possession or trance). [source: Anjara et al. 2021; Hidajat 2008] None of these is among the DSM-5-TR glossary concepts listed in secondary sources (for example ataque de nervios, susto, khyâl cap, kufungisisa). Use them as the client's explanations or idioms, not as DSM syndromes. [source: UNMC DSM-5-TR slides; [uncertain] glossary contents]
  • Steps:
    1. Adopt the client's term in your reflections.
    2. Ask what the idiom means to them: its signs, its causes, and what usually helps.
    3. Screen for the underlying symptoms (mood, anxiety, trauma, psychosis) separately and gently.
    4. Link the idiom to the plan (for example, work on banyak pikiran as a shared target for worry interventions). [synthesis]
  • Example language (illustrative): "When you say banyak pikiran, what is that like day to day? Sleep, appetite, your body?"
  • Watch for: idioms masking severe depression or suicidality, so always complete risk assessment; over-reading an idiom as exotic. It is working when the client uses the shared term to report progress.

4.9 Distinguishing culturally normative trance and possession from disorder

  • Purpose: to avoid both pathologising an accepted experience and missing illness, when a client or family reports kesurupan (possession or trance) or a spirit explanation. [source: DSM-5 via PMC9199574; ICD-11]
  • Diagnostic anchors:
    • DSM-5, dissociative identity disorder. Identity disruption "may be described in some cultures as an experience of possession." The criteria exclude a disturbance that is "a normal part of a broadly accepted cultural or religious practice." DSM-5-TR keeps these points in substance [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299]; whether it keeps the exact wording is [uncertain].
    • DSM-5, other specified dissociative disorder (dissociative trance). This is an acute narrowing or loss of awareness of surroundings. It is excluded when the trance is a normal part of a broadly accepted collective cultural or religious practice. [source: PMC9199574]
    • ICD-11 6B62 trance disorder and 6B63 possession trance disorder. Both require the state to be involuntary and unwanted, outside accepted cultural or religious practice, and causing significant distress or impairment. In 6B63, the customary identity is replaced by an external "possessing" identity. [source: findacode ICD-11 mirror; PMC9199574]
  • Steps:
    1. Ask where and when the episodes happen, and whether they occur inside a recognised practice or community setting or outside it.
    2. Ask whether the client experiences them as wanted or unwanted, and as controllable or not.
    3. Ask how the client's community and religious authorities regard them. With consent, consult a cultural broker or a community member the client trusts.
    4. Assess distress, impairment, duration and recurrence, and screen for psychosis, epilepsy or other medical causes, substance use and trauma.
    5. For group episodes in schools or workplaces (kesurupan massal), note Hidajat's account. She reports outbreaks from 2004 onward among mostly female schoolchildren and factory workers, which she linked to stress, exhaustion, overwork, underpayment and trauma. Assess the individual and the setting's stressors. [source: Hidajat 2008]
  • Example language (illustrative): "When this happens, is it something you or your community expect, or does it come when you don't want it?" / "How do the people you trust at the mosque or in your village understand these episodes?"
  • Watch for: functional decline, self-harm during episodes, abuse histories, and persistent hallucinations outside episodes. It is working when your formulation names both the cultural meaning and any disorder you find, and the client accepts both.

4.10 Sorcery (santet) beliefs and accusation risk

  • Purpose: to respond to a client who believes they are a victim of santet, or that a named person is a dukun santet, and to manage risk to everyone involved. [source: Anjara et al. 2021; Brown, Inside Indonesia]
  • Context: in Banyuwangi, East Java, in 1998, mobs killed people suspected of being dukun santet. A Nahdlatul Ulama team counted 143 killed in Banyuwangi and 105 more in neighbouring regions, and some killings were paid revenge. [source: Brown, Inside Indonesia] Anjara et al.'s participants described envious people sending spirits through santet. [source: Anjara et al. 2021]
  • Steps:
    1. Explore the belief as an explanation: who, why, what signs, and what the client's family and religious leaders say. Do not debate whether santet is real. [synthesis]
    2. Assess the client's distress, functioning and safety, including suicidality and fear-driven avoidance.
    3. Ask directly whether anyone plans to confront, expose or harm the suspected person. If the risk is credible, follow your local duty-to-protect and police reporting procedures. [synthesis]
    4. Distinguish a shared cultural attribution from a fixed, idiosyncratic persecutory belief. Ask whether family and community hold the same view. [synthesis]
    5. Work on the underlying stressors, such as conflict, envy or loss, alongside the attribution.
  • Example language (illustrative): "You feel this is santet from someone who envies you. What does your family think? Has anyone talked about doing something to that person?"
  • Watch for: escalating anger toward a named person; family pressure for retaliation; isolation. It is working when distress drops and the client can name coping options that harm no one.

4.11 Collaboration and referral with healers and religious leaders (when the client wishes)

  • Purpose: to coordinate care with a healer or religious leader the client chooses, where this helps the client and is safe. A formal Indonesian programme of psychotherapist–dukun collaboration is [uncertain: not verified]. Collaboration evidence comes from elsewhere. The COSIMPO cluster randomised trial in Nigeria and Ghana (Gureje et al., The Lancet 2020) found that collaborative care between traditional or faith healers and primary health care workers reduced psychotic symptoms (PANSS) and harmful practices more than usual care [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839]. A Ghana prayer-camp trial (Ofori-Atta et al., Br J Psychiatry 212(1)) found that adding psychiatric medication to prayer-camp care reduced symptoms but did not significantly reduce days in chains [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial]. WHO's strategy 2014–2023 aims to integrate traditional and complementary medicine and its practitioners into health systems where safe. [source: WHO strategy page]
  • Steps:
    1. Let the client lead. Ask whether they want any contact between you and the healer or religious leader, and what for.
    2. Get explicit, specific, written consent covering what you share, with whom, and for how long.
    3. Where relevant, note whether a traditional practitioner holds registration (STPT for empirical healers) as a factual safety point. Registration does not stand in for the client's own judgement of legitimacy. [source: Hukumonline 2024 for STPT]
    4. In any contact, ask how the healer understands the problem and what they advise. Share only what was agreed. Look for shared goals such as sleep, calm, family harmony and continued medical care.
    5. Agree red lines: no confinement or restraint, no stopping of prescribed treatment without the prescriber, and no harm. Document them.
    6. Religious leaders the client respects may support continued care. Anjara et al. note that religious leaders helped shift care-seeking toward modern medicine. [source: Anjara et al. 2021]
    7. Never refer to, recommend or arrange ritual practices yourself. Never ask a healer to perform anything. [synthesis]
  • Example language (illustrative): "Would it help if I spoke with your ustad, so we're pulling in the same direction? You decide what I can say."
  • Watch for: the client feeling pushed toward or away from healers; healers demanding exclusivity; payment pressure. It is working when the client experiences one coherent plan.

4.12 Interpreters and cultural brokers

  • Purpose: accurate communication across Indonesian, Javanese or other regional languages, and help in reading cultural meaning. [synthesis; CFI Domain 4 names language barriers]
  • Steps:
    1. Use trained interpreters, not family members, for assessment.
    2. Brief the interpreter on confidentiality, and on rendering spirit and sorcery terms literally rather than "cleaning them up."
    3. Check whether the client minds an interpreter from their own community, because of gossip and sorcery-accusation risks.
    4. Use a cultural broker separately from the interpreter where possible, with consent. [synthesis]
  • Example language (illustrative): "Please translate exactly what [client] says, including words about spirits or santet; I want their own words."
  • Watch for: the interpreter softening or editorialising; client reticence. It is working when the client corrects the interpretation freely.

4.13 Safeguarding: pasung, restraint and abuse in healing settings

  • Purpose: to recognise and act on shackling or confinement and on abuses in healing centres. Indonesia banned pasung in 1977, yet about 57,000 people have been shackled or confined at least once, and about 18,800 were thought to be in pasung when HRW reported in 2016. HRW documented chaining, forced "treatments" and sexual violence in faith-healing centres. Indonesia's government ran an "Indonesia Free from Pasung" programme, with a target first set for 2014 and later extended to 2019. [source: HRW 2016]
  • Local procedure example (Yogyakarta, Pergub DIY 81/2014):
    • Families and community must report temporary restraint to a puskesmas (primary health centre) worker within 24 hours. Health workers follow up within 24 hours.
    • Restraint that threatens life, risks permanent injury or degrades dignity is prohibited.
    • Health workers verify the case, give first aid, release the person, assess needs and refer. Refusals by families go to a sub-district team. [source: Pergub DIY 81/2014, Arts. 12–13, 16, 18, 21] Other provinces have their own rules [uncertain: not verified].
  • Steps:
    1. Ask every family that cares for a seriously ill member how they manage dangerous moments, including locking in, tying or chaining.
    2. Ask clients who have stayed at healing centres about restraint, seclusion, forced bathing or massage, and sexual contact.
    3. If restraint or abuse is current, follow your jurisdiction's adult or child safeguarding and reporting law. In Indonesia that means the puskesmas pathway in the regional regulation. [source: Pergub DIY 81/2014; synthesis]
    4. Work with the family on alternatives (crisis plan, medical review, community support), because HRW found that released people often return to pasung without follow-up. [source: HRW 2016]
  • Example language (illustrative): "When things get very hard at home, some families feel they have no choice but to lock someone in or tie them. Has anything like that happened?"
  • Watch for: minimised injuries; family exhaustion; a healer controlling admission and discharge, which HRW reports. It is working when restraint stops and a crisis plan is in place.

4.14 Working with families

  • Purpose: families often decide on care and choose healers first. HRW notes beliefs that mental illness comes from spirits, sin or curses lead families to healers before doctors. Indonesia's 2014 Mental Health Act lets families admit people without consent. [source: HRW 2016]
  • Steps:
    1. Use the Informant CFI (4.3).
    2. Acknowledge the caregiving burden.
    3. Offer psychoeducation framed alongside the family's beliefs, not against them. Anjara et al. recommend culturally and religiously aligned education. [source: Anjara et al. 2021]
    4. Agree shared goals and warning signs.
    5. Respect the client's own decisions where they have capacity. [synthesis]
  • Example language (illustrative): "You've been carrying a lot. Alongside the help from your kyai, here's what the medical side can add."
  • Watch for: coercion of the client; disagreements between relatives about healers. It is working when the family joins the crisis plan.

4.15 Integrating healing experiences

  • Purpose: to help the client make sense of a visit to a dukun, a ruqyah or a jamu routine, and any feelings it left: relief, fear, guilt or debt. [synthesis]
  • Steps:
    1. Invite the client to describe the meaning of the experience, not its procedure.
    2. Explore what changed, and what they took from it.
    3. Address religious conflict, for example guilt that the visit went against their faith, with the help of the client's own religious frame. [source: Anjara et al. 2021 for faith-based discontinuation]
    4. Fold any helpful meaning into coping and relapse plans. [synthesis]
  • Example language (illustrative): "What did you take away from seeing the dukun? What does it mean to you now?"
  • Watch for: fear or dependence after the visit; financial exploitation; a sense of being cursed. It is working when the experience sits coherently in the client's story.

4.16 Two-model formulation and treatment plan

  • Purpose: to bring the cultural formulation and the clinical diagnosis into one agreed plan. [source: APA Section III Outline for Cultural Formulation; synthesis]
  • Steps:
    1. Write the client's model in their words: name, cause, course and preferred help.
    2. Write your clinical formulation and any diagnosis.
    3. Mark where the two overlap (for example banyak pikiran and generalised worry) and where they conflict.
    4. Agree goals both can endorse, the role of other helpers, and medical safety routes.
    5. Review the plan at each phase. [synthesis]
  • Example language (illustrative): "In your words, this is too much thinking, and maybe something sent by someone else. In my words, it looks like anxiety. Can we agree on the parts we both want to change?"
  • Watch for: the client agreeing out of politeness. Check with open questions. It is working when the client restates the plan in their own words.

5. Handling problems

The sources cited describe the traditions and the risks. Most problem-handling below is this guide's own [synthesis] unless a source is tagged.

  • The client hides healer or jamu use for fear of judgement. Normalise early: tell them many people combine doctors, dukun, ustad and jamu, which is consistent with Arini et al. and Anjara et al. Ask again later, and explain why you ask (to keep everything safe together, not to criticise). [source: Arini et al. 2016; Anjara et al. 2021; synthesis]
  • The client asks whether santet or spirits are "real." Do not rule on it. "I can't speak to that from my training, but I take seriously that this is how you and your family understand it, and I can help with the fear and the stress around it." (illustrative) [synthesis]
  • The client asks you to recommend a dukun or a jamu. Decline kindly. Say this is outside your role. Point them to people they trust in their own community or religious tradition, and to their doctor or pharmacist for products. [synthesis]
  • A healer or family advises stopping psychiatric medication, or the client stops for jamu. Do not advise on medicines. Contact the prescriber with consent and help the client voice their preferences there. Keep the alliance by focusing on shared goals. Arini et al. report that some clients reject doctors' medicines because they trust their dukun strongly. [source: Arini et al. 2016; synthesis]
  • Possible adulterated product or new physical symptoms. Route to medical care the same day for warning signs (bleeding, rash, jaundice, reduced urine). Anyone in Indonesia can report suspicious products to BPOM through HALOBPOM. [source: BPOM 2015]
  • Stuck: the client sees the problem only as spiritual and therapy as irrelevant. Revisit the explanatory model. Find a target within their model that therapy can serve, such as sleep, family conflict or worry about santet. Invite a religious leader they respect, with consent. Agree a time-limited trial of sessions. [source: Anjara et al. 2021 on religious leaders; synthesis]
  • Resistance from religious conflict (guilt about having seen a shaman). Explore within the client's religious frame. Offer to involve their ustad or kyai if they wish. Avoid taking sides between Islamic reform critiques and Javanese practice. [source: Arini et al. 2016; Anjara et al. 2021; synthesis]
  • Overwhelm when discussing sorcery or possession fears. Slow down. Ground the client in the present. Move from cause to coping. Check dissociation and risk. Do not push for details of rituals. [synthesis]
  • Non-adherence to between-session tasks. Check fit (cocog): does the task make sense within the client's model? Reframe tasks in their terms, for example a short worry-postponement practice for banyak pikiran. Simplify, or drop tasks that clash with religious observance. [source: Arini et al. 2016 for cocog; synthesis]
  • Rupture: the client feels dismissed or exoticised. Name it, apologise for the specific moment, and ask what you missed. Use the CFI Patient–Clinician Relationship module to explore trust, language and perceived discrimination. [source: APA Supplementary Modules; synthesis]
  • The family insists on a healer and refuses medical care for a severely ill relative. Assess immediate risk. Explain the medical options alongside, not instead of, the healer. Where life or safety is at risk, follow local emergency and safeguarding procedures. [synthesis]
  • Disclosure of pasung, chaining or abuse in a healing centre. Treat it as a safeguarding matter at once. Follow local law; in Yogyakarta, the puskesmas reporting route under Pergub DIY 81/2014. Plan follow-up so the person does not return to confinement, which HRW found common. [source: Pergub DIY 81/2014; HRW 2016]
  • A sorcery accusation against a named person. Assess the risk of harm to the accused, the client and the family. Follow duty-to-protect rules. Do not share the accused's identity beyond what safety requires. The 1998 Banyuwangi killings show how accusations can turn lethal. [source: Brown, Inside Indonesia; synthesis]
  • Group trance in a school or workplace. Assess individuals, not just the group. Advise the institution to reduce stressors and avoid sensational attention. Support coping and supportive relationships, as Hidajat recommends. Work with the community's own religious figures if the institution chooses to involve them. [source: Hidajat 2008; synthesis]
  • Interpreter from the client's own community. Offer an alternative interpreter. Re-state confidentiality. Watch for withheld content. [synthesis]
  • Your own discomfort or curiosity. Take it to supervision (4.1). Do not use the client to satisfy interest in esoteric practices. [synthesis]

Sources

Web sources:

Books and papers cited:

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