Kazakh tauyp healers and baksy

1. Introduction

Version followed: the healer typology published by the Qazaqstan tarihy portal (e-history.kz, 2016, drawing on Kabuldinov's History of Kazakhstan), cross-checked against Yermagambetova and Atanakova's 2023 cultural-anthropological typology and Penkala-Gawęcka's 2013 ethnography of post-Soviet Kazakh spiritual healing; the psychotherapist's own work follows the DSM-5-TR Cultural Formulation Interview (CFI) and its supplementary modules.

What it is. Kazakh folk healing is not a single therapy but a living set of healer roles. The national history portal describes healers collectively as tauyp (тәуіп), with specialists: dariger (дәрігер, herbalists treating with plant remedies), otashy (оташы, surgeons), synykshy (сынықшы, bone-setters who reduced dislocations) and baksy (бақсы, shamans), stating that mental illnesses were treated by the baksy. The same page notes that some healers trained in the Bukhara and Samarkand madrasahs and knew Ibn Sina's medical works, diagnosed by pulse, and passed the art down the generations. [source: e-history.kz, Healers in Kazakhstan]

Versions differ on the word tauyp. e-history.kz uses it as the umbrella term for all healers. Yermagambetova and Atanakova (2023) instead place the tәуіп among "spiritual healers" who treat through Qur'anic prayer and religious rites, alongside the baksy, the mullah (molda) and Sufi healers; they group bone-setters (synykshy), pulse-readers (tamyrshy), masseurs and the now largely forgotten otashy as "bodily healers", and diviners (shoulder-blade readers, balger, qumalaqshy, köripkel) as "magical healers" who, in their account, do not treat illness so much as advise people in uncertainty. Penkala-Gawęcka (2013) uses ta'wip for an ordinary spiritual healer, often combining healing with divination, and baqsı for the shaman. This guide uses each term as the source in question does. [source: Yermagambetova & Atanakova 2023; Penkala-Gawęcka 2013]

How change happens, as the tradition holds it. In the spiritual-healing strand, affliction is commonly linked to the ancestor spirits (aruaq, аруақ), to harmful spirits (jyn, жын), to black magic (porcha) or to the evil eye; healing restores right relations with these forces, and the healer's power is held to come from the ancestors. Penkala-Gawęcka reports that the condition anthropologists call "shamanic illness" (Kazakhs more often say a person is "pressed or smothered" by ancestor spirits) marks a person chosen by the spirits to become a healer; Soviet biomedicine reclassified these experiences as mental illness, and traditional interpretations returned after the 1990s. These are the tradition's own concepts, described here as its members hold them. [source: Penkala-Gawęcka 2013]

The psychotherapist's place. The psychotherapist does not practise any of these healing roles. The psychotherapist's work, which this guide covers, is culturally responsive assessment and therapy alongside the tradition: understanding what the client and family believe is happening, distinguishing culturally recognised experiences from disorders that need treatment, coordinating with physicians, healers or clergy the client chooses, integrating what the client experiences, and safeguarding. [synthesis; source: APA DSM-5-TR CFI]

2. Framework

This is a framework for the psychotherapist's own work, not the tradition's healing sequence (which is not described here). Session counts are illustrative. [synthesis]

Who holds authority in the tradition. Within the spiritual strand, authority is held to come from the spirits and ancestors who choose a healer; senior healers diagnose and recognise new healers, often by tracing ancestral healers in the family; legitimacy also draws on pilgrimage to shrines (mazar) and kinship with a "spiritual person". [source: Penkala-Gawęcka 2013] Islamic authority is plural: mullahs and Sufi healers practise their own healing, while the Muslim Spiritual Directorate (muftiyat) is described as generally critical of popular religious practice, and Yermagambetova and Atanakova report that under Islamic norms the "magical" healers' practice is regarded as forbidden (haram) for both healer and client. [source: Penkala-Gawęcka 2013; Yermagambetova & Atanakova 2023] The state does not license healers today: in March 2025 the Ministry of Health's Committee on Medical and Pharmaceutical Control stated that healers are people without medical education whose activity is not licensed or certified, and that the Association of Folk Healers of Kazakhstan is not a healthcare organisation and is not regulated by the Ministry. The Health Code of 7 July 2020 bans healing sessions involving two or more people, including via mass media, and makes a healer who harms health liable under the law. Licensed "traditional medicine" (e.g. herbal medicine, reflexology, manual therapy) is a separate, medically qualified field. [source: Kazinform 13 Mar 2025; NUR.KZ 3 Jul 2023] Yermagambetova and Atanakova state that the Association screens types of healing before allowing practice; this differs from the Ministry's position that the Association has no health-system role. [uncertain: sources conflict] A 2025 article reports a deputy saying healing is not defined in the Code's Article 132 and has no bylaws; the Ministry says the Code has an article defining traditional medicine and healing. [uncertain: sources conflict]

Historical note relevant to assessment. From 1990 the Republican Centre of Eastern and Contemporary Medicine in Almaty (first the Centre of Folk Medicine, under the Ministry of Health) vetted and certified healers; between 1991 and 1996 it rejected 80.5% of 2,508 candidates for "psychiatric disorders", and certified healers were barred from treating psychiatric problems, cancer, infectious disease and surgical conditions. [source: Penkala-Gawęcka 2013] Older clients and families may remember this vetting, Soviet psychiatric labelling of the "call", or both.

Phases of the psychotherapist's work [synthesis unless tagged]

Engagement and cultural assessment (sessions 1–2, 50–60 min; family session optional). Goal: understand the problem in the client's own terms. Core CFI, explanatory-model questions, healer-consultation history, language choice (Kazakh, Russian or both) and interpreter or broker if needed. [source: APA DSM-5-TR CFI; Kleinman et al. 1978 via Tanenbaum handout] Move on when you can state the client's explanatory model back in words they accept.
Differential formulation and safety (sessions 2–4). Goal: decide what, if anything, is a disorder needing clinical treatment, and what is a culturally recognised experience; screen physical and medical risks from any healing received; complete a risk assessment. Use relevant CFI modules and ICD-11/DSM-5-TR criteria. Move on when risk is assessed, medical review is arranged where needed and a shared formulation is agreed.
Collaborative plan (sessions 3–5). Goal: agree with the client which helpers are involved (psychiatrist, GP, healer, mullah, family), with written consent for any information sharing. Move on when roles are clear and safeguarding concerns, if any, are acted on.
Therapy and integration (ongoing, often 8–20 sessions; weekly then fortnightly). Goal: evidence-based treatment of any diagnosed condition, made consistent with the client's model, plus space to integrate healing experiences, family conflicts about the "call", and the history of suppression. Move on to review when goals agreed in phase 3 are met or redefined.
Review and ending. Re-run brief CFI questions on help-seeking and the relationship; plan for future crises, including which helpers the client will turn to first.

3. Guiding principles

Describe, do not adjudicate, spiritual causes. Practical meaning: record "the client understands the illness as pressure from ancestor spirits", never "spirit possession is present" or "no spirits are involved". [synthesis]
The client, not the clinician, defines the problem first. Practical meaning: start with the CFI's cultural definition of the problem before your own diagnostic questions. [source: APA DSM-5-TR CFI]
The CFI informs, it does not diagnose. Practical meaning: use the answers to shape the formulation; base diagnosis on full clinical assessment. [source: APA DSM-5-TR CFI]
Neither pathologise nor miss illness. Practical meaning: a recognised "call" can coexist with depression, psychosis or a medical condition; assess both. DSM-5-TR and ICD-11 exclude trance or possession that is part of broadly accepted cultural or religious practice, and code it only when involuntary, unwanted and impairing. [source: PMC9199574; findacode ICD-11 6B62]
Remember the Soviet legacy. Practical meaning: expect some clients to fear that disclosing spirit experiences will lead to a psychiatric label, because that is what happened historically; say plainly how you will use what they tell you. [source: Penkala-Gawęcka 2013; Kengesbekova 2024]
Authority sits inside the community. Practical meaning: do not recognise, endorse or rank healers; ask the client and their own community who is respected. [synthesis; source: Penkala-Gawęcka 2013]
Respect plural and conflicting authorities. Practical meaning: a family may include members who value the baksy and members who regard such practice as forbidden in Islam; do not take sides. [source: Yermagambetova & Atanakova 2023; synthesis]
No healing procedure, ritual or remedy advice from the therapist. Practical meaning: you never suggest a ceremony, a healer, a remedy or a dose, and never advise starting, stopping or changing a medicine; route medicine questions to the prescriber. [synthesis]
Safety and law are non-negotiable. Practical meaning: physical harm, harm to children, or delayed urgent care triggers safeguarding and medical action regardless of cultural framing. [source: NUR.KZ 9 Jan 2025; Kazinform 30 Apr 2026]
Consent governs all sharing and contact. Practical meaning: no contact with a healer, mullah or family member without the client's explicit, recorded consent, except where safeguarding law requires. [synthesis]
Language is part of the explanatory model. Practical meaning: offer Kazakh or Russian terms and an interpreter; some idioms lose meaning in translation. [synthesis]
Cultural humility over expertise. Practical meaning: treat yourself as a learner about this client's version of the tradition; regional and family practice varies. [synthesis]

[source for section: e-history.kz; Yermagambetova & Atanakova 2023; Penkala-Gawęcka 2013; Kazinform 2025; NUR.KZ 2023; APA DSM-5-TR CFI]

4. Intervention inventory

All interventions below are the psychotherapist's own. None of them is a Kazakh healing procedure, and none should be presented to the client as one. Example language is illustrative. [synthesis]

4.1 Cultural self-examination before and during the work

Purpose / when: before the first session with a Kazakh or Central Asian client, and whenever you notice strong reactions (fascination, scepticism, alarm) to talk of spirits or healers. [synthesis]
Steps: (1) Note your own assumptions about shamanism, Islam and "folk medicine", and about post-Soviet societies. (2) Check whether you equate spirit experiences with psychosis by default, which repeats the Soviet biomedical reclassification the ethnography describes. (3) Check the opposite pull: romanticising the baksy and overlooking risk. (4) Take these reflections to supervision or consultation. [source: Penkala-Gawęcka 2013; synthesis]
Example language (to yourself or supervisor, illustrative): "Am I listening for symptoms or for what this means to her family?"
Watch for: rushing to diagnose or, conversely, avoiding a risk assessment because the topic feels culturally off-limits. Working when you can hold the client's model and your clinical questions at the same time.

4.2 Core Cultural Formulation Interview

Purpose / when: first or second session with any client for whom culture, religion or healers may shape the problem; again at major turning points. [source: APA DSM-5-TR CFI]
Steps: (1) Explain that you will ask about the problem as the client and the people around them see it. (2) Work through the four CFI domains in order: cultural definition of the problem; cultural perceptions of cause, context and support (including the role of cultural identity); cultural factors in self-coping and past help-seeking (including barriers); cultural factors in current help-seeking (preferences and the clinician-client relationship). (3) Use the client's own words, including Kazakh or Russian terms, in your notes. (4) Note where a supplementary module would help (see 4.3). The APA permits clinicians to reproduce the CFI for use with their patients; translation or modification needs APA permission. [source: APA DSM-5-TR CFI] Time needed is not stated on the APA form. [uncertain: not verified]
Example language (illustrative): "Sometimes people describe their problem to family or friends in their own words. How would you describe it to them, in Kazakh or in Russian?" "Is there anything about your background, such as your family's history with healers or your faith, that makes a difference to this problem?"
Watch for: brief, guarded answers about causes, which may reflect fear of being labelled; return to cause later once trust grows. Working when the client volunteers their own term and explanation.

4.3 CFI supplementary modules and Informant Version

Purpose / when: for in-depth assessment of areas the core CFI flags; can be used at intake, later or repeatedly. [source: APA CFI Supplementary Modules]
Steps: Choose modules by need: (1) Spirituality, Religion and Moral Traditions when the client links the problem to ancestors, Islam or a healer's call; (2) Explanatory Model when cause and course are unclear; (3) Cultural Identity for clients navigating Kazakh, Russian-speaking, urban or diaspora identities; (4) Coping and Help-Seeking to map healer, mullah and clinic use; (5) Immigrants and Refugees for clients outside Kazakhstan; (6) Older Adults or School-Age Children and Adolescents by age; (7) Caregivers for a carer. Use the 17-question Informant Version with a family member, with the client's consent. [source: APA CFI Supplementary Modules; APA CFI Informant Version]
Example language (illustrative): "You mentioned your grandmother was a healer. Could we spend some time on the role faith and your ancestors play in your life?"
Watch for: module length tiring the client; spread modules across sessions. Working when the family's account and the client's can both be placed in the formulation.

4.4 Explanatory-model inquiry

Purpose / when: whenever the client's account of cause or cure differs from yours, or treatment stalls. [source: Kleinman et al. 1978 via Tanenbaum handout]
Steps: Ask, in your own words and the client's language, the eight areas Kleinman and colleagues proposed: what the client calls the problem; its cause; why it started when it did; what it does to them and how; 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; what they fear most. Then summarise the model back and ask for correction. Note whether the cause named is spiritual (ancestors, jyn, evil eye, black magic), bodily, social or mixed. [source: Tanenbaum handout; Penkala-Gawęcka 2013; Yermagambetova & Atanakova 2023]
Example language (illustrative): "What do you think started this when it did?" "What are you most afraid will happen if it is not treated in the right way?"
Watch for: the fear behind the model, for example that refusing a spirits' call will harm relatives, which Penkala-Gawęcka reports as a widely held belief. Working when the client says "yes, that is it" to your summary. [source: Penkala-Gawęcka 2013]

4.5 Asking about healer consultation without judgement

Purpose / when: at intake and whenever new physical or psychological symptoms appear; clients may already have seen a healer before reaching you. [synthesis]
Steps: (1) Normalise the question. (2) Ask which kinds of helper they have seen, using the community's categories where the client does: herbalist, bone-setter, masseur, pulse-reader, baksy, tauyp, mullah or Sufi healer, diviner. (3) Ask what each said the problem was, what the client felt helped, and anything that worried them. Do not ask for ritual details. (4) Ask, in plain terms, about any physical treatment, anything taken by mouth, and any injury, so you can arrange medical review. (5) Record without evaluative language. [source: Yermagambetova & Atanakova 2023 for categories; synthesis]
Example language (illustrative): "Many families here see an emshi or a mullah as well as a doctor. Have you or your family asked anyone like that for help with this?" "Was there anything about that visit you would like me to know, either what helped or anything that worried you?"
Watch for: shame or secrecy, particularly where relatives regard such visits as forbidden in Islam; reassure about confidentiality limits. Working when disclosure becomes routine across sessions.

4.6 Mapping Kazakh idioms and cultural concepts of distress

Purpose / when: when the client uses a culturally specific term or explanation. DSM-5-TR describes cultural concepts of distress as idioms, explanations or perceived causes, and syndromes; its glossary examples do not include Kazakh terms. [source: APA DSM-5-TR Section III; UNMC slides]
Steps: (1) Note the term exactly. Terms described in the sources include being pressed or smothered by the ancestor spirits; jyn qonu (spirit possession); albasty basu (an attack by the albasty); köz tiyu (evil eye); til tiyu (evil tongue); porcha (black magic); and fright (şoşynu) and fear (qorqu). [source: Penkala-Gawęcka 2013; Yermagambetova & Atanakova 2023] (2) Ask what the term means for this client and family, since usage varies. (3) Record it as an explanation or idiom in the cultural formulation, alongside, not instead of, any diagnosis. (4) Use it in your own speech if the client welcomes that.
Example language (illustrative): "You said people at home would call this köz tiyu. What does that mean in your family, and what do people usually do about it?"
Watch for: imposing a meaning from a book onto the client. Working when the client corrects or enriches your understanding.

4.7 Distinguishing the "call of the spirits" and possession experiences from disorder

Purpose / when: when a client reports visions, voices, frightening dreams, unusual behaviour or bodily symptoms that they or their family link to ancestors or spirits. Penkala-Gawęcka describes the onset of the condition as often sudden, sometimes after trauma or a shrine visit, with anxiety, frightening dreams and visions (often of old men in white), panic, hearing voices, unusual behaviour and severe physical symptoms such as paralysis or loss of sight. [source: Penkala-Gawęcka 2013]
Steps: (1) Elicit the experiences in the client's terms (4.4, 4.6). (2) Ask how their family and community understand it, and whether a respected senior healer or other recognised person has interpreted it. (3) Complete a standard mental state and risk assessment, including suicidality, command content, self-neglect and functioning. (4) Apply diagnostic criteria with their cultural exclusions: DSM-5 dissociative identity disorder (possession form) and dissociative trance exclude states that are a normal part of broadly accepted cultural or religious practice; ICD-11 6B62 trance disorder and 6B63 possession trance disorder require the state to be involuntary, unwanted, outside accepted practice and impairing. DSM-5-TR keeps these exclusions in substance [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299]; whether it keeps identical wording is [uncertain: not verified]. (5) Arrange medical and neurological review for paralysis, loss of sight or other physical symptoms. (6) Consult a cultural broker (4.9) if the picture is unclear. (7) Keep both possibilities open over time; a recognised call and a treatable disorder can coexist. [source: PMC9199574; findacode ICD-11 6B62; synthesis]
Context to hold: in the 1990s Almaty centre's vetting, 80.5% of healer candidates were rejected for "psychiatric disorders", while a psychiatrist on the commission argued that someone diagnosed with schizophrenia might be "entirely normal" and said most colleagues disagreed with her. This shows how contested the boundary has been locally. [source: Penkala-Gawęcka 2013]
Example language (illustrative): "I want to understand this the way your family does, and I also want to make sure nothing is being missed for your health. Can we look at both?"
Watch for: declining function, inability to care for self, persecutory distress, suicidal ideation, or experiences the client finds unwanted and frightening, which point to clinical treatment whatever the cultural meaning. Working when the client can tell you which experiences they want help with.

4.8 Physical and medical safety screening after folk treatment

Purpose / when: when a client has received bone-setting, surgery-type treatment, bloodletting, plant or animal remedies, or other physical treatment, or when physical complaints accompany psychological ones. The national history portal records historical use of bloodletting and leeches, bone-setting of limb, collarbone and hip dislocations, and plant remedies including black henbane, and notes that healers used poisons in small doses. [source: e-history.kz] A systematic review of treatment by traditional bone-setters found limb- and life-threatening complications, including deaths, across 12 observational studies (not specific to Kazakhstan). [source: Garikapati et al. 2023, Tropical Doctor]
Steps: (1) Ask plainly about any injury, pain, swelling, numbness, colour change or wound after bodily treatment, and arrange urgent medical review if present. (2) Ask about anything swallowed, applied or inhaled, and pass this to the client's physician or prescriber; do not identify, judge, dose or advise on remedies. (3) Note that some plant remedies can cause confusion or agitation that may be mistaken for psychiatric symptoms [synthesis]; request medical assessment for acute changes in mental state. (4) Never advise starting, stopping or changing any medicine or remedy; route these questions to the prescriber. (5) The psychotherapist does not touch the client as part of this work; if a client describes or re-enacts bodily treatment, keep the discussion verbal and use clinical, non-explicit terms for intimate areas. [synthesis]
Example language (illustrative): "Since the synykshy treated your arm, has it felt or looked different? I would like a doctor to check it." "Your doctor needs to know about everything you are taking, including anything from a healer. Would you be comfortable telling them, or shall we do it together?"
Watch for: delay of urgent medical care, which features in reported deaths (see 4.13). Working when the client accepts medical review without feeling their healer has been attacked.

4.9 Consulting cultural brokers and using interpreters

Purpose / when: when language, regional variation, or the line between recognised experience and disorder is unclear. [synthesis]
Steps: (1) Offer the client a choice of Kazakh, Russian or another language, and a trained interpreter rather than family members. (2) Brief the interpreter on confidentiality and on conveying spiritual terms without translating them into clinical labels. (3) With consent, consult a cultural broker: a Kazakh clinician, a community member the client respects, or, if the client wishes, a religious figure or healer they already trust. (4) Share only what the client permits. (5) Record the broker's view as one perspective in the formulation. [synthesis]
Example language (illustrative): "Is there someone in your community whose understanding of these things you trust, and who you would be happy for me to speak with?"
Watch for: a broker whose religious stance (for example, regarding healer visits as forbidden) differs sharply from the client's; seek another perspective. Working when the broker's input helps the client feel understood rather than judged.

4.10 Collaboration and referral with healers or clergy the client chooses

Purpose / when: when the client wants a healer, baksy, tauyp or mullah involved alongside therapy. In Kazakhstan healers are not licensed or certified by the state, and the Association of Folk Healers is not a healthcare body; legitimacy within the tradition rests on recognition by senior healers, ancestry and community, not on state approval. Licensed "traditional medicine" is a separate, medically qualified field. [source: Kazinform 13 Mar 2025; Penkala-Gawęcka 2013] The ethnography reports collaboration between doctors and healers in the institutionalised setting of the 1990s; no current formal referral pathway for psychotherapists was found. [source: Penkala-Gawęcka 2013; uncertain: not verified]
Steps: (1) Let the client lead: who they already see, and who their family or community respects. Do not recommend, rank or seek out healers. (2) Obtain explicit, written consent for any contact, stating what may be shared. (3) If contact occurs, aim for mutual understanding of roles: you treat any mental disorder and support coping; the healer or clergy member holds their own role as the client and community understand it. (4) Agree on safety points: urgent medical care is not delayed, medication is changed only by the prescriber, no physical force, and children are protected. (5) Note warning signs: group healing sessions (prohibited under the Health Code), demands for large sums, discouragement from medical care, or physical force. [source: NUR.KZ 3 Jul 2023; Azattyq Ruhy 1 Feb 2025; synthesis]
Example language (illustrative): "If you would like the person helping you at home and me to understand each other's part, I am happy to do that with your permission. What would you want me to share, and what should stay between us?"
Watch for: the client feeling pressured to choose between you and the healer; make clear both can continue. Working when the client describes the two kinds of help as complementary.

4.11 Working with the family

Purpose / when: when relatives hold strong and possibly divided views, for example where the call is believed to bring harm to relatives if refused, or where some members regard healer visits as un-Islamic. [source: Penkala-Gawęcka 2013; Yermagambetova & Atanakova 2023]
Steps: (1) With the client's consent, invite key relatives. (2) Use the CFI Informant Version or its themes to hear each perspective. (3) Name the disagreement without ruling on it. (4) Find shared goals, such as safety, sleep, return to work or study. (5) Agree who the client will turn to in a crisis. [source: APA CFI Informant Version; synthesis]
Example language (illustrative): "I hear that your mother sees this as a call from the ancestors and your brother sees it as something that should not be followed in Islam. You both want Aigerim to be well again. Can we start from that?" (name invented)
Watch for: the client being blamed or isolated within the family. Working when the family can agree on immediate safety steps despite different beliefs.

4.12 Integrating healing and spiritual experiences

Purpose / when: after a client has seen a healer or had an experience they link to ancestors or spirits, whether it felt helpful, confusing or frightening. [synthesis]
Steps: (1) Invite the client to describe what the experience meant, not how the ritual was done. (2) Explore what changed in feelings, relationships, sense of identity or obligations. (3) If the client has been recognised as having a healer's calling, explore its effect on work, family and identity, as a life transition. (4) If the experience was distressing, treat the distress with standard trauma-informed methods, consistent with the client's beliefs. (5) Link insights to therapy goals. [synthesis; context: Penkala-Gawęcka 2013]
Example language (illustrative): "What has changed for you since then? What do you want to hold on to, and is there anything that still troubles you?"
Watch for: intrusive memories, guilt about refusing a call, or sudden role changes that strain the family. Working when the experience becomes part of a coherent story the client can live with.

4.13 Safeguarding and reporting

Purpose / when: whenever a practice harms or risks harming a client or a child: physical force, restraint, injury, fraud, delay of urgent care, or harm to a minor. Reported Kazakh cases include: a woman in Atyrau region who died of traumatic shock after "treatment"; a healer in Shymkent who killed a 13-year-old in 2019 while setting a fracture; a fatal anaphylactic reaction to an unlicensed substance in Astana in 2023; a large fraud in Aktobe; and the 2025 Atyrau case of a nine-year-old girl subjected to a spirit-expulsion session, which the Ministry of Education's Committee for the Protection of Children's Rights called unacceptable and took under its control while the Interior Ministry investigated. In 2026 a Mangistau healer was convicted of causing a client's death through negligence (Criminal Code Art. 104 Part 1) and barred from healing. [source: Azattyq Ruhy 1 Feb 2025; NUR.KZ 9 Jan 2025; Kazinform 30 Apr 2026] Penkala-Gawęcka reports that whipping patients was formally prohibited in the 1990s certification rules, though enforcement was weak. [source: Penkala-Gawęcka 2013]
Steps: (1) Assess immediate danger and arrange medical care. (2) For a child, follow your jurisdiction's child-protection procedure; in Kazakhstan, child-rights commissioners and the Committee for the Protection of Children's Rights are the bodies named in the reported case. (3) Document facts, not cultural judgements. (4) Explain to the client and family that the concern is about harm, not about their beliefs or tradition. (5) Do not name minors in any shared record beyond what procedures require. [source: NUR.KZ 9 Jan 2025; synthesis]
Example language (illustrative): "I respect that your family looks to healers for help. My concern is only about the injuries. When someone is hurt, I have a duty to make sure they are safe."
Watch for: abuse described as tradition, and tradition misread as abuse; consult a cultural broker and safeguarding lead together. Working when protective action is taken without the family withdrawing from all care.

4.14 Addressing historical suppression, stigma and religious conflict

Purpose / when: when mistrust of psychiatry, fear of labels, or conflict between religious and traditional views blocks engagement. Penkala-Gawęcka describes Soviet militant atheism and biomedical dominance reclassifying the call as mental illness, healers working underground, and the later state framing of folk medicine as national heritage; she also reports the 2009 criminalisation of the Aq jol movement, which organised healing séances. Students in a 2024 Nazarbayev University study linked present-day mental-health stigma to labelling from the Soviet period. [source: Penkala-Gawęcka 2013; Kengesbekova 2024]
Steps: (1) Ask about the client's and family's experiences with psychiatric services. (2) Acknowledge the history openly. (3) Explain how you use diagnosis and what you record. (4) Where religious and traditional views conflict, help the client clarify their own values rather than resolving the dispute. [synthesis]
Example language (illustrative): "Some families remember a time when people with these experiences were simply called mentally ill. I want you to know I will not do that. Diagnosis, if we use one, is only to help find the right treatment."
Watch for: the client testing whether you will dismiss their beliefs. Working when the client raises spiritual topics without prompting.

4.15 Clients outside Kazakhstan

Purpose / when: Kazakh clients living abroad, including migrants and refugees, who may lack access to healers their family trusts or face pressure to return for treatment. [synthesis]
Steps: (1) Use the CFI Immigrants and Refugees module. (2) Map transnational help-seeking, such as relatives consulting a healer at home on the client's behalf. (3) Explore isolation from the community that would interpret their experiences. (4) Apply the same safety, consent and safeguarding steps. [source: APA CFI Supplementary Modules; synthesis]
Example language (illustrative): "Is anyone at home doing something on your behalf for this, and how do you feel about that?"
Watch for: loneliness when experiences cannot be shared locally. Working when the client finds trusted interpreters of their experience, here or at home.

5. Handling problems

The sources describe the tradition and its regulation, not therapy problems; the guidance below is [synthesis] unless tagged.

Client will not talk about spirits or healers (guarded). Likely fear of a psychiatric label, given the Soviet history [source: Penkala-Gawęcka 2013]. Response: state how you use information, move to less loaded CFI questions (supports, stressors), return to causes later, and offer the client's preferred language.
Client wants you to confirm or deny that spirits are involved. Response: say honestly that you are not the person to judge that, that you take their experience seriously, and that your role is their wellbeing and safety. Offer to help them think about whom in their own community they would ask.
Client asks you to recommend a healer or baksy. Response: decline to recommend or rank healers; explore whom their family and community respect, and how they would judge whom to trust. Do not encourage seeking practices outside the client's own community pathways.
Client stops medication on a healer's advice, or asks you whether to. Response: never advise on medication; acknowledge the dilemma, encourage an urgent conversation with the prescriber, and offer to support that conversation. Assess risk of relapse.
Stuck between "call" and "illness" framings. Response: shift to shared, practical goals (sleep, safety, functioning); treat target symptoms the client wants help with; revisit meaning later. Use a cultural broker (4.9).
Overwhelm during discussion of frightening experiences. Response: slow down, ground in the present, pause detailed recounting; resume with standard stabilisation methods before any trauma processing. Ask if religious or family resources help them feel safe and invite those, within safety limits.
Rupture after a safeguarding report or a medical referral. Response: name the rupture, repeat that the concern is harm, not belief; acknowledge your part; keep offering sessions. Expect family members to withdraw temporarily.
Family conflict over religion and tradition escalates in sessions. Response: return to agreed shared goals; meet subgroups separately if needed; avoid aligning with either the traditional or the religious-reformist side. [context: Yermagambetova & Atanakova 2023; Penkala-Gawęcka 2013]
Non-adherence to therapy tasks. Response: check fit with the explanatory model (4.4); reframe tasks in terms the client values, such as restoring strength or harmony in the family; reduce task size.
Physical complications after bone-setting or other bodily treatment. Response: urgent medical referral; do not delay therapy contact; document. [source: Garikapati et al. 2023]
Suspected fraud or exploitation by a self-described healer (e.g. large payments, loans, hypnosis claims, group sessions, which the Health Code prohibits). Response: assess financial and psychological harm, help the client consider reporting to police, and treat shame. [source: Azattyq Ruhy 1 Feb 2025; NUR.KZ 3 Jul 2023]
Psychotic or suicidal crisis framed as a spiritual event. Response: follow standard crisis and risk-assessment practice, including emergency psychiatric care where indicated, while telling the family that urgent care does not deny their beliefs. Lethal-means counselling covers safe storage and removal only.
Therapist's own discomfort or curiosity about rituals. Response: do not ask for ritual details, songs, prayers or objects beyond what the client chooses to share for their own purposes; take reactions to supervision (4.1).
Gaps in the published record. No published Kazakh community guidance for psychotherapists working alongside healers was found, and no Kazakh cultural concept of distress appears in the DSM-5-TR glossary. [uncertain: not verified]

Sources

Pages used:

Books and articles cited:

Kabuldinov Z.E. History of Kazakhstan (as credited by e-history.kz; edition and year [uncertain: not verified]).
Kleinman A., Eisenberg L., Good B. (1978). Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88:251–258.
American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).
Kazakhstan, Code "On public health and the healthcare system" of 7 July 2020 (as reported by the Ministry of Health via Kazinform and NUR.KZ; article numbering [uncertain: sources conflict]).

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