Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 029
Guide XI-029

Central Asian folk cures (köz tiyüü, ap-ap, archa)

Kyrgyzstan
A 36 · L 55 · M 917 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: Kyrgyz household folk cures as described in Danuta Penkala-Gawęcka's ethnography (fieldwork in Bishkek, 2011–2013; Public Health Panorama 2017, English and Russian editions; Ethnologia Polona 2019). The psychotherapist's own work follows the DSM-5-TR Cultural Formulation Interview (CFI) and Kleinman's explanatory-model approach. All accounts of the cures are outsiders' ethnography, not texts published by the practitioners themselves.

What it is. This is not a codified medical system and has no regulator, licensing body or curriculum. It is a set of everyday home cures used in Kyrgyz families, mostly for small children. The ethnographer names four [source: Penkala-Gawęcka 2017, EN and RU]:

  • Köz tiyüü (evil eye; Russian sglaz). Families say it mainly affects small children, though adults can be affected too, and that it shows as anxiety and crying. Women of the family, usually the mother or grandmother, remove it with short home rituals. These rituals combine Islamic references with references to the older Turkic figure Umay-ene.
  • Korkuu (fright; also jürök müshüü; Russian ispug). Mothers say they can tell a sudden, loud cry at night caused by fright from ordinary crying. Many women treat infant fright at home with the cure called ap-ap, which involves a family member making contact with the inside of the infant's mouth (the palate); it is named here only so it can be recognised, and for the therapist it is a medical and safeguarding question, not a technique (see 4.8 and 4.15). Others hold that fright needs a specialist (a bakshy, bübü or moldo).
  • "Fallen" organs. Fright is linked to the belief that an organ, especially the heart, has "fallen". The ethnography describes this in adults. Female relatives or neighbours who are seen as skilled massage the person to "raise" the organ.
  • Archa (juniper) fumigation. Smoke from burnt dried mountain-juniper twigs is widely believed to protect against both evil spirits and bacteria.

These cures sit within a wider field of healers that the same author describes. It includes shamans (bakshy, bübü), clairvoyants (közü achyk), tabyp (who diagnose by pulse and use traditional and Islamic healing), moldo (Qur'anic healing), bone-setters and herbalists. She calls healer terminology "unstable" [source: Penkala-Gawęcka 2017; 2019]. Kyrgyz-language scholarship defines a tabyp as a folk healer who treats with empirical methods and medicinal plants, and notes that knowledge passed down orally [source: Mambetakunova 2024]. Turkish-language scholarship describes Kyrgyz folk medicine as resting on both pre-Islamic shamanic and Islamic foundations. It is often the first resort and complements modern medicine [source: Kiyat 2022, abstract].

Core idea of change, as families hold it (attributed, neither endorsed nor dismissed): a child's distress may come from an envious or admiring gaze (köz tiyüü) or a shock (korkuu), and a properly performed home cure removes the cause. Specialist healers are thought to address causes in the spirit world that doctors cannot reach.

The psychotherapist's role. The therapist does not perform, recommend or imitate any of these cures. Their job is to understand the family's explanatory model and protect the child's medical safety. Where the client wishes, they work alongside the family and community healers. [source: CFI, APA; synthesis]

2. Framework

There are no therapy phases for the cures themselves. They are home practices carried out when a symptom appears, and there is no published session structure. The framework below is for the therapist's own work. Its phase structure is [synthesis]; its content draws on the CFI materials and the ethnography.

Phase A: Engagement and cultural assessment (sessions 1–2, sometimes woven into intake).

  • Goal: learn what the client or parent calls the problem, what they think caused it, and what they have already done, including home cures and healers.
  • Format: the core CFI (16 questions in four domains), with the Informant Version for a parent or grandmother. Add supplementary modules as needed. [source: APA CFI; Supplementary Modules]
  • Time: APA does not state one. Field-trial reports of about 15–20 minutes for the core CFI are [uncertain: not verified].
  • Move on when you can state the family's explanatory model in their words, and you know every cure and healer they have used for the current problem.

Phase B: Safety triage (same session where a child or physical symptom is involved).

  • Goal: check whether a folk diagnosis such as fright or evil eye in an infant, or a "fallen heart" in an adult, could be covering a medical problem. Also check whether any practice in use poses a physical risk.
  • Move on when medical assessment has been arranged or already done, and any safeguarding concern has been dealt with under local procedure.

Phase C: Formulation and shared plan (sessions 2–4).

  • Goal: build a cultural formulation that holds both the family's account and the clinical picture. Agree which parts are for the doctor, which for the therapist, and which for the family or healer.
  • Move on when the client agrees the plan. Where they want it, consent to collaborate with a healer is recorded.

Phase D: Parallel or collaborative care (ongoing; the number of sessions depends on the presenting disorder).

  • The therapist treats the presenting disorder (e.g. anxiety, PTSD, postnatal depression) with their usual evidence-based method, adapted to the family's model.
  • Kyrgyz psychiatrists have described a similar "double assistance" or parallel model: the psychiatrist treats symptoms while the healer addresses the perceived cause. They saw it as especially suited to non-psychotic patients with a traditional worldview [source: Penkala-Gawęcka 2017; 2019].

Phase E: Integration and review.

  • Goal: help the client make sense of what both kinds of help meant to them, review outcomes, and plan for relapse, including how the family will decide when to see a doctor next time.

3. Guiding principles

  • Outsider position. You are not a practitioner of these cures. Meaning: never perform, teach or recommend them; describe them only as the family does. [source: synthesis]
  • Attribute, don't adjudicate. Köz tiyüü, korkuu and spirits are described as the family holds them, neither as fact nor as superstition. Meaning: say "in your family, fright is understood as…" rather than "you believe…". [source: synthesis]
  • Authority lies with the family and the community, not the clinic. Women of the family, especially mothers, grandmothers and mothers-in-law, decide on home cures. Specialist healers claim legitimacy as "a gift from spirits and from God", which can be confirmed by an experienced healer's endorsement or by an illness read as a spirit's call. Puristic Islamic groups oppose such healing. The state promoted traditional healing in the 1990s and later stopped its professionalisation, though healers can still practise freely. Meaning: find out who decides in this family, and do not take sides in religious disputes. [source: Penkala-Gawęcka 2017; 2019; Exeter 2017]
  • Use cultural concepts as signals, not diagnoses. DSM-5-TR treats cultural concepts of distress (idioms, explanations and syndromes) as aids to communication. Korkuu is not among the DSM-5-TR glossary entries. It resembles susto, which is listed, but treating the two as equivalent is [synthesis]. Meaning: a report of fright or evil eye opens questions about symptoms; it does not replace them. [source: APA Section III; UNMC slides]
  • Child medical safety comes first. Folk diagnoses in infants can sit on top of real illness. A study of a comparable infant folk illness found that parents often delayed or never sought medical care. Meaning: any infant with inconsolable night crying, poor feeding, fever, vomiting or diarrhoea needs medical assessment, whatever cure is also used. [source: Trotter et al. 1989; synthesis]
  • Touch is the client's and the family's business, with consent. The therapist never touches the client. Meaning: when a relative or neighbour massages an adult for a "fallen" organ, explore whether the adult agrees to it and can stop it. Infants cannot consent, so their safety is judged under safeguarding standards. [source: synthesis]
  • Don't pathologise and don't miss illness. Korkuu after violence may be how a survivor names trauma. A spirit-calling narrative may be culturally normative, or it may be an early psychosis. Kyrgyz psychiatrists report that patients often visit several healers before reaching psychiatry. Meaning: assess properly, and do it with cultural consultation. [source: Penkala-Gawęcka 2019]
  • Respect practical reasons for healer use. Families describe distrust of doctors, cost, holistic attention to family problems, and family hierarchy as reasons. Meaning: treat these as information about barriers, not as non-compliance. [source: Penkala-Gawęcka 2017; Exeter 2017]
  • Collaborate only if the client wishes, with consent and confidentiality. Meaning: never contact a healer without explicit, recorded consent, and never urge a client to seek one. [source: synthesis; WHO TM Strategy 2014–2023 for the general aim of integration]
  • Safeguarding overrides cultural deference. Belief in spirit possession and similar ideas can lead to children being blamed and abused. Meaning: tradition is never a reason to skip a safeguarding referral, and a practice is never reported simply because it is unfamiliar. [source: DfE 2012]

4. Intervention inventory

Every intervention below is the psychotherapist's own work. None of them reproduces, teaches or recommends a folk cure. The folk cures themselves are described in Section 1 for recognition only, and no instructions for them are given. [source: synthesis]

4.1 Cultural humility and self-examination

  • Purpose / when: before and throughout the work, especially if you have no Central Asian background, or if you share one but hold different views (e.g. secular, biomedical, or puristic Islamic).
  • Steps:
    1. Note your own reactions to evil eye, fright and spirit beliefs: curiosity, amusement, alarm, or a pull to rescue.
    2. Note any assumptions about "post-Soviet" families, rural or urban background, religion and gender roles.
    3. Ask yourself whether you are more alarmed by the practice or by the symptom.
    4. Take this to supervision or a cultural consultant.
  • Example language: to yourself or a supervisor, "What would I need to understand to see why a grandmother would treat this at home first?" (illustrative)
  • Watch for: a tone of dismissal ("just superstition") or of exoticising; over-reporting unfamiliar practices; under-reporting real risk out of fear of seeming culturally insensitive. It's working when families talk about home cures without your having to ask twice. [source: synthesis]

4.2 Core Cultural Formulation Interview (adult client or parent as client)

  • Purpose / when: at intake, or when the client uses köz tiyüü, korkuu or "fallen heart" language. APA says the CFI is for any clinician in any setting, supports clinical understanding, and is not the only basis for diagnosis. [source: APA CFI; Section III]
  • Steps:
    1. Introduce the interview as a way to understand the problem in the client's own terms.
    2. Work through the four domains: cultural definition of the problem; perceived causes, context and supports (including cultural identity); self-coping and past help seeking (including barriers); and current help-seeking preferences and the relationship with you.
    3. Under past help seeking, ask specifically about home cures, family elders and healers.
    4. Under the relationship domain, ask about language preference (Kyrgyz or Russian) and any experiences of being disrespected by doctors.
    5. Summarise back and check.
    6. Paraphrase the questions in your own words; APA permits clinicians to reproduce the form for use with their own patients, but modifying or translating it needs APA permission. [source: APA CFI]
  • Example language: "People describe troubles like this in different ways. How would you, or your mother, describe what is happening?" "Before coming here, what did you or your family try?" (illustrative)
  • Watch for: brief answers that suggest the client expects to be judged; a client who gives a medical account to you and a different one at home. It's working when they name the folk term spontaneously.

4.3 CFI Informant Version (parent, grandmother or mother-in-law about a child or adult)

  • Purpose / when: when the identified patient is an infant or young child, or when a senior family member makes the health decisions. Family hierarchy, such as a mother-in-law's influence, shapes health choices [source: Exeter 2017]. The Informant Version has 17 questions: the first covers the informant's relationship to the patient, and the same four domains follow. It is labelled DSM-5 (2013). [source: APA Informant Version]
  • Steps:
    1. Ask who usually decides about a child's health in this household, and invite that person if the parent agrees.
    2. Establish the informant's relationship to the patient.
    3. Cover the four domains as in 4.2, from the informant's view.
    4. Hear each family member's view separately if they differ.
  • Example language: "You know this baby well. When she cries like this at night, what do you think is happening?" (illustrative)
  • Watch for: a young mother deferring silently. Offer her a private moment. It's working when you can state each adult's account and what each fears.

4.4 CFI supplementary modules

  • Purpose / when: to go deeper. APA lists 12 modules, usable as add-ons or standalone, at first evaluation or repeatedly [source: APA Supplementary Modules]. The ones most relevant here:
    • Explanatory Model: fright, evil eye, "fallen" organs.
    • Spirituality, Religion, and Moral Traditions: the mix of Islam, Umay-ene and ancestor spirits (arbaktar), and any family conflict over it.
    • Coping and Help-Seeking: the order of home cure, healer and doctor.
    • Caregivers: completed by the caregiver.
    • School-Age Children and Adolescents.
    • Cultural Identity: Kyrgyz, Russian-speaking, urban or rural.
    • Immigrants and Refugees: for labour migrants and diaspora families.
    • Patient-Clinician Relationship.
  • Steps:
    1. From the core CFI, note which subtopic needs depth. The core form shows which module expands each subtopic.
    2. Use one module per session if time is short.
    3. Record the answers in the formulation.
  • Example language: "You mentioned your grandmother and the mosque see this differently. Can we talk about where you stand?" (illustrative)
  • Watch for: fatigue from too many questions; religious conflict that becomes the real presenting problem. It's working when the plan reflects what the client actually values.

4.5 Kleinman explanatory-model questions applied to the folk diagnosis

  • Purpose / when: when a specific folk diagnosis is named. Kleinman, Eisenberg and Good (1978) set out eight questions [source: Tanenbaum handout; Dinos et al. 2017]. In paraphrase, they ask:
    1. what the person calls the problem;
    2. what caused it;
    3. why it started when it did;
    4. what it does and how it works;
    5. how severe it is and how long it will last;
    6. what treatment it needs;
    7. what problems it has caused;
    8. what the person fears most.
  • Steps:
    1. Ask the questions conversationally, using the client's term (e.g. "köz tiyüü" or "ispug").
    2. Ask who in the family recognised it and how.
    3. Ask what the family expects to happen if it is not treated.
    4. Ask what would show it is gone.
    5. Ask what a doctor could or could not do for it.
  • Example language: "When your son was frightened, why do you think it started that night?" "What worries you most if the fright stays?" "How will you know the evil eye has gone?" (illustrative)
  • Watch for: a feared outcome that is medically serious (e.g. "he stopped feeding"), which is a cue for 4.7. It's working when the client's account and yours can be laid side by side without contradiction or ridicule.

4.6 Non-judgemental inquiry about home cures and healers

  • Purpose / when: at every assessment. Healers are often consulted before or alongside doctors, not as a last resort [source: Penkala-Gawęcka 2017].
  • Steps:
    1. Normalise the question: many families use home cures.
    2. Ask what was done, by whom, how often, and with what effect, in the client's own words. Do not ask for, or record, ritual words or methods beyond what safety needs.
    3. Ask which healers were seen (e.g. moldo, bübü, tabyp, közü achyk) and what they said.
    4. Ask about cost and travel.
    5. Record this in neutral terms.
  • Example language: "Lots of families I see use home remedies like archa smoke or the ap-ap cure, or see a moldo. Has anything like that been part of looking after him?" (illustrative)
  • Watch for: fear that disclosure will bring a safeguarding report. Explain plainly what you would and would not need to act on. It's working when disclosure is spontaneous at later sessions.

4.7 Treating the folk diagnosis as a medical signal (infants and children)

  • Purpose / when: whenever an infant is said to have fright or evil eye, or to have been treated for it. The mothers' sign of fright, a sudden loud cry at night, overlaps with signs of pain, infection and other illness [source: Penkala-Gawęcka 2017; synthesis]. In a comparable infant folk illness (caída de mollera, "fallen fontanelle", in Mexican-American families), the authors argued that the syndrome often reflects gastroenteritis with dehydration. Home treatment was usual and medical care was often postponed or never sought [source: Trotter et al. 1989]. Applying this finding to korkuu is [synthesis].
  • Steps:
    1. Ask about duration, feeding, wet nappies, fever, vomiting, diarrhoea, breathing, rash, lethargy, and any fall or injury.
    2. If any are present, or the parent is unsure, arrange same-day contact with the child's doctor, or emergency care if red flags are present, under your service's protocol.
    3. Frame this as "both, not either": the family's cure is not the issue; checking the body is.
    4. Follow up to confirm the child was seen.
  • Example language: "I understand your mother has done ap-ap for the fright. Alongside that, I'd like a doctor to check her today, because she's feeding less. Is that all right?" (illustrative)
  • Watch for: a parent who says the doctor "won't understand fright". Offer to help explain the symptoms to the doctor. It's working when the family seeks medical review on their own the next time.

4.8 Infant safety conversation about the ap-ap cure and archa smoke

  • Purpose / when: when ap-ap or juniper fumigation is used with an infant, especially one who is unwell, premature, or has breathing problems.
  • What is known:
    • The ap-ap cure's physical effects are not documented in the medical or ethnographic sources cited here [uncertain: not verified].
    • The general risks of contact inside an infant's mouth (oral injury, gagging, choking, infection) are [synthesis] and are not documented for this cure. Treat any mouth injury, bleeding, feeding difficulty, choking or marked distress after the cure as a medical concern needing prompt assessment, and any injury as a safeguarding matter (4.15) [synthesis].
    • The main documented risk with home-treated infant folk illness is delayed medical care [source: Trotter et al. 1989].
    • For smoke, a survey of Omani schoolchildren found home incense (bakhour) burning was a common reported trigger of wheeze in asthmatic children, though not linked to asthma prevalence. The authors advised less frequent burning, ventilating rooms, and avoiding use around children and other susceptible people [source: Al-Rawas et al. 2009]. Applying this to juniper smoke is [synthesis].
  • Steps:
    1. Ask permission to share health information.
    2. Acknowledge what the practice means to the family: protection and care.
    3. Share the specific medical concern factually: smoke and breathing, delay of care.
    4. Ask what the family thinks they could change while keeping what matters to them (e.g. fumigating when the infant is out of the room, airing the room, never letting a cure delay a doctor's visit).
    5. Do not instruct on how to perform or modify the cure itself.
    6. Copy the child's doctor or health visitor in, with consent.
  • Example language: "Archa is part of how your family protects the baby. Smoke can make breathing harder for small children, especially with a cough. What would keep the protection you want and keep the smoke away from her chest?" (illustrative)
  • Watch for: defensiveness, which signals you have sounded like an accusation, so return to their goals; any sign of injury, which goes to safeguarding (4.15). It's working when the family proposes its own adjustment.

4.9 Physical screening and consent around massage for "fallen" organs (adults)

  • Purpose / when: when an adult client reports a "fallen heart" or other organ after fright, and relatives or neighbours massage to "raise" it [source: Penkala-Gawęcka 2017].
  • Steps:
    1. Explore the experience in the client's terms: what they feel, and when it began.
    2. Screen for symptoms that need medical review (chest pain, palpitations, breathlessness, fainting, abdominal pain, pregnancy, recent surgery, bleeding disorders or anticoagulants) and route to a doctor. Never advise on medicines.
    3. Ask whether the massage is wanted, who does it, whether the client can say no or stop it at any point, and whether it ever involves intimate areas or makes them uncomfortable.
    4. The therapist never touches the client or demonstrates any massage.
    5. Treat panic, anxiety or trauma symptoms with your usual methods.
  • Example language: "When your aunt does this, is it something you want, and could you tell her to stop if you needed to?" "Some of what you feel in your chest is worth a doctor checking too." (illustrative)
  • Watch for: coercion by a relative, or any sexual or genital contact presented as treatment. Either one is a safeguarding or adult-protection matter. It's working when the client feels in control of what happens to their body. [source: synthesis, except where cited]

4.10 Distinguishing culturally normative experience from disorder

  • Purpose / when: when distress is framed in spirit terms (köz tiyüü, korkuu, jinn, albarsty, ancestor spirits) or as a calling to become a healer.
  • Background:
    • Kyrgyz shamanic illness is understood as a spirit's call, and refusing it is believed to bring more suffering [source: Penkala-Gawęcka 2019]. A first psychotic episode is often read as a "spiritual emergence", and patients may see several healers before a psychiatrist. A Kyrgyz psychiatrist reported 40 healers with severe psychotic disorders among 358 studied [source: Penkala-Gawęcka 2019, citing Adylov].
    • DSM excludes trance or possession that is part of a broadly accepted collective cultural or religious practice. ICD-11 6B62 (trance disorder) and 6B63 (possession trance disorder) require the state to be involuntary and unwanted [source: PMC9199574; findacode ICD-11]. The DSM-5-TR culture note on psychotic symptoms is [uncertain: not verified].
  • Steps:
    1. Establish whether the family and community see the experience as normal for the situation.
    2. Assess function, distress, duration, insight and whether the experience is wanted, and run your usual mental-state examination.
    3. Consult a cultural broker or a community member the client trusts, with consent.
    4. Look for features outside the cultural pattern (e.g. disorganisation, prolonged decline, voices commanding harm).
    5. Record both readings.
  • Example language: "In your family, is what happened to your sister after the fright something people would recognise? What makes it different from what they'd expect?" (illustrative)
  • Watch for: two errors. One is labelling a normative belief as delusion. The other is missing psychosis, mania or postpartum illness because a spiritual account is offered. It's working when the client and family accept the formulation as fair.

4.11 Trauma-informed work with korkuu after violence

  • Purpose / when: when an adult names fright (korkuu) after an assault, conflict or disaster. After the 2010 Osh and Jalal-Abad clashes, survivors, especially women who had been raped, often turned to a bübü or közü achyk. One bübü diagnosed a rape survivor's illness as korkuu ("great fear") and performed purifying rituals. Mental health teams judged healers' help to be valued and sometimes more effective. [source: Penkala-Gawęcka 2017; 2019]
  • Steps:
    1. Accept "fright" as the client's name for what happened.
    2. Screen for PTSD, depression and suicide risk in line with current standard practice.
    3. Offer an evidence-based trauma therapy, explaining it in terms that connect with "removing the fright".
    4. If the client has seen or wants to see a healer, plan how the two kinds of help fit together (4.12).
    5. Protect confidentiality carefully where sexual violence carries stigma.
  • Example language: "You've called this the fright that stayed with you. In our work we can try to loosen its hold on your sleep and your body." (illustrative)
  • Watch for: shame or fear that the family will learn what happened; dissociation in session. It's working when symptoms reduce and the client can speak of the fright as past. [source: synthesis, except where cited]

4.12 Parallel care and collaboration with community healers (only if the client wishes)

  • Purpose / when: when the client wants their healer and their therapist to work together, or is already seeing both. Kyrgyz psychiatrists have used "double assistance": the psychiatrist addresses symptoms and the healer the perceived cause. Healers often refer seriously psychotic patients to doctors. Authors after Osh proposed local mediators and "effective communication" between healers and mental health professionals. [source: Penkala-Gawęcka 2017; 2019] WHO's 2014–2023 strategy promotes the safe integration of traditional medicine into health systems [source: WHO TM Strategy page]. Trial evidence on collaborative care with traditional and faith healers 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].
  • Steps:
    1. Obtain explicit, recorded consent for any contact: what will be shared, with whom, and for what purpose.
    2. Agree roles: you treat the disorder; the healer addresses what the family sees as the cause; the doctor covers physical health.
    3. Agree red flags on which each party will refer to medical care, such as suicidality, psychosis, or an infant who is unwell.
    4. Never ask the healer to teach you their methods, and never comment on their legitimacy. Authority over who is a genuine healer rests with the community.
    5. Never refer a client to a healer you have chosen; the client and family choose.
  • Example language: "Would it help if I spoke with the moldo you trust, so we aren't pulling in different directions? I'd only share what you agree to." (illustrative)
  • Watch for: a healer advising the client to stop medicines (route this to the prescriber); pressure on the client from either side; payment pressure. It's working when the client reports feeling supported by both rather than torn.

4.13 Interpreters and cultural brokers

  • Purpose / when: whenever the client's best language is Kyrgyz (or Russian, Uzbek and so on), or the concepts need a cultural explanation.
  • Steps:
    1. Use a trained interpreter, not a family member, for clinical content.
    2. Brief the interpreter that folk terms (köz tiyüü, korkuu, archa) should be kept as spoken, not translated as "superstition".
    3. Check that the interpreter is not known to the family.
    4. For cultural consultation, use a broker the client accepts.
  • Example language: to the interpreter, "Please keep the words she uses for fright, and tell me if a word has no simple English match." (illustrative)
  • Watch for: the interpreter softening or editorialising. It's working when the client corrects your summary in detail. [source: synthesis]

4.14 Working with family hierarchy and decision-making

  • Purpose / when: when elders, especially a mother-in-law or grandmother, decide on cures and care [source: Exeter 2017; Penkala-Gawęcka 2017].
  • Steps:
    1. Map who decides what.
    2. Invite key decision-makers, with the client's consent.
    3. Acknowledge their experience and their role in protecting the child.
    4. Find a shared goal, such as the child's health or the client's recovery.
    5. Support the parent or client to voice their own view.
  • Example language: "You've raised many children. What has helped you know when a baby needs a doctor as well as home care?" (illustrative)
  • Watch for: a parent caught between generations; your own alliance tilting towards the person most like you. It's working when decisions become shared. [source: synthesis, except where cited]

4.15 Safeguarding and reporting

  • Purpose / when: when any practice injures, restrains, starves or sexually abuses a child or adult; when a child is blamed for misfortune as possessed or bewitched; or when a cure delays urgent medical care. UK guidance notes that belief in witchcraft, spirit possession and similar ideas can lead to children being blamed and abused [source: DfE 2012].
  • Steps:
    1. Distinguish ordinary home cures (as families describe them) from harm.
    2. Where harm or risk exists, follow your local child or adult protection procedure and seek advice from your safeguarding lead.
    3. Explain your duties to the family without shaming their tradition.
    4. Document facts, not judgements about beliefs.
    5. Never name minors in any record beyond what the procedure requires.
  • Example language: "I respect that your family uses these cures. Because of the marks on his mouth, I have a duty to ask a doctor and a colleague to help me make sure he's safe." (illustrative)
  • Watch for: both errors, reporting an unfamiliar but harmless practice and overlooking abuse framed as tradition. It's working when the response is proportionate and the family stays engaged. [source: DfE 2012; synthesis]

4.16 Children and adolescents: consent and assent

  • Purpose / when: when the client is a child or adolescent who has had home cures or seen healers.
  • Steps:
    1. Obtain parental consent and the young person's assent for therapy.
    2. Use the CFI School-Age Children and Adolescents module.
    3. Ask the young person, privately where appropriate, how they feel about cures done to them, and whether they want them.
    4. Respect developing autonomy within local law.
  • Example language: "When your grandmother does archa for you, how do you feel about it? You can tell me even if it's different from what your family thinks." (illustrative)
  • Watch for: a young person caught between peers or school and family; embarrassment. It's working when the young person speaks for themselves. [source: APA Supplementary Modules; synthesis]

4.17 Integration and meaning-making

  • Purpose / when: after the client has had a home cure or seen a healer, or at the end of treatment.
  • Steps:
    1. Invite the client to say what the cure or visit meant, what changed, and what did not.
    2. Link their experience with the therapy work without claiming either caused the other.
    3. Plan how they will decide next time between home care, a healer and a doctor.
    4. For diaspora or migrant clients, explore what it means to keep these practices far from home (Immigrants and Refugees module).
  • Example language: "After the moldo's visit you said you felt lighter. What was different, and what's still left for us to work on?" (illustrative)
  • Watch for: the client crediting only one source and dropping the other abruptly. It's working when they hold a coherent, self-chosen plan. [source: APA Supplementary Modules; synthesis]

5. Handling problems

The published sources do not address these problems directly. Unless a source is cited, the guidance below is [synthesis].

  • The client won't talk about home cures. They may fear ridicule or a report. Explain what you would act on (injury, an unwell infant, coercion) and what you would not (ordinary household practices). Mention archa or ap-ap yourself as familiar examples (4.6). Return to the topic in a later session rather than pressing.
  • The family insists the doctor "can't treat fright". Agree that the doctor's role is the body, not the fright. Ask for both: "Let the doctor check the fever. Your family can look after the fright." Distrust of doctors is common and has reasons behind it [source: Exeter 2017; Penkala-Gawęcka 2017], so offer practical help, such as a symptom list to bring or a warm handover.
  • An unwell infant and a delayed doctor's visit. This is urgent. Follow 4.7. Where the risk is serious and the family declines care, follow safeguarding procedure (4.15). [source: Trotter et al. 1989 for the delay pattern]
  • Conflict between elders and a young parent. Hold separate conversations, and then a joint one framed around the child's health. Don't let the session become a vote on tradition (4.14).
  • Religious conflict. A client torn between a grandmother's practices and a puristic Islamic view that opposes them [source: Penkala-Gawęcka 2017] needs space to decide for themselves. Use the Spirituality, Religion, and Moral Traditions module. Don't adjudicate theology. Offer an imam, a moldo or another religious advisor of the client's choosing if they want one.
  • Overwhelm or dissociation when fright is linked to trauma. Slow down, ground the client with your usual stabilisation methods, and postpone trauma processing until they are stable (4.11).
  • Non-adherence to therapy or medication because a healer said to stop. Don't argue about the healer's authority. Explore the client's own view, and route any medicine question to the prescriber. With consent, seek a shared plan with the healer (4.12).
  • Rupture after a safeguarding referral. Name it, take responsibility for your part, restate your respect for the family's traditions, and explain the reason and the next steps. Offer continuity of care.
  • A spirit-calling narrative alongside possible psychosis. Hold both readings. Seek cultural consultation and a psychiatric assessment. Remember that psychiatric care is often delayed in this context while several healers are seen [source: Penkala-Gawęcka 2019]. Agree warning signs with the family.
  • The therapist is asked to perform or bless a cure, or to recommend a healer. Decline warmly: "That belongs to your family and the people you trust. My part is the talking and the checking with doctors." (illustrative) Don't name or recommend healers.
  • A healer's practice seems harmful, or payments seem exploitative. Ethnography records a Bishkek healer whose practices were seen as harmful, where attempts to stop him met patient protests [source: Exeter 2017]. Explore the client's own concerns, document them, and follow adult-protection or consumer-protection routes where harm is present. Don't campaign against the healer within therapy.
  • Diaspora or migrant clients far from family healers. They may feel cut off from protection. Explore safe ways they have found to stay connected (Immigrants and Refugees module), without suggesting ceremonies or healers outside legitimate community pathways.

Sources

Pages and documents used

Books and articles cited by author

  • 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 (page range per Dinos et al. 2017; one handout gives 251–288) [uncertain].
  • American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).

Not verified

  • The WHO Traditional Medicine Strategy 2025–2034 and mhGAP guidance on healers [uncertain: not verified].
  • Exact DSM-5-TR wording for possession-form DID (its substance is retained [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299]) and the culture note on psychotic symptoms [uncertain: not verified].
  • CFI timing of 15–20 minutes [uncertain: not verified].
  • Any published study of the physical effects of the ap-ap cure [uncertain: not verified].
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