Mongolian and Buryat shamanism

1. Introduction

Version followed: the living Mongolian (including Darhad) and Buryat shamanic traditions as Mongolian and Buryat scholars, shamans' organisations and ethnographers describe them after the post-socialist revival (Badam-Ochir 2024; Buyandelger 2013; Kharitonova 2015; Fridman 2010; Pedersen 2011), with the psychotherapist's own work based on the DSM-5-TR Cultural Formulation Interview (APA, 2022) and Kleinman's explanatory-model questions (Kleinman, Eisenberg and Good 1978).

What it is. Mongolian and Buryat shamanism is a living spiritual and healing tradition, not a psychotherapy. A shaman (böö; female udgan, male zairan) is understood within the tradition to work with guardian and ancestral spirits (ongod) on behalf of individuals, families and clans [source: Badam-Ochir 2024]. Practitioners and clients describe healing for psychological, physical and social troubles, mostly in one-to-one consultations, alongside clan-level rituals for collective wellbeing [source: Fridman 2010]. Clients also bring business failure, infertility and other personal misfortune [source: Stern 2012]. Shamanism coexists and often merges with Buddhism (and, among Buryats, with Christianity) [source: Stern 2012]. In Buryatia the movement is sometimes called "Tengerism" [source: Mater 2015].

History that shapes every encounter. In Mongolia, atheist state policies from 1921 to 1990 marginalised shamanism; written sources were lost and knowledge survived mainly orally, with Darhad shamanism persisting in remote northern areas through a few remaining shamans [source: Badam-Ochir 2024]. A Darhad shaman reported that his community hid its rituals until about 1995 [source: Stern 2012]. The 1992 Constitution's guarantee of freedom of belief enabled a revival [source: Badam-Ochir 2024]. Among Buryats, Soviet repression disrupted kinship lineages; post-Soviet healers rebuilt practice partly from early-1900s ethnographies and often feel less powerful than their ancestors [source: Fridman 2010]. Among Buryats in eastern Mongolia (Dornod), anthropologist Manduhai Buyandelger describes people attributing post-socialist hardship to ancestral spirits returning angry at having been abandoned under socialism, and using shamanic consultation to recover lost family history [source: University of Chicago Press, Buyandelger 2013; MIT News 2013]. In the Darhad region, Morten Axel Pedersen describes a post-socialist "shamanism without shamans" centred on people seen as instruments of forces they cannot control [source: De Gruyter Brill, Pedersen 2011]. These ethnographies are scholars' accounts, mostly by outsiders; Badam-Ochir writes as a Mongolian scholar.

The psychotherapist's role and how change happens in your work. You do not practise shamanism or interpret spirits. Your work is culturally responsive psychotherapy alongside the tradition: understanding the client's own explanatory model (which may involve ancestors, ongod, a shamanic calling or misfortune), distinguishing culturally normative experience from mental disorder, supporting the client's chosen help-seeking (shaman, lama, physician, therapist, often several), integrating what those consultations mean to the client, and safeguarding against exploitation or delayed medical care. Change in your work comes from a shared, respectful understanding of the problem that lets the client use both their tradition and clinical care without having to choose [synthesis; source for the CFI's aim: APA DSM-5-TR CFI].

2. Framework

There is no manualised protocol for psychotherapy alongside Mongolian or Buryat shamanism. The phases below are a [synthesis] structured around the DSM-5-TR Cultural Formulation Interview and its supplementary modules, which can be used at intake, later in care or repeatedly [source: APA CFI Supplementary Modules].

Who holds authority in the tradition (for orientation, not for you to adjudicate).

Lineage and calling: authority rests primarily on shamanic ancestry. A person with "shamanic illness" (böögiin övchin) is understood to be called by their lineage; ancestral spirits are believed to pass to particular descendants [source: Badam-Ochir 2024]. Healers describe the call coming through a mysterious illness, dreams or visions, and most credit their ancestry [source: Fridman 2010].
Teachers and other shamans: recognition is conferred socially, through initiation witnessed and blessed by other healers and the community [source: Fridman 2010]. Teacher-led disciple groups and shamanic centres (böögiin gal) have become institutionalised; terms include bagsh (teacher) and zamch (guide) [source: Badam-Ochir 2024].
Mongolian organisations: Blue Temple of Heaven (Tengeriin Khökh Süm, established 1990 by the shaman Tseren Zairan); the Mongolian Shamanic Golomt Centre (Ulaanbaatar, May 1996, initiated by Shagdarjavyn Sükhbat); Spirit of Heaven Association (Tengeriin Sülder, first congress 2003, 126 shamans); the Corporate Union of Mongolian Shamans (2012). As of 2023, Mongolia had fourteen officially registered shamanic centres and over a hundred NGOs; no single body speaks for all shamans, and membership claims are disputed [source: Badam-Ochir 2024]. The Golomt Center was described in 2012 as functioning somewhat like a trade union, claiming about 10,000 members [source: Stern 2012]. Figures differ between sources [uncertain].
Buryat organisations (Russia): the Local Religious Organisation of Shamans Tengeri (Ulan-Ude; head named as B. Tsyrendorzhiev), which became the Inter-Regional Centre of Shamans Khaan-Tengeri in 2013 [source: Kharitonova 2015]; Tengeri was co-founded by Oleg Dorzhiyev [source: Stern 2012]. Shaman centres also operate in Irkutsk [source: Mater 2015]. Shamanic groups registered as religious organisations; under Russia's 2012 health-care law, spiritual healing is treated as unrelated to medicine and needs no licence [source: Kharitonova 2015].
State: in Mongolia, registering as a religious organisation is described as challenging; there is no verified national licensing of shamans [uncertain: not verified]. In 2012 President Elbegdorj publicly suggested prohibiting the initiation of new shamans; no ban is reported as enacted [source: Badam-Ochir 2024].
Implication: when a client names a shaman, authority comes from that shaman's lineage, teacher and community recognition, not from you or any outside credential [synthesis].

Phase 1: Engagement and cultural assessment (sessions 1–2, about 60–90 minutes each) [synthesis].

Goals: rapport; core CFI; Explanatory Model and Spirituality, Religion and Moral Traditions modules as needed; a current risk and medical screen; map of all help sought (shaman, lama, doctor, family).
Format: individual, with interpreter or cultural broker if needed; Informant Version with a family member if the client agrees [source: APA CFI Informant Version].
Move on when: you can state the problem in the client's terms, know what help they want from you, and have screened for urgent risk.

Phase 2: Formulation and shared plan (sessions 2–4) [synthesis].

Goals: cultural formulation; differential assessment of normative experience versus disorder; consultation with a cultural broker where uncertain; agreement on how your work and any shamanic or Buddhist help will sit together.
Move on when: the client agrees with a written or spoken summary of the plan, including what each helper is for.

Phase 3: Parallel or collaborative care (variable; often 8–20 sessions) [synthesis; session counts uncertain].

Goals: evidence-based treatment for any diagnosed disorder, adapted to the client's model; integration of consultations; family and intergenerational work; safeguarding review.
Move on when: symptoms and functioning improve on the client's own markers, and the client can use traditional and clinical help without conflict.

Phase 4: Consolidation and ending (2–3 sessions) [synthesis].

Goals: relapse plan including when to seek medical, psychiatric and traditional help; how to contact you again.

3. Guiding principles

You work alongside, never as, a shaman. Do not interpret spirits, recommend rituals or evaluate a shaman's spiritual competence; stay within psychotherapy [synthesis].
Attribute, do not adjudicate. Describe spirits, ancestors, ongod and shamanic calling as the client and tradition hold them, neither as fact nor as delusion. In practice: "In your family's understanding…" rather than "the spirits are…" or "you believe that…" [synthesis].
Shamanic illness is not a European psychiatric category. A Mongolian scholar states that shamanic illness is not understood locally as a pathology or mental disorder in the European sense [source: Badam-Ochir 2024]. Practically: do not translate böögiin övchin into a diagnosis; assess for disorder separately and on its own evidence.
But do not miss illness. In the 1990s many new Buryat shamans experienced depression and psychosomatic illness that many interpreted as shamanic illness, and the concept has broadened towards general misfortune [source: Kharitonova 2015]. Practically: a calling narrative and a treatable depression can coexist; screen for both.
Plural help-seeking is normal. Clients may consult several shamans, lamas and doctors; Buyandelger describes clients testing shamans to find the most trustworthy, and scepticism coexisting with participation [source: MIT News 2013]. Practically: ask about all helpers without implying the client must choose.
History is clinical context. Seventy years of suppression, lost genealogies and disrupted lineages shape distress, meaning and trust [source: Badam-Ochir 2024; Fridman 2010; Buyandelger 2013]. Practically: include family and historical loss in the formulation.
The tradition has its own internal critics. Mongolian and Buryat shamans and scholars themselves criticise commercialisation, intimidation, "fake shaman creation" and neo-shamans [source: Badam-Ochir 2024; Mater 2015; Stern 2012]. Practically: raising exploitation is not disrespect to the tradition; frame it in the community's own terms.
Cultural humility. Examine your own assumptions, including romanticised Western images of "Siberian shamanism" and dismissive secular ones [synthesis].
Client self-determination with safeguarding. The client decides whether to consult or involve a shaman; your duties to act on risk, abuse and urgent medical need remain [synthesis].
No substances, no ritual content. You do not advise on rituals, offerings, objects or any ingested remedy, and never on starting, stopping or changing medicines; route medication questions to the prescriber [synthesis].
Consent for collaboration. Any contact with a shaman, lama or family member needs the client's explicit, specific consent and agreed limits on what is shared [synthesis].
Touch. Psychotherapy here involves no touch; if a client describes touch in a healing encounter, it should have been consensual and never sexual, and anything else is a safeguarding matter [synthesis].

4. Intervention inventory

All interventions below are the psychotherapist's own culturally responsive work. None involves performing, prescribing or interpreting shamanic ritual, spirits or divination. Example language is illustrative unless quoted.

4.1 Cultural humility and self-examination

Purpose / when: before and throughout work with Mongolian, Buryat or Darhad clients, or with non-Mongolian clients drawn to "Tengerism" or Siberian shamanism.
Steps: (1) Note your own reactions to spirit-based explanations: belief, romance, scepticism, discomfort. (2) Learn the basic history: suppression 1921–1990 in Mongolia, Soviet repression in Buryatia, post-1990 revival [source: Badam-Ochir 2024; Fridman 2010]. (3) Learn the client's own terms (böö, udgan, zairan, ongod, böögiin övchin) and ask how the client uses them. (4) Bring cases to supervision or consult a cultural broker when your reactions are strong. [synthesis]
Example language (illustrative): "I know a little about shamanism in Mongolia, but I'd like to learn how it is in your family, in your words."
Watch for: treating the client as a cultural spokesperson; exoticising; quiet dismissal (changing the subject when spirits are mentioned). Working when the client explains more, not less, over time. [synthesis]

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

Purpose / when: at intake, to understand the problem from the perspective of the client and their social network, its meaning, sources of help and expectations of services [source: APA DSM-5-TR CFI]. APA describes it as usable by any clinician in any setting [source: APA DSM-5-TR Section III].
Steps: (1) Use the official 16-question form, free to reproduce for clinicians' use with their patients; translation or modification needs APA permission [source: APA DSM-5-TR CFI]. (2) Cover its four domains: cultural definition of the problem; cultural perceptions of cause, context and support (including cultural identity); cultural factors affecting self-coping and past help seeking; cultural factors affecting current help seeking, including the clinician–patient relationship [source: APA DSM-5-TR CFI]. (3) Where answers mention ancestors, spirits, a calling or a shaman, note them and plan the relevant supplementary module (4.3). (4) Use the CFI to inform, not replace, diagnosis [source: APA DSM-5-TR CFI]. Time needed is [uncertain].
Example language (illustrative): "People explain problems like this in different ways. How would you describe what is happening, and how would your family or people back home describe it?" / "Have you already looked for help from anyone, a doctor, a lama, a shaman, anyone else?"
Watch for: the client giving "clinic-acceptable" answers out of fear of being judged; mention of perceived racism or language barriers in the relationship domain [source: APA DSM-5-TR CFI]. Working when the client volunteers their own idioms.

4.3 CFI supplementary modules

Purpose / when: to deepen specific domains as add-ons or standalone, at first evaluation or later [source: APA CFI Supplementary Modules]. Most relevant here: Explanatory Model; Spirituality, Religion and Moral Traditions; Cultural Identity; Coping and Help-Seeking; Social Network; Immigrants and Refugees (for migrants from Mongolia or Russia); Older Adults; School-Age Children and Adolescents; Caregivers [source: APA CFI Supplementary Modules].
Steps: (1) Choose the module that expands the subtopic the core CFI raised; the core form shows which module expands each subtopic [source: APA CFI Supplementary Modules]. (2) In the Spirituality module, map shamanism, Buddhism and any Christian identity without forcing a single label (shamanism often merges with Buddhism here [source: Stern 2012]). (3) In Cultural Identity, ask about Buryat, Darhad, Khalkh or other identity, clan and language. (4) Record answers in the client's words. [synthesis for steps 2–4]
Example language (illustrative): "Some families keep both Buddhist and shamanic practices. What is part of your life, and what matters most to you right now?"
Watch for: overload (use one module at a time); assuming that an urban, educated client has no traditional ties (Badam-Ochir notes shamanism is no longer limited to uneducated people [source: Badam-Ochir 2024]).

4.4 Explanatory-model exploration (Kleinman)

Purpose / when: whenever the client's understanding of cause or remedy differs from yours, especially when misfortune, ancestral anger or a calling is invoked.
Steps: Work through Kleinman's eight areas, in your own words: what they call the problem; what caused it; why it began when it did; what it does and how it works; how severe and how long; what treatment they think they should receive; the chief problems it has caused; what they fear most [source: Tanenbaum handout, Kleinman et al. 1978]. Then (1) summarise the model back, (2) identify where it overlaps with a clinical model (e.g. sleep loss, grief, stress), (3) agree on goals both models can support. [synthesis for 1–3]
Example language (illustrative): "You said the troubles began after your grandfather's spirit was forgotten. What do you think would help, and what would you want from our sessions alongside that?"
Watch for: explanations that shift as trust grows; ancestral-anger explanations tied to real historical loss (Buyandelger's account of returning ancestral spirits after socialism [source: University of Chicago Press, Buyandelger 2013]). Working when the client can hold both their model and the treatment plan.

4.5 Non-judgemental inquiry about shamans, lamas and other healers

Purpose / when: at intake and at each review; plural help-seeking is common and may otherwise stay hidden.
Steps: (1) Ask routinely, normalising the question. (2) Ask what was advised and how the client felt about it. (3) Ask about costs, pressure and any instruction to stop medical care. (4) Ask whether any remedy or substance was given, so the prescriber can be informed; do not advise on it yourself. (5) Document neutrally. [synthesis]
Example language (illustrative): "Many of my clients see a shaman or lama as well as a doctor. Is anyone like that helping you? I ask so we can work together, not to judge."
Watch for: concealment; distress about fees or demands (sources report intimidation and money demanded "under the guise of offerings" [source: Badam-Ochir 2024]); instructions to delay medical treatment. Working when the client reports consultations freely.

4.6 Using cultural concepts of distress and shamanic illness as idioms

Purpose / when: when the client uses böögiin övchin (shamanic illness), spirit punishment, soul loss or ancestral calling to describe distress.
Steps: (1) Treat it as a cultural explanation or idiom in the DSM-5-TR sense ("idioms, explanations or perceived causes, and syndromes" [source: APA DSM-5-TR Section III]). Shamanic illness is not among the DSM-5-TR named cultural concepts [source: UNMC slides]. (2) Ask what it means for this client and family. (3) Note scholarly context: in traditional Turkic-Mongolian understandings, certain mental and physical conditions could be seen as communication from spirits, as punishment, or as a sign of destiny to become a shaman [source: Sodnompilova 2021]; in Mongolia, shamanic illness is not seen as pathology in the European sense [source: Badam-Ochir 2024]. (4) Record it in the cultural formulation, separately from any diagnosis.
Example language (illustrative): "When you say this might be böögiin övchin, what does that mean to you and your family? What would it mean for your future?"
Watch for: the client fearing you will call it "madness"; family conflict over the meaning. Working when the idiom becomes a shared word in sessions.

4.7 Distinguishing normative experience from mental disorder

Purpose / when: when visions, dreams, voices, trance or unusual illness are part of the presentation.
Steps: (1) Ask whether the experience is recognised and accepted by the client's community and family, and by experienced shamans. (2) Apply diagnostic exclusions: DSM-5 possession-form dissociative identity disorder excludes disturbances that are "a normal part of a broadly accepted cultural or religious practice" (DSM-5-TR keeps this in substance [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299]; exact DSM-5-TR wording [uncertain]); ICD-11 6B62 trance disorder and 6B63 possession trance disorder require the state to be involuntary and unwanted and not part of accepted cultural or religious practice [source: PMC9199574; findacode ICD-11 mirror]. (3) Assess independently: mood, sleep, psychotic features outside the cultural frame, cognitive decline, substance use, medical causes, functional decline, risk. (4) Consult a cultural broker or, with consent, a trusted community member when uncertain. (5) Hold both possibilities in the formulation if they coexist. [synthesis for 1, 3–5]
Example language (illustrative): "Some experiences are part of a calling in your tradition, and some people also have an illness at the same time. I'd like to check your sleep, mood and health so we don't miss anything that medicine can help."
Watch for: distress, disorganisation or risk beyond what the community regards as part of a calling; Kharitonova's report that 1990s depression and psychosomatic illness were often read as shamanic illness [source: Kharitonova 2015]. Working when assessment is shared and the client accepts treatment where indicated.

4.8 Interpreters and cultural brokers

Purpose / when: limited English, or concepts that do not translate (Mongolian, Buryat or Russian speakers).
Steps: (1) Use a trained interpreter, not family. (2) Brief them on confidentiality and that spirit terms should be rendered as said, not explained away. (3) Check community overlap in small diasporas; offer a remote interpreter. (4) A cultural broker may advise you on meaning; separate their role from interpreting. [synthesis]
Example language (illustrative): "Please translate the words exactly, including words about spirits or ancestors; I will ask if I need explanation."
Watch for: the interpreter's own religious views colouring translation; client shame about being overheard. Working when the client's idioms appear in the record.

4.9 Collaboration and referral with community-sanctioned shamans (when the client wishes)

Purpose / when: the client wants their shaman or lama involved, or asks how to find one. No formal clinical–shamanic collaboration programme for Mongolian or Buryat communities has been verified [uncertain: not verified]. Collaborative-care trials with traditional healers have been run 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].
Steps: (1) Do not refer to, recommend or vet individual shamans yourself; the client finds help through their own family, lineage and community pathways. (2) If the client already works with a shaman, ask what kind of contact (if any) they want: none, the client relaying information, or direct contact. (3) Get written, specific consent stating what may be shared. (4) In any contact, describe your role, ask how the shaman sees the client's wellbeing and how you can avoid working at cross-purposes; never ask about or comment on ritual content. (5) Agree on urgent-care boundaries (e.g. medical review for injury, risk or psychosis). (6) Note the community's own markers of legitimacy: lineage, teacher, recognition by other shamans and community [source: Fridman 2010; Badam-Ochir 2024], and the community's own criticism of exploitative or "fake" shamans [source: Badam-Ochir 2024; Mater 2015]. [synthesis for 1–5]
Example language (illustrative): "If you'd like, and only with your permission, I could speak with your udgan so we're not giving you opposite advice. What would you be comfortable with me sharing?"
Watch for: the client feeling pushed into or out of shamanic help; demands for large payments; advice to stop medication or avoid doctors. Working when the client reports the helpers are not in conflict.

4.10 Integration of shamanic consultations and experiences

Purpose / when: after the client has consulted a shaman, attended a clan ritual, or had experiences they attribute to ancestors or ongod.
Steps: (1) Invite the client to share only what they wish; do not ask for ritual details. (2) Explore meaning, feelings and consequences for relationships and daily life. (3) Link with goals (e.g. reconnecting with family history, reducing guilt, restoring sleep). (4) Note distress or confusion that persists and assess as in 4.7. [synthesis] Buyandelger describes consultations producing fragmentary stories of ancestors that function as family history where records were erased [source: MIT News 2013]; integration can attend to that memory work without judging its truth [synthesis].
Example language (illustrative): "What did you take away from that visit? How has it changed how you think about your family, or about what's been happening?"
Watch for: fear, guilt or obligation after a consultation (e.g. being told a misfortune is one's fault); new demands or costs. Working when the experience is woven into a coherent, less frightening story.

4.11 Supporting a client facing a perceived shamanic calling

Purpose / when: the client or family believes the client is being called to become a shaman (often after illness, dreams or misfortune).
Steps: (1) Do not encourage or discourage becoming a shaman. (2) Explore what the calling means, who says so, and what the client wants. (3) Explore pressures: Badam-Ochir notes that negative public beliefs about shamanism create psychological pressure on those seeking to become shamans, and reports "fake shaman creation" (khuuramch böö törüülekh), sometimes for financial gain [source: Badam-Ochir 2024]. (4) Assess separately for depression, psychosis, substance use and medical illness (4.7). (5) Support decision-making over time; the decision belongs to the client and their community's authorities. [synthesis for 1, 2, 4, 5]
Example language (illustrative): "It sounds like several people have told you this is a calling. What do you feel about it yourself? Whatever you decide, I'd like to make sure your health is looked after too."
Watch for: coercion; costs; exhaustion and alcohol use (a Darhad shaman described the role's "heavy psychological toll," and alcohol abuse appeared common among shamans the reporter met [source: Stern 2012]). Working when the client describes the choice as their own.

4.12 Historical, political and intergenerational trauma work

Purpose / when: when loss of genealogies, repression, displacement or ancestral "abandonment" appears in the client's story.
Steps: (1) Ask about family history under socialism, if known; Mongolian written sources were lost and knowledge survived orally [source: Badam-Ochir 2024]; Buryat kin lineages were disrupted [source: Fridman 2010]. (2) Use a genogram, leaving space for unknowns and for ancestors the client names through shamanic consultation. (3) Validate grief for what was lost; distinguish historical and personal causation without dismissing the spiritual frame. (4) Apply standard trauma-focused treatment where a trauma disorder is present. [synthesis for 2–4]
Example language (illustrative): "So much family history was lost in those years. What do you know, what have you been told, and what would you like to know?"
Watch for: the client feeling responsible for ancestors' anger; reactivation of family trauma. Working when blame shifts towards grief and connection.

4.13 Work with families, lineage and the Informant Version

Purpose / when: family or clan members hold views about cause and remedy, or rituals are organised at clan level [source: Fridman 2010].
Steps: (1) With consent, use the CFI Informant Version with a relative (17 questions; relationship question first, then the same four domains) [source: APA CFI Informant Version]. (2) Map who decides about help-seeking. (3) Hold family sessions to negotiate disagreements (e.g. relatives favouring shamanic help and the client favouring medication, or the reverse). (4) Protect the client's confidentiality and autonomy. [synthesis for 2–4]
Example language (illustrative): "Your mother sees this as connected to your grandfather's spirit; you've wondered about depression. Can we find a plan that respects both views?"
Watch for: the client's voice disappearing; family pressure about fees or a calling. Working when family members support the agreed plan.

4.14 Safeguarding: exploitation, intimidation and harmful practices

Purpose / when: any sign of financial exploitation, intimidation, abuse, coercion, or harm to a child or vulnerable adult in a healing context.
Steps: (1) Ask directly and privately. (2) Know the risks sources name: commercialisation, intimidation and money demanded "under the guise of offerings"; fraud exploiting people who enter trance easily through drumming or alcohol, called "harmful practices" [source: Badam-Ochir 2024]; high fees and "circuslike spectacles" criticised by Buryat shamans themselves [source: Stern 2012]. (3) Follow local safeguarding and reporting law for abuse, sexual misconduct, violence, coercive control, financial abuse of a vulnerable adult and any risk to children; never name minors in records shared outside the service. (4) Frame concern in the community's own terms (legitimate shamans and organisations also condemn these practices). [synthesis for 1, 3, 4]
Example language (illustrative): "Some people have told me they felt pressured to pay more than they could. Has anything like that happened? You can still keep your practice; I just want you safe."
Watch for: debt, fear of spiritual retaliation for refusing, isolation from family. Working when the client can set limits or seek help.

4.15 Safeguarding: delayed or replaced medical care

Purpose / when: physical symptoms, injury, serious illness, or advice to avoid doctors or stop medication.
Steps: (1) Ask what medical care is in place. (2) Encourage medical assessment for physical symptoms and injuries; a journalist reported a shaman binding the head of a man who may have had a skull fracture [source: Stern 2012]. (3) Some shamans claim to cure cancer, a claim the same report doubted [source: Stern 2012]; no shamanic practice should be presented as treatment for physical disease, and you do not endorse or dispute specific healing claims; you advocate medical care [synthesis]. (4) Never advise on starting, stopping or changing medicines; route to the prescriber. (5) Escalate urgently where life or health is at risk. [synthesis for 1, 4, 5]
Example language (illustrative): "Seeing your shaman and seeing a doctor don't have to compete. Would you be willing to get that head pain checked this week?"
Watch for: worsening symptoms; secrecy about remedies. Working when medical and traditional care run in parallel.

4.16 Risk assessment within a spiritual frame

Purpose / when: at intake and whenever distress is high; traditional descriptions of spirit-related conditions include depression and suicidal tendencies [source: Sodnompilova 2021].
Steps: (1) Ask directly about suicidal thoughts, including those framed as joining ancestors or being taken by spirits. (2) Follow standard risk-assessment and safety-planning practice; for lethal means, discuss safe storage and removal only. (3) Include traditional and religious supports in the safety plan if the client wishes. (4) Screen alcohol and other substance use. [synthesis]
Example language (illustrative): "Sometimes people feel the ancestors are calling them away, or think about not being alive. Has anything like that been in your mind?"
Watch for: fatalism ("the spirits will decide"); heavy drinking. Working when the client engages in a safety plan.

4.17 Clients drawn to neo-shamanism or shamanic tourism

Purpose / when: non-Mongolian or diaspora clients engaging with "Tengerism", workshops or travel to Mongolia or Buryatia.
Steps: (1) Explore what they seek (meaning, belonging, healing). (2) Note that Buryat shamans themselves distinguish lineage practitioners from "neo-shamans" they regard as fake [source: Mater 2015], and that paid seminars and initiations for outsiders have grown [source: Kharitonova 2015]. (3) Do not facilitate access to ceremonies or initiations; respect community pathways. (4) Screen mental-health vulnerability, substance use and finances. [synthesis for 1, 3, 4]
Example language (illustrative): "What draws you to this? How do the people whose tradition this is see visitors taking part?"
Watch for: spiritual bypassing of treatable problems; exploitation; destabilisation after intense experiences (assess as spiritual emergency versus disorder). Working when the client's choices are informed and their mental health is stable.

5. Handling problems

The sources describe the tradition, not psychotherapy alongside it; all guidance in this section is [synthesis] unless a source is cited.

Client fears being labelled mad. Name the fear, explain that you use the CFI to understand, not to judge, and that a calling or spirit explanation will be recorded as the client's understanding, separate from any diagnosis [synthesis; CFI purpose per APA DSM-5-TR CFI].
Client tests you, as they may test shamans. Clients may compare helpers to find the trustworthy one [source: MIT News 2013]. Respond with consistency, transparency about your limits and follow-through; do not compete with the shaman.
Stuck: the client attributes everything to spirits and declines clinical goals. Return to the explanatory model and find goals both frames support (sleep, family harmony, work). Ask what the shaman or lama would consider a good outcome.
Stuck: the family insists on shamanic help, the client wants medication (or the reverse). Family session with the Informant Version perspective; affirm the client's autonomy; propose parallel help.
Non-adherence to medication. Explore the explanatory model of the medicine and any advice received; never advise changing medicines; involve the prescriber with consent.
Rupture after you question a shaman's fees or advice. Acknowledge that you are not judging the tradition; refer to the community's own criticism of exploitation [source: Badam-Ochir 2024; Stern 2012]; return to the client's safety and choices.
Overwhelm after a consultation or ritual. Grounding and stabilisation; assess for dissociation, psychosis, substance use and risk; apply ICD-11 and DSM exclusions carefully (4.7); arrange medical or psychiatric review if symptoms persist or escalate.
Diagnostic uncertainty (calling versus psychosis or depression). Hold both in the formulation; consult a cultural broker; review over time; treat clear disorder. Kharitonova's observation that depression was often read as shamanic illness is a reason to screen, not to override the client's meaning [source: Kharitonova 2015].
Fear of spiritual retaliation for stopping a consultation or refusing payment. Explore it within the client's own frame, identify trusted community or religious figures the client respects, and apply safeguarding if coercion is present (4.14).
Client asks you to recommend a shaman or join a ritual. Decline both; explain your role; encourage the client to use family, lineage and community pathways; offer to coordinate with their chosen helper, with consent (4.9).
Client asks you to interpret a dream or spirit message. Decline to interpret spiritually; explore the feelings and meanings for the client and suggest they take spiritual questions to the person they trust in their tradition.
Therapist discomfort or over-identification. Supervision; consider whether romantic or dismissive views are shaping your questions (4.1).
Small-community confidentiality. Diasporas are small; check interpreter overlap and agree how the client wants their consultations described in records.
Alcohol use linked to trance or role strain. Screen and treat substance use directly and non-judgementally; reports link alcohol to trance-related exploitation and to shamans' role strain [source: Badam-Ochir 2024; Stern 2012].
Medical emergency or injury managed only traditionally. Treat as urgent: advocate medical assessment immediately (4.15).
Child or vulnerable adult at risk in a healing context. Follow statutory safeguarding procedures; consult your safeguarding lead; do not investigate the ritual yourself.

Sources

Web pages

Books and articles cited

Buyandelger M. (2013). Tragic Spirits: Shamanism, Memory, and Gender in Contemporary Mongolia. Chicago: University of Chicago Press.
Pedersen M.A. (2011). Not Quite Shamans: Spirit Worlds and Political Lives in Northern Mongolia. Ithaca: Cornell University Press (Culture and Society after Socialism).
Humphrey C. with Onon U. (1996). Shamans and Elders: Experience, Knowledge, and Power Among the Daur Mongols. Oxford: Oxford University Press. (Author order [uncertain]: the Oxford Academic page lists Urgunge Onon.)
Dulam S. (1992). Darkhad böögiin ulamjlal [Darkhad shamanic tradition], as cited by Badam-Ochir 2024 [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).

Gaps [uncertain: not verified]: Mongolian- and Buryat-language institutional publications of the Golomt Centre, Tengeriin Sülder and Khaan-Tengeri; any formal Mongolian or Russian statement asking outsiders not to take part in shamanic ceremonies; any clinical collaboration programme between mental-health services and Mongolian or Buryat shamans.

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