Korean mudang, paksu and kut

1. Introduction

Version followed: Korean shamanism (musok / mugyo) as Korean heritage bodies, UNESCO, Korean-language scholarship and Korean psychiatrists (Kim Kwang-iel and colleagues) describe it. The clinical frame is the DSM-5-TR Cultural Formulation Interview (CFI), with ICD-11 for trance and possession codes. This is a living religious and healing tradition, not a psychotherapy. A psychotherapist does not perform it. This guide covers the therapist's own culturally responsive work with clients for whom it matters.

What it is. Mudang is the general, gender-neutral word for Korean shamans. Baksu (paksu) is a less common term used only for male practitioners. Mansin ("10,000 spirits") is a respectful term. Gut (kut) are the shamans' rituals, which combine music, song, chant and dance. Their content is passed on orally and through practice from shaman to apprentice. [source: Korea Times, Korean shamanism terms, 2026]
Two routes into the role. Practitioners and scholars distinguish two kinds of shaman. The gangsinmu are called by spirits, usually after sinbyeong ("spirit sickness"). The seseupmu inherit the role through their families and usually do not go through sinbyeong. [source: Korea Times 2026; Kim, Kim and Yoshinaga 1999] An established shaman (sineomeoni, "spirit mother") takes on a protégé (sinttal, "spirit daughter"). The naerim-gut is the initiation rite. [source: Korea Times 2026] Its content is not described here.
Sinbyeong as the tradition holds it. Within the tradition, sinbyeong is the experience of being called by a spirit. It is described as a period of physical and psychological suffering that usually eases after initiation. [source: Korea Times 2026; Kim, Kim and Yoshinaga 1999] Tae-gon Kim's account of Muism (as summarised in a secondary encyclopedia) frames it as a religious experience of connection between the divine and the human. In that account, believers hold that medical treatment cannot cure it and that it resolves only when the person accepts the spirit. [source: Wikipedia, Sinbyeong, citing Kim Tae-gon 1998] [uncertain: secondary summary]
Disease deities. In Korean folk belief, smallpox was attributed to a deity addressed respectfully as mama, or as sonnim ("guest"). Measles was called the "small guest" and smallpox the "big guest". Mudang were called on to send the pox deity on its way as an honoured guest. During an epidemic, gut were held to appease the vengeful dead. [source: Hwang Byeong-ik, Jeongsin Munhwa Yeongu 34(2); Yun Ju, Jeonbuk Ilbo 2020] These are historical and belief accounts. They do not describe a treatment for any physical disease.
Who holds authority. Authority lies within the tradition itself: the spirit-mother lineage and the community of practising mudang. Korea's state heritage system names specific gut as national intangible heritage. Examples are the West Coast Baeyeonsin-gut and Daedong-gut (No. 82-2), whose designated holder from 1985 was the shaman Kim Keum-hwa (1931–2019), and Jeju Chilmeoridang Yeongdeunggut, designated in 1980 and inscribed on UNESCO's Representative List in 2009. [source: Korea Times on Kim Keum-hwa 2026; UNESCO ICH 00187; Korea Times 2021] Jeju Keungut, led by Jeju shamans (simbang), was announced for national designation by the Cultural Heritage Administration in 2021. [source: Korea Times 2021] That administration is now called the Korea Heritage Service (Gukgayusancheong). [uncertain: not verified] Heritage designation gives no authority over a client's healing or care. No state licensing of mudang is documented here. [uncertain: not verified]
How change happens, in the therapist's work. Distress is understood, and help is offered, through the client's own explanatory model. That model may hold a spirit calling and a psychiatric condition at the same time. The therapist's job is to understand, assess risk and illness carefully, and support the pathways the client chooses. [synthesis, built on the CFI's stated purpose: source APA DSM-5-TR CFI]

2. Framework

The tradition has no therapist-facing framework of its own, so the phases below are the therapist's own work. [synthesis] The CFI can be given at the first evaluation, later in care, or repeatedly. Its supplementary modules can be added or used on their own. [source: APA CFI Supplementary Modules]

Phase A: Engagement and cultural assessment (sessions 1–3, individual; include family with consent). Goal: understand the problem in the client's own terms, including any idea that it is sinbyeong, a spirit calling, or the work of a deity or ancestor. Tools: the core CFI (16 questions, four domains), the Explanatory Model and Spirituality, Religion and Moral Traditions modules, and Kleinman's questions. A time figure of about 15–20 minutes for the core CFI is [uncertain]. Move on when the client's explanatory model, help-seeking history (including any consultation with a mudang or baksu), and current risk are documented. [source: APA CFI; Kleinman et al. 1978 via Tanenbaum handout] [synthesis for session counts]
Phase B: Differential understanding (sessions 2–5, overlapping with A). Goal: tell apart culturally normative calling or possession experience, a mental disorder, and a mix of the two, without pathologising and without missing illness. Use the DSM-5-TR possession-form DID criteria, the cultural exclusion for dissociative trance, ICD-11 6B62/6B63, medical work-up, and cultural consultation. Move on when a working formulation exists that both the client and the clinician can state. [source: PMC9199574; Lewis 2023 study guide; ICD-11 via findacode; Kim, Kim and Yoshinaga 1999]
Phase C: Collaborative plan (ongoing). Goal: agree on goals. These might include symptom relief, sleep, working through a decision about the calling, family conflict, or work and study. Agree on which helpers the client wants involved: psychiatry, primary care, a mudang or baksu the client already knows, church or temple, family. Move on when consent and information-sharing boundaries are recorded. [synthesis]
Phase D: Integration and follow-up. Goal: help the client make meaning of whatever they lived through (illness, a gut they attended, initiation or a decision not to be initiated) and fold it into daily life and relationships. Repeat CFI modules if the picture changes. [source: APA CFI Supplementary Modules on repeated use] [synthesis]
Throughout: safety and safeguarding. Watch for suicide risk, severe psychosis or mania, medical illness being left untreated, exploitation, and risks to children. These override sequencing. [synthesis]
Format. Individual 50-minute sessions. Family sessions use the CFI Informant Version (17 questions). Use a professional interpreter where Korean is the client's preferred language. [source: APA CFI Informant Version] [synthesis]

3. Guiding principles

The therapist works alongside the tradition, not inside it. Never offer, arrange, simulate or interpret gut, naerim-gut, divination or spirit communication. [synthesis]
Attribute, do not adjudicate. Describe spirits, deities and callings as the client and tradition hold them ("in your family's understanding…"), neither affirming them as fact nor dismissing them. [synthesis]
Authority sits with the tradition and the client. Whether someone is "called", and who may initiate them, is for the spirit-mother lineage and practising mudang, not the clinician. In practice: do not tell a client whether they "really" have sinbyeong. [source: Korea Times 2026 on spirit mother/daughter] [synthesis]
Both/and is common. Kim and colleagues note that most people who experience shin-byung do not become shamans. The conflict this creates can worsen or speed up the illness, so psychiatric care may be needed. In practice: a spirit explanation does not rule out depression, psychosis or a dissociative disorder, and a diagnosis does not cancel the spiritual meaning. [source: Kim, Kim and Yoshinaga 1999]
Do not use outdated categories as diagnoses. DSM-IV listed shin-byung as a culture-bound syndrome. DSM-5 dropped it, while its table of cultural concepts lists hwa-byung, not shin-byung. In practice: treat sinbyeong as the client's idiom and explanation, and use the CFI rather than a code. [source: Park and Park, J Korean Med Sci] [uncertain: DSM-5-TR's own list]
CFI findings inform, not decide. The CFI supports clinical understanding and decisions. It is not the only basis for a diagnosis. [source: APA CFI]
Respect for heritage and stigma. Gut are recognised national heritage, yet clients may carry shame about shaman relatives or their own calling. In practice: name the tradition respectfully and ask how the client's community regards it. [source: UNESCO ICH 00187; Korea Times 2021] [synthesis on stigma] Korean psychiatrists have described colonial-era psychiatry as tied to colonial ethnopsychiatry and to stigma, including research that linked lower inpatient numbers among Koreans to reliance on shamanism. [source: J Korean Neuropsychiatr Assoc 2015 review, abstract]
No physical-disease claims. Beliefs about disease deities are explored as meaning, never as a substitute for medical care. [synthesis]
Consent and confidentiality govern every contact with healers or family. [synthesis]
The client chooses. Collaboration with a mudang or baksu happens only when the client wishes it and with their consent. Do not send clients looking for ceremonies outside legitimate community pathways. [synthesis]
Cultural humility. Examine your own religious stance (e.g. Christian, secular-scientific or Buddhist) and your reactions to possession and shamanism. [synthesis]

4. Intervention inventory

Every item below is the psychotherapist's own work. None reproduces or substitutes for a mudang's or baksu's practice. Example language is illustrative throughout.

4.1 Cultural self-examination and humility

Purpose / when: Before and during work with any client involved with musok, especially if you have strong views about shamanism (religious, scientific, or shaped by stigma in Korean or diaspora communities). [synthesis]
Steps: (1) Write down your assumptions about possession, spirit calling and shamans. (2) Notice whether you lean towards treating sinbyeong as "just" psychosis or towards romanising it. (3) Take reactions to supervision. (4) Learn the client's terms (mudang, baksu, mansin, gangsinmu, seseupmu, sinbyeong, gut) as general orientation only, and let the client define what they mean for them. [source: Korea Times 2026 for terms] [synthesis]
Example language (illustrative): "I know a little about musok, but I'd like to learn how you and your family understand it."
Watch for: Over-explaining the tradition to the client, curiosity that feels voyeuristic, or asking for ritual details the client has not offered. It is working when the client corrects you freely and uses their own words.

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

Purpose / when: Early assessment (Phase A). Repeat when the problem is described as spirit-related or treatment stalls. [source: APA CFI]
Steps: Work through the four domains, in your own words or the APA wording (clinicians may reproduce it for patient use). (1) Cultural definition of the problem (Q1–3). (2) Perceived causes, stressors and supports, and the role of cultural identity (Q4–10). (3) Self-coping, past help-seeking and barriers (Q11–13): name mudang, baksu, temple, church, Korean medicine and psychiatry as possible helpers. (4) Current help-seeking preferences and the clinician–patient relationship, including language and experiences of racism (Q14–16). Record answers verbatim where you can. [source: APA CFI] Do not change or translate the form without APA permission. [source: APA CFI permission note]
Example language (illustrative): "People describe problems like this in many ways. How would you describe it to your family or friends?" / "Have you gone to anyone else for help, such as a doctor, a church or temple, or a mudang?"
Watch for: Guarded answers about shamans, which can reflect stigma or fear of being judged psychotic. Go back to it later. It is working when the client gives their own label for the problem (e.g. sinbyeong, hwa-byung, "nerves", depression).

4.3 CFI supplementary modules

Purpose / when: To go deeper when spirit, family or migration themes are central. [source: APA CFI Supplementary Modules]
Steps: Pick from the 12 modules. Most relevant here: Explanatory Model; Spirituality, Religion and Moral Traditions; Cultural Identity; Coping and Help-Seeking; Social Network; Immigrants and Refugees; Patient-Clinician Relationship; Older Adults; School-Age Children and Adolescents. Use the Caregivers module with a caregiver, not the client. Use them as add-ons or on their own, at any point in care. [source: APA CFI Supplementary Modules]
Example language (illustrative): "You mentioned your grandmother was a mansin. What part has that played in how your family sees what is happening to you?"
Watch for: Overloading early sessions. One module per session is usually enough. [synthesis] It is working when you can map who in the client's network holds influence (spirit mother, parents, pastor, doctor).

4.4 Explanatory-model inquiry (Kleinman)

Purpose / when: Whenever the client links symptoms to spirits, ancestors, a deity or a calling. [source: Kleinman, Eisenberg and Good 1978 via Tanenbaum handout]
Steps: Ask in turn, in your own words: what the client calls the problem; what caused it; why it began when it did; what it does to them and how; how severe it is and how long it will last; what treatment they think they should get; what problems it has caused; what they fear most. Then summarise their model back and ask how your view could fit alongside it. [source: Tanenbaum handout] [synthesis for summarising]
Example language (illustrative): "What do you think started this, and why now?" / "What are you most afraid will happen if this isn't resolved?"
Watch for: Fear of the consequences of refusing a calling, of letting family down, or of being labelled mentally ill. It is working when the client can hold more than one explanation without feeling dismissed.

4.5 Asking about consultation with a mudang or baksu, without judgement

Purpose / when: In Phase A and whenever the client mentions gut, fortune-telling or a shaman. [synthesis, aligned with CFI Q12 and Q14: source APA CFI]
Steps: (1) Normalise the question. (2) Ask who they saw, whether this was someone the family already knew, what was said about the problem, what was recommended, and how they felt about it. (3) Ask about costs, pressure, or recommendations to stop medical treatment, as safety screening, without implying wrongdoing. (4) Do not ask for ritual content, words or objects. [synthesis]
Example language (illustrative): "Some of my clients have also seen a mudang. If you have, I'd like to know what that was like and what you were told, only as much as you want to share."
Watch for: Shame, secrecy from Christian family members, or financial strain. It is working when the client tells you about it freely and you can include it in the shared formulation.

4.6 Working with cultural concepts of distress (sinbyeong, hwa-byung)

Purpose / when: When the client uses these terms or presents with the features linked to them. [source: Park and Park; Kim, Kim and Yoshinaga 1999]
Steps: (1) Treat the term as the client's idiom and explanation, not as a diagnosis. Shin-byung was a DSM-IV culture-bound syndrome but is not in DSM-5. DSM-IV described anxiety and bodily complaints followed by dissociation and possession by ancestral spirits. Hwa-byung appears among DSM-5 cultural concepts. [source: Park and Park] (2) Explore what the term means for this client and family. (3) Run a separate DSM-5-TR/ICD-11 assessment (4.7). (4) Write both into the formulation. [synthesis] Whether DSM-5-TR lists hwa-byung by name is [uncertain: not verified].
Example language (illustrative): "When your mother calls this sinbyeong, what does she mean will happen, and what does she hope for?"
Watch for: The clinician quietly translating the idiom straight into a diagnosis. It is working when the formulation records the client's term next to any diagnosis.

4.7 Distinguishing a normative calling or possession experience from disorder

Purpose / when: Phase B. Whenever there are possession experiences, hearing or seeing spirits, dreams of deities, or long periods of bodily illness tied to a calling. [source: Kim, Kim and Yoshinaga 1999] [synthesis]
Steps: (1) Cultural fit: is the experience recognised and accepted within the client's community and lineage, and do people in it see this as a calling? Consult a cultural broker with consent. (2) Diagnostic rules: DSM-5 allows DID identity disruption to be described as possession in some cultures, and excludes a disturbance that is a normal part of broadly accepted cultural or religious practice. Dissociative trance, under other specified dissociative disorder, is excluded when it is a normal part of broadly accepted collective cultural or religious practice. A study guide citing DSM-5-TR (Lewis 2023) paraphrases both points, so DSM-5-TR keeps them in substance; that it keeps the exact wording is [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, with significant distress or impairment. [source: PMC9199574; Lewis 2023 study guide; findacode ICD-11 mirror] (3) Illness markers regardless of culture: disorganisation, loss of function, persistent insomnia and weight loss, mood elevation or severe depression, suicidality, substance use, and bodily symptoms needing medical work-up (Korean accounts describe appetite loss, insomnia, digestive pain and weakness). [source: Wikipedia Sinbyeong, secondary] [uncertain: Wikipedia only] [synthesis] (4) Distress and choice: is the person distressed by or resisting the calling? Kim and colleagues note this conflict can worsen the course. [source: Kim, Kim and Yoshinaga 1999] (5) Hold the formulation as provisional and review it.
Example language (illustrative): "Some people in your tradition go through something like this and see it as a calling. Others go through it and are also unwell in a way doctors can help with. Can we look at both?"
Watch for: Two errors, pathologising a sanctioned experience and missing psychosis, mania or medical illness. It is working when the client agrees with the formulation and red flags are actively monitored.

4.8 Exploring the decision about a calling

Purpose / when: When the client feels called but is unsure, unwilling, or under pressure from family or a shaman. [source: Kim, Kim and Yoshinaga 1999 on conflict] [synthesis]
Steps: (1) Clarify who is saying what (client, family, mudang, church). (2) Explore values, fears and practical consequences (work, marriage, faith, stigma) without steering in either direction. (3) Separate the spiritual question, which belongs to the client and the tradition, from symptom management, which you can help with. (4) Support the client to seek guidance within legitimate community pathways if they choose. Never advise on initiation itself. [synthesis]
Example language (illustrative): "This is a decision for you and the people you trust in your tradition. My part is to help you think clearly and to look after your health while you decide."
Watch for: Therapist bias towards one outcome, and coercion from any side. It is working when the client describes the choice as their own.

4.9 Family and informant work

Purpose / when: When family beliefs differ (e.g. Christian versus musok-affiliated relatives), or when a caregiver brings the client. [source: APA CFI Informant Version] [synthesis]
Steps: (1) With consent, give the Informant Version (17 questions). (2) Map family history of shamans, both inherited (seseupmu) and spirit-called. [source: Korea Times 2026] (3) Hold a joint session to state each person's model and agree what everyone wants for the client's safety and functioning. (4) Address shame and secrecy. [synthesis]
Example language (illustrative): "Each of you has a way of understanding this. Let's put them side by side and see where you agree about helping her."
Watch for: One relative overriding the client, or confidentiality being breached. It is working when family conflict over meaning eases enough to support the care plan.

4.10 Collaboration and referral with community-recognised practitioners (when the client wishes)

Purpose / when: When the client wants their mudang, baksu or other religious helper to be part of their care. [synthesis]
Steps: (1) Confirm in writing what the client wants: whether you may contact the practitioner, and what information may be shared. (2) Only work with practitioners the client already has a relationship with, or who are recognised within the client's own community. The therapist does not find, vet or book shamans or gut. (3) Agree on a shared aim (e.g. safety, sleep, keeping up medical care) and keep the roles separate. (4) Record that this is a client-chosen collaboration. Outside Korea, no formal referral programme for mudang is documented. [uncertain: not verified] For context, collaborative-care trials with traditional and faith healers elsewhere (COSIMPO in Nigeria and Ghana; a prayer-camp trial in Ghana) found symptom benefits from structured cooperation. In the prayer-camp trial, days in chains did not fall significantly. [source: COSIMPO via PubMed 32861306; Ofori-Atta et al. Br J Psychiatry] These do not concern Korean shamanism directly.
Example language (illustrative): "If it would help to have your mansin and me on the same page about your health, we can talk about what you'd be comfortable with me saying."
Watch for: Advice to stop medicines or avoid doctors, large financial demands, or the client feeling pressured. Respond through safeguarding (4.15). It is working when the client feels their two sources of help are not in conflict.

4.11 Medical and psychiatric liaison

Purpose / when: When there are bodily symptoms (appetite loss, insomnia, digestive pain, weakness), possible psychosis or mood disorder, or medicine questions. [source: Wikipedia Sinbyeong, secondary, for symptom picture] [uncertain: Wikipedia only] [synthesis]
Steps: (1) Arrange a medical review for persistent bodily symptoms. (2) Refer to psychiatry when psychotic, manic, severe depressive or dissociative features impair functioning. (3) Never advise starting, stopping or changing a medicine, whether prescribed, herbal or Korean medicine. Route these questions to the prescriber. (4) Share the cultural formulation with the prescriber, with consent. [synthesis]
Example language (illustrative): "Whatever the deeper meaning, your body hasn't been sleeping or eating. I'd like a doctor to check that, and I'll tell them what this means to you so they understand."
Watch for: A belief that medical treatment will make sinbyeong worse, which some accounts report. [source: Wikipedia Sinbyeong, secondary] [uncertain: Wikipedia only] Discuss it openly rather than overriding it. It is working when the client accepts a check-up without feeling their belief is under attack.

4.12 Illness meanings involving disease deities, ancestors or the restless dead

Purpose / when: When a client or family links a physical or mental illness to a deity (e.g. the smallpox deity called mama or sonnim), an ancestor, or the unquiet dead. [source: Hwang Byeong-ik; Yun Ju 2020]
Steps: (1) Explore the belief's meaning and emotions (fear, guilt, obligation). (2) Explore family history, e.g. grief or a death without proper mourning, using the client's framing. (3) Make sure medical care for any physical illness goes ahead. Historically, folk practice around the pox deity avoided medicine and relied on offerings and taboos. [source: Hwang Byeong-ik] (4) Support whatever religious response the client chooses within their community, without recommending one. [synthesis]
Example language (illustrative): "In your family's understanding, what does this illness want or need? And alongside that, what do the doctors need to do?"
Watch for: Delayed treatment, especially for children or older adults. It is working when meaning-making and medical care go on together.

4.13 Integration after a gut or an initiation decision

Purpose / when: After the client has attended or sponsored a gut, gone through or declined a naerim-gut, or left an apprenticeship with a spirit mother. [source: Korea Times 2026 for roles] [synthesis]
Steps: (1) Invite the client to say what the experience meant, without asking for ritual content. (2) Track changes in symptoms, relationships and identity. (3) Work with the relationship to the spirit mother, which can be close and strict, "just like a mother" in one spirit daughter's words, including endings or ruptures. [source: Korea Times on Kim Keum-hwa] (4) Fold insights into daily life and goals. [synthesis]
Example language (illustrative): "You don't need to tell me what happened in the gut. I'm interested in what's different for you since."
Watch for: Worsening after the event, or feelings of failure if relief did not come. It is working when the client tells a coherent story that ties together the experience, symptoms and next steps.

4.14 Diaspora and immigrant work

Purpose / when: Korean clients outside Korea, or in contact with several cultures, including Christian or secular settings where musok may be stigmatised. [source: Yi 2000; APA CFI Immigrants and Refugees module]
Steps: (1) Use the Immigrants and Refugees and Cultural Identity modules. (2) Assess isolation and language access. (3) Pay attention to dreams and images the client brings, as their own symbols. Yi's psychoanalytic case report of a Korean immigrant woman with shin-byung read her dream figures as condensed images of nurturing caregivers, and her improvement came partly through relationships outside therapy. [source: Yi 2000, Culture, Medicine and Psychiatry, abstract excerpt] (4) Strengthen supportive relationships in the client's community. [synthesis]
Example language (illustrative): "Who here understands this the way people back home would?"
Watch for: Over-interpreting dreams through the therapist's own framework. It is working when the client's support network widens.

4.15 Safeguarding

Purpose / when: When any practice, from any source, involves restraint, physical harm, coercion, exploitation, sexual contact, starvation, or delay of urgent medical care, or a child is at risk. [synthesis]
Steps: (1) Ask direct, non-accusing questions. (2) Assess the risk. (3) Follow local adult and child safeguarding duties and report where required. (4) Keep the client's dignity and their wider spiritual life separate from the specific harm. (5) Never name minors in records shared with outside parties beyond what the duty requires. [synthesis] No documented pattern of specific harms within musok is reported in the sources cited. [uncertain: not verified]
Example language (illustrative): "I respect what this means to you. I also have to ask: has anyone, in any setting, held you down, hurt you, or told you not to see a doctor?"
Watch for: Fear that disclosure will bring shame on the family or tradition. It is working when the client stays engaged after safety steps.

4.16 Interpreters and cultural brokers

Purpose / when: When Korean is the client's preferred language for distress, or you need help understanding community norms. [synthesis]
Steps: (1) Use professional interpreters, not family. (2) Brief them on confidentiality and on neutral rendering of spiritual terms. Agree to keep words such as sinbyeong, mudang and gut in Korean. (3) Consult a cultural broker, with consent and without identifying information, about how the client's community regards a given experience. [synthesis]
Example language (illustrative): "Please translate exactly what I say, and keep her words like 'sinbyeong' as she says them."
Watch for: An interpreter softening or editorialising religious content. It is working when the client's own terms appear in session notes.

5. Handling problems

The sources do not address therapy problems directly. Everything in this section is [synthesis] unless a source is tagged.

Client won't discuss shamans or spirits (guardedness, stigma). Say plainly that you will not judge them, and that experiences like these are common and are recognised as part of Korean heritage. [source: UNESCO ICH 00187 for heritage status] Come back to it later through the Spirituality module. Don't push for detail.
Client wants the therapist to confirm or deny the calling. Say this is outside your role and belongs to the client and the tradition. Offer to help with what you can: symptoms, sleep, the decision process, family conflict. Example (illustrative): "I can't tell you whether the spirits are calling you. I can help you get through this time and think it through."
Client refuses all medical or psychiatric input because it is believed to worsen sinbyeong. Explore the belief respectfully. [source: Wikipedia Sinbyeong, secondary, for the belief] [uncertain: Wikipedia only] Negotiate the smallest acceptable step, such as a physical check-up. If risk is high (psychosis with danger, suicidality, severe weight loss), act on duty of care whatever the belief.
Stuck between family pressure and personal wishes about initiation. Use 4.8 and 4.9. Bring in each party's view and keep the client's own choice at the centre. Kim and colleagues note that this conflict can make the illness worse. [source: Kim, Kim and Yoshinaga 1999]
Overwhelm or dissociation in session. Ground in the present: the room, the senses, the time. Slow the pace. Don't explore possession content while the client is in an altered state. Afterwards, review safety and whether psychiatric input is needed.
Rupture: the client feels pathologised (e.g. after a diagnosis is mentioned). Acknowledge it. Restate the both/and formulation (4.7), and invite the client to correct how you described their experience.
Rupture: the therapist is seen as "too accepting" (e.g. by Christian family members). Clarify your neutral stance and your focus on the client's wellbeing and choices.
Non-adherence to plans or medicines. Explore the client's model of the medicine (4.4). Don't advise on medication changes. Liaise with the prescriber with consent.
Conflicting advice from a shaman and from clinicians. With consent, set up role clarity through the client (4.10). If advice includes stopping urgent medical care, follow safeguarding (4.15).
Financial pressure or exploitation concerns. Look at the client's own sense of fairness and choice. Help them consult trusted community members. Safeguard if exploitation of a vulnerable adult is suspected.
Children and adolescents described as "called". Use the School-Age Children and Adolescents module. Involve caregivers. Ensure medical, educational and safeguarding needs are met. Consent and assent come first. [source: APA CFI Supplementary Modules]
Therapist's own discomfort, or romanticising the tradition. Take it to supervision (4.1). Don't ask the client for ritual experiences for your own interest.
Diagnostic uncertainty persists. Keep the formulation provisional. Review regularly with the CFI and symptom tracking, and get a second opinion from a clinician experienced with Korean clients.

Sources

Books and articles cited:

Kim Tae-gon (1998). Korean Shamanism—Muism. Trans. Chang Soo-kyung. Jimoondang. (Cited via secondary summary.) [uncertain]
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). DSM-5-TR.

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