Yoruba Ifá and orisha healing

1. Introduction

Version followed: for the tradition, the UNESCO Representative List entry for the Ifá divination system (inscribed 2008, proclaimed 2005), with Yoruba-language institutions and published ethnography as attributed context; for the psychotherapist's own work, the DSM-5-TR core Cultural Formulation Interview (APA 2022) and the APA supplementary modules and Informant Version (labelled DSM-5, 2013).

Ifá and orisha (òrìṣà) healing are not a psychotherapy and not a technique a therapist can adopt. They belong to Yoruba religion and culture in south-west Nigeria and neighbouring areas, and to diaspora religions in the Americas and the Caribbean (for example Santería in Cuba, Candomblé in Brazil, and communities in Trinidad and the United States). UNESCO describes Ifá as a divination system and literary corpus held by Ifá priests, the babaláwo, and consulted when an important individual or collective decision has to be made. Its verses carry Yoruba history, language, beliefs and worldview. [source: UNESCO Ifa divination system] In Yoruba understanding, as secondary sources report, medicine and ritual are not sharply separated, so babaláwo and other healers attend to physical, mental and spiritual states together; Ifá is held to convey the teachings of Ọ̀rúnmìlà, the òrìṣà of wisdom and divination. [source: Wikipedia, Babalawo, citing Olupona 2014 and others; secondary] [uncertain: Wikipedia only] The UNESCO entry itself does not describe Ifá as a healing practice. [source: UNESCO]

This guide covers the psychotherapist's work alongside the tradition: understanding the client's Yoruba or orisha-based explanatory model, assessing culturally, telling culturally normative experience apart from disorder, collaborating with community-sanctioned healers when the client wishes, and safeguarding. How change happens, from the therapist's side: care improves when the clinician understands what the problem means to the client and their network, what help they have sought and expect, and builds a plan that fits that meaning, rather than replacing or competing with it. [source: APA DSM-5-TR CFI] [synthesis] The healing itself is the domain of the tradition's own authorities; this guide gives no divination method, ceremony, prayer, sacred object, initiation step or herbal preparation.

Who holds authority

Babaláwo (Ifá priests). UNESCO names them as the holders and transmitters of Ifá knowledge, passed among Ifá priests within Yoruba communities. [source: UNESCO] A babaláwo is expected to memorise the Ifá corpus, organised in 256 odù, and works with Ifá poetry, divination and herbal medicine; historically the role has generally been held by men. [source: Rinne 2001] How apprenticeship is organised and who authorises initiation are not set out in the sources cited [uncertain].
Titled priests. In Ilé-Ifè, the Àràbà is described as the head of all Ifá chief-priests, and with the Agbóngbòn stands at the top of the town's hierarchy of diviners. [source: Elugbaju 2022] Titles and their ranking differ from town to town; the Olúwo title and its place in other towns are [uncertain: secondary, unverified].
Women diviners. Ifá's priesthood has historically been male-dominated, yet several women have practised as Ifá diviners in West Africa; the sharpest current debate concerns women seeking the highest levels of initiation (tied to rituals of the òrìṣà Odu), mainly in Cuba and the United States. [source: Ogunnaike 2018] The title Ìyánífá is used for women in Ifá [uncertain: secondary, unverified]. Treat this as an internal matter for the community, not for the therapist to rule on. [synthesis]
Herbalists and traditional psychiatric healers. Yoruba healers who specialise in mental disorders have been studied as a group (e.g. 20 healers in the Ife area, 10 key informants in Ibadan, a well-known healer in Abeokuta). [source: Makanjuola 1987; Jegede 2005; Alabi 2019] In Ilé-Ifè research, oníṣègùn names a herbalist expert in traditional herbal medicine; pure herbalists are hard to find, because many also practise divination or other ritual specialties. [source: Rinne 2001] Use the term the client uses.
Institutions. The Ifá Heritage Institute in Ọ̀yọ́, a two-year college teaching in Yorùbá from Ifá and Yoruba indigenous knowledge, opened in November 2008 as the main part of a UNESCO-supported project to safeguard the Ifá divination system. [source: Ifá Heritage Institute page, Wándé Abímbọ́lá] In Nigeria, state traditional medicine boards register practitioners; for example, the Lagos State Traditional Medicine Board (set up 1980) required all complementary and alternative medicine practitioners and premises to register by March 2022, following National Council on Health directives. [source: Federal Ministry of Information, 2022] Registration is a state regulatory act and says nothing about religious standing in Ifá. [synthesis]
Diaspora. Diaspora houses (Santería or Lucumí, Candomblé and others) have their own lineages and elders and have adapted the practice to new settings. [source: Wikipedia, Babalawo, citing Capone 2022; secondary] [uncertain: secondary, unverified] The authority structures of specific diaspora houses are [uncertain]; ask the client who holds authority in their house.

Yoruba terms for mental illness reported by researchers (attributed)

Wèrè: the Yoruba term for manifest mental disorder; Jegede reports it frames illness at its severe, "terminal" stage, carries strong stigma as a derogatory label, and that people tend to seek help only at crisis. Healer informants in Ibadan distinguished three kinds of wèrè (Were Amutorinwa, Were Iran, Were Afise, in the article's spelling). [source: Jegede 2005] (Literal glosses of these three were not verified. [uncertain: not verified])
Asínwín and ode orí: healers in the Ife study grouped disorders into asínwín (described as psychotic disorders) and ode orí (a less severe condition with prominent bodily symptoms). Causes named: enemies, with emphasis on supernatural forces; self-induced disorder (cannabis cited most often); Ṣọ̀pọ̀nná (smallpox); and "hereditary" factors understood differently from biomedicine. [source: Makanjuola 1987]
Àbísínwín ("born to be mad"): a predisposition from birth, linked by healers to blood ties or conception at a particular time in the Yoruba calendar; healers named natural causes (accidents, substance use) and preternatural ones (curses, bewitchment), and treated with "tangible" (medicine) and "intangible" (instruction, ritual appeasement, etutu) approaches, often combined. Recovery is understood as also protecting relatives and descendants. [source: Alabi 2019, conference abstract]
These concepts are presented as healers and communities hold them, neither as fact nor as error. [synthesis] Note the outsider and clinical framing of some of this research (e.g. a 1987 study counting healers' methods as "paranormal"). [synthesis]

2. Framework

There is no manualised protocol for psychotherapy alongside Ifá or orisha healing. The phases below organise the published tools (CFI, modules, Informant Version) and the Nigerian and Ghanaian collaboration evidence into a working sequence. [synthesis]

Phase	Goals	Typical format	Move on when
0. Preparation	Examine own assumptions about African religions, divination, "juju" stereotypes and Christian or Muslim framings of orisha worship; learn basic terms; arrange a Yoruba interpreter if needed	Before first contact; supervision	You can name your own biases and have an interpreter or cultural consultant plan
1. Engagement and cultural assessment	Hear the problem in the client's terms; core CFI (16 questions, four domains)	First assessment session(s); CFI time not stated by APA [uncertain]	Client's name for the problem, causes, help seeking and expectations are recorded
2. Deepening	Supplementary modules as needed (Explanatory Model; Spirituality, Religion and Moral Traditions; Cultural Identity; Coping and Help-Seeking; Immigrants and Refugees; Social Network; Patient-Clinician Relationship); Informant Version with family if the client agrees	1 to 3 further sessions, or spread through care; modules can be repeated	You know which healers are involved, what they advised, and what the family believes
3. Formulation and differential	Separate culturally normative experience from disorder; risk; medical review	Formulation session; consultation with cultural broker or community member if the client consents	A shared formulation the client recognises; urgent illness ruled in or out
4. Collaborative plan	Agree goals and roles; decide with the client whether and how to communicate with a healer	Ongoing sessions; written consent for any contact	Client has chosen a plan; safety plan in place
5. Ongoing care and integration	Psychotherapy for the agreed problems; help the client integrate religious guidance with treatment; review the CFI material over time	Usual weekly or as agreed; review every few sessions	Goals met, or care shared with or handed to other services
Throughout	Safeguarding (restraint, chaining, beating, forced fasting or herbal ingestion, sexual abuse, delay of urgent care)	Immediate action when indicated	Not phase-limited

[source: APA core CFI; APA Supplementary Modules; APA Informant Version; Gureje et al. 2020; HRW 2019] [synthesis for the phase sequence and session counts]

3. Guiding principles

Alongside, not in place of. You do not divine, interpret Ifá verses, recommend sacrifices or prescribe herbs; you work with the client's meaning. Practical meaning: never say what an odù or an òrìṣà "means" for the client. [synthesis]
Authority stays with the tradition. Babaláwo, titled priests, Ìyánífá and diaspora elders hold religious authority. Practical meaning: questions about the legitimacy of a priest or the content of a reading go back to the client and their community. [source: UNESCO; Elugbaju 2022; Ogunnaike 2018] [synthesis]
The client's terms first. Use the client's own words (wèrè, orí, an òrìṣà's name) as they use them. Practical meaning: ask what a word means to them before using it yourself. [source: APA core CFI, Cultural Definition of the Problem]
Neither fact nor dismissal. Spiritual causes (enemies, curses, ancestors, destiny) are recorded as the client's explanatory model. Practical meaning: write "client understands the illness as…" in notes. [synthesis]
Stigma is part of the presentation. Wèrè is a heavily stigmatised label and help is often sought late. Practical meaning: expect shame and crisis presentations; normalise earlier help seeking. [source: Jegede 2005]
Plural help seeking is normal. Many clients use healers, churches or mosques and clinics at once, partly because psychiatric services are scarce (fewer than 300 psychiatrists for over 200 million people in Nigeria, per HRW). Practical meaning: ask about all sources of help at every review. [source: HRW 2019; APA core CFI]
Religious discrimination is real. Colonial rule and religious pressure led to discrimination against Ifá, and intolerance of divination is growing. Practical meaning: check whether the client expects you to condemn their practice, and say plainly that you will not. [source: UNESCO]
Normative is not pathological; distress is not normative. Trance or possession that is part of broadly accepted collective religious practice is excluded from dissociative diagnoses; involuntary, unwanted, distressing states are not. Practical meaning: assess context, control, distress and impairment, not content alone. [source: ICD-11 6B62 and 6B63; DSM-5-TR via secondary sources]
Consent and confidentiality govern collaboration. Practical meaning: no contact with a healer, family member or community member without the client's explicit, specific consent. [synthesis]
Safety overrides deference. Respect for tradition never covers chaining, beating, forced fasting, forced ingestion or sexual abuse. Practical meaning: act on safeguarding duties whoever the practitioner is, including psychiatric hospitals. [source: HRW 2019]
Medicines go to the prescriber. Practical meaning: never advise starting, stopping or combining medicines or herbs; refer to the prescriber and pharmacist. [synthesis]
Strengths as well as risks. Religious practice can support coping, social support and well-being. Practical meaning: ask what the tradition gives the client, not only what worries you. [source: Oswald et al. 2018]

4. Intervention inventory

All interventions below are the psychotherapist's own. None involves performing, imitating or advising on Ifá consultation, orisha worship, ritual or herbal treatment. Example language is illustrative unless quoted. [synthesis unless a source is given]

4.1 Cultural humility and self-examination

Purpose / when: before and throughout work with any client who practises Ifá or orisha religion, or whose family does. Counters the discrimination UNESCO records against Ifá and the stereotypes clients may expect from services. [source: UNESCO] [synthesis]
Steps: (1) Write down what you associate with "divination", "juju", "Santería" or "voodoo" and where those images came from (films, religious upbringing, colonial-era writing). (2) Note your own religious commitments and any view that orisha worship is "demonic" or "superstition"; take these to supervision. (3) Learn the basic vocabulary (babaláwo, Ìyánífá, òrìṣà, orí, wèrè) from community and scholarly sources, not from practice manuals or online "initiation" sellers. (4) Recognise that Yoruba clients may themselves be Christian or Muslim and hold mixed or hostile views of Ifá. (5) Plan how you will respond if a client asks your opinion of their religion.
Example language (illustrative): "I don't practise your religion and I'm not here to judge it. I'd like to understand how it fits into what's happening for you."
Watch for: your own reactions when the client mentions sacrifice, enemies or curses; urges to correct or to over-romanticise. Working: the client discloses religious practice early and without testing you.

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

Purpose / when: at the first assessment for every client; especially when the client or family names a spiritual cause, has seen a healer, or when you are unsure what the problem means to them. It supports clinical understanding and is not a basis for diagnosis on its own. [source: APA core CFI]
Steps: (1) Download the official APA form; it may be reproduced by clinicians for use with their patients, but modifying or translating it needs APA permission. [source: APA core CFI] (2) Introduce it as questions about the client's own understanding. (3) Domain 1, Cultural Definition of the Problem (Q1 to 3): ask what brings them and how they and their family describe it; note Yoruba terms. (4) Domain 2, Perceptions of Cause, Context and Support: causes (Q4 to 5), stressors and supports (Q6 to 7), role of cultural identity (Q8 to 10). (5) Domain 3, Self-Coping and Past Help Seeking (Q11 to 13): include babaláwo, herbalists, churches, mosques, prayer camps, hospitals, and barriers to each. (6) Domain 4, Current Help Seeking (Q14 to 16): preferences, and the clinician-patient relationship, including perceived racism or religious prejudice and language barriers. (7) Paraphrase back, in their words. (8) Use the form's pointers to the relevant supplementary module. [source: APA core CFI] Do not reproduce the item wording in notes; summarise answers.
Example language (illustrative): "People explain problems like this in different ways. How would you describe it, and how does your family describe it?" / "Have you asked anyone else for help, for example a babaláwo, a herbalist, a pastor or an imam? What did they say?"
Watch for: guarded or very brief answers about causes (fear of being judged "backward" or demonic); family members answering for the client; time pressure (APA gives no duration; the field trial found later interviews took less time). [source: Lewis-Fernández et al. 2017 abstract] [uncertain: no time figure verified] Working: the client corrects your paraphrase or adds detail.

4.3 Explanatory model exploration (Kleinman; CFI Explanatory Model module)

Purpose / when: whenever the client attributes illness to destiny, enemies, a curse, an òrìṣà, ancestors, heredity (including "born to be mad") or substance use; to plan treatment the client finds sensible. [source: Kleinman et al. 1978 via handout; APA Supplementary Modules; Makanjuola 1987; Alabi 2019]
Steps: Over one or more sessions, cover Kleinman's eight areas in your own words: (1) what they call 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 they think they should receive; (7) the main problems it has caused; (8) what they fear most. [source: Tanenbaum handout of Kleinman et al. 1978] Then (9) ask what a babaláwo, healer, pastor or family has said, and whether the client agrees; (10) record differences between client, family and healer models without ranking them; (11) look for overlap you can build on (for example, a shared aim of calm, sleep, return to work or protecting the family).
Example language (illustrative): "You said this may have been sent by someone. What would help, in your view? And what do you fear most if it continues?" / "If your family sees this as wèrè, what does that word mean for how people treat you?"
Watch for: fear that being called wèrè means permanent disgrace (Jegede reports the label is derogatory and framed at a severe stage); beliefs that illness threatens descendants (Alabi) driving family pressure; client presenting a "biomedical" model to please you. Working: client states their model openly and you can name a goal it shares with treatment. [source: Jegede 2005; Alabi 2019] [synthesis]

4.4 Spirituality, Religion and Moral Traditions module

Purpose / when: when religion is central to identity, coping or the problem; when the client is initiated, consulting a priest, or in religious conflict (for example, converted to Christianity or Islam and fearful of returning to Ifá, or the reverse). [source: APA Supplementary Modules]
Steps: (1) Ask which religious or spiritual traditions the client and family follow, including more than one. (2) Ask about their role and standing in a community or house (without asking for secrets). (3) Ask how the tradition helps or burdens them now. (4) Ask about any conflict between traditions in the family. (5) Ask whether there is anything they are not permitted to share, and say that is fine. (6) Summarise and note which elements matter for the treatment plan.
Example language (illustrative): "You don't need to tell me anything that is private to your religion. What I'd like to know is how it helps you, and whether any of it is a source of worry right now."
Watch for: pressing for ritual detail (stop); assuming all Yoruba clients practise Ifá; missing religious conflict as a stressor. Working: the client names specific supports (a priest, a house, regular practice) and specific strains.

4.5 Cultural Identity and Immigrants and Refugees modules (diaspora clients)

Purpose / when: for Nigerian and other West African migrants, and for Caribbean, Latin American or US clients in orisha-based religions (Santería or Lucumí, Candomblé and others), where identity, migration, race and religion intersect. [source: APA Supplementary Modules; Wikipedia, Babalawo, diaspora; secondary]
Steps: (1) Explore ethnic, national, linguistic, racial and religious identities and which matter most now. (2) For migrants: pre-migration life, journey, status, losses, contact with home and with religious elders at home. (3) Ask how practice has changed since migration (availability of priests, secrecy, family disapproval). (4) Ask about experiences of racism or religious discrimination, including in health services. (5) Link these to the presenting problem in the formulation.
Example language (illustrative): "Some people find it harder to keep up their religious life after moving. Has that been part of your experience?"
Watch for: treating diaspora religions as identical to Yoruba practice in Nigeria; immigration fears limiting disclosure. Working: the client describes how identity and practice bear on the problem.

4.6 Informant Version and work with family

Purpose / when: when family make treatment decisions, brought the client, or hold a different explanatory model (for example, expecting a healer's treatment to come first). [source: APA Informant Version]
Steps: (1) Get the client's consent to speak with the family member and agree what you will not discuss. (2) Use the Informant Version (17 questions: the informant's relationship with the client, then the same four domains). [source: APA Informant Version] (3) Ask what the family has already done, including healers, prayer camps or churches, and who decided. (4) Ask what they fear (stigma of wèrè, harm to descendants, enemies). (5) Compare with the client's account and look for shared goals. (6) Give feedback to the client.
Example language (illustrative): "You know your son well. What do you think is happening, and what have you tried so far?"
Watch for: family pressure toward residential healing settings where restraint may occur (see 4.13); coercion of the client's choices. Working: the family accepts a role in a shared plan.

4.7 Asking about healers and traditional treatment without judgement

Purpose / when: at intake and at every review; healers and faith settings are major sources of care where psychiatric services are scarce. [source: HRW 2019; Makanjuola and Jaiyeola 1987]
Steps: (1) Ask open questions about all help sought, naming babaláwo, herbalists, churches, mosques and prayer camps as ordinary options. (2) Ask what was advised and how the client felt about it. (3) Ask whether they are taking any herbal or traditional medicine, and pass that information to the prescriber with consent; do not ask for or record recipes. (4) Ask whether any treatment involved being held, tied, chained, beaten, denied food, or touched sexually (see 4.13). (5) Ask whether they plan to continue and what they want from you alongside.
Example language (illustrative): "Lots of people see a healer as well as coming here. It helps me to know, so we can make sure things fit together. Is anyone else treating you at the moment?"
Watch for: concealment if the client expects disapproval; herbal use not known to the prescriber (healers in one Yoruba study named 163 plants, so assume you will not know what was used). [source: Makanjuola and Jaiyeola 1987] Working: the client volunteers ongoing healer contact.

4.8 Distinguishing culturally normative experience from disorder

Purpose / when: when the client reports trance, possession by or communication with an òrìṣà or ancestor, messages in dreams, or a calling to the priesthood; or when a family reads symptoms as spiritual and you suspect illness, or the reverse.
Steps: (1) Establish the context: did the experience occur within broadly accepted collective religious practice in the client's community or house? (2) Ask whether it was expected, voluntary and welcome, and whether it ends as expected. (3) Assess distress and impairment in daily life. (4) Check for features beyond the tradition's norms as the client and community describe them: persistent experiences outside religious settings, disorganisation, loss of self-care, mood or sleep change, substance use (healers themselves name cannabis as a cause), first onset with medical illness. (5) With consent, ask a family member or community member whether this is ordinary in their practice. (6) Apply the diagnostic exclusions: ICD-11 6B62 trance disorder and 6B63 possession trance disorder require states that are involuntary, unwanted and not part of accepted cultural or religious practice; DSM-5-TR dissociative identity disorder notes possession forms but excludes disturbance that is a normal part of broadly accepted cultural or religious practice, and dissociative trance (other specified dissociative disorder) excludes trance that is a normal part of collective practice. [source: ICD-11 via findacode and PMC9199574; DSM-5 wording via PMC9199574; DSM-5-TR paraphrase via Lewis 2023 study guide] The exact DSM-5-TR wording, and its note on culturally sanctioned beliefs versus delusions, are [uncertain: not verified]. (7) Record both the client's understanding and your clinical judgement.
Example language (illustrative): "In your community, is this something people expect to happen during worship? When it happens to you, does it feel welcome or does it frighten you?"
Watch for: pathologising religious experience; equally, missing psychosis, mania, delirium or epilepsy because "it's cultural". Possession or orisha trance in diaspora worship is not described in the sources cited, so do not assume what is normative in a given house. [uncertain: not verified] Working: you and the client agree whether the experience needs treatment.

4.9 Using DSM-5-TR cultural concepts of distress

Purpose / when: to remember that idioms, explanations and syndromes are culturally shaped; DSM-5-TR revised its examples to avoid stigmatising or generalising language. [source: APA DSM-5-TR Section III]
Steps: (1) Note that none of the DSM-5-TR glossary examples (reported as ataque de nervios, dhat, hikikomori, khyâl cap, kufungisisa, maladi dyab, nervios, shenjing shuairuo, susto, taijin kyofusho) is Yoruba; the list is [uncertain] as it comes from a secondary source. [source: UNMC webinar slides] (2) Treat Yoruba terms such as wèrè, asínwín and ode orí as the client's idioms and explanations, documented by researchers, not as DSM categories. [source: Jegede 2005; Makanjuola 1987] (3) Ask whether the term is an idiom of distress, an explanation of cause, or a named illness for this client. (4) Use it in formulation alongside, not instead of, diagnosis.
Example language (illustrative): "When you say ode orí, is that the name of the illness, or a way of saying how it feels?"
Watch for: turning a Yoruba term into a pseudo-diagnosis; somatic presentations (ode orí is described with prominent bodily symptoms) being missed as distress. Working: your formulation uses the client's term accurately.

4.10 Medical review and urgent care

Purpose / when: whenever there is possible psychosis, mania, severe depression, delirium, seizures, substance problems or physical illness; families may seek help only at crisis. [source: Jegede 2005]
Steps: (1) Screen for red flags (new confusion, fever, head injury, seizures, rapid decline, not eating or drinking, high risk to self or others). (2) Arrange medical and psychiatric assessment promptly; explain why in the client's terms. (3) Explain that treatment from the clinic need not mean giving up religious care, unless a specific practice is unsafe. (4) Follow up that the appointment happened.
Example language (illustrative): "I respect the help your family is getting. I'm worried about how little he's eating and sleeping, and I'd like a doctor to see him this week as well."
Watch for: delay while awaiting a healer's treatment; refusal framed as loyalty. Working: medical review occurs without rupture with the family or healer.

4.11 Collaboration and referral with community-sanctioned healers

Purpose / when: only when the client wants it, for example when they want their babaláwo or healer to know about treatment, or when shared care would reduce risk. Evidence: in the COSIMPO cluster trial in Nigeria and Ghana, collaborative shared care between traditional and faith healers and primary care workers produced greater reductions in psychosis symptoms and fewer harmful practices than usual care (harmful practices fell from 57% to 9% with the intervention versus 42% to 10% in controls). [source: Gureje et al. 2020 via PubMed record; Centre for Global Mental Health] In a Ghanaian prayer-camp trial, adding psychiatric medication reduced symptoms but did not significantly reduce days in chains. [source: Ofori-Atta et al. via repository]
Steps: (1) Ask whether the client wants any contact and with whom; the client chooses the healer, never you. (2) Get specific written consent: who, what information, for what purpose, how long. (3) Ask the client how the healer prefers to be approached and whether a family member should introduce you. (4) In contact, describe your role, ask how they understand the problem and what they are doing, agree on safety issues (medication continuity, no restraint, urgent referral signs), and agree how to share concerns. (5) Do not ask the healer to explain divination, rituals or medicines. (6) Report back to the client. (7) In Nigeria, practitioners may be registered with a state traditional medicine board (for example Lagos); registration is regulatory, not a judgement of religious standing. [source: Federal Ministry of Information, 2022] (8) Never refer a client to a healer you selected, and never to online sellers of readings or initiations. [synthesis]
Example language (illustrative): "Would it help if I spoke with your babaláwo, with your permission? I would only share what we agree, and I'd ask how we can both support you."
Watch for: breaches of confidentiality in small communities; the healer viewing you as a competitor; pressure on the client from either side. Formal shared-care programmes like COSIMPO existed as research; local programmes are not documented in the sources cited. [uncertain: not verified] Working: consistent messages to the client and no harmful practice.

4.12 Medicines and herbal treatment: liaison only

Purpose / when: whenever the client uses traditional or herbal medicines alongside prescribed medication. In one Yoruba healer study, all 20 healers used the root bark of Rauwolfia vomitoria for mental disorders. [source: Makanjuola and Jaiyeola 1987] No source cited here sets out its interactions with psychiatric medication [uncertain]; do not advise on combining or stopping anything, and route every question to the prescriber.
Steps: (1) Ask whether the client takes anything from a healer, herbalist or market, by name if they know it. (2) With consent, tell the prescriber and suggest pharmacist review. (3) Do not comment on safety, dose or whether to continue; do not ask for preparation details. (4) Encourage the client to tell both prescriber and healer about everything they take.
Example language (illustrative): "I'm not the right person to say whether these mix safely. Can we tell your doctor what you're taking so they can check?"
Watch for: stopping prescribed medication because of a healer's advice or the reverse; forced ingestion (see 4.13). Working: the prescriber knows the full picture.

4.13 Safeguarding

Purpose / when: whenever a client, especially a child, older adult or person with psychosis, has been or may be placed in a residential healing setting, prayer camp, church, mosque-linked rehabilitation centre or hospital. Human Rights Watch visited 28 facilities in 8 Nigerian states and the FCT (2018 to 2019), including traditional healing centres, Islamic rehabilitation centres, churches and psychiatric and state hospitals; people were chained or shackled in 27 of 28, and it documented unlawful detention by relatives, forced fasting, whipping, forced herbal ingestion, forced medication, ECT without consent in two psychiatric hospitals, and one report of molestation by a traditional healer. The youngest person chained was a 10-year-old boy. [source: HRW 2019] Nigeria's Mental Health Act, signed in January 2023, repealed the Lunacy Act and protects people with mental health conditions from abuse and "inhuman or degrading treatment", making ill-treatment or neglect an offence. [source: PLAC 2023]
Steps: (1) Ask directly, in plain words, about being held, tied, chained, locked in, beaten, denied food, forced to drink anything, or touched sexually, in any setting, including hospitals. (2) If a child is involved, follow your local child protection procedure at once. (3) For adults, assess capacity, current risk and wishes; follow adult safeguarding procedures. (4) Document what was reported, not your interpretation of the religion. (5) Separate the harmful act from the tradition when talking with the family. (6) Consult your safeguarding lead; know the law where the client lives (in Nigeria, the 2023 Act; elsewhere, local adult and child protection law). [synthesis for steps 2 to 6]
Example language (illustrative): "Some places that care for people with these problems tie or chain them, or stop them eating. I ask everyone. Has anything like that happened to you, anywhere?"
Watch for: assuming harm is only in traditional settings (HRW found it in hospitals too); assuming every healer harms; family fear that reporting will bring spiritual or social danger. Working: the client is safe and the family stays engaged.

4.14 Integrating religious guidance and healing experiences into therapy

Purpose / when: when the client has consulted Ifá or received guidance about a decision, their orí or destiny, or a duty to an òrìṣà or ancestors, and wants to think it through in therapy. UNESCO notes Ifá is consulted for important individual and collective decisions. [source: UNESCO] [synthesis]
Steps: (1) Ask what the client took from the consultation in their own words; do not ask for the verses or method. (2) Ask how it felt (relief, fear, obligation, hope). (3) Explore how it relates to their goals in therapy. (4) If it conflicts with treatment or safety, name the conflict and ask how they would like to resolve it, including taking the question back to their priest. (5) Do not reinterpret the guidance or offer an alternative spiritual reading.
Example language (illustrative): "You said the reading told you to be patient about this marriage. What did that mean for you, and how does it sit with what you want?"
Watch for: the therapist acting as a second diviner; fatalism used to avoid action, or meaning-making that brings relief. Working: the client integrates guidance and treatment in a way they own.

4.15 Stigma, early help seeking and psychoeducation in the client's terms

Purpose / when: when shame about wèrè delays help, or the family fears illness marks the lineage. [source: Jegede 2005; Alabi 2019]
Steps: (1) Ask what people will think if they learn of the problem. (2) Separate the client from the label. (3) Explain early treatment in plain terms, linked to the client's goals and model (for example, calm and sleep, protecting the family). (4) Offer information about mental health problems, diagnosis and prevention, which Jegede recommends to avoid crisis presentations. [source: Jegede 2005] (5) Agree what will be shared with whom.
Example language (illustrative): "Coming early is a sign of strength. We can work on what's happening now so it doesn't get worse."
Watch for: psychoeducation that implicitly calls the client's model wrong. Working: the client returns, or brings relatives earlier.

4.16 Interpreters and cultural brokers

Purpose / when: when the client prefers Yorùbá or another language, or when religious terms need careful handling.
Steps: (1) Use a trained interpreter, not a family member, for assessment. (2) Brief the interpreter on confidentiality and on not adding religious commentary. (3) Check whether the interpreter shares the community or holds strong religious views; offer the client a choice. (4) With consent, consult a cultural broker or community member about what is normative (see 4.8). [synthesis]
Example language (illustrative): "Would you prefer to speak Yorùbá today? Is it all right if the interpreter is from the Yoruba community?"
Watch for: the interpreter softening or omitting talk of Ifá, curses or chaining. Working: rich answers in the client's own terms.

4.17 The clinician-patient relationship, racism and religious discrimination

Purpose / when: at intake (CFI Domain 4) and whenever trust falters; services may carry colonial-era and religious prejudice against Ifá and orisha worship. [source: APA core CFI; APA Supplementary Modules, Patient-Clinician Relationship; UNESCO]
Steps: (1) Ask whether the client has felt judged in services for their race, religion or language. (2) Acknowledge it without defensiveness. (3) Ask what would make this service feel safer. (4) Repair openly when you get something wrong.
Example language (illustrative): "Some people have been told their religion is the problem. If anything I say feels like that, I'd like you to tell me."
Watch for: polite compliance masking distrust. Working: the client challenges you.

4.18 Strengths-based use of religious life

Purpose / when: when religious practice gives support, meaning and community; scholarship on Santería practitioners links spirituality to coping, social support and well-being. [source: Oswald et al. 2018]
Steps: (1) Ask what practice gives the client. (2) Identify supportive people in the community. (3) Build these into the coping and relapse plan, with the client's wording. (4) Leave religious content to the religion.
Example language (illustrative): "Who in your community do you turn to when things are hard? Should they be part of your plan?"
Watch for: community members who are also sources of pressure or harm. Working: the plan uses supports the client already trusts.

4.19 Suicide and self-harm risk assessment

Purpose / when: whenever there is depression, psychosis, shame, a frightening reading or curse belief, or loss of standing. [synthesis]
Steps: Use your standard risk assessment and safety plan; ask about spiritual meanings of death and ancestors without assuming; include trusted religious supports if the client wishes; lethal-means counselling covers safe storage and removal only. [synthesis]
Example language (illustrative): "When things feel this heavy, some people think about dying. Has that been on your mind?"
Watch for: a belief that one's destiny is fixed or that one is cursed feeding hopelessness. Working: a safety plan the client and family will use.

5. Handling problems

The sources describe the tradition, the assessment tools and the collaboration and harm evidence; they do not give guidance on therapy difficulties with Ifá or orisha clients. Everything in this section is [synthesis] unless a source is given.

Client asks you to interpret a reading, or asks whether Ifá is "real". Decline kindly and return the question: "That's for you and your priest. What I can help with is how you're living with what you were told." Do not give a view that endorses or dismisses it.
Client asks you to recommend a babaláwo, herbalist or online reader. Do not recommend. Ask whom their family or community trusts; for diaspora clients, their own house or elders. Warn generally that paid online readings or initiations are outside community pathways the client can check.
Stuck: the client says only the healer's treatment can work. Accept their model as the starting point; ask what the healer's treatment is meant to achieve and how they will know; agree to review together; keep medical and risk monitoring in place. Use 4.3 and 4.14.
Resistance from family who fear stigma or spiritual danger. Use the Informant Version (4.6); acknowledge that wèrè is a feared label [source: Jegede 2005]; frame your work as protecting the family's aims; involve the elder the family trusts if the client consents.
Overwhelm: the client is frightened by a curse belief or a reading. Slow down; ground in the present; separate the fear from the decision; ask who in their tradition could help them make sense of it; screen for risk (4.19); consider whether fear is part of an anxiety, depressive or psychotic disorder (4.8).
Non-adherence to medication on religious advice. Do not argue the theology. Ask what the advice was meant to protect; inform the prescriber with consent; explore whether the client wants to ask the healer about continuing; support the client's decision while keeping risk under review. Never advise stopping or starting medicines yourself.
Concealment, discovered later. Treat it as understandable given discrimination [source: UNESCO; APA core CFI Domain 4]; thank the client for telling you; repeat 4.7.
Rupture after you named a practice as unsafe. Separate the act from the religion; acknowledge the client's loyalty; restate your duty and your respect; invite their view of what would have been a better way to raise it.
Religious conflict in the family (for example, Christian or Muslim relatives opposing Ifá, or the reverse). Do not take sides; use the Spirituality, Religion and Moral Traditions module (4.4); focus on the client's wellbeing and choices; consider family sessions if safe.
Your own discomfort (with sacrifice, divination or talk of enemies). Bring it to supervision; check it is not shaping your formulation; do not transfer the client because of it unless it cannot be managed.
Normative experience versus illness unclear. Hold both possibilities; seek medical and psychiatric review; consult a community member with consent; avoid both pathologising and missing illness (4.8); revisit as more information comes.
Possible harm in a healing setting. Act under 4.13 even when the client or family defends the setting; HRW found chaining in traditional, religious and state settings alike. [source: HRW 2019]
Requests to attend or observe ceremonies. Do not attend in a professional role or seek out ceremonies. If a client invites you, discuss boundaries and the meaning of the invitation in therapy.
Diaspora practices differ from what the client grew up with. Do not adjudicate authenticity; ask what matters to the client and which authority they recognise.

Sources

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