Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 091
Guide XI-091

Hoodoo / rootwork

southern United States
A 35 · L 54 · M 1117 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: hoodoo / rootwork has no codified version, governing body or licensing route. The tradition is described here through scholarly and archival accounts: Hurston 1931; Brown, Folklore Forum 23; Chireau 2003; Hazzard-Donald 2012; the Avery Research Center, College of Charleston. The therapist's own work follows the DSM-5-TR Cultural Formulation Interview (CFI; APA 2022) and the CFI supplementary modules (APA 2013).

What it is. Conjure, also called hoodoo or rootwork, is described by the historian of religion Yvonne Chireau as "the African American tradition of healing and harming". It developed from African, European and American sources. From slavery onward it was "woven together" with Christianity to give enslaved and free African Americans spiritual support [source: https://works.swarthmore.edu/fac-religion/55]. Writing in the 1990s from ex-slave narratives, WPA interviews and folklore collections, the folklorist David H. Brown calls conjure "an explicit, culturally specific way of thinking and talking about cause, effect, power, and agency". He notes that the terms "conjure", "hoodoo", "root work" and "two-heads" overlap [source: https://scholarworks.iu.edu/iuswrrest/api/core/bitstreams/d90d62c5-cd44-4286-8883-6aa72e114a89/content]. Practitioners have been called rootworkers, root doctors, conjure doctors and hoodoo doctors. "Two-headed doctor" is also used, and is often glossed as a seer, but that meaning is [uncertain: not verified]. Zora Neale Hurston's fieldwork was published as "Hoodoo in America", Journal of American Folklore 44(174), 1931. Hurston distinguished practitioners, writing that "some of the root doctors are not hoodoo doctors" [source: https://iopn.library.illinois.edu/scalar/beyondnola/doctor-redmond---note-4]. Katrina Hazzard-Donald, a scholar, separates "Old tradition Black Belt Hoodoo", practised mainly among African Americans, from commercially marketed forms. She says outsiders have controlled, modified and often fabricated these commercial forms [source: https://citylights.com/africa-diaspora/mojo-workin-african-amer-hoodoo]. In the South Carolina Lowcountry, the Avery Research Center describes Root Medicine as "above all a practice of healing". It distinguishes Root Medicine from the hexing it is often wrongly equated with [source: https://avery.charleston.edu/?p=5446]. All of these are scholarly or archival accounts, some by outsiders and some by members of the community. None speaks for every practitioner.

Who holds authority. No regulator, college or council exists. Historical accounts describe conjure doctors as "powerful, recognized men and women". Their standing rested on reputation, on signs attributed to them and on an initiation that is not described here. Many were also preachers or exhorters. The practitioner–client relationship was largely private and often paid [source: https://scholarworks.iu.edu/iuswrrest/api/core/bitstreams/d90d62c5-cd44-4286-8883-6aa72e114a89/content]. Today, authority is recognised within families, local communities and practitioner networks. Contemporary practitioner-authors describe hoodoo as a collection of folk practices rather than a religion [source: https://popula.com/2018/10/02/rootwork-and-the-dsm/].

Rootwork in psychiatry. DSM-IV (1994) listed rootwork in its glossary of culture-bound syndromes as cultural interpretations of illness that attribute it to "hexing, witchcraft, sorcery, or the evil influence of another person". The entry was linked to the southern United States and the Caribbean. DSM-5 replaced that glossary with cultural concepts of distress [source: https://popula.com/2018/10/02/rootwork-and-the-dsm/] [source: https://revistapsiquiatria.pt/index.php/sppsm/article/download/139/69]. Rootwork does not appear in the DSM-5-TR example list as one secondary source reproduces it [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf]. That list does include maladi dyab, a Haitian concept of illness caused by others, which is conceptually close. Whether DSM-5-TR replaced maladi moun with maladi dyab is [uncertain]. The psychiatrist James Hillard (1982) warned that rootwork beliefs can resemble bizarre delusions [source: https://popula.com/2018/10/02/rootwork-and-the-dsm/]. Goldwasser (1991) reported a case in which cross-cultural misunderstanding led to misdiagnosis [source: https://jdc.jefferson.edu/jeffjpsychiatry/vol9/iss1/11].

How change happens. As historical sources describe it, the tradition distinguishes "natural" from "unnatural" illness. A conjure doctor diagnosed unnatural illness partly through social and contextual analysis, and healing was attributed to the practitioner's power and knowledge [source: https://scholarworks.iu.edu/iuswrrest/api/core/bitstreams/d90d62c5-cd44-4286-8883-6aa72e114a89/content]. That is the tradition's own account. It is neither endorsed nor dismissed here. For the psychotherapist, change comes from accurately understanding the client's explanatory model, separating culturally shared meaning from illness, treating any disorder present and supporting the client's own help-seeking, which may include a rootworker, the church and medicine. [synthesis]

2. Framework

This is not a therapy. It is a framework for the therapist's culturally responsive work alongside a tradition the client may hold. The phases below are [synthesis], built on the CFI's structure [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].

  • Phase 1: Engagement and safety (session 1). Goal: establish trust, screen for urgent risk (suicide, violence, medical emergency, psychosis needing urgent care) and signal that the client's beliefs and other help-seeking can be discussed. Move on once urgent risk is managed and the client has some willingness to talk about meaning.
  • Phase 2: Cultural assessment (sessions 1–3). Goal: complete the core CFI. It has 16 questions in four domains: cultural definition of the problem; perceptions of cause, context and support; self-coping and past help-seeking; and current help-seeking [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]. Add modules as needed (explanatory model; spirituality, religion and moral traditions; coping and help-seeking; social network; patient–clinician relationship; cultural identity). You can also use the Informant Version with a family member [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]. APA gives no time for the CFI. In the DSM-5 field trial, later interviews "required less time" [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]. A figure of 15–20 minutes is [uncertain]. Move on when you can state the client's explanatory model in their words and they agree with your summary.
  • Phase 3: Formulation and differential (sessions 2–4). Goal: separate culturally shared belief and experience from disorder, and record a cultural formulation. The CFI supports clinical judgement and is not the sole basis for diagnosis [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]. Move on when there is a working diagnosis, or no diagnosis, that you have checked against cultural norms, ideally with a cultural consultant or a family informant.
  • Phase 4: Shared plan (from session 3–4). Goal: agree on the treatment of any disorder present (psychotherapy, medical review, prescriber referral) and on how the plan sits alongside the client's own practice, church and, if the client wishes, a rootworker. Agree consent and confidentiality for any liaison. Move on when the client endorses the plan and knows what you will and won't do.
  • Phase 5: Treatment, integration and review (ongoing). Goal: deliver the evidence-based treatment chosen for the disorder, revisit the explanatory model as it changes, integrate the client's experiences and review safeguarding. The CFI modules can be repeated during treatment [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]. End or step down by the usual criteria for the disorder being treated.

Format: individual sessions, with family sessions when the client agrees. This tradition sets no session count of its own. Total length depends on the disorder treated. [synthesis]

3. Guiding principles

  • You are alongside the tradition, not in it. Never perform, imitate, recommend or "remove" rootwork. Your work is assessment, formulation, therapy and coordination. [synthesis]
  • Neither affirm nor dismiss. Describe being "fixed", "crossed" or "conjured" as the client's understanding, recorded in their words, without stating that it is or isn't real. [synthesis]
  • Normal belief is not a symptom. Belief in rootwork shared by the client's family or community is not a delusion. Hillard and Goldwasser warn of misdiagnosis [source: https://popula.com/2018/10/02/rootwork-and-the-dsm/] [source: https://jdc.jefferson.edu/jeffjpsychiatry/vol9/iss1/11]. In practice: judge content against the client's own reference group, not yours.
  • A cultural explanation does not rule out illness. Practically: still screen for psychosis, depression, anxiety, trauma, substance use and medical illness. [synthesis]
  • Conjure and Christianity often coexist. Brown writes, "God was someone to have on your side. But that never precluded a visit to the conjure doctor" [source: https://scholarworks.iu.edu/iuswrrest/api/core/bitstreams/d90d62c5-cd44-4286-8883-6aa72e114a89/content]. In practice: don't assume a churchgoing client has no hoodoo framework, or the reverse, and don't assume their church approves.
  • Expect secrecy and stigma. The practice has long been private and disparaged [source: https://avery.charleston.edu/?p=5446]. In practice: raise the topic gently and normalise discussing it, and don't push for disclosure.
  • Name history and mistrust. Medicine has pathologised Black people before, for example in "drapetomania" [source: https://scholarworks.iu.edu/iuswrrest/api/core/bitstreams/d90d62c5-cd44-4286-8883-6aa72e114a89/content]. In practice: use the CFI clinician–patient relationship question to invite talk about racism and trust.
  • Parallel help-seeking is common. "Most believers in folk healing also go to physicians" [source: https://psychiatryonline.org/doi/10.1176/ajp.138.11.1477]. In practice: ask about every source of help without ranking them.
  • Distinguish traditions and variants. The Old tradition, commercial "spiritual supply" products, Lowcountry Root Medicine, and Vodou or other Afro-Caribbean religions differ [source: https://citylights.com/africa-diaspora/mojo-workin-african-amer-hoodoo] [source: https://avery.charleston.edu/?p=5446]. In practice: ask which the client means, and don't merge them.
  • Use the client's words. In practice: use the client's own terms, such as "rootworker" or "root doctor". Avoid pejorative labels for healers, "superstition" or "voodoo" unless the client uses them. [synthesis]
  • Consent governs any contact with a practitioner. In practice: contact a rootworker only at the client's request, with written consent, a stated purpose and limited information. [synthesis]
  • Herbs, products and medicines go to the prescriber. In practice: record what the client takes and pass it to the prescriber or GP. Never advise starting, stopping or changing anything. [synthesis]
  • Safety and safeguarding come before cultural deference. In practice: exploitation, threats, violence, harm to children or delayed urgent care are acted on as usual, whatever explanation is offered. [synthesis]
  • Not a treatment for physical disease. In practice: support medical care for physical symptoms whatever explanation the client holds. [synthesis]

4. Intervention inventory

These are the psychotherapist's own interventions. None of them is a hoodoo or rootwork practice, and none reproduces one. The CFI forms may be reproduced by clinicians for use with their patients. Modifying or translating them needs APA permission [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]. Below they are paraphrased, not reproduced.

4.1 Cultural self-examination before and during the work

  • Purpose / when: before you first see a client who may hold conjure beliefs, and whenever you feel strong reactions such as amusement, fear, a religious objection or a wish to rescue. [synthesis]
  • Steps: (1) Write down what you learned about hoodoo, "voodoo" and Black folk healing, and where you learned it (films, church, family, training). (2) Note any reflex to label these beliefs superstition or psychosis. (3) Read at least one scholarly account of the tradition, such as Chireau 2003 or Hazzard-Donald 2012, and one account of psychiatry's history with Black patients. (4) In supervision, name your own racial and religious position and how the client may see it. (5) Repeat after sessions where the topic came up. [synthesis]
  • Example language (illustrative, to yourself or in supervision): "When she said she'd been fixed, I felt an urge to correct her. Where does that come from?"
  • Watch for: mocking or exoticising language in your notes; turning the formulation into a lesson on folk belief; avoiding the topic altogether. It's working when you can write the client's explanation in their words, without scare quotes or judgement. [synthesis]

4.2 Opening the topic of other help and other explanations

  • Purpose / when: at intake and whenever symptoms seem tied to conflict, envy, a failed relationship or sudden misfortune. Belief in rootwork is often kept private, and disclosure depends on the client feeling safe [source: https://avery.charleston.edu/?p=5446]. [synthesis]
  • Steps: (1) Normalise first by saying that people make sense of problems in many ways. (2) Ask open questions about what the client or family thinks is going on, then about anyone else they have seen: doctor, pastor, prayer group, "someone who works with roots" or a spiritual adviser. (3) Use the client's terms once they offer them. (4) Don't ask for details of what the practitioner did. Ask only what it meant to the client and whether it helped. (5) Thank them for telling you. [synthesis]
  • Example language (illustrative): "Some people I work with see things like this as purely medical, some as spiritual, and some as something another person has done to them. How do you and your family see it?" / "Have you seen anyone else about this: a doctor, someone at church, a root doctor or anyone like that?"
  • Watch for: a guarded "I don't believe in that stuff" said while watching your reaction; laughter that tests you; disclosure arriving only in later sessions. It's working when the client uses their own terms with you and brings up the topic unprompted. [synthesis]

4.3 Core Cultural Formulation Interview

  • Purpose / when: a structured cultural assessment at the first evaluation or early in treatment. APA designed it for "any clinician" in any setting [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf].
  • Steps: (1) Introduce it as questions about how the client understands their situation. (2) Domain 1, cultural definition of the problem: ask how they would describe the problem to family or friends, and what troubles them most. (3) Domain 2, cause, context and support: ask what they think caused it, what others in their life think, what makes it worse or better, and how their background or identity affects it. (4) Domain 3, coping and past help-seeking: ask what they have done themselves, whom they have consulted, what helped, and what barriers they met. (5) Domain 4, current help-seeking: ask what help they want now, what others suggest, and whether differences between you, such as race, language or religion, might get in the way. (6) Summarise back and check your summary [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]. Use the official form; this list paraphrases its structure.
  • Example language (illustrative): "If you were explaining this to your sister or your pastor, what would you call it?" / "Sometimes it's hard to talk to someone of a different background. Is there anything about me or this clinic that makes this harder?"
  • Watch for: answers that shift as trust grows, so record them as provisional; the client mentioning a person they blame (see 4.9). It's working when the domains yield a picture of cause, coping and preferences you couldn't have guessed. The field trial found the CFI "feasible, acceptable and useful" [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/].

4.4 Explanatory model (CFI module and Kleinman's questions)

  • Purpose / when: when the client names rootwork, "being fixed" or another non-medical cause, to map their full model of the illness [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
  • Steps: Cover Kleinman's eight areas in your own words: what they call the problem; its cause; why it started when it did; what it does and how it works; how severe it is and how long it will last; what treatment they think they need; the main problems it has caused; and what they fear most [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf] (Kleinman, Eisenberg and Good 1978 [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader]). Then ask whether they see it as "natural" or "unnatural" illness, or both, if they use that distinction [source: https://scholarworks.iu.edu/iuswrrest/api/core/bitstreams/d90d62c5-cd44-4286-8883-6aa72e114a89/content]. Ask what role they see for medicine, therapy, church and other help. Write a two-to-three-line summary in the client's words.
  • Example language (illustrative): "What do you think set this off, and why now?" / "What are you most afraid will happen?" / "Do you see this as something a doctor can treat, something spiritual, or a mix?"
  • Watch for: a model that combines several causes, such as stress, a curse and God's plan, which is common and need not be resolved; fear of death or of serious harm, which you should assess for risk and medical urgency. It's working when your treatment rationale can be framed so that it fits the client's model, for example therapy for sleep and fear "whatever else is going on". [synthesis]

4.5 Spirituality, religion and moral traditions module

  • Purpose / when: when church, prayer or faith matter to the client, or when conjure and Christianity seem to be in tension [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
  • Steps: (1) Ask about the client's religious identity, community and practices in general terms. (2) Ask how their faith understands the problem. (3) Ask whether consulting a rootworker fits with their faith, conflicts with it, or is something they keep separate. Brown describes the two as often complementary, though some church settings condemn conjure [source: https://scholarworks.iu.edu/iuswrrest/api/core/bitstreams/d90d62c5-cd44-4286-8883-6aa72e114a89/content]. (4) Ask whom in their faith community they trust for support. (5) Don't record or ask for prayers or practices. Record only their role in the client's coping.
  • Example language (illustrative): "How does your faith help you with this?" / "Some people feel church and root doctors go together, others feel torn. Where are you with that?"
  • Watch for: shame or fear of judgement from church, and guilt over consulting a rootworker; spiritual struggle (feeling abandoned by God), which is linked to distress and is worth working on. It's working when the client can name their religious resources without having to defend them. [synthesis]

4.6 Coping, help-seeking and social network modules

  • Purpose / when: to understand who is involved in the client's care, including family, church and any rootworker, and how help-seeking decisions are made [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
  • Steps: (1) Draw a simple map of the client's supports and sources of strain. (2) For each source of help, ask what the client sought, what they got, what helped and what it cost in money, time and relationships. (3) Ask who decides whether they keep seeing you. (4) Note any person the client believes is harming them through rootwork, and the current state of that relationship. (5) Note paid spiritual services and how much the client is spending (see 4.13).
  • Example language (illustrative): "Who knows you're coming here, and what do they think about it?" / "Of everything you've tried, what's helped most?"
  • Watch for: relatives pushing either for or against traditional help; high spending on spiritual services; isolation because the client fears the person they think is working against them. It's working when you can predict who will support or undermine the plan. [synthesis]

4.7 Informant Version with family or a trusted person

  • Purpose / when: when the client agrees and a relative or friend can clarify the family's explanatory model, or when the client's account is limited by illness [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf].
  • Steps: (1) Get the client's consent and agree what can be shared. (2) Ask about the informant's relationship to the client, then cover the same four domains from the informant's point of view. (3) Ask whether the family considers the client's beliefs and behaviour usual within their community. This is your key normative check. (4) Note where the informant and the client agree and disagree.
  • Example language (illustrative): "In your family, would people see what he's describing as a normal worry about being worked on, or as something different?"
  • Watch for: informants who have their own stake in the conflict, such as when the person blamed is a relative; breaches of confidentiality. It's working when the informant's account helps you place the client's experience as typical or unusual for their setting. [synthesis]

4.8 Clinician–patient relationship: race, trust and history

  • Purpose / when: early, and whenever there are signs of mistrust. The CFI asks about clinician–patient differences such as perceived racism and language [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]. A Patient–Clinician Relationship module also exists [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
  • Steps: (1) Name the difference openly and invite feedback. (2) Acknowledge, without defending, that services have misjudged Black clients and their traditions. Brown cites "drapetomania" as pseudo-medical pathologising of enslaved people [source: https://scholarworks.iu.edu/iuswrrest/api/core/bitstreams/d90d62c5-cd44-4286-8883-6aa72e114a89/content]. (3) Explain what you will and won't do with information about their beliefs, and that the belief alone won't lead to a diagnosis. (4) Check in again at reviews.
  • Example language (illustrative): "I'm a white therapist and you may wonder whether I'll take what you believe seriously. I'd rather you told me if I'm getting it wrong." / "Believing someone has put something on you doesn't make you 'crazy' in my book. I want to understand it."
  • Watch for: polite compliance hiding mistrust; missed appointments after diagnostic discussions. It's working when the client corrects you, disagrees with you or adds information you hadn't asked for. [synthesis]

4.9 Distinguishing shared cultural belief from disorder

  • Purpose / when: whenever beliefs about being hexed or "fixed", or experiences of spirits, could be read as delusions, hallucinations or dissociation. Rootwork beliefs can resemble bizarre delusions [source: https://popula.com/2018/10/02/rootwork-and-the-dsm/], and misdiagnosis has been reported [source: https://jdc.jefferson.edu/jeffjpsychiatry/vol9/iss1/11].
  • Steps: (1) Check whether the client's family, community or congregation shares the belief (4.7, 4.11). (2) Look at the form, not only the content. Consider how fixed and elaborated the belief is, whether it spreads to many people, whether there are other psychotic features (disorganisation, negative symptoms, hallucinations beyond culturally expected forms), the level of functioning and the course. (3) Screen formally for depression, anxiety, PTSD, substance use and psychosis. (4) Possession or trance: DSM-5-TR still holds that dissociative identity disorder may present as possession, and that DID, and dissociative trance under other specified dissociative disorder, apply only when the experience is not part of broadly accepted cultural or religious practice [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299] [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]. The exact DSM-5-TR wording is [uncertain]. ICD-11 6B62 trance disorder and 6B63 possession trance disorder both require the state to be involuntary and unwanted, and not part of accepted cultural or religious practice [source: https://www.findacode.com/icd-11/code-1807490186.html] [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]. (5) Consult a cultural broker or colleague familiar with the tradition (4.11). (6) Record your reasoning in the cultural formulation.
  • Example language (illustrative): "Do others in your family see it the same way?" / "Apart from the rootwork, have you noticed changes in your thinking, like hearing things others don't, or feeling your thoughts aren't your own?"
  • Watch for: both errors, diagnosing psychosis from content alone and missing psychosis because "it's cultural"; a belief that has grown beyond what the client's family recognises. It's working when the diagnosis, or the absence of one, holds up after cultural consultation and over time. [synthesis]

4.10 Fear of being worked on: anxiety, somatic and risk assessment

  • Purpose / when: when a client believes someone has put rootwork on them and shows fear, insomnia, appetite loss, bodily complaints or hypervigilance. [synthesis]
  • Steps: (1) Assess symptoms in detail, including sleep, appetite, panic, avoidance and somatic complaints. (2) Arrange medical review for physical symptoms (4.12). (3) Assess suicide risk using standard practice. Hopelessness about an "unremovable" curse may raise it [synthesis]. (4) Assess the risk of harm to and from the person believed responsible, including any intent to confront or retaliate, and any real threats the client has received. (5) Treat the anxiety and trauma symptoms with evidence-based methods, framed so they fit the client's model. (6) Don't argue about whether the rootwork is real. Work on fear, safety, coping and relationships. [synthesis]
  • Example language (illustrative): "Whatever is behind this, you haven't slept properly in weeks. Can we work on the fear and the sleep together, while you keep getting the other help you've chosen?" / "Have you had thoughts of doing something to the person you think is behind this?"
  • Watch for: rapid weight loss or refusal to eat for fear of poisoning, which needs medical review; escalating conflict with a neighbour or relative; despair. It's working when anxiety and sleep improve and the client feels some control, whatever their explanation. [synthesis]

4.11 Cultural brokers and consultation

  • Purpose / when: when you are unsure whether a belief or experience is typical, or how the client's community would view a plan. [synthesis]
  • Steps: (1) With the client's consent, or anonymised without it, consult someone knowledgeable. This could be a colleague from the client's community, a Black faith leader the client trusts, a scholar or folklorist of African American traditions, or a family member (4.7). (2) Ask about norms, not about ritual detail. (3) Keep the consultant's role advisory. Clinical decisions stay with you. (4) Record the consultation. [synthesis]
  • Example language (illustrative, to a consultant): "In your experience, how would people in this community usually talk about being 'fixed'? What would worry you?"
  • Watch for: one consultant treated as speaking for every African American; confidentiality in small communities. It's working when consultation changes or firms up your formulation. [synthesis]

4.12 Physical symptoms and medical care

  • Purpose / when: whenever the client reports bodily symptoms attributed to rootwork. No practice discussed here is a treatment for physical disease. Most people who use folk healing also see physicians [source: https://psychiatryonline.org/doi/10.1176/ajp.138.11.1477].
  • Steps: (1) Encourage prompt medical assessment and offer to help arrange it. (2) Frame it as "as well as", not "instead of". (3) Liaise with the GP or physician with the client's consent and tell them about the client's explanatory model, so it isn't dismissed. (4) Follow up on whether the appointment happened. [synthesis]
  • Example language (illustrative): "Whatever else is going on, I'd like a doctor to check your stomach pain so nothing physical is missed. Would that be all right alongside the other help you're getting?"
  • Watch for: delayed care for serious symptoms (urgent: escalate); a client who fears that doctors will mock them. It's working when medical and cultural help run in parallel without conflict. [synthesis]

4.13 Remedies, products and paid spiritual services

  • Purpose / when: when the client uses or is given herbal, root or commercial products, or pays for spiritual work. Hazzard-Donald describes commercial forms marketed and often fabricated by outsiders [source: https://citylights.com/africa-diaspora/mojo-workin-african-amer-hoodoo]. Brown notes that conjure services were historically paid [source: https://scholarworks.iu.edu/iuswrrest/api/core/bitstreams/d90d62c5-cd44-4286-8883-6aa72e114a89/content].
  • Steps: (1) Ask neutrally whether the client takes, drinks, applies or burns anything for the problem. Don't ask about preparation. (2) Record the names as given and pass them to the prescriber or GP. Never advise on starting, stopping or combining anything with medication. (3) Ask about money spent and any pressure to pay more. (4) If you suspect exploitation or fraud, discuss it with the client and follow your usual consumer-protection and safeguarding routes (4.16). [synthesis]
  • Example language (illustrative): "Are you taking or using anything for this, from a store, a rootworker or family? I'll let your doctor know so they have the full picture." / "How much has this cost you so far? Does that feel all right to you?"
  • Watch for: the client stopping prescribed medication on someone else's advice (route to the prescriber); escalating payments; online "curse removal" sellers. It's working when the prescriber has an accurate list and the client feels free to discuss costs. [synthesis]

4.14 Narrative work with folk beliefs

  • Purpose / when: when the client's story of their difficulty is told in the language of conjure, faith and dreams. Parks names four themes common in such narratives: spirituality, ritual, the power of words and dreams. She illustrates narrative therapy with a depressed client who held a folk belief system [source: https://digitalcommons.georgiasouthern.edu/leadership-facpubs/125]. The article's specific questions weren't available, so the steps below are [synthesis].
  • Steps: (1) Invite the full story in the client's terms. (2) Track the four themes as they appear, without asking for ritual content. (3) Externalise the problem, for example "the fear" or "the heaviness", so it is separate from the client and from the person they blame. (4) Look for times when the client resisted or got through it, including through faith, family and community. (5) Co-author a preferred story that keeps their cultural meanings. (6) Ask what their dreams mean to them, and use that meaning rather than your own interpretation. [synthesis]
  • Example language (illustrative): "When the heaviness is strongest, what does it tell you about yourself?" / "Tell me about a time this week when you didn't let it run the day." / "What did that dream mean to you?"
  • Watch for: imposing a psychological reframe that dismisses the client's meaning; a story that hardens around blame and revenge. It's working when the client describes more agency and options within their own framework. [synthesis]

4.15 Liaison with a rootworker the client already consults

  • Purpose / when: only when the client asks for it, and only with a practitioner they already see. No US programme sanctioning collaboration with rootworkers is documented in the sources cited [uncertain: not verified]. Collaboration evidence comes from other settings. In the COSIMPO cluster trial in Nigeria and Ghana (Gureje et al., The Lancet 2020), collaborative shared care between traditional and faith healers and primary care reduced psychotic symptoms (PANSS) more than enhanced usual care. Harmful practices also fell in both arms, from 57% to 9% with the intervention [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839]. In a Ghanaian prayer-camp trial (Ofori-Atta et al., Br J Psychiatry 212(1)), adding psychiatric care reduced symptoms, but days in chains were not significantly reduced [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial]. These are analogies, not evidence about rootwork. [synthesis]
  • Steps: (1) Clarify what the client hopes contact would achieve, for example that the practitioner supports their continuing therapy and medication. (2) Get specific written consent naming the person, purpose, content and duration. (3) Limit what you share to what is needed. (4) Present yourself as a colleague with a different role, and don't ask about methods. (5) Agree on shared safety points, such as no advice to stop medicines and urgent medical help for physical danger. (6) Tell the client what was discussed. (7) Withdraw if the contact harms the client. [synthesis]
  • Example language (illustrative, to the practitioner): "Ms X has asked me to call. I'm her therapist, working on her sleep and fear. She values your help, and I wanted us both to know she's also seeing her doctor about her medication."
  • Watch for: the client feeling pressured by you or by the practitioner; conflicting advice about medicines; boundary problems or fees. It's working when the client feels supported by both and adherence holds. [synthesis]

4.16 Safeguarding

  • Purpose / when: when the explanation offered involves threats, coercion, financial exploitation, violence, sexual contact, harm to children, or delay of urgent care. [synthesis]
  • Steps: (1) Assess the facts and the risk as you would for any client. A cultural explanation doesn't change your duties. (2) Act on child-protection, adult-safeguarding and duty-to-warn obligations as usual, and consult your supervisor or safeguarding lead. (3) Where a client or family believes a child is the source of harm or under a spell, assess the child's safety urgently. (4) Separate the practice from the harm. You are responding to a specific act, not condemning the tradition. (5) Keep the client informed where safe. [synthesis]
  • Example language (illustrative): "I respect what you believe, and I'm not questioning your faith. What you've told me about the money and the threats is something I have to act on to keep you safe."
  • Watch for: abuse described as tradition, and ordinary tradition misread as abuse. Consult before concluding either. It's working when the risk is reduced and the therapeutic relationship survives. [synthesis]

4.17 Cultural formulation and integration

  • Purpose / when: at the end of the assessment and at reviews, to record and use what you have learned. The DSM-5-TR Outline for Cultural Formulation sits alongside the CFI in Section III [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf].
  • Steps: (1) Write: the client's cultural identity; their explanation of the illness, in their words; stressors and supports, including church and family; the clinician–client relationship; and the overall assessment, with your normative-versus-disorder reasoning. (2) Share the summary with the client and revise it. (3) At reviews, ask how the client's understanding has changed, and repeat modules as needed [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]. (4) Help the client integrate what they have experienced, from rootwork, church, medicine and therapy, into a coherent account they own. [synthesis]
  • Example language (illustrative): "Here's how I've understood things. Tell me what I've got wrong." / "Looking back over these months, how do you make sense of what happened and what helped?"
  • Watch for: notes that read as dismissive if the client sees them; formulations frozen at intake. It's working when the client recognises themselves in the formulation. [synthesis]

5. Handling problems

The sources cited above don't address these problems directly. All responses below are [synthesis] unless a source is cited.

  • Client won't discuss beliefs ("I don't believe in that"). Response: don't push. Normalise once (4.2), say the door stays open, and come back to it when conflict or misfortune recurs. Secrecy is historically understandable [source: https://avery.charleston.edu/?p=5446].
  • Client asks you to say whether the rootwork is real. Response: be honest about your role, saying that it is not yours to judge, and turn to what helps. (Illustrative: "I can't tell you whether someone has worked on you. What I can do is help with the fear and the sleep, and support you with whatever other help you choose.")
  • Client asks you to recommend, find or vet a rootworker. Response: decline to recommend practitioners. Point the client to people they already trust in their family, church or community. If they choose someone, offer liaison as in 4.15. Never act as a broker for paid services.
  • Client wants you to "remove" the root or do spiritual work. Response: name the limit of your role kindly and clarify what therapy can offer alongside other help.
  • Stuck: "Nothing can help until the curse is lifted." Response: accept their framework for now. Agree on small goals that are useful whatever the cause, such as sleep, safety, work and relationships, and review progress. Explore what the client's own tradition, faith or family says about getting through it. Assess hopelessness and suicide risk.
  • Rupture after a diagnosis is mentioned. Response: repair explicitly. Explain that a diagnosis such as depression describes symptoms and doesn't deny the client's explanation. Invite their reaction. Check whether race or past mistreatment is part of it (4.8).
  • Non-adherence to medication on spiritual grounds. Response: don't argue. Explore their concerns, then link them quickly with the prescriber. Offer joint meetings, and family involvement with consent. Never advise on medicines yourself.
  • Overwhelm or acute fear ("something's going to happen to me tonight"). Response: use grounding and safety planning, check for immediate risk and medical symptoms, and identify who the client can be with. Escalate to urgent care if there is psychotic deterioration, physical danger or serious suicide risk.
  • Family conflict over the explanation (for example, one relative blames rootwork and another blames mental illness). Response: hold a family meeting using the Informant Version and explanatory-model questions (4.4, 4.7). Look for shared goals and avoid taking sides on cause.
  • The client believes a named person is responsible, with risk of confrontation or violence. Response: assess risk to others and follow your duty-to-protect procedures. Work on de-escalation and safety, and avoid repeating accusations in your notes beyond what is clinically necessary.
  • You suspect financial or sexual exploitation by someone presented as a practitioner. Response: act as you would for any exploitation (4.16). Discuss it with the client respectfully and document it. You are responding to that person's conduct, not condemning the tradition.
  • Possible psychosis presented as rootwork. Response: use the normative check and full mental-state examination (4.9) and seek a cultural consultation. If you are in doubt and risk is high, refer for psychiatric assessment while staying respectful of the client's explanation.
  • Clinician discomfort, including your own religious objection. Response: take it to supervision. If it impairs your care, refer the client on with a warm handover.
  • Commercial or online "hoodoo" products bought by the client. Response: treat these as you would any unregulated product (4.13). Give the list to the prescriber and look at costs and pressure tactics with the client. Hazzard-Donald distinguishes such commercial forms from the Old tradition [source: https://citylights.com/africa-diaspora/mojo-workin-african-amer-hoodoo].
  • Clients outside the tradition who adopt hoodoo from books or online. Response: explore what it means to them as you would any spiritual practice, without assuming it carries the same family or community meaning. The Old tradition is described as practised mainly among African Americans [source: https://citylights.com/africa-diaspora/mojo-workin-african-amer-hoodoo]. Whether practitioners have formally asked outsiders not to take part is [uncertain: not verified].

Sources

← Previous · XI-090María Lionza devotion (Venezuela)Next · XI-092 →Garifuna dügü