Shipibo-Konibo onanya healers

1. Introduction

Version followed: Shipibo-Konibo-Xetebo ancestral medicine as described by the Shipibo-Konibo-Xetebo Association of Onanyabo/Ancestral Healers (ASOMASHK) and its founding Yarinacocha Declaration (August 2018), convened by Coshikox, with Shipibo healers' published interviews and attributed scholarship as context; the psychotherapist's own work follows the APA DSM-5-TR Cultural Formulation Interview (CFI) and its supplementary modules.

What it is. This is a living Indigenous healing tradition of the Shipibo-Konibo-Xetebo people of the Ucayali region of the Peruvian Amazon, not a psychotherapy. Its practitioners are the onanya (plural onanyabo; also spelled onaya/onayabo), colloquially called médicos, curanderos or maestros/maestras. ASOMASHK states that its members reject "shaman" and "shamanism" as "imported terminologies that do not apply historically to the particularities of our culture". [source: https://shipiboconibo.org/union-of-healers] A 2019 interview-based article glosses onaya as a healer who works with oni (ayahuasca), a word it relates to knowledge or wisdom, so roughly "the one who knows"; it describes ikaros as songs the healers use, including to help settle community conflicts, and dieta as a period of work with "master plants" that the healers regard as the basis of real knowledge. [source: https://psymposia.com/magazine/shipibo-ayahuasca-global-marketplace/] These are the healers' and authors' accounts, presented as the tradition holds them, neither as fact nor dismissed.

How healing is understood (attributed). A 2025 PUCP anthropology thesis describes a relational ontology in which physical, mental, social and spiritual health are connected; training and healing centre on the dieta (sama), understood as building reciprocal relationships with plant spirits (ibo), with dreams and visions as spaces of learning, so that for patients healing also reshapes how they understand illness and recovery. [source: https://tesis.pucp.edu.pe/items/1155349e-5165-4f00-bc2c-bea5b37ca5cf] A 2026 article drawing on 15 years of fieldwork argues that Shipibo use of ayawaska cannot be separated from its linguistic, cosmogonic and spiritual framework, and that Western psychological readings can reduce Indigenous ontologies to psychological projections; it proposes reciprocal dialogue, not absorption. [source: https://cris.pucp.edu.pe/es/publications/oni-pae-mera-ayawaska-among-the-shipibo-konibo-and-the-crisis-of-/] Both are outsider or academic accounts of what healers teach.

Heritage status in Peru. The National Institute of Culture declared the knowledge and traditional uses of ayahuasca by native Amazonian communities part of the nation's cultural patrimony (Resolución Directoral Nacional 836/INC, 2008), to protect traditional use and distinguish it from decontextualised, consumerist and commercial Western uses. [source: https://www.bialabate.net/blog-archive/news/ayahuasca-is-declared-cultural-patrimony-of-peru] The Shipibo-Konibo kené designs, made mainly by women, were declared national cultural heritage in 2008, and Shipibo-Konibo-Xetebo ikaros were declared intangible cultural heritage by the Ministry of Culture (reported June 2016; resolution number [uncertain: not verified]). [source: https://www.actualidadambiental.pe/?p=38380] No UNESCO listing was confirmed [uncertain: not verified].

Why this matters to a psychotherapist. Two groups of clients bring this tradition into therapy: Shipibo-Konibo people (in Ucayali, in Peruvian cities, or abroad) for whom onanyabo are part of ordinary help seeking; and non-Indigenous clients who have attended, or plan to attend, ayahuasca retreats run by or marketed with Shipibo healers. The therapist does not practise onanya healing, give ayahuasca, sing, diet or use kené. The therapist's change model here is their own: understanding the client's explanatory model, preventing misdiagnosis of culturally normative experience, keeping the client medically and psychologically safe, collaborating with legitimate community healers when the client wishes, integrating what the client experienced, and safeguarding. [synthesis] Psychedelic-assisted therapy and psychedelic integration as clinical modalities are covered in Domain VII.

2. Framework

This is a framework for the therapist's work alongside the tradition, not a protocol of the tradition. Phases, session counts and criteria below are [synthesis] built on the CFI's stated uses unless a source is given.

Who holds authority. Within the tradition, authority rests with recognised onanyabo and their lineages and families, with the healers' own association (ASOMASHK, which asks centres to register so authorised malokas are on record) and with Coshikox, which Cultural Survival describes as the highest representative authority of the Shipibo people. [source: https://shipiboconibo.org/union-of-healers] [source: https://psymposia.com/magazine/shipibo-ayahuasca-global-marketplace/] [source: https://www.culturalsurvival.org/node/12202] Heritage protection rests with Peru's Ministry of Culture. A therapist cannot certify who is a legitimate healer; only the community can. [synthesis]

Phase A: Preparation (before or alongside the first contact). Goal: examine your own assumptions (romanticising or dismissing the tradition; "shaman" language; tourism framing) and learn the community's own published positions. Format: personal study and supervision. Move on when you can describe the tradition in the community's terms and name who holds authority. [synthesis]

Phase B: Cultural assessment (sessions 1-2, can recur). Goal: understand the problem in the client's terms using the core CFI (16 questions in four domains) and relevant supplementary modules, plus Kleinman's explanatory-model questions. The CFI supports clinical understanding and is not a sole basis for diagnosis; modules may be used at first evaluation, later or repeatedly. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] Time needed: a field trial found later interviews required less time but no minutes are verified [uncertain]. Move on when you can state the client's name for the problem, its cause, the help they have sought and what they expect from you.

Phase C: Safety and differential formulation (session 1-3, urgent if needed). Goal: screen medical and psychiatric risk around ayahuasca (medication interactions, psychiatric history, abuse or coercion) and distinguish culturally normative experiences from disorder. Move on when risks are addressed with the prescriber or medical services and the formulation names both the cultural meaning and any disorder present. [synthesis]

Phase D: Collaboration or referral (only if the client wishes). Goal: with written consent, coordinate with a community-sanctioned healer, family member or cultural broker, or support the client's own contact with them. Move on when roles, information sharing and safety limits are agreed. [synthesis]

Phase E: Ongoing therapy and integration (weekly or as agreed; typically 6-20 sessions). Goal: work on the presenting problem, integrate healing or ceremonial experiences into the client's life and meaning system, and address colonial, intergenerational or tourism-related harms. End or step down when the presenting goals are met and the client has a support network that fits their culture. [synthesis]

Safeguarding runs across all phases. Disclosure of sexual abuse, violence, coercion, threats or neglect of urgent medical care moves straight to safety planning and reporting duties. [synthesis]

3. Guiding principles

Alongside, not inside. You work alongside the tradition; you never imitate, perform or teach onanya healing. Practical meaning: no songs, kené, diets or ayahuasca in your room or your advice. [synthesis]
Use the community's own words. Say onanya/onanyabo or médico, not "shaman". Practical meaning: ask the client which word they use and mirror it. [source: https://shipiboconibo.org/union-of-healers]
Authority belongs to the community. Practical meaning: refer to legitimacy as Coshikox, ASOMASHK and recognised healers define it, never your own judgement of who is "authentic". [source: https://shipiboconibo.org/union-of-healers]
Healing and self-determination are linked. ASOMASHK states that "the work of healing and the struggle towards self-determination are not separable." Practical meaning: treat land, livelihood, violence and racism as clinical context, not background. [source: https://shipiboconibo.org/union-of-healers]
Do not add to spiritual extractivism. The Yarinacocha Declaration takes "a strong stand against spiritual extractivism" and links foreign apprenticeship to appropriation. Practical meaning: do not recommend retreats, collect or publish Shipibo knowledge, or market yourself with Shipibo imagery. [source: https://shipiboconibo.org/union-of-healers]
Attribute, don't adjudicate. Spirits, plant teachers and sorcery are described as the client and tradition hold them. Practical meaning: "in your understanding" or "as the médico explained it", never "that isn't real" or "that's real". [synthesis]
Culture is not a diagnosis, and it does not rule one out. Practical meaning: use the CFI and the cultural exclusion criteria for trance and possession, and still assess psychosis, mania, suicidality and trauma. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]
Medicines belong to the prescriber. Practical meaning: you never advise starting, stopping or changing medication; you name the risk and route it to the prescriber. [synthesis]
Consent and the right to say no. Practical meaning: any collaboration, information sharing or family involvement needs the client's explicit, revocable consent. [synthesis]
Safety over deference. Respect for tradition never overrides safeguarding where sexual abuse, violence or neglect of urgent care is disclosed. [synthesis]
Ask, don't assume. Shipibo clients differ in religion (many communities also include Christian churches), urban or rural life and attitudes to healers. Practical meaning: let the CFI's cultural identity questions establish what applies. [synthesis] The role of Christianity in Shipibo communities is [uncertain: not verified].

4. Intervention inventory

All interventions are the psychotherapist's own. None involves performing, teaching or recommending onanya healing, ayahuasca, dieta, ikaros or kené. Example language is illustrative.

4.1 Cultural humility and self-examination

Purpose / when: before and throughout work with Shipibo-Konibo clients or retreat-goers; whenever you notice fascination, scepticism or a wish to "learn the medicine". [synthesis]
Steps: (1) List your assumptions about Amazonian healing, ayahuasca and Indigenous people, including romantic and dismissive ones. (2) Read what the community publishes about itself first (ASOMASHK's Yarinacocha Declaration on spiritual extractivism, appropriation and self-determination). [source: https://shipiboconibo.org/union-of-healers] (3) Check your own language: replace "shaman" with the client's word. (4) Bring cases to supervision with someone who has Amazonian or Indigenous health experience where possible. (5) Re-examine after each session in which the tradition comes up. [synthesis]
Example language (illustrative): "I'm not part of your tradition and I won't pretend to understand it from the inside. I'd like you to teach me what matters for our work."
Watch for: you asking more questions out of curiosity than for the client's benefit; the client performing "Indigenous wisdom" for you; you taking a position on whether the healing "worked". Working: the client corrects you freely and the sessions stay focused on their goals. [synthesis]

4.2 Core Cultural Formulation Interview

Purpose / when: first assessment of any client whose problem, or whose help seeking, involves onanyabo, ayahuasca or Shipibo identity. The CFI is a 16-question interview that clarifies the problem from the perspective of the person and their social network, possible sources of help, and expectations of services. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Steps: Follow the four APA domains in order, in your own words: (1) cultural definition of the problem (Q1-3); (2) cultural perceptions of cause, context and support: causes (Q4-5), stressors and supports (Q6-7), role of cultural identity (Q8-10); (3) self-coping and past help seeking, including healers consulted and barriers (Q11-13); (4) current help seeking: preferences (Q14-15) and the clinician-patient relationship, e.g. perceived racism and language barriers (Q16). [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] APA permits clinicians to reproduce the form for use with their patients; translation or modification needs APA permission. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] Record the client's own terms verbatim (e.g. their word for the illness, for the healer). Time per interview is [uncertain].
Example language (illustrative): "People describe problems in different ways. How would you describe what's been happening, and how would your family or your community describe it?" / "Have you seen a médico or anyone else for this? What did they say it was?"
Watch for: guarded answers about healers (fear of being judged or reported); clients who were told by retreat staff that distress is "part of the process" and so do not mention it. Working: the client names their own explanation and help seeking without hedging. [synthesis]

4.3 CFI supplementary modules and Informant Version

Purpose / when: for depth where the core CFI shows the tradition is central. APA lists 12 modules, usable as add-ons or standalone, at first evaluation, later or repeatedly. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
Steps: Choose by need: Explanatory Model (how the client understands cause and course); Spirituality, Religion and Moral Traditions (relationship with healers, plant teachers, churches); Coping and Help-Seeking (sequence of healers, clinics, retreats); Cultural Identity (Shipibo, mestizo, urban, diaspora; language); Patient-Clinician Relationship (trust, racism, fear of judgement); Social Network; Psychosocial Stressors (land, violence, tourism economy); Immigrants and Refugees (for clients living abroad); Caregivers. Use the Informant Version (17 questions) with a family member when the client consents. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
Example language (illustrative): "You mentioned the médico and also your church. How do those fit together for you, if they do?" / "With your permission, I'd like to hear how your mother sees what's been happening."
Watch for: module overload in one session; family informants who disagree with the client about healers. Working: modules yield information that changes the plan (e.g. who to involve, which language to use). [synthesis]

4.4 Explanatory-model questions (Kleinman)

Purpose / when: to map the client's model when it differs from a biomedical or psychological one, e.g. distress attributed to spirits, plant teachers, sorcery or envy, or to a difficult ceremony. [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf]
Steps: Ask, in your words, Kleinman's eight areas: what the client calls 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 should get; the main problems it has caused; what they fear most. (Kleinman, Eisenberg and Good 1978, Annals of Internal Medicine 88:251-258, as cited). [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader] Then write a short side-by-side summary: the client's model, your model, overlaps, and points to negotiate. [synthesis]
Example language (illustrative): "What do you think caused this? … And what do you fear most about it?" / "So in your understanding something happened in the ceremony that is still affecting you. In my training I'd also look at sleep and anxiety. Can we work with both?"
Watch for: the client switching to "therapy language" to please you. Working: the client's model and yours are both written into the plan, and the client agrees with the summary. [synthesis]

4.5 Asking about healer consultation and ayahuasca use without judgement

Purpose / when: at intake and whenever travel, retreats or a visit to a médico comes up. Many clients do not volunteer this. [synthesis]
Steps: (1) Normalise the question as routine. (2) Ask what kind of help, with whom (community healer, family healer, retreat centre), when, and in what setting, without asking for ceremony details. (3) Ask what the client took from it and whether anything was hard afterwards. (4) Ask about any plans for further participation. (5) Record facts, not judgements. [synthesis] Do not ask the client to describe songs, plant names, diets or ritual sequence; that knowledge belongs to the healer and community. [synthesis]
Example language (illustrative): "I ask everyone about healers, churches or ceremonies they've used, because it helps me understand. Have you been to a médico or a retreat?" / "You don't need to tell me what happened in the ceremony itself. I'm interested in how you've been since."
Watch for: shame, secrecy pacts or loyalty to a healer that make disclosure hard (secrecy is a warning sign in the abuse guidance below). Working: the client brings healer contacts up spontaneously later. [source: https://chacruna.net/?p=8765] [synthesis]

4.6 Cultural concepts, normative experience and the differential

Purpose / when: when the client reports visions, contact with spirits or plant teachers, sorcery, a sense of being affected by another person's envy or harm, or altered states during or after ceremonies.
Steps: (1) Establish whether the experience is accepted within the client's tradition and community (ask the client and, with consent, a family member or cultural broker). (2) Apply the manuals' cultural exclusions: DSM-5 states that DID identity disruption may be described in some cultures as possession and requires that the disturbance is not a normal part of broadly accepted cultural or religious practice; dissociative trance is not diagnosed when it is a normal part of broadly accepted collective cultural or religious practice. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] DSM-5-TR retains this in substance (exact wording [uncertain]). [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299] ICD-11 6B62 Trance disorder and 6B63 Possession trance disorder require that the state is involuntary, 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] (3) Separately assess features that point to disorder regardless of meaning: persistence outside ceremonial context, distress and impairment, functional decline, mania, suicidality, intrusive trauma symptoms, and whether the client's own community sees the person as unwell. [synthesis] DSM-5-TR's guidance that culturally sanctioned beliefs are not counted as psychotic symptoms is [uncertain: not verified]. (4) Formulate both: the cultural meaning and any disorder. [synthesis] No Shipibo-specific DSM-5-TR cultural concept of distress exists among those listed (e.g. susto, ataque de nervios, nervios); do not force one. [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf]
Example language (illustrative): "In your community, is what you saw something people would expect after working with a médico, or would they be worried about you?" / "Has this happened outside of ceremonies too?"
Watch for: pathologising normative experience; and the opposite error, missing mania or psychosis because a retreat framed it as spiritual. Working: the formulation is acceptable to the client and family and still addresses risk. [synthesis]

4.7 Medical and psychiatric safety screening and prescriber liaison

Purpose / when: whenever a client has drunk ayahuasca or plans to. You do not advise on medicines; you identify risk and route it.
Steps: (1) Ask about all prescribed and non-prescribed medicines and substances, physical health conditions, and personal or family history of psychosis, bipolar disorder, suicidality or substance use. (2) Know the documented risks: ayahuasca's harmala alkaloids inhibit MAO, and combining them with serotonin reuptake inhibitors can cause serotonin syndrome, which can be fatal; early signs overlap with ordinary ayahuasca effects, which can delay emergency care; the authors note risk may persist for some time after some antidepressants are stopped. [source: https://bibliography.maps.org/resources/download/12197] In the Global Ayahuasca Survey (10,836 respondents), about 70% reported acute physical effects (mostly vomiting), 2.3% needed medical attention, about 56% reported psychological effects in the following weeks or months, and about 12% sought professional help; physical-effect risk factors included older age at first use, physical conditions, previous substance use disorder and unsupervised settings; psychological-effect risk factors included anxiety disorders and physical conditions. [source: https://researchers.westernsydney.edu.au/en/publications/adverse-effects-of-ayahuasca-results-from-the-global-ayahuasca-su/] (3) With consent, contact the prescriber or GP and say what the client plans or has done; any decision about medication is theirs. (4) Tell the client which symptoms need emergency care (e.g. confusion, high fever, rigidity, seizures), without giving any ayahuasca guidance. [synthesis] (5) Do not encourage or arrange attendance. Legal status varies by country; outside Peru check local law [uncertain: not verified].
Example language (illustrative): "I can't advise you about medication or about the brew itself. What I can do, with your permission, is let your doctor know your plans so they can talk through the risks with you." / "If you or anyone with you notices confusion, a very high temperature or stiffness, that's a medical emergency."
Watch for: clients stopping medication on their own or on a retreat's advice; recent psychosis or mania; suicidality framed as "needing a breakthrough". Working: the prescriber is informed and the client has a medical safety plan. [synthesis]

4.8 Abuse-awareness conversation for clients who have attended or plan to attend retreats

Purpose / when: when a client (often non-Indigenous) has decided to attend, or has attended, a retreat. You do not recommend attendance; you reduce risk of sexual abuse and coercion, and open the door to disclosure.
Steps: (1) Ask whether they know who runs the centre and whether it is recognised locally; ASOMASHK asks healing centres to register with the association so authorised centres are on record, and the healers interviewed warn about unregistered people who approach foreigners at the airport. [source: https://psymposia.com/magazine/shipibo-ayahuasca-global-marketplace/] (2) Share, in your own words, the warning signs named in the Chacruna Institute's community guide (2018, developed with healers, facilitators and researchers): attention to appearance or excessive touching; requests for secrecy; offers of "love magic"; being told one is special or chosen; other substances offered as medicine; sex framed as healing or energy work. [source: https://chacruna.net/?p=8765] (3) Affirm, as the guide does, that a participant never has to accept touch they do not consent to or remove clothing, can decline or leave at any time, and that sex with a healer confers no healing or status. [source: https://chacruna.net/?p=8765] (4) Note the guide's point that people seeking healing from past sexual trauma are especially vulnerable. [source: https://chacruna.net/?p=8765] (5) Agree a plan to check in with you afterwards. [synthesis]
Example language (illustrative): "I'm not going to tell you whether to go. Because this matters for your safety, can I share some warning signs that people in the ayahuasca community themselves have published?" / "If anything happened there that didn't feel right, even if you froze at the time, you can tell me."
Watch for: client dismissing risk because the healer is "authentic"; trauma survivors seeking a ceremony to process abuse without support; disclosures framed as "energy work". Working: the client can name warning signs and has a safety contact. [synthesis]

4.9 Collaboration and referral with community-sanctioned healers

Purpose / when: only when a client (usually a Shipibo-Konibo client) wants their therapist and their healer or family to work in concert.
Steps: (1) Ask the client which healer they trust and how that healer is recognised in their community; legitimacy is defined by the community (recognised families and lineages, ASOMASHK, Coshikox), not by you. [source: https://shipiboconibo.org/union-of-healers] (2) Obtain written, specific, revocable consent covering what may be shared and with whom. (3) Agree roles: the healer leads in their domain; you lead on psychotherapy, risk and liaison with medical services; neither directs the other's practice. (4) Agree a shared safety line: urgent medical care, restraint, violence and abuse are never acceptable reasons for delay. (5) Review at set intervals with the client. [synthesis] Evidence that collaboration can be safe and helpful comes from other regions: 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 gave greater symptom reduction in psychosis and harmful practices fell more than in controls; [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839] in a Ghana 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] No published Shipibo-specific collaboration programme for psychotherapists was confirmed [uncertain: not verified].
Example language (illustrative): "Would you like me to be in touch with the médico, or would you rather keep the two separate? Either is fine." / "What would you like me to know from them, and what is private?"
Watch for: the client feeling pressured to choose; you drifting into advising on the healer's work; disagreement about medication (route to prescriber). Working: the client experiences the two sources of help as complementary. [synthesis]

4.10 Interpreters and cultural brokers

Purpose / when: when the client prefers Shipibo or Spanish, or when meaning needs a community member's explanation.
Steps: (1) Ask language preference (CFI Q16 covers language barriers). [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] (2) Use a trained interpreter, not a family member, for clinical content; check for community ties that affect confidentiality. (3) Brief the interpreter or broker that you are asking about meaning and help seeking, not ritual detail. (4) Debrief after the session. [synthesis]
Example language (illustrative): "Is there a word in Shipibo for what you're describing? Could you help me understand what it means?"
Watch for: the broker answering for the client; confidentiality fears in a small community. Working: the client speaks at length in their preferred language. [synthesis]

4.11 Integrating healing or ceremonial experiences

Purpose / when: after a client has worked with an onanya or attended a retreat and wants help making sense of it, or is struggling afterwards. In the Global Ayahuasca Survey about 88% of those reporting psychological effects saw them as part of a positive process, but about 12% sought professional help. [source: https://researchers.westernsydney.edu.au/en/publications/adverse-effects-of-ayahuasca-results-from-the-global-ayahuasca-su/] Clinical psychedelic-integration methods are in Domain VII.
Steps: (1) Screen first for risk (4.6, 4.7, 4.12). (2) Ask what the experience meant in the client's terms and in their healer's terms, without interpreting symbols for them; scholars caution that Western psychology can reduce Indigenous ontologies to psychological projections. [source: https://cris.pucp.edu.pe/es/publications/oni-pae-mera-ayawaska-among-the-shipibo-konibo-and-the-crisis-of-/] (3) Identify concrete, chosen changes in relationships, work and health. (4) Address destabilising after-effects (sleep, anxiety, intrusive memories) with ordinary evidence-based care. (5) For questions about the healing itself, the client returns to their healer or community. [synthesis]
Example language (illustrative): "What did you bring back from it that you want to keep?" / "That part sounds like a question for the médico. What I can help with is how you're sleeping and coping now."
Watch for: spiritual bypassing of real problems; repeated ceremonies to fix distress; grandiosity; ongoing anxiety or derealisation. Working: the client's daily functioning improves and the experience is held as meaningful without dominating. [synthesis]

4.12 Safeguarding and responding to harm

Purpose / when: disclosure of sexual abuse, assault, coercion, threats, violence, or harm through delayed medical care, in any setting.
Steps: (1) Believe and stabilise; the Chacruna guide stresses abuse is never the victim's fault and that freezing is common and does not prevent later reporting. [source: https://chacruna.net/?p=8765] (2) Assess current safety and medical needs. (3) Explain your reporting duties (mandatory where children or vulnerable adults are involved) and the client's options, including reporting where the incident occurred and legal advice; Chacruna publishes a legal resource companion. [source: https://chacruna.net/?p=8765] (4) For Shipibo clients facing threats or violence, recognise the context: Cultural Survival reported that in April 2018 the elder healer Olivia Arévalo Lomas was shot dead at her home near Yarinacocha, and FECONAU and Coshikox demanded justice and protection for other threatened leaders; [source: https://www.culturalsurvival.org/node/12202] ASOMASHK describes the killing as committed by a Canadian ayahuasca tourist. [source: https://shipiboconibo.org/union-of-healers] (5) Document and follow local procedures. [synthesis]
Example language (illustrative): "Thank you for telling me. What happened was not your fault." / "There are some things I'm required to report; I'll tell you exactly what and why before I do anything."
Watch for: self-blame framed in spiritual terms; fear of retaliation in small communities; pressure from others to keep silent. Working: the client is safe, informed of options and still engaged. [synthesis]

4.13 Addressing colonial, economic and tourism-related harm

Purpose / when: with Shipibo-Konibo clients whose distress is tied to land, violence, racism, loss of youth transmission or the ayahuasca economy; and with non-Indigenous clients exploring their role in it.
Steps: (1) Name structural context as real: ethnographic research in Ucayali (2015-2019) describes reduced local access to the plants used, healers treated as replaceable and valued for labour and representation of indigeneity, and persistent colonial hierarchies, alongside new income not tied to logging. [source: https://lauradev.com/research-projects/dissertation-research/] Healers interviewed in 2019 raised false healers, foreigners calling themselves maestros after short stays, appropriation, rivalry and young people leaving communities. [source: https://psymposia.com/magazine/shipibo-ayahuasca-global-marketplace/] (2) Explore personal impact using CFI stressors and identity questions. (3) Link to community and advocacy resources the client chooses. (4) With non-Indigenous clients, explore wishes to train as healers or adopt Shipibo identity markers against ASOMASHK's stated concerns about appropriation. [source: https://shipiboconibo.org/union-of-healers] [synthesis]
Example language (illustrative): "It sounds like what's happening to your community is part of what you're carrying. Can we make room for that here?"
Watch for: the therapist taking a political lead the client has not chosen; guilt-driven over-identification in non-Indigenous clients. Working: the client feels their context is understood and acts on it in their own way. [synthesis]

4.14 Consent, confidentiality, documentation and working with families

Purpose / when: throughout, especially where family members or healers are involved.
Steps: (1) Record the client's own terms and model. (2) Record healer contact and ayahuasca use factually, without detail of practices. (3) Seek consent before speaking with family, healers or brokers, and agree what remains private. (4) Include family through the Informant Version when the client agrees. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf] (5) Never publish or present case material that reveals community knowledge without the community's consent. [synthesis]
Example language (illustrative): "I'll write down that you've seen a médico, but not the details of the healing. Is that okay with you?"
Watch for: records that could expose the client to stigma or legal risk; family members using sessions to settle disputes about healers. Working: the client knows what is recorded and who knows what. [synthesis]

5. Handling problems

The published sources address community concerns (appropriation, false healers, abuse, violence) and medical risk; they do not address psychotherapy process. Everything below is [synthesis] unless a source is given.

Client won't talk about healers or ceremonies. Likely fear of judgement, reporting or loyalty. Response: state plainly that you ask everyone, will not judge, and do not need ceremony details; return to it later via CFI help-seeking questions. If secrecy was requested by a healer, treat that as a possible warning sign. [source: https://chacruna.net/?p=8765]
Client asks you to recommend a healer, centre or "the real Shipibo experience". Decline; you cannot judge legitimacy and recommending would feed the spiritual extractivism the Yarinacocha Declaration opposes. [source: https://shipiboconibo.org/union-of-healers] Explore what the client hopes to get and what other routes exist.
Client asks your view on whether to stop or change medication before a retreat. Do not advise. Name the documented interaction risk and route urgently to the prescriber with consent. [source: https://bibliography.maps.org/resources/download/12197]
Client returns destabilised (insomnia, panic, derealisation, suicidal thoughts, manic signs). Do a risk assessment, involve medical services as needed, and treat symptoms with standard care; do not frame it as "the process" because the retreat did. Psychological after-effects are common and most resolve, but a minority need professional help. [source: https://researchers.westernsydney.edu.au/en/publications/adverse-effects-of-ayahuasca-results-from-the-global-ayahuasca-su/]
Client says the problem is sorcery or a spirit, and rejects your formulation. Do not argue. Hold both models side by side (4.4); agree on shared targets such as sleep, safety and relationships; offer collaboration with a healer they trust if they wish. Watch for whether their own community regards them as unwell.
Stuck therapy because the healer and you seem to pull in different directions. Return to the agreed roles; ask the client what they need from each; never ask the client to choose; if a conflict concerns medication, the prescriber decides.
Rupture after you used a dismissive or exoticising word (e.g. "shaman", "drug trip"). Acknowledge, apologise, ask the client's preferred term and use it. [source: https://shipiboconibo.org/union-of-healers]
Overwhelm when discussing violence, threats or loss in the community. Slow down, ground, pace the material, and attend to practical safety; the reported 2018 killing of Olivia Arévalo Lomas and threats to other leaders show these fears may be realistic. [source: https://www.culturalsurvival.org/node/12202]
Non-adherence to sessions during healing periods. A client may be away for long periods with a healer or in a community. Agree in advance how to pause and resume, and a safety plan for the interval.
Non-Indigenous client wants to become a healer or adopts Shipibo identity markers. Explore motives non-judgementally; reflect the community's published concerns that foreigners who complete short periods of training call themselves maestros and that appropriation is harmful. [source: https://psymposia.com/magazine/shipibo-ayahuasca-global-marketplace/] [source: https://shipiboconibo.org/union-of-healers]
Disclosure of sexual abuse by a healer or facilitator. Move to 4.12; avoid any suggestion that the abuse was part of healing; support reporting options. [source: https://chacruna.net/?p=8765]
Your own fascination or scepticism is steering sessions. Take it to supervision; re-centre on the client's goals (4.1).
Uncertainty about whether an experience is normative or a disorder. Consult a cultural broker or community member with consent, apply the cultural exclusion criteria, and keep assessing over time rather than forcing an early decision. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]

Sources

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