Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 117
Guide XI-117

Jaguar shamans of Yuruparí

Pirá Paraná river, Vaupés, Colombia
A 36 · L 55 · M 918 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the knowledge system as its holders describe it in the Plan Especial de Salvaguardia (PES) prepared by ACAIPI (Pirá Paraná, Mitú and Bogotá, July 2010), as approved by Colombia's Ministry of Culture (Resolución 1690 de 2010) and inscribed by UNESCO in 2011 (decision 6.COM 13.9). For the psychotherapist's own work: the DSM-5-TR Cultural Formulation Interview (CFI) and its supplementary modules, and Kleinman's explanatory-model questions.

What it is. This is not a therapy. It is a living Indigenous knowledge system of several Eastern Tukanoan peoples of the Pirá Paraná river in Vaupés, south-eastern Colombia. UNESCO lists it as "Traditional knowledge of the jaguar shamans of Yuruparí" on the Representative List of the Intangible Cultural Heritage of Humanity (2011). Colombia lists it nationally as "He Yaia Keti Oka, el Conocimiento Tradicional (Jaguares de Yuruparí) para el Manejo del Mundo". Spellings vary across official documents (He / Hee Yaia Keti Oka). [source: https://ich.unesco.org/en/RL/knowledge-of-the-jaguar-shamans-of-yurupari-00574] [source: https://www.mincultura.gov.co:443/prensa/noticias/Documents/Patrimonio/04-Resolución%20pira%20parana.pdf]

Who holds it. ACAIPI (Asociación de Capitanes y Autoridades Tradicionales Indígenas del río Pirá Paraná), founded in 1996, represents about 2,000 people in some 17 communities and nearby malocas (communal houses). Sources differ on which groups they list. UNESCO's project page names Tatuyo, Eduria, Bará, Barasana, Rasegana, Itana and Makuna. The PES names Barasana, Eduria, Makuna, Bará, Tatuyo, Tuyuca and Carapana, among others, and describes seven Eastern Tukanoan languages. [source: https://ich.unesco.org/en/project-education/safeguarding-traditional-knowledge-in-the-territory-of-the-jaguars-of-yurupar-00433] [source: https://mincultura.gov.co/direcciones/patrimonio-y-memoria/Documents/04-jaguares-de-yurupari.pdf]

Core idea of how health is kept (as the communities describe it). UNESCO describes knowledge that the communities say comes from Yuruparí, an all-powerful mythical anaconda who lived as a person. The jaguar shamans follow a ceremonial calendar "to unite the community, heal, prevent illness and revitalize nature" (paraphrased from UNESCO). The territory's sacred sites are said to hold the spiritual energy that sustains living things. In the PES, ACAIPI describes the territory as a maloca and a body that breathes, with sacred sites as its vital organs. It attributes illness to failing to follow the ecological-cultural calendar, breaking the diets and restrictions set by the knowledge holders, and disrespecting sacred sites. Care is described as mainly preventive and seasonal. Health of people and health of territory are treated as one task. These are the community's own concepts. This guide neither presents them as fact nor dismisses them. [source: https://ich.unesco.org/en/decisions/6.COM/13.9] [source: https://mincultura.gov.co/direcciones/patrimonio-y-memoria/Documents/04-jaguares-de-yurupari.pdf]

The psychotherapist's place. A psychotherapist does not practise this tradition and cannot become a "jaguar" through study. Its healing, ritual and initiation belong to the community's own specialists, under community authority. Your work is culturally responsive psychotherapy alongside it. You understand the client's own framework, assess carefully, and avoid both pathologising normal experience and missing illness. When the client wishes, you coordinate with the community's own authorities and health structures. You also protect the client's safety. This guide describes no ceremony, song, sacred object, initiation step or plant use. [synthesis]

2. Framework

2a. The tradition's own structure (for orientation only)

  • Authority. The PES and Resolución 1690 name the Asamblea General de Autoridades Tradicionales (Kubua) as ACAIPI's highest authority. Elders and sabedores (knowledge holders) guide decisions, and capitanes represent communities. The PES names specialist roles, among them:
    • the Hee Gu (curer of Yuruparí), who manages the territory and the people's wellbeing;
    • the maloca owner (Wii Ihi);
    • master orators, dance masters and Kubua sabedores, including curers of the epochs (Rodori Wadogi);
    • specialists who extract illness;
    • snakebite specialists;
    • food curers who attend pregnancy, childbirth and early childhood.
    The PES counts more than 200 traditional specialists. [source: https://mincultura.gov.co/direcciones/patrimonio-y-memoria/Documents/04-jaguares-de-yurupari.pdf] [source: https://www.mincultura.gov.co:443/prensa/noticias/Documents/Patrimonio/04-Resolución%20pira%20parana.pdf]
  • Gendered transmission. According to UNESCO, guidance on the health of people and territory passes to boys in a strict initiation. Knowledge of child care, pregnancy and food preparation passes among women. The PES states that women do not hold curative roles. It describes women as responsible for ritual food and drink, as godmothers to initiates, and as leading their own work on crops, seeds and maternal health, coordinated with the departmental health secretariat. The PES also describes boys' Yuruparí education as historically excluding women. [source: https://ich.unesco.org/en/RL/knowledge-of-the-jaguar-shamans-of-yurupari-00574] [source: https://mincultura.gov.co/direcciones/patrimonio-y-memoria/Documents/04-jaguares-de-yurupari.pdf]
  • Calendar. The PES describes an ecological-cultural calendar of four main epochs: crops (November–February), Yuruparí (March–May, the most sacred), wild fruits (June–August) and "jaguar worm" (September–October, described as the most dangerous, needing prevention). More than ten further rituals take place each year. The calendar sets the proper time for healing. Resolución 1690 makes strengthening the maloca as the space for this calendar part of the safeguarding plan. A client may live by this calendar, so it can shape when they can attend sessions and what they may eat or do. [source: https://mincultura.gov.co/direcciones/patrimonio-y-memoria/Documents/04-jaguares-de-yurupari.pdf]
  • Relation to biomedicine. The PES criticises health posts staffed by outside promoters and short visiting medical brigades ("correrías médicas"). It asks for its own health system ("salud propia") to be protected, with selective use of Western medicine that respects traditional knowledge. ACAIPI has negotiated an intercultural basic-care plan (PABI) with the departmental health secretariat. Resolución 1690 sets an intercultural health programme that prioritises traditional medicine. Its prevention is centred on the epoch curers, and it includes a women's health research programme. At national level, Decree 1953 of 2014 recognises SISPI, the Indigenous health system (Sistema Indígena de Salud Propio e Intercultural), which is meant to link with the general social security health system. [source: https://mincultura.gov.co/direcciones/patrimonio-y-memoria/Documents/04-jaguares-de-yurupari.pdf] [source: https://www.mincultura.gov.co:443/prensa/noticias/Documents/Patrimonio/04-Resolución%20pira%20parana.pdf] [source: https://scielosp.org/pdf/rsap/2020.v22n4/463-467/es]
  • Outsiders. Resolución 1690 states that outside research requires ACAIPI's endorsement. The PES names tourism and outside research among external threats, along with mining and climate change. The PES describes sacred objects as untouchable and their access as governed by ritual and dietary rules. [source: https://www.mincultura.gov.co:443/prensa/noticias/Documents/Patrimonio/04-Resolución%20pira%20parana.pdf] [source: https://mincultura.gov.co/direcciones/patrimonio-y-memoria/Documents/04-jaguares-de-yurupari.pdf]

2b. The psychotherapist's phases [synthesis, built on the CFI]

No source sets session counts for this work. The phases below are [synthesis].

  1. Preparation (before the first session, then ongoing). Read the published sources above. Examine your own assumptions. Arrange a language-matched interpreter or cultural broker if needed. Move on when you can name who holds authority (ACAIPI, its Kubua assembly, the community's capitanes) without treating any individual as the spokesperson for the whole tradition.
  2. Engagement and cultural assessment (sessions 1–3). Core CFI, the explanatory model, relevant supplementary modules and the Informant Version if family is present. The APA says modules can be used at first evaluation, later or repeatedly. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] Move on when you can state the problem in the client's words, their view of its cause, the help they have sought and the help they want.
  3. Formulation and differential diagnosis (sessions 2–4). Distinguish culturally normative experience from disorder. Check medical causes. Agree on a shared plan. Move on when the client agrees with your summary and with what each helper (family, community specialists, medical team, you) is doing.
  4. Coordinated care (ongoing; weekly to fortnightly, flexed around the client's ritual obligations and travel). Psychotherapy for the agreed goals, plus coordination with community and medical structures when the client consents. Move on when the goals are met, or the client chooses community care alone and is safe.
  5. Integration and closure. Help the client make sense of their experiences, including any community healing they chose, in their own terms. Plan relapse prevention across both systems.

Safeguarding and suicide risk are assessed in every phase, not just once.

3. Guiding principles

  • The tradition is the community's, not yours. Never offer, imitate or interpret its healing, ritual or initiation. [synthesis, in line with ACAIPI's control over outside research and use]
  • Name the right authority. ACAIPI, the Kubua assembly and community capitanes hold authority, not a single "shaman" a client met online. Route any contact through them. [source: https://www.mincultura.gov.co:443/prensa/noticias/Documents/Patrimonio/04-Resolución%20pira%20parana.pdf]
  • Restricted knowledge stays restricted. Do not ask about initiation content, sacred objects or ritual detail, and do not record it if it comes up. Ask what the experience means to the client, not how it is done. [synthesis]
  • Attribute, do not adjudicate. Write "the client understands the illness as resulting from…", never "the illness was caused by…" or "the client believes, wrongly…". [synthesis]
  • Health and territory are linked. Displacement, mining or loss of access to sacred sites may be experienced as direct threats to health. Take them as clinical material. [source: https://mincultura.gov.co/direcciones/patrimonio-y-memoria/Documents/04-jaguares-de-yurupari.pdf]
  • Gender shapes knowledge. Do not expect a woman to speak to men's ritual knowledge, or the reverse. Offer a same-gender clinician or interpreter where the client prefers. [synthesis, from the gendered transmission UNESCO and the PES describe]
  • Respect the community's stance on biomedicine. It is selective, critical use. Do not assume refusal, and do not assume full acceptance. Ask. [source: https://mincultura.gov.co/direcciones/patrimonio-y-memoria/Documents/04-jaguares-de-yurupari.pdf]
  • Avoid both errors: pathologising and missing illness. DSM-5-TR excludes trance and possession experience that is a normal part of broadly accepted cultural or religious practice. Involuntary, unwanted, distressing states can still be disorders. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://www.findacode.com/icd-11/code-1807490186.html]
  • Consent and confidentiality govern collaboration. Make no contact with community authorities or specialists without the client's explicit, specific consent. Small communities make confidentiality fragile. [synthesis]
  • Safety is not negotiable. Any risk of harm, to the client or to a child, triggers standard risk and safeguarding duties, whatever the cultural framing. [synthesis]
  • Humility about evidence. No trial has tested collaboration with Pirá Paraná specialists. The evidence for collaborating with healers comes from West Africa. Treat its transfer as [uncertain]. [synthesis]

4. Intervention inventory

Every intervention below is the psychotherapist's own work. None of them is a practice of the Yuruparí tradition. All example language is (illustrative), written for this guide, and should be adapted with the client and the interpreter.

4.1 Cultural humility and self-examination

  • Purpose: to stop your assumptions from shaping the assessment. These include romantic images of "jaguar shamans", missionary or developmentalist attitudes, and the belief that "real" treatment is biomedical. Use before and throughout contact. [synthesis]
  • Steps:
    1. List what you already "know" about Amazonian shamanism, and its source (media, tourism, psychedelic culture, missionary history). Mark each item as unverified.
    2. Read the published sources (UNESCO element page, ACAIPI's PES, Resolución 1690) so you know who holds authority and what the community has chosen to make public.
    3. Note the PES criticism of outside health workers who arrive briefly and of outside researchers. Ask yourself how you could repeat those patterns.
    4. Bring this to supervision or consultation, ideally with someone who has worked with Indigenous Amazonian clients in Colombia.
  • Example language (to yourself or in supervision): "What am I hoping this client will show me, and why?" (illustrative)
  • Watch for: curiosity about ritual that goes beyond what the client needs; treating the client as an informant; feeling disappointed when the client is Christian, urban or uninterested in tradition. It is working if your questions stay on the client's goals and you can tolerate not knowing.

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

  • Purpose: to clarify the problem as the client and their network see it: its meaning, possible sources of help and what they expect from services. Use at the first evaluation for every client from these communities. The APA designed it for use by any clinician, with any individual, in any setting. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]
  • Steps:
    1. Use the official APA form. Clinicians may reproduce it for use with their own patients, but modifying or translating it needs APA permission. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
    2. Cover its four domains in order:
      • cultural definition of the problem;
      • cultural perceptions of cause, context and support, including the role of cultural identity;
      • cultural factors affecting self-coping and past help seeking, including barriers;
      • cultural factors affecting current help seeking, including preferences and the clinician–patient relationship.
    3. Use the client's words for the problem throughout. If they use a term in their own language, ask the interpreter to keep it untranslated and to explain it.
    4. In the help-seeking domain, ask neutrally about every source of help: family, the community's specialists, church, health post, hospital.
    5. In the relationship domain, ask directly about past experiences of discrimination, language barriers or being disbelieved in services.
    6. Use the answers to support your clinical judgement. The CFI is not meant to be the only basis for a diagnosis. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
    7. Time: the DSM-5 field trial found that later interviews took less time but did not report minutes. The common estimate of 15–20 minutes is [uncertain]. [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]
  • Example language: "People see problems in different ways. In your own words, how would you describe what is happening? How would people in your community or family talk about it?" (illustrative) "Have you or your family looked for help from anyone in your community or elsewhere? What was helpful?" (illustrative)
  • Watch for: short, polite, agreeable answers. These can signal distrust of outside services, which the PES itself names. Slow down, explain why you ask, and say there are no wrong answers. It is working when the client corrects you or adds detail on their own.

4.3 CFI supplementary modules

  • Purpose: to go deeper on topics the core CFI flags. The APA has 12 modules. The most relevant here are Explanatory Model; Spirituality, Religion, and Moral Traditions; Cultural Identity; Coping and Help-Seeking; Social Network; Psychosocial Stressors; Patient-Clinician Relationship; School-Age Children and Adolescents; Older Adults; Immigrants and Refugees; and Caregivers. Use them as add-ons or on their own, at first evaluation, later, or repeatedly. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
  • Steps:
    1. Note which core CFI subtopics raised more questions. The core form shows which module expands each subtopic.
    2. Choose modules for this client:
      • Spirituality, if the client links distress to obligations, restrictions or sacred sites;
      • Cultural Identity, for a young person living between town schooling and maloca life;
      • Immigrants and Refugees, adapted by you [synthesis], for people displaced to Mitú, Bogotá or elsewhere, or affected by armed conflict or mining;
      • Caregivers, for a family member who carries the care.
    3. Give one module per session if the client tires easily.
    4. Record the client's answers in their words, without restricted ritual detail (see 4.16).
  • Example language: "You mentioned that things started after you were away from your community for a long time. Can you tell me what being away means for you and for your health?" (illustrative)
  • Watch for: module questions that invite disclosure of restricted knowledge. If the client hesitates, say they need not describe anything that is not to be shared. It is working when themes from the module turn up in later sessions as shared reference points.

4.4 Informant Version of the CFI

  • Purpose: to include a family member's or friend's view of the problem. Family and community often frame illness collectively here. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
  • Steps:
    1. Get the client's consent for who joins and what may be discussed.
    2. Start with the informant's relationship to the client, then cover the same four domains as the core CFI.
    3. Compare the two accounts with the client, privately if they prefer.
  • Example language: "You know her well. How do you and your family understand what is happening, and what do you hope we can do?" (illustrative)
  • Watch for: the informant speaking over the client; differences between generations (an elder's view of a broken restriction versus a young person's view of stress at school). Treat differences as information, not as a contest. It is working when the plan reflects both views.

4.5 Exploring the explanatory model (Kleinman)

  • Purpose: to learn the client's own account of the illness: name, cause, timing, course, severity, treatment, effects and fears. Use alongside or within the CFI. [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf] [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader]
  • Steps:
    1. Ask the eight explanatory-model questions in your own words:
      • what they call the problem;
      • what caused it;
      • why it started when it did;
      • what it does to them and how it works;
      • how severe it is and how long it will last;
      • what treatment they should get;
      • what problems it has caused;
      • what they fear most.
    2. Expect causes the community names. The PES lists not following the calendar, breaking diets and restrictions, and disrespecting sacred sites. Cayón's outsider ethnography of the Makuna also describes illness linked to conflict and to unauthorised specialist practice. Accept these as the client's framework without endorsing or contesting them. [source: https://mincultura.gov.co/direcciones/patrimonio-y-memoria/Documents/04-jaguares-de-yurupari.pdf] [source: https://www.redalyc.org/pdf/557/55703505.pdf]
    3. Also ask about everyday causes the client may hold at the same time (loss, school, money, conflict, alcohol). Several explanations can coexist.
    4. Summarise the model back and ask for corrections.
  • Example language: "What do you think started this? … And why now, at this time of year or this point in your life?" (illustrative) "What worries you most about where this could go?" (illustrative)
  • Watch for: your own urge to translate the client's model into a diagnosis too quickly; clients giving you a "medical" answer because they think you want one. It is working when the client's fears (for example, harm spreading to family) become explicit treatment targets.

4.6 Asking about the community's specialists and other help without judgement

  • Purpose: to know all the care the client is getting or wants, so that it can be coordinated and not hidden. [synthesis]
  • Steps:
    1. Normalise: say that many people use more than one source of help.
    2. Ask whether they have consulted, or wish to consult, specialists in their community, a church, the health post or a hospital.
    3. Ask what the specialists advised in terms of behaviour (rest, food restrictions, staying near the community, timing), not about methods.
    4. Ask whether any advice or plant use affects sleep, eating or medicines. Route any medicine question to the prescriber (see 4.11).
    5. Record the information neutrally.
  • Example language: "Some people see a specialist from their own community as well as coming here. Is that part of your care, or something you'd want? I'm not asking about what they do, only so we can make sure everything fits together." (illustrative)
  • Watch for: the client concealing community care out of fear of disapproval, or concealing biomedical care from family. It is working when the client tells you, unprompted, what a specialist or doctor said.

4.7 Distinguishing culturally normative experience from disorder

  • Purpose: to avoid diagnosing as illness what the community regards as normal (for example, attributing illness to a broken restriction, or experiences connected with sanctioned ritual life), while not missing psychosis, mood disorder, dissociative disorder, substance problems or medical illness. [synthesis]
  • Steps:
    1. Use DSM-5-TR cultural concepts of distress as the manual intends: idioms, explanations or perceived causes, and syndromes. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf] No DSM-5-TR glossary entry is specific to the Pirá Paraná peoples. Commonly cited DSM-5-TR examples include susto, ataque de nervios and nervios. [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf] Do not force the client's terms into those categories. [uncertain: whether any glossary entry fits these communities]
    2. Ask whether family and community regard the experience as normal or expected for someone in the client's position, and whether it is wanted or unwanted, voluntary or involuntary.
    3. Apply the published exclusions:
      • DSM: identity disruption "may be described in some cultures as an experience of possession", and the disorder criterion excludes experience that is "a normal part of a broadly accepted cultural or religious practice" (DSM-5 wording; DSM-5-TR keeps the substance, exact wording [uncertain]). [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299]
      • DSM: dissociative trance under other specified dissociative disorder does not apply when it is part of a broadly accepted collective cultural or religious practice. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]
      • ICD-11: 6B62 trance disorder and 6B63 possession trance disorder require that the state be involuntary and unwanted and not part of accepted cultural or religious practice, with significant distress or impairment. [source: https://www.findacode.com/icd-11/code-1807490186.html] [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]
    4. Look for the markers of disorder that apply across cultures: distress or impairment the client and family themselves see as abnormal, change from the person's baseline, persistence outside any ritual context, functional decline, risk.
    5. Screen for medical and substance causes. Refer for a medical examination where indicated.
    6. When unsure, consult a cultural broker or, with consent, a family member or community authority about whether the experience is "usual". [synthesis]
    7. The DSM-5-TR note that culturally shared beliefs should not count as delusions is [uncertain]. Clinically, judge a belief against the client's own community norms. [synthesis]
  • Example language: "In your community, would people see what is happening to you as something that happens and has a known path, or as something unusual that worries them?" (illustrative)
  • Watch for: two opposite errors: reading every spiritual explanation as a delusion, or accepting a cultural label when the family themselves are alarmed by new, persistent, disabling symptoms. It is working when the family's and the client's view of what is "not normal" matches your formulation.

4.8 Working with interpreters and cultural brokers

  • Purpose: to make communication accurate. The PES describes Eastern Tukanoan languages as first languages, with Spanish taught as a second language. [source: https://mincultura.gov.co/direcciones/patrimonio-y-memoria/Documents/04-jaguares-de-yurupari.pdf]
  • Steps: [synthesis]
    1. Ask the client's language preference. Do not assume Spanish fluency covers emotional vocabulary.
    2. Use a trained interpreter where possible. Avoid children as interpreters.
    3. Consider small-community confidentiality: ask the client whether they know the interpreter, and whether gender or clan matters to them.
    4. Brief the interpreter: keep terms for illness and causes untranslated and explain them afterwards; tell the clinician if a question is culturally inappropriate.
    5. Debrief after the session.
  • Example language (to interpreter): "If I ask something that shouldn't be asked, or that a woman or man wouldn't usually answer, please tell me rather than translating it." (illustrative)
  • Watch for: the interpreter softening or summarising; the client's discomfort with a particular interpreter. It is working when the client's own terms appear in your notes with their meanings.

4.9 Collaboration and referral with community-sanctioned authorities and specialists

  • Purpose: to coordinate care when the client wishes to involve their community's specialists, through pathways the community itself controls. [synthesis]
  • Steps:
    1. Ask whether the client wants their community involved, and whom they regard as legitimate (their own community's sabedores, capitanes, ACAIPI). Never refer to a self-described "shaman" outside these structures.
    2. Get explicit, written, specific consent: who may be contacted, what may be shared, and for what purpose.
    3. Let the client or family lead the contact where possible. They know the protocol. Community authority rests with the Kubua assembly and community capitanes. [source: https://www.mincultura.gov.co:443/prensa/noticias/Documents/Patrimonio/04-Resolución%20pira%20parana.pdf]
    4. Share only what is needed for safety and coordination, for example "under treatment for low mood; please let us know if you are worried about her safety".
    5. Agree on roles: the community's care follows its own authority. Yours covers psychotherapy and coordination with medical care.
    6. Evidence for the general approach (from elsewhere): in Nigeria and Ghana, the COSIMPO cluster trial (Gureje et al., The Lancet 2020) found that collaborative shared care between traditional and faith healers and primary-care workers reduced psychosis symptoms more than usual care, and harmful practices fell. [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] Neither trial involved Amazonian communities. Transfer is [uncertain].
  • Example language: "Would it help you to have someone from your community involved in your care? If so, who would be the right person, and how would your family want that to happen?" (illustrative)
  • Watch for: pressure from you or the family; any request to share restricted content; the client feeling caught between systems. It is working when the client feels both forms of care respect each other.

4.10 Linking with Colombia's intercultural health structures

  • Purpose: to use official channels for intercultural care. [source: https://scielosp.org/pdf/rsap/2020.v22n4/463-467/es] [source: https://mincultura.gov.co/direcciones/patrimonio-y-memoria/Documents/04-jaguares-de-yurupari.pdf]
  • Steps:
    1. Find out whether the client is registered with an Indigenous health provider or whether SISPI arrangements (Decree 1953 of 2014) apply where they live.
    2. For clients from the Pirá Paraná, ask whether ACAIPI's intercultural arrangements with the Vaupés departmental health secretariat apply to them. [uncertain: current status of the PABI]
    3. With consent, coordinate through these structures rather than going around them.
  • Example language: "Is there an Indigenous health service or organisation you're connected with that we should work with?" (illustrative)
  • Watch for: assuming every Indigenous client wants Indigenous-specific services. It is working when referrals are accepted and followed up.

4.11 Medicines, plants and medical care: route to the prescriber

  • Purpose: to keep the client physically safe without advising on medicines or plants. The PES names coca, tobacco and yagé among sacred plants, with yagé used by specialists. This guide gives no information on their use. [source: https://mincultura.gov.co/direcciones/patrimonio-y-memoria/Documents/04-jaguares-de-yurupari.pdf]
  • Steps:
    1. Ask, without judgement, whether the client takes any prescribed medicine and has used any plant or preparation recently.
    2. Do not advise starting, stopping or changing any medicine.
    3. With consent, inform the prescriber or primary-care doctor. For ayahuasca-type brews, Callaway and Grob (1998) warned that the MAO-inhibiting harmala alkaloids combined with serotonin reuptake inhibitors may induce a serotonin syndrome with a potentially grave outcome, and advised caution with certain medicines. [source: https://pubmed.ncbi.nlm.nih.gov/9924842/] Interaction risks for other plant preparations are [uncertain]. Never advise on medicines; route the question to the prescriber. For psychedelic-related questions, see Domain VII.
    4. For new physical symptoms, urge prompt medical assessment.
  • Example language: "I'm not the right person to advise on medicines or plants, but your doctor needs to know everything you're taking so they can keep you safe. Can we tell them together?" (illustrative)
  • Watch for: the client stopping prescribed medicine to observe restrictions, or the reverse. It is working when the prescriber is informed and the client feels respected.

4.12 Fitting therapy to the calendar and restrictions

  • Purpose: to make treatment practicable for a client who lives by the ecological-cultural calendar and its restrictions. [synthesis, from the PES]
  • Steps:
    1. Ask whether there are times of year, obligations or restrictions (food, travel, activity) that affect attendance or homework.
    2. Plan around them: flexible scheduling, phone or remote sessions where available, breaks agreed in advance.
    3. Adapt behavioural tasks (activity scheduling, sleep or food-related tasks) so they do not conflict with restrictions the client observes.
  • Example language: "Are there times coming up when it would be hard or not right for you to come, or things you shouldn't eat or do? Let's plan around them." (illustrative)
  • Watch for: interpreting missed sessions as resistance. It is working when attendance is steady across the year.

4.13 Working with families, and with women's areas of knowledge

  • Purpose: to work with the collective frame of health, and to respect the gendered knowledge that UNESCO and the PES describe. Women hold knowledge on child care, pregnancy and food. Specialists who care for pregnancy, birth and early childhood are named in the PES. [source: https://ich.unesco.org/en/RL/knowledge-of-the-jaguar-shamans-of-yurupari-00574] [source: https://mincultura.gov.co/direcciones/patrimonio-y-memoria/Documents/04-jaguares-de-yurupari.pdf]
  • Steps: [synthesis]
    1. Map the family and who the client consults (genogram with the client's own kinship terms).
    2. In perinatal work, ask which family members and community carers are supporting the pregnancy or infant. Coordinate with them as the client wishes.
    3. Offer family sessions with consent. Let the family set who speaks first.
    4. Offer a same-gender clinician where the client prefers.
  • Example language: "Who in your family looks after you when you're unwell? Who would you want to know how you're doing?" (illustrative)
  • Watch for: family decisions overriding the client's own wishes on safety or treatment; postnatal depression or psychosis framed only as a broken restriction while symptoms escalate. It is working when the family and the client agree on a shared plan, including when to seek urgent help.

4.14 Territory, displacement, discrimination and intergenerational loss

  • Purpose: to treat losses the community itself names as health threats. These include weakened governance of knowledge holders, poor transmission to youth, imposed settlement models, mining and tourism (PES). Authors of a UNICEF study of adolescent suicide in other Indigenous peoples describe cultural trauma and loss of cultural bonds as risk factors. [source: https://mincultura.gov.co/direcciones/patrimonio-y-memoria/Documents/04-jaguares-de-yurupari.pdf] [source: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/INEC/INTOR/Suicidio-adolescente-pueblos-indigenas.pdf]
  • Steps: [synthesis]
    1. Ask about displacement, distance from territory, boarding school or town schooling, and experiences of racism in services and institutions.
    2. Name the losses as real and collective, not only individual.
    3. Support connection to community and language on the client's terms, through legitimate community channels (not through you).
    4. Use standard trauma-focused approaches where indicated, adapted with the client's explanatory model.
  • Example language: "Being away from your territory and people seems to weigh on you. What has that been like, and what keeps you connected?" (illustrative)
  • Watch for: framing culture only as loss; a young person who feels caught between worlds. It is working when the client describes more connection and less shame.

4.15 Suicide and self-harm risk assessment, culturally adapted

  • Purpose: to assess and manage risk in every phase. The UNICEF study reports that individual-risk programmes alone have not worked in the Indigenous communities it studied and recommends community-led prevention that respects cultural meanings. [source: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/INEC/INTOR/Suicidio-adolescente-pueblos-indigenas.pdf]
  • Steps: [synthesis, standard practice]
    1. Ask directly about suicidal thoughts, plans, past attempts and access to means, using the client's own idioms for distress.
    2. Explore the client's explanatory model of the suicidal feelings (e.g. as caused by an outside harm) without dismissing it.
    3. Build a safety plan that includes the people and community supports the client names.
    4. Use lethal-means counselling (safe storage and removal), with family where appropriate.
    5. Follow local emergency procedures when risk is high.
  • Example language: "Sometimes when people feel this way they think about dying or ending their life. Has that happened for you?" (illustrative)
  • Watch for: risk minimised as a spiritual matter that only the community can address, or the reverse. It is working when the safety plan names real people the client trusts.

4.16 Documentation and confidentiality of cultural knowledge

  • Purpose: to protect the client and the community's control over its knowledge. Resolución 1690 requires ACAIPI's endorsement for outside research. [source: https://www.mincultura.gov.co:443/prensa/noticias/Documents/Patrimonio/04-Resolución%20pira%20parana.pdf]
  • Steps: [synthesis]
    1. Record the client's meaning and the clinical relevance, not ritual detail.
    2. Never publish, present or teach from case material involving this knowledge without the client's consent and, where it concerns community knowledge, ACAIPI's endorsement.
    3. Tell the client how notes are kept and who can see them.
  • Example language: "I'll write down what this means for you and your care, not the details of anything that belongs to your community." (illustrative)
  • Watch for: case write-ups that turn into ethnography. It is working when the client is comfortable with what is recorded.

4.17 Non-Indigenous clients seeking "jaguar shaman" or Yuruparí experiences

  • Purpose: to respond to clients who want to take part in, or have taken part in, experiences marketed as Amazonian or "jaguar" shamanism. [synthesis]
  • Steps:
    1. Explore what they are seeking (healing, meaning, belonging) and address it in therapy.
    2. Share that the knowledge holders' own organisation controls outside involvement, and that the PES names tourism and outside research as threats. Do not help clients seek ceremonies outside legitimate community pathways. [source: https://mincultura.gov.co/direcciones/patrimonio-y-memoria/Documents/04-jaguares-de-yurupari.pdf]
    3. For clients who took part in plant-based ceremonies elsewhere, screen for psychiatric and medical after-effects and integrate the experience (cross-refer Domain VII).
  • Example language: "What draws you to this? … The communities themselves decide who takes part. What could give you what you're looking for in a way that doesn't depend on that?" (illustrative)
  • Watch for: reinforcing appropriation; dismissing the client's longing. It is working when the client's underlying goals become the work.

4.18 Safeguarding

  • Purpose: to meet your duties when a client or a child is at risk, whatever the framing. [synthesis]
  • Steps:
    1. Know local child-protection and adult-safeguarding procedures in your jurisdiction.
    2. Distinguish respectful questioning about cultural practices from assumptions of abuse. Do not treat a tradition as abuse. Do not accept abuse because it is framed as tradition.
    3. Act on: physical harm, restraint, sexual abuse, neglect, coercion, delay of urgent medical care, and domestic violence.
    4. Where possible and safe, involve the community's own authorities in a way consistent with your legal duties.
  • Example language: "I respect your community's ways. My job also means I must act if someone is at risk of harm. Let's talk about how we keep everyone safe." (illustrative)
  • Watch for: your own hesitation to act out of cultural deference; over-reporting out of unfamiliarity. It is working when safety is secured and the client stays engaged.

5. Handling problems

The published sources do not address psychotherapy problems directly. All guidance below is [synthesis], drawing on the sources cited where noted.

  • Client gives minimal or agreeable answers (guardedness). The PES records distrust of outside health workers and researchers. [source: https://mincultura.gov.co/direcciones/patrimonio-y-memoria/Documents/04-jaguares-de-yurupari.pdf] Explain why you ask and what you will do with the answers. Slow the pace. Offer the client control over what is shared, and invite family or a trusted person. Do not push for ritual detail.
  • Client says only the community's specialists can help. Accept this as their choice. Offer to stay available. Agree on warning signs that would lead them to seek medical help, and check in on safety. If there is acute risk, follow standard duties.
  • Family insists on community care only while symptoms escalate. Use the Informant Version to understand their view. Name the shared goal (the client's recovery). Offer collaboration rather than replacement. If risk is high, explain your legal duties plainly and act.
  • Missed sessions or non-adherence. Check first for calendar obligations, restrictions, travel or cost (4.12). Re-plan before interpreting it as resistance.
  • Rupture after a perceived dismissal of spiritual explanations. Acknowledge it directly. Restate that you are not judging their understanding. Return to the client's explanatory model (4.5).
  • Client asks you to perform or validate a ritual, or to obtain plants. Decline clearly and warmly. Explain that this belongs to their community's own specialists and to their doctor, and return to the therapeutic goals. Do not give any advice on plants or medicines.
  • Overwhelm during trauma work. Use standard grounding and pacing. Ask whether there are community-sanctioned supports the client wants alongside you. Do not use any element of the tradition as a technique.
  • Uncertainty whether an experience is normative or a disorder. Postpone diagnosis. Gather collateral (with consent). Consult a cultural broker. Arrange medical review. Re-assess over time (4.7).
  • Conflict between the client's religious affiliation (e.g. church) and traditional obligations. Explore both without taking sides, and help the client find their own position.
  • Confidentiality concerns in a small community. Agree explicitly on who knows what. Choose interpreters carefully. Limit what is shared with community authorities to what the client consents to.
  • Your own discomfort or fascination. Take it to supervision. Watch for countertransference (romanticising, rescuing, distancing).
  • Research or teaching requests. Decline to use this material without the client's consent and ACAIPI's endorsement. [source: https://www.mincultura.gov.co:443/prensa/noticias/Documents/Patrimonio/04-Resolución%20pira%20parana.pdf]

Sources

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