Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 119
Guide XI-119

Ngangkari healing, bush medicine and dadirri

Central Australia
A 40 · L 43 · M 1719 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: ngangkari healing as the NPY Women's Council (NPYWC) Ngangkari Program and the Aṉangu Ngangkaṟi Tjutaku Aboriginal Corporation (ANTAC) describe it, including its use in South Australian hospital and mental health services; Arrernte angangkere healing and bush medicine as Akeyulerre Healing Centre (Alice Springs) describes them; dadirri as Miriam-Rose Ungunmerr-Baumann describes it in her 2002 text (© Emmaus Productions) and as the Miriam Rose Foundation presents it, with Judy Atkinson's We Al-li use of dadirri as summarised from her 2012 Australian Institute of Family Studies seminar; the therapist's own assessment follows the DSM-5-TR Cultural Formulation Interview.

What this guide covers. This entry groups three different things, none of which is a psychotherapy. (1) Ngangkari are the traditional healers of the Ngaanyatjarra, Pitjantjatjara and Yankunytjatjara (NPY) lands of the Central Australian western desert, who have supported Aṉangu physical and emotional health "for thousands of years" and now also work in clinics and hospitals [source: https://www.npywc.org.au/ngangkari/ngangkari-resources/]. Other Aboriginal nations have their own healers under their own names; Akeyulerre, for example, describes Arrernte healers (angangkere) as highly respected practitioners [source: https://www.akeyulerre.org.au/angkwerre-iweme]. (2) Bush medicine is plant-based healing knowledge held and passed on by Elders; Akeyulerre describes Elders and young women collecting and preparing bush medicine rubs for community care, and plant smoke used to heal and cleanse people and places [source: https://www.akeyulerre.org.au/angkwerre-iweme]. (3) Dadirri is a word from the Ngangikurungkurr people of the Daly River (Nauiyu), Northern Territory, which Miriam-Rose Ungunmerr-Baumann, an Elder, artist and educator, renders as "inner, deep listening and quiet, still awareness" [source: https://eden.uca.org.au/media/16807/dadirri-paper-by-miriam-rose-unganmerr.pdf]. The Miriam Rose Foundation describes it as rooted in Ngangiwumirr culture, "a way of being passed down through generations" [source: https://miriamrosefoundation.org.au/dadirri/] (the two sources name the cultural group differently; both are given here).

How change is understood. As NPYWC's ngangkari describe it, Aṉangu often understand some illness as caused by harmful elements in the spiritual world; ngangkari are valued for healing and protecting people from these; depression and anxiety are spoken of as weakening of the spirit; and family talking with the person over time helps them become more balanced [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf]. Ngangkari themselves state that "the best health outcomes for anangu come from western trained doctors and ngangkari working together" and that some conditions (effects of petrol and cannabis, new diseases) are beyond traditional treatment [same source]. Dadirri locates healing in listening, stillness and waiting: Ungunmerr-Baumann writes that it makes her feel whole again, and that in grief people wait with the sorrow and let it heal slowly [source: https://eden.uca.org.au/media/16807/dadirri-paper-by-miriam-rose-unganmerr.pdf].

The psychotherapist's place. A psychotherapist does not practise ngangkari healing or bush medicine; these belong to ngangkari, Elders and Aboriginal community organisations. The therapist's work is: cultural self-examination; cultural assessment (CFI, explanatory model); listening in a way informed by dadirri, with attribution and humility; recognising spiritual understandings without pathologising them or missing illness; offering collaboration and referral to community-sanctioned healers through Aboriginal organisations and health-service pathways when the client wishes; integrating that care into therapy; and safeguarding. Dadirri is offered by its custodian to all Australians as a way of listening (she asks non-Aboriginal people to "be still and listen" and to learn both ways) [source: https://eden.uca.org.au/media/16807/dadirri-paper-by-miriam-rose-unganmerr.pdf]; using a dadirri-informed listening stance is not the same as teaching or leading dadirri, for which the Foundation runs its own programmes and accreditation [source: https://miriamrosefoundation.org.au/dadirri/] [synthesis].

2. Framework

No Aboriginal organisation in the sources here publishes a phased therapy protocol for psychotherapists. The phases below are a [synthesis] built from the published service models (NPYWC, ANTAC with the Northern Adelaide Local Health Network, Akeyulerre), dadirri as its custodian describes it, and the CFI.

Phase 0: Preparation (before any client). Goal: cultural learning, local knowledge and pathways in place. Content: learn whose Country you work on and which Aboriginal community-controlled organisations, healers' organisations and liaison staff exist locally; complete cultural learning (Northern Adelaide Local Health Network requires its staff to do so before working with ngangkari services [source: https://www.racp.edu.au/policy-and-advocacy/policy-and-advocacy-priorities/first-nations-health-and-equity/medical-specialist-access-framework/case-studies/antac-and-the-ngangkari-healers-of-central-australia]); arrange interpreter and Aboriginal liaison access. Move on when: you know the local referral routes and who to ask for cultural advice.

Phase 1: Engagement and listening (sessions 1–3, often longer; may be yarning-style, with family present if the client wishes). Goal: safety, trust, the client's story in their own terms and pace. Content: dadirri-informed listening; establishing language, interpreter, who should be present. Move on when: the client is talking freely about what is wrong in their own words, and has agreed how they want the work to go [synthesis].

Phase 2: Cultural assessment (woven through sessions 1–4). Goal: a shared understanding of the problem. Content: core CFI (16 questions in four domains) [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf], relevant supplementary modules, explanatory model, current and past help-seeking including ngangkari and bush medicine, risk assessment. Move on when: you can state the client's own explanation, what help they want, and current risk.

Phase 3: Shared plan and collaboration. Goal: a plan that honours the client's preferences across both systems. Content: offer (never require) referral to ngangkari or other community healers through the proper pathway; agree consent for information-sharing; coordinate with GP/psychiatry, Aboriginal Health Practitioners and liaison officers. Move on when: the client has decided what they want, and roles are clear.

Phase 4: Parallel care and integration (ongoing; frequency set by need). Goal: therapy that sits alongside healing, not in competition. Content: integrating healing experiences, family work, grief and intergenerational-trauma work, continued risk review. Move on when: goals reviewed and met, or the client chooses to end.

Phase 5: Review and ending. Goal: an ending that keeps connection to community and healers. Content: review with the client (and family if wished), plan for relapse, confirm ongoing links. Session counts are not published for any of this; set them with the client [synthesis].

Throughout: safeguarding and suicide/self-harm risk sit above every phase; ngangkari themselves say people at risk of self-harm need hospital treatment and professional care, especially when they cannot be monitored in community [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf].

3. Guiding principles

  • Two ways, working together. Ngangkari and doctors together give the best outcomes [source: NPYWC submission above]; ANTAC's model is "two-way" [source: RACP case study above]. Practical meaning: frame your work as alongside healing, never as the replacement or the judge of it.
  • Complementary, not alternative. NALHN describes ngangkari care as "complementary not an alternative" [source: https://anmj.org.au/aboriginal-healers-treat-patients-in-sa-hospitals/]. Practical meaning: neither encourage stopping medical or psychological care for healing, nor discourage healing in favour of yours.
  • Authority stays with community. Ngangkari, senior Aṉangu, Elders and their organisations (NPYWC, ANTAC, Akeyulerre) hold authority over healing knowledge; NALHN recognises ngangkari "as a profession in their own right" [source: ANMJ above]. Practical meaning: you refer and collaborate; you do not describe, imitate or assess healing practice.
  • Deep listening first. Dadirri as "inner, deep listening and quiet, still awareness" [source: Ungunmerr-Baumann above]; ngangkari stress sitting and listening gently when someone first mentions self-harm [source: NPYWC submission above]. Practical meaning: listen more than you ask; silence is not a gap to fill.
  • Do not hurry. "We cannot hurry the river" [source: Ungunmerr-Baumann above]. Practical meaning: let pace, timing and the right people present be set with the client and family, not by your session plan (within safety limits).
  • Learning goes both ways. Ungunmerr-Baumann asks non-Aboriginal people to wait with Aboriginal people rather than for them to catch up [source: Ungunmerr-Baumann above]. Practical meaning: be the learner about culture; offer your expertise without assuming it is the only one.
  • Language and meaning matter. Uti Kulintjaku developed words for mental health in NPY languages so people can seek help and talk with health workers [source: https://www.npywc.org.au/blogs/stories/uti-kulintjaku-project-wins-2015-nt-administrators-medal-for-excellence-in-primary-health-care]; speakers stress resources "in language" [source: https://www.beyondblue.org.au/video-transcripts/npy-womens-council-ngangkari-program-and-meditation]. Practical meaning: use interpreters and the client's own words; check understanding both ways.
  • Family and community are part of care. Ngangkari describe family talking with the person as part of recovery [source: NPYWC submission above]. Practical meaning: ask who should be involved; do not default to individual-only work.
  • Spirit as the client holds it. Spiritual causes and the spirits of deceased kin are described as Aṉangu and ngangkari hold them [source: NPYWC submission; RACP case study above], neither confirmed nor dismissed. Practical meaning: record the client's explanation in their words; assess for illness separately and carefully.
  • Culture is assessment, not a diagnosis. The CFI supports understanding and is not meant to be the only basis for diagnosis [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]. Practical meaning: use it to understand, not to label.
  • Consent and choice. Referral to ngangkari is a client choice; Watto Purrunna clients can also ask directly [source: RACP case study above]. Practical meaning: offer, explain, accept a no.
  • Safety above all. Ngangkari themselves direct people at risk of self-harm to hospital care [source: NPYWC submission above]. Practical meaning: cultural respect never lowers your risk threshold.
  • Cultural protocols around death and naming. NPYWC warns its materials may contain names, images and stories of people who have died [source: https://www.npywc.org.au/ngangkari/ngangkari-resources/]. Practical meaning: ask how the client and family wish deceased people to be referred to [synthesis].
  • Historical and ongoing harm is context. Atkinson's work links colonisation, the Stolen Generations and stigma to trauma passed across generations [source: https://www.recoverystories.info/an-educaring-approach-to-healing-generational-trauma-in-aboriginal-australia/]. Practical meaning: expect mistrust of services as reasonable, and examine your own service's part in it.

4. Intervention inventory

All interventions below are the psychotherapist's own work. None describes, imitates or replaces ngangkari healing, bush medicine preparation or ceremony; those remain with ngangkari, Elders and their organisations. Example language is illustrative unless quoted.

4.1 Cultural self-examination and preparation

  • Purpose / when: before working with Aboriginal clients and repeatedly during the work; reduces the risk of judging, romanticising or appropriating healing practices.
  • Steps: (1) Complete cultural learning offered by your service or a local Aboriginal organisation (NALHN requires this of staff working with ngangkari services [source: https://www.racp.edu.au/policy-and-advocacy/policy-and-advocacy-priorities/first-nations-health-and-equity/medical-specialist-access-framework/case-studies/antac-and-the-ngangkari-healers-of-central-australia]). (2) Write down your own assumptions about spirit, healing and "evidence", and how your profession and service have treated Aboriginal people historically. (3) Identify, before you need them, the local Aboriginal community-controlled health service, Aboriginal liaison officers, interpreter service and any healers' organisation (NPYWC Ngangkari Program, ANTAC, Akeyulerre or their local equivalents). (4) Arrange cultural supervision or consultation with an Aboriginal colleague. [synthesis, except step 1]
  • Example language (to a colleague, illustrative): "I want to check my own reactions here: am I hearing this healing as a risk because it's unfamiliar, or because something actually is unsafe?"
  • Watch for: urges to explain the client's spiritual account in psychological terms; urges to adopt or perform practices yourself; working without any Aboriginal consultation. Working: you can name local pathways and have someone to ask.

4.2 Dadirri-informed deep listening

  • Purpose / when: the core listening stance, from first contact onwards; especially when someone tells a painful story, speaks of grief or of self-harm, or is slow to speak. Ungunmerr-Baumann describes dadirri as "inner, deep listening and quiet, still awareness", comparable to what others call contemplation, needing no words, a deep spring within everyone [source: https://eden.uca.org.au/media/16807/dadirri-paper-by-miriam-rose-unganmerr.pdf]. She describes Aboriginal learning as watching, listening, waiting and then acting, rather than questioning [same source]. Atkinson's We Al-li programs were built by deep listening (dadirri) to people's stories of pain and abuse [source: https://www.recoverystories.info/an-educaring-approach-to-healing-generational-trauma-in-aboriginal-australia/].
  • Steps (therapist's adaptation, attributed to the source descriptions above; step detail is [synthesis]): (1) Before the session, take a few minutes of quiet to settle your own attention; arrive without a script. (2) Open with an invitation, not a question list; say you are there to listen and that there is no hurry. (3) Let silences run; do not fill them with prompts. Watch and wait before asking (the order the source gives is watch, listen, wait, then act). (4) Listen for the whole person: family, Country, spirit, history, as well as symptoms. (5) Reflect back sparingly, in the client's own words, checking you have heard rightly. (6) Hold off on advice and formulation until the story has been told, possibly over several meetings. (7) Afterwards, sit with what you heard before writing notes; note what you did not understand as questions to learn about, not as pathology. (8) Where questions are needed (risk, CFI), explain why you need to ask them and ask fewer, slower.
  • Example language (illustrative): "I'm here to listen. There's no rush; we can take as long as we need, today and other days." / "Take your time. I'm still listening." / "I want to make sure I've got this right, in your words: you said your spirit feels weak since your brother passed. Is that right?"
  • Watch for: your own discomfort with silence; slipping back into rapid questioning; treating silence as resistance or poor engagement; time pressure from the service. Do not present this as "doing dadirri" or teaching it; it is a listening stance informed by an Elder's published teaching [synthesis]. Working: the client offers more of their story without prompting; family members join or speak; the client returns.

4.3 Waiting and pacing ("we cannot hurry the river")

  • Purpose / when: when the right time, right people or right preparation is not yet present: grief, family business, ceremony obligations, a person not ready to speak. Ungunmerr-Baumann describes things being allowed to unfold in their natural order, like the seasons, and people waiting for the right time, people and preparation [source: https://eden.uca.org.au/media/16807/dadirri-paper-by-miriam-rose-unganmerr.pdf].
  • Steps: (1) Ask whether now is the right time to talk about this, and who else should be there. (2) Agree flexible scheduling where your service allows (gaps for travel, sorry business, community obligations). (3) Keep contact low-pressure during gaps (brief check-in with consent). (4) Keep a separate, non-negotiable track for safety: risk is never deferred. [synthesis]
  • Example language (illustrative): "It sounds like this isn't the right time, or I'm not the right person yet. We can come back to it. Is there anything about safety we need to sort out today?"
  • Watch for: waiting being used to avoid a hard topic (yours or the client's); service rules (missed-appointment discharge) that punish culturally necessary absence. Working: the client returns to the topic when ready; attendance stabilises.

4.4 Sitting with grief

  • Purpose / when: bereavement, which is frequent and often multiple. Ungunmerr-Baumann writes that in grief people wait with the sorrow, acknowledge it and let it heal slowly, and that she finds peace through silent awareness [source: https://eden.uca.org.au/media/16807/dadirri-paper-by-miriam-rose-unganmerr.pdf]. NPYWC's ngangkari describe deep sadness weakening the spirit, and ngangkari work concerning the spirits of deceased kin [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf]; ANTAC describes ngangkari helping with grief and depression, sometimes involving spirits of deceased kin [source: https://www.racp.edu.au/policy-and-advocacy/policy-and-advocacy-priorities/first-nations-health-and-equity/medical-specialist-access-framework/case-studies/antac-and-the-ngangkari-healers-of-central-australia].
  • Steps: (1) Ask how the person and family wish the deceased to be referred to (some avoid names of people who have died) [synthesis]. (2) Listen without pushing to "process"; allow silence. (3) Ask what the family and community are doing to look after the grieving person and the spirit of the person who died, as they understand it, without asking for ceremony details. (4) Ask whether they would like ngangkari or other community support; refer through the proper pathway (4.11). (5) Monitor for complicated grief, depression and suicide risk; ngangkari themselves describe sadness weakening the spirit when people stop eating and drinking [source: NPYWC submission above].
  • Example language (illustrative): "How would you like me to speak about him?" / "What is your family doing to look after you right now?" / "Some people want a ngangkari to help at a time like this. Is that something you'd want?"
  • Watch for: asking about ceremony content; naming the deceased without checking; missing weight loss, not eating, withdrawal or suicidal thinking. Working: the person speaks of the loss more freely and stays connected to family supports.

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

  • Purpose / when: early structured cultural assessment, usable by any clinician in any setting [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]; supports understanding and decision-making, not the sole basis for diagnosis [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].
  • Steps: (1) Obtain the APA form; clinicians may reproduce it for use with their patients, but modification or translation needs APA permission [source: CFI form above]. (2) Cover its four domains (16 questions): 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; cultural factors affecting current help-seeking, including preferences and the clinician-patient relationship (e.g. perceived racism, language) [source: CFI form above]. (3) With an interpreter where needed, adapt pace and phrasing to a conversational, dadirri-informed style; the domains are a map, not a script [synthesis]. (4) Use the Informant Version (17 questions) with a family member if the client wishes [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]. (5) Summarise the client's own account in the formulation, in their words. Time required: APA forms give none; a field trial found later interviews took less time [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]; any minutes figure is [uncertain: not verified].
  • Example language (illustrative, not the CFI's wording): "People understand troubles in different ways. How would you and your family describe what's been happening?" / "Who have you gone to for help so far, family, clinic, ngangkari, anyone else?" / "Is there anything about me or this service that makes it harder to talk?"
  • Watch for: firing questions in sequence; mistrust triggered by form-filling; an interpreter softening or omitting spiritual content. Working: you can state the client's explanation, supports and preferred help.

4.6 CFI supplementary modules

  • Purpose / when: to deepen a domain; usable at first evaluation, later or repeatedly [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]. Most relevant here: Explanatory Model; Spirituality, Religion and Moral Traditions; Cultural Identity; Social Network; Coping and Help-Seeking; Patient-Clinician Relationship; School-Age Children and Adolescents; Older Adults; Caregivers (12 modules in all) [same source].
  • Steps: (1) Pick the module the core CFI flags as most relevant (the core form shows which module expands each subtopic) [same source]. (2) Explain its purpose. (3) Ask in your own conversational words; do not reproduce the module as a questionnaire to the client. (4) Record answers in the client's terms.
  • Example language (illustrative): "Can you tell me about the people you're connected to, family, community, Country, who matter most when things go wrong?"
  • Watch for: overlong assessment; probing spiritual or ceremonial matters the person may not be able to share (some knowledge is restricted) [synthesis]. Working: a richer picture of supports and help-seeking.

4.7 Explanatory-model questions (Kleinman)

  • Purpose / when: to learn the client's own understanding of the illness: what they call it, cause, timing, how it works, severity, what treatment they think is needed, chief problems, and what they fear most (eight questions, paraphrased) [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf]; from Kleinman, Eisenberg and Good 1978 [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader].
  • Steps: (1) Ask a few, not all eight at once. (2) Accept spiritual, family, Country or substance-related explanations as the client's model (e.g. harmful elements in the spiritual world; a weakened spirit; cannabis distorting thinking, which ngangkari also describe [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf]). (3) Ask what treatment they think will help, and who should give it. (4) Find the overlap with your own formulation and name it.
  • Example language (illustrative): "What do you think started this? Why now?" / "What do you think would help, and who should do it?" / "What worries you most about it?"
  • Watch for: asking in a way that sounds like testing belief; the client giving the "clinic answer" to please you. Working: the client volunteers their own explanation and preferences, and your plan reflects both.

4.8 Asking about ngangkari, other healers and bush medicine without judgement

  • Purpose / when: at assessment and at review; people may already be seeing ngangkari or using bush medicine, and may not tell clinicians unless asked respectfully.
  • Steps: (1) Normalise: healing is offered in hospitals and clinics (e.g. ngangkari in NALHN acute, rehabilitation, palliative, mental health and forensic mental health services [source: https://anmj.org.au/aboriginal-healers-treat-patients-in-sa-hospitals/]). (2) Ask whether they have seen ngangkari or another healer, and what it was like for them, in general terms only; do not ask what the healer did. (3) Ask whether they use bush medicines and whether their GP or prescriber knows. (4) Record that the client sees a healer and finds it helpful (or not), without describing the practice. [synthesis for steps 2–4]
  • Example language (illustrative): "A lot of people see ngangkari as well as the clinic. Have you? How did you feel afterwards?" / "Do you use any bush medicine? That's fine. Your doctor might want to know so they can look after you properly."
  • Watch for: the client's caution (past experience of disapproval); your own curiosity about practice details. Working: open disclosure, and the client sees you as supportive of both.

4.9 Distinguishing culturally held spiritual experience from illness

  • Purpose / when: when a client or family describes spiritual causes, spirits of deceased kin, or spiritual concerns about a place (ANTAC reports ngangkari clearing a spiritual concern in an Adelaide dialysis unit so treatment could proceed [source: https://www.racp.edu.au/policy-and-advocacy/policy-and-advocacy-priorities/first-nations-health-and-equity/medical-specialist-access-framework/case-studies/antac-and-the-ngangkari-healers-of-central-australia]), or when hallucination-like or trance-like experiences are reported.
  • Background: DSM-5-TR describes cultural concepts of distress as idioms, explanations or perceived causes, and syndromes [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]; its named examples (from secondary listing) do not include an Aboriginal Australian concept [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf], so use the CFI rather than a glossary. Dissociative identity disorder and dissociative trance criteria exclude experiences that are a normal part of broadly accepted cultural or religious practice (DSM-5 wording; DSM-5-TR retains the substance, exact wording [uncertain: not verified]) [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299]. ICD-11 trance disorder (6B62) and possession trance disorder (6B63) 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]. Whether DSM-5-TR's note on culturally sanctioned beliefs versus psychotic symptoms applies in identical wording is [uncertain: not verified].
  • Steps: (1) Ask whether family and community see this experience as expected or understandable in the circumstances (e.g. after a death), or as a sign that something is wrong. (2) Look for features beyond the shared cultural frame: distress or impairment out of proportion, disorganisation, prolonged sleeplessness, not eating, risk to self or others, substance use (ngangkari themselves link cannabis to distorted, paranoid thinking [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf]). (3) Consult an Aboriginal mental health worker, liaison officer, or (with consent) family and community members as cultural advisers before concluding. (4) Where illness is present, the spiritual account can stay valid alongside medical care; offer both. [synthesis for steps 1–4]
  • Example language (illustrative): "When your family hears about this, do they think it's something that can happen after someone passes, or are they worried it's something else?" / "Has anyone, like a ngangkari or an Elder, said what they think is going on?"
  • Watch for: two errors: pathologising a culturally understood experience, and missing psychosis, mania, delirium, intoxication or depression by attributing everything to culture. Working: the formulation is shared with cultural advisers and holds both accounts.

4.10 Language, interpreters, liaison officers and shared vocabulary

  • Purpose / when: whenever English is not the client's first language or cultural meaning needs bridging. Speakers from Uti Kulintjaku describe barriers such as lacking words to ask for help and health information not being in language [source: https://www.beyondblue.org.au/video-transcripts/npy-womens-council-ngangkari-program-and-meditation]; the project, led by senior Aṉangu women with mental health professionals, developed words for mental health in NPY languages [source: https://www.npywc.org.au/blogs/stories/uti-kulintjaku-project-wins-2015-nt-administrators-medal-for-excellence-in-primary-health-care]. ANTAC uses Aboriginal liaison officers to accompany ngangkari where language or misunderstanding is a barrier [source: RACP case study above].
  • Steps: (1) Book an accredited interpreter in the client's language; ask the client's preference (gender, family relationships, community) [synthesis]. (2) Brief the interpreter: spiritual content is to be conveyed, not softened. (3) Ask the client what words they use for feelings and for being unwell; use those words. (4) Ask whether NPY-language or other in-language resources exist for the client's region (NPYWC lists Uti Kulintjaku resources) [source: https://www.npywc.org.au/ngangkari/ngangkari-resources/]. (5) Check understanding both ways, often.
  • Example language (illustrative): "What word would you use for that feeling in your language?" / "Tell me if I'm using words that don't fit."
  • Watch for: relying on family members, especially children, as interpreters for sensitive topics; nodding agreement that hides confusion. Working: the client corrects you, uses own-language terms and asks questions.

4.11 Collaboration and referral with ngangkari and other community healers

  • Purpose / when: when the client or family wishes to see ngangkari or another community-sanctioned healer, or already does.
  • Published pathways (examples): NPYWC has employed ngangkari since 1999 (funded by Country Health SA), providing healing in the NPY region and educating health professionals; the program received the 2009 Dr Margaret Tobin Award, and two senior ngangkari received the RANZCP Mark Sheldon Prize in 2009 [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf]. ANTAC, described as "the first organisation of Aboriginal traditional healers in Australia", includes ngangkari of the APY Lands; SA Health sites refer patients to it; ngangkari give individual healing sessions and clinic appointments paid through a brokerage fund; Watto Purrunna clients may be referred by a doctor or Aboriginal Health Practitioner or ask directly [source: https://www.racp.edu.au/policy-and-advocacy/policy-and-advocacy-priorities/first-nations-health-and-equity/medical-specialist-access-framework/case-studies/antac-and-the-ngangkari-healers-of-central-australia]. In NALHN, doctors, nurses and allied health staff can refer patients for a ngangkari appointment under a formal agreement with ANTAC [source: https://anmj.org.au/aboriginal-healers-treat-patients-in-sa-hospitals/]. Akeyulerre's Angkwerre-iweme program supports Arrernte angangkere to work in hospitals, clinics and aged care [source: https://www.akeyulerre.org.au/angkwerre-iweme]. How ngangkari come to be healers is not described in these sources and is not the clinician's to assess.
  • Steps: (1) Ask the client (and family, if wished) whether they want healer involvement; offer, never require. (2) Use the established pathway (your health network's agreement, the Aboriginal health team or liaison officer, or the community organisation); do not contact individual healers privately on the client's behalf unless that is the community's way and the client asks [synthesis]. (3) Obtain explicit consent for what information is shared, with whom; share only what is needed. (4) Follow the setting's protocols (ANTAC has developed practice protocols, including infection protection in acute settings [source: RACP case study above]). (5) Agree how you and the healer will keep each other informed, through the client or liaison staff. (6) Continue your own care in parallel: healing is complementary, not an alternative [source: ANMJ above]. (7) Wider evidence on collaboration elsewhere: a Nigeria–Ghana cluster trial (COSIMPO; Gureje et al., The Lancet 2020) found collaborative care between traditional/faith healers and primary care reduced psychosis symptoms more than usual care and reduced harmful practices [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839]; a Ghana prayer-camp trial (Ofori-Atta et al., Br J Psychiatry 212(1)) found symptoms fell when psychiatric care was added, 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 not Aboriginal settings and are context only.
  • Example language (illustrative): "Our hospital can arrange for a ngangkari to see you, if you'd like. You can say yes or no, and it won't change anything about the care you get from us." / "Is it OK if I let the Aboriginal liaison officer know you'd like this, and nothing else?"
  • Watch for: pressure in either direction; referral used as a substitute for your own care; breach of confidentiality within small communities; delays in medical treatment. Working: the client reports feeling better supported, attends both, and services are used more (NALHN reports increased engagement [source: RACP case study above]).

4.12 Bush medicine and other medicines: routing to the prescriber

  • Purpose / when: when a client uses bush medicine alongside prescribed medicines or is considering changes. Bush medicine knowledge is held by Elders [source: https://www.akeyulerre.org.au/angkwerre-iweme]; NALHN lists bush medicines as part of ngangkari care [source: https://anmj.org.au/aboriginal-healers-treat-patients-in-sa-hospitals/].
  • Steps: (1) Ask, respectfully, what the client uses, in general terms; do not ask for or record preparation details. (2) Encourage the client to tell their GP, prescriber or pharmacist; with consent, inform them yourself. (3) Never advise starting, stopping or changing any medicine, bush or prescribed; route all such questions to the prescriber. (4) If the client stops prescribed medicine in favour of healing, explore the reasons without judgement and link them to the prescriber promptly. [synthesis]
  • Example language (illustrative): "That's your choice and I respect it. I'm not the right person to say how it mixes with your tablets. Can we let your doctor know so they can check?"
  • Watch for: abrupt medication cessation; physical symptoms; the client hiding use. Working: the prescriber is informed and the client continues both without conflict.

4.13 Working with family and community

  • Purpose / when: NPYWC's ngangkari describe recovery involving family talking with the person over time until they feel more balanced [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf]; Uti Kulintjaku aims to help families understand and talk about mental health with children and grandchildren [source: https://www.npywc.org.au/blogs/stories/uti-kulintjaku-project-wins-2015-nt-administrators-medal-for-excellence-in-primary-health-care].
  • Steps: (1) Ask who the client wants involved; respect kinship and gender considerations they raise. (2) Offer family meetings, possibly outside the clinic. (3) Share information only with consent. (4) Give family simple, in-language explanations of what you are doing and how they can help. (5) Support family members' own distress and refer them if needed. [synthesis]
  • Example language (illustrative): "Who in your family should be part of this? Is there anyone who shouldn't be?"
  • Watch for: family members speaking for the client; abuse or coercion within the family (go to 4.18). Working: family understand and support the plan.

4.14 Integrating healing experiences into therapy

  • Purpose / when: after a client has seen ngangkari or used bush medicine and wants to talk about it, or when you notice change. ANTAC reports clients often feel better afterwards, as if their spirit has returned [source: https://anmj.org.au/aboriginal-healers-treat-patients-in-sa-hospitals/]; ngangkari describe their work as helping clear thinking [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf].
  • Steps: (1) Invite the client to say how they feel since, in their own terms; do not ask what the healer did. (2) Reflect changes they name (sleep, thinking, spirit, connection). (3) Link those changes to therapy goals and family supports. (4) If the client feels worse or frightened, explore and check risk; offer to involve liaison staff. [synthesis]
  • Example language (illustrative): "You said you feel lighter since then. What's different in your days?" / "How can what we do here sit alongside that?"
  • Watch for: you interpreting the healing in psychological terms the client did not use; the client feeling they must choose. Working: the client speaks of both as helping.

4.15 Suicide and self-harm risk alongside cultural care

  • Purpose / when: at every contact where distress is present. Ngangkari link marijuana, alcohol and petrol to self-harm and suicidal thinking, emphasise listening and sitting with someone the first time they mention self-harm, advise against "giving them a hard time", and say people at risk need hospital treatment, especially when they cannot be monitored in community [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf].
  • Steps: (1) Listen first, calmly and without alarm or reproach. (2) Ask directly about thoughts of suicide or self-harm, using an interpreter where needed. (3) Conduct your standard risk assessment and safety planning, including substance use and access to means (storage and removal by family, not method detail). (4) Involve family and supports as the client agrees. (5) Escalate to acute or hospital care when risk requires; ngangkari care can continue alongside, including in hospital where services exist [source: ANMJ above]. [synthesis for steps 2–5]
  • Example language (illustrative): "Thank you for telling me. I'm not going to growl at you. Can you tell me more about those thoughts?" / "Some ngangkari say that when someone feels like this, the hospital and the ngangkari can both help. What do you think?"
  • Watch for: cultural deference lowering your threshold; isolation in remote settings without monitoring; intoxication. Working: a safety plan the client and family own.

4.16 Storytelling and creative expression in trauma work (informed by We Al-li)

  • Purpose / when: trauma, grief and loss, especially where words are hard. Atkinson's We Al-li approach treats the arts as central, a safe space to explore trauma, grief and loss, highlighting storytelling, theatre, dance, music and writing because storytelling is already part of Indigenous cultural practice; visual and performing arts are described as particularly useful for pre-verbal trauma; the approach is used in group and individual work [source: https://www.recoverystories.info/an-educaring-approach-to-healing-generational-trauma-in-aboriginal-australia/]. The full method is in Atkinson's 2002 book Trauma Trails, Recreating Song Lines; We Al-li session structure, phases and workshop content are [uncertain: not verified] here, and delivering the We Al-li program itself requires its own training.
  • Steps (general creative-arts stance, [synthesis]): (1) Offer, do not require, non-verbal or story-based expression (drawing, writing, music the client chooses). (2) Let the client tell their story in their own form and order; listen in the dadirri-informed way (4.2). (3) Do not ask for or use cultural songs, ceremonial designs or sacred stories; invite only what the client chooses to share and is free to share. (4) Close sessions with grounding and connection to supports.
  • Example language (illustrative): "Some people find it easier to draw or write than to talk. Would you like to try that, or would you rather just tell it?"
  • Watch for: overwhelm (go to section 5); appropriating cultural forms; pressing for trauma detail early. Working: the client can tell more of their story with less distress.

4.17 Formulating intergenerational and historical trauma

  • Purpose / when: when distress is shaped by family histories of removal, violence and loss. Atkinson links colonisation, the Stolen Generations and ongoing stigma to trauma across generations, and used genograms to show these patterns [source: https://www.recoverystories.info/an-educaring-approach-to-healing-generational-trauma-in-aboriginal-australia/]. The AIFS/Closing the Gap Clearinghouse practice guide Trauma-informed services and trauma-specific care for Indigenous Australian children (2013) covers service design [source: https://aifs.gov.au/node/20751]; its content is [uncertain: not verified] here.
  • Steps: (1) With consent, map family history across generations (a genogram, drawn together), including removals, losses, strengths and cultural connections. (2) Name historical and structural causes alongside personal ones. (3) Identify strengths and survival: family, Country, culture, community organisations. (4) Pace carefully; this may surface grief and anger. [synthesis, except genogram use attributed above]
  • Example language (illustrative): "Would it help to draw out your family together, who was where, what happened, and who kept things going?"
  • Watch for: framing the client or family as damaged; retraumatisation; your service's own role in that history. Working: the client sees their distress in context and names strengths.

4.18 Safeguarding

  • Purpose / when: when any practice, person or situation causes harm: family or community violence, child abuse or neglect, coercion, sexual abuse, or delay of urgent medical care. The sources here describe no harmful practice within ngangkari care; harm can occur in any setting.
  • Steps: (1) Apply your standard safeguarding and mandatory reporting duties; culture never exempts them. (2) Distinguish cultural practice misunderstood as abuse from abuse presented as culture by consulting Aboriginal colleagues and liaison staff, while not delaying protective action. (3) Where urgent medical care is being delayed, act to secure it while respecting the client's healing preferences. (4) Never name minors; involve Aboriginal child protection or community-controlled services where available. (5) Any touch in healing is for the client to consent to; anything sexual or coercive is a safeguarding matter [synthesis].
  • Example language (illustrative): "I respect your family's ways. I also have to make sure everyone is safe, and some things I have to report. Can we talk about what that means?"
  • Watch for: cultural deference delaying action; reporting without cultural consultation where time allows. Working: safety secured with as little cultural harm as possible.

4.19 Consent, confidentiality and documentation

  • Purpose / when: throughout; small communities make confidentiality fragile.
  • Steps: (1) Separate consents: for therapy, for family involvement, for each information-sharing with healers, liaison staff or other services. (2) Document the client's explanatory model and healing involvement in their words, without details of healing practice. (3) Do not record or publish cultural knowledge shared in confidence. (4) Check before using names or images of people who have died (NPYWC flags this sensitivity [source: https://www.npywc.org.au/ngangkari/ngangkari-resources/]). [synthesis]
  • Example language (illustrative): "I'll write that you see a ngangkari and find it helps. I won't write down anything about what happens there. Is that OK?"
  • Watch for: notes that read as dismissive or pathologising; over-sharing. Working: the client can read their notes and feel accurately represented.

5. Handling problems

Most guidance in this section is [synthesis]; source-based points are tagged.

  • Client is silent or gives short answers. Do not read this as resistance. Return to dadirri-informed listening: wait, reduce questions, offer another time or another person present, check language and interpreter fit [source for listening and waiting: https://eden.uca.org.au/media/16807/dadirri-paper-by-miriam-rose-unganmerr.pdf]. Example (illustrative): "We don't have to talk much today. I'm happy just to sit for a bit."
  • Mistrust of you or the service. Expect it given history [source: https://www.recoverystories.info/an-educaring-approach-to-healing-generational-trauma-in-aboriginal-australia/]. Ask the CFI clinician-relationship question in your own words; name your service's limits; offer an Aboriginal worker or liaison officer [source for CFI domain: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].
  • Missed appointments and long gaps. Ask about travel, family and cultural obligations, sorry business; adapt scheduling; avoid automatic discharge; keep a safety check-in route.
  • Client wants only ngangkari and declines your care. Respect the choice; keep the door open; make sure they know how to reach urgent help; if risk is high, act on risk (ngangkari themselves direct people at risk to hospital care [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf]).
  • Client stops prescribed medicine. Do not advise; explore reasons; inform the prescriber with consent, urgently if relapse risk is high (4.12).
  • Colleagues are dismissive of healing, or over-enthusiastic. Point to the health-service model: complementary, not alternative [source: https://anmj.org.au/aboriginal-healers-treat-patients-in-sa-hospitals/]; suggest cultural learning and use of established pathways rather than informal arrangements.
  • No local healer pathway exists. Ask the local Aboriginal community-controlled health service or Aboriginal health team how people in the area access healers; do not set up arrangements yourself or direct clients to people outside legitimate community pathways.
  • Pressure to describe, record or teach healing practice. Decline; this knowledge belongs to ngangkari and Elders; refer questions to their organisations.
  • Requests to "do dadirri" with clients or groups. You can listen in a dadirri-informed way and credit its source; leading dadirri programmes belongs with the Miriam Rose Foundation's programmes and accreditation [source: https://miriamrosefoundation.org.au/dadirri/] or local Aboriginal leadership.
  • Overwhelm during trauma or grief work. Slow down, return to the present, ground with what the client finds settling (Country, family, music they choose), shorten sessions, revisit safety; resume only when the client chooses. Meditations made in NPY languages with Smiling Mind helped people feel calmer, as speakers describe [source: https://www.beyondblue.org.au/video-transcripts/npy-womens-council-ngangkari-program-and-meditation]; ask whether in-language resources exist for the client.
  • Unusual experiences: culture or illness? Use 4.9; consult cultural advisers; avoid both errors; where uncertain, keep assessing while offering both forms of help.
  • Rupture after a misstep (e.g. naming the deceased, questioning belief, a breach of confidence). Acknowledge directly, apologise without defending, ask how to put it right, and offer an Aboriginal worker if the client prefers.
  • Interpreter or family-as-interpreter problems. Switch to an accredited interpreter of appropriate kinship distance and gender where possible; debrief the interpreter after heavy sessions.
  • Small-community confidentiality. Agree with the client what can be said to whom; check that referrals do not expose them.
  • Your own discomfort or vicarious trauma. Seek supervision, including cultural supervision; in Ungunmerr-Baumann's terms, take time to be still and listen yourself [source: https://eden.uca.org.au/media/16807/dadirri-paper-by-miriam-rose-unganmerr.pdf].

Sources

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