Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 125
Guide XI-125

Tongan and Fijian healers

Tonga and Fiji
A 39 · L 50 · M 1116 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: Tongan and iTaukei Fijian healing as Pacific researchers and community-based studies describe it (chiefly Vaka 2014 and the ūloa model work for Tongans in Aotearoa New Zealand; Orcherton et al. 2021 and Aporosa and Perrin 2024 for iTaukei Fiji). Clinical tools follow the DSM-5-TR Cultural Formulation Interview (core 16-question version) and ICD-11.

What it is. These are living healing traditions, not a psychotherapy. Tongan faito'o means treatment, removal or the process of healing. Faito'o faka-Tonga is Tongan traditional medicine, set beside faito'o faka-Pālangi (Western medicine) [source: Vaka 2014 thesis glossary, https://mro.massey.ac.nz/bitstream/handle/10179/5777/02_whole.pdf]. In iTaukei Fijian villages, everyday illness is first managed at home. Traditional knowledge is held mainly by healers (soli wai in the authors' usage) and elders (qase/matua) and passed down through families and ancestral lineages. Complex cases go to specialised healers, sometimes outside the village [source: https://www.mdpi.com/2071-1050/13/16/9003]. The Fijian term dauvagunu for a healer is widely used in the literature but is [uncertain: not verified] here.

How these traditions understand distress (attributed). In Tongan talanoa research, mental distress is understood in three ways: Tongan constructions (tufunga faka-Tonga), biopsychosocial constructions (tufunga faka-paiōsaikosōsiolo), and the intersection of the two (tufunga fepaki) [source: Vaka, Pacific mental health presentation, https://www.nzno.org.nz/Portals/0/Files/Documents/Resources/Presentations/2019-09-18%201110%20Pacific%20Mental%20Health%20-%20Sione%20Vaka.pdf]. Tongan terms include mahaki faka-tēvolo (spirit-related illness), puke faka-tēvolo (possession by devils) and 'āvanga (psychotic behaviour interpreted as spirit possession). Illness is also described, following Bloomfield (2002), as a breakdown in relationships with family, land, ancestors and spirits [source: Vaka 2014 thesis]. In iTaukei accounts, causes include natural causes, food choices, "European illness", and social, cultural or spiritual causes such as mate ni vanua, curses and witchcraft linked to breaking ancestral protocols. "Health of the land means the health of the people" [source: https://www.mdpi.com/2071-1050/13/16/9003]. These are the communities' and researchers' accounts, presented neither as fact nor as error.

How change happens for the psychotherapist. Your part is not to heal in the tradition. It is to (a) understand the client's and family's own model of the problem, (b) assess carefully without pathologising normative belief or missing illness, (c) work with the family, church and, if the client wishes, a healer the community recognises, and (d) help the client integrate the different kinds of help. Pacific authors argue that a "biomedical linear, individually focused" system fits poorly with collective Tongan communities, and that care built on Tongan concepts may give better outcomes [source: https://mro.massey.ac.nz/items/10e3f6f1-77c4-48db-9d34-ff48e719f6f3/full; https://www.proquest.com/docview/1852699714].

2. Framework

This is a framework for the clinician's culturally responsive work alongside Tongan and Fijian healing. It is not a treatment protocol. The traditions themselves are not staged for outsiders here. [synthesis, built on the sources cited per phase]

Who holds authority.

  • Fiji (iTaukei): healers and elders within family and ancestral lineages; the vanua (land, people and chiefly order) for problems understood as collective, such as mate ni vanua; churches, with Methodist ministers involved in interpreting and addressing a curse in one documented village [source: https://www.mdpi.com/2071-1050/13/16/9003; https://par.nsf.gov/servlets/purl/10511893].
  • Tonga and the Tongan diaspora: healers of faito'o faka-Tonga, families and churches. In the New Zealand ūloa research, traditional healers and the Aotearoa Tongan Health Workers Association took part as Tongan providers [source: Vaka presentation]. Any formal registration or regulation of healers in Tonga or Fiji is [uncertain: not verified].
  • Clinical services: a psychiatrist in Tonga features in the 2019 documentary The Healer and the Psychiatrist (Mike Poltorak, University of Kent), which aims to support collaboration between healers and psychiatrists [source: https://results2021.ref.ac.uk/outputs/52b3237d-1302-47dc-b3f8-306117370800?page=1; https://matangitonga.to/node/25635]. In South Auckland, Counties Manukau Community Mental Health Services and its Faletoa Cultural Liaison team are testing an ūloa care pathway [source: https://www.waikato.ac.nz/news-events/news/putting-pacific-values-at-the-centre-of-mental-health-care/].

Phases of the clinician's work [synthesis]

  1. Engagement (session 1, often with family present). Goal: build the relational space (vā), use talanoa-style conversation, and learn who should be involved. Move on when the client and family agree on who takes part and how decisions are made.
  2. Cultural assessment (sessions 1–3). Goal: core CFI, relevant supplementary modules, the explanatory model in the client's own terms, history of healer and church help, kava use, risk screening. Move on when you can state the client's and family's model of the problem, your clinical view, and where they agree and differ.
  3. Shared formulation and plan (sessions 2–4). Goal: a plan the client and family accept that names roles for clinical care, family, church and (if wished) a healer. Move on when there is consent for any contact with others and a safety plan.
  4. Parallel care and collaboration (ongoing; weekly to fortnightly). Goal: therapy for the agreed problems, liaison with the prescriber and any community helpers, monitoring of symptoms and harms. Move on when symptoms and functioning improve or a change of plan is needed.
  5. Integration and review. Goal: help the client make sense of healing experiences and clinical treatment together, revisit the plan, and close or step down with family and community supports in place.

The Kakala stages (teu, toli, tui, luva, mālie, māfana) can be used to structure the planning and review of this work with the family [source: https://www.hqsc.govt.nz/assets/Consumer-hub/Publications-resources/Pacific-models-for-engagement_Kakala_final.pdf] [synthesis for clinical use]. Vaka's thesis names a healing sequence of tofoto'o (consultation), faito'o (treatment or removal) and tukuto'o (discharge). Its content is [uncertain: not verified], so it is not used to structure phases here.

Format. Individual sessions with family invited at the client's choice; home or community venues where the service permits. Session counts above are illustrative [synthesis].

3. Guiding principles

  • You work alongside the tradition, not inside it. Never offer, imitate or arrange healing practices yourself; ask, listen and coordinate. [synthesis]
  • Collective, not only individual. Tongan communities are described as collective, and nursing codes that put individual dignity first can clash with family-centred needs (Vaka 2014). Practical meaning: ask early who should be involved, and hold confidentiality and family involvement together by explicit consent [source: Vaka 2014 thesis].
  • Tend the relationship (vā, tauhi vā, veiyaloni). Vā is the relational space between people and their environments, including spiritual ties (Wendt 1999); tauhi vā is nurturing social ties through reciprocity (Ka'ili 2005) [source: https://moanaroa.aut.ac.nz/__data/assets/pdf_file/0006/1060098/Moanaroa-Pacific-Research-Guidelines_Appendix.pdf]. Trust (vā/veiyaloni) comes before any shared plan [source: https://par.nsf.gov/servlets/purl/10511893]. Practical meaning: spend time on relationships and respect before tasks.
  • Talanoa. Face-to-face conversation and storytelling that reduce the gap between asker and teller (Vaioleti 2006) and allow "speaking from the heart" (Halapua 2003) [source: Moanaroa appendix]. Practical meaning: allow open, unhurried conversation; structured questions follow, not lead.
  • Cultural safety and critical consciousness. Examine your own biases instead of dismissing local belief systems [source: https://par.nsf.gov/servlets/purl/10511893].
  • Neither pathologise belief nor miss illness. A belief in spirit-related illness, curse or mate ni vanua is not itself a symptom; DSM and ICD exclude states that are part of broadly accepted cultural or religious practice [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]. Practical meaning: assess function, distress, course and risk, not the belief.
  • Use the client's words. Tongans mix Tongan terms, English and medical terms when talking about distress [source: Vaka presentation]. Practical meaning: record and use the client's own idiom.
  • Both models can be true for the client. The tufunga fepaki (intersection) theme shows many Tongans hold traditional and biopsychosocial views together [source: Vaka presentation]. Practical meaning: do not ask the client to choose.
  • Faith matters. Christian faith is one of the factors where Tongan and biomedical models meet [source: Vaka presentation]. Practical meaning: ask about church and minister support as a resource.
  • Shared decision-making. In ūloa, provider, healer, family and community share the role of toutai (decision-maker), with the aim of the service user becoming toutai themselves [source: https://researchfeatures.com/wp-content/uploads/2025/03/University-of-Waikato-2.pdf]. Practical meaning: decisions are made with the client and the people they choose.
  • Respect the authority of healers, elders and the vanua. Practical meaning: contact anyone only with consent and through the client or family's own channels; do not seek healers yourself on the client's behalf without their lead [synthesis].
  • No advice on remedies, kava or medicines. Practical meaning: record what is used; route all questions about combining remedies or kava with medicines to the prescriber [synthesis].
  • Safety first. Practical meaning: risk to life, delay of urgent medical care, or harm to a child overrides preference for any pathway [synthesis].

4. Intervention inventory

These are the psychotherapist's own interventions. None of them is a Tongan or Fijian healing practice, and no healing procedure, prayer, preparation or ritual is described. Example language is illustrative.

4.1 Cultural self-examination and cultural safety

  • Purpose: reduce the risk that your own assumptions about spirits, curses, kava or church shape the assessment. Use before and throughout work with Tongan and Fijian clients.
  • Steps: (1) Before the first session, note your own beliefs about spirit-related illness and traditional healers, and any training that framed them as "superstition". (2) Note what you know and do not know about the client's island, village, church and migration history. (3) After sessions, review where you steered the client toward a biomedical account. (4) Take this to supervision or a Pacific cultural adviser. [source: https://par.nsf.gov/servlets/purl/10511893 for the aim of cultural safety and critical consciousness; steps are synthesis]
  • Example language (illustrative): "I'm not Tongan, so I'll get some things wrong. Please tell me when I do."
  • Watch for: your own urge to correct the client's explanation, or the opposite, over-agreeing to seem respectful. It is working when the client corrects you freely and brings more of their own explanations.

4.2 Talanoa-style engagement and tending the vā

  • Purpose: create the relational trust that Pacific authors place before any task. Use from the first contact and whenever trust is strained.
  • Steps: (1) Begin with introductions of family, village or island, church and connections, not only the problem. (2) Invite the client to tell the story in their own order. (3) Keep structured questions for later in the session. (4) Allow family members to speak, and check the client's own view separately if needed. (5) Close by naming what you heard and what happens next. [source: talanoa as face-to-face storytelling, Vaioleti 2006, and vā, Wendt 1999, in https://moanaroa.aut.ac.nz/__data/assets/pdf_file/0006/1060098/Moanaroa-Pacific-Research-Guidelines_Appendix.pdf; Vaka's use of talanoa groups, Vaka presentation; clinical steps are synthesis]
  • Example language (illustrative): "Before we talk about what's been happening, can you tell me a bit about your family and where you're from?"
  • Watch for: short answers, deferring to an elder, or silence, which may mean respect or discomfort rather than lack of insight. It is working when the client and family talk at length and return.

4.3 Core Cultural Formulation Interview (CFI)

  • Purpose: clarify the problem from the client's and their network's perspective, its meaning, sources of help and expectations of services. Use at the first assessment with every client; it is meant for "any clinician" in "any care setting" [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf].
  • Steps: Work through the four domains of the 16 questions: (1) cultural definition of the problem (Q1–3); (2) cultural perceptions of cause, context and support (Q4–10), including the role of cultural identity; (3) self-coping and past help seeking (Q11–13), including barriers; (4) current help seeking (Q14–16), including preferences and the clinician–patient relationship. Use the official APA form; it may be reproduced by clinicians for their patients, but changing or translating it needs APA permission. It supports, but is not the sole basis for, diagnosis. Time needed is [uncertain]; the field trial found later interviews took less time. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf; https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]
  • Example language (illustrative): "People explain problems like this in different ways. How would you describe it to your family or your minister?"
  • Watch for: in Tongan clients, a mix of Tongan, English and medical words; record each. Ask specifically about past help from healers and churches under the help-seeking questions. It is working when you can write the problem in the client's own terms.

4.4 CFI supplementary modules and Informant Version

  • Purpose: deepen areas the core CFI opens. Use when the core CFI shows spiritual causes, family conflict over treatment, migration stress or a family member who holds the history.
  • Steps: Choose from the 12 APA modules: especially Spirituality, Religion and Moral Traditions; Explanatory Model; Social Network; Coping and Help-Seeking; Cultural Identity; Immigrants and Refugees; Caregivers (given to the caregiver); School-Age Children and Adolescents. Modules can be used at the first evaluation, later or repeatedly. Use the 17-question Informant Version with a family member, with the client's consent. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf; https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
  • Example language (illustrative): "Your mother may see things I haven't asked about. Would it be all right if I asked her some questions too?"
  • Watch for: differences between the client's and family's accounts; these are information, not errors. In Aotearoa, New Zealand-born Pacific people reported higher rates of disorder than island-born migrants, so ask about generation and migration [source: Vaka presentation].

4.5 Explanatory-model inquiry in Tongan and Fijian terms

  • Purpose: learn what the client calls the problem and what they think will help. Use in assessment and when treatment stalls.
  • Steps: Paraphrase Kleinman's eight questions: what they call it; what caused it; why it started then; what it does to them; how severe it is and how long it will last; what treatment they should get; the main problems it has caused; what they fear most [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf; Kleinman, Eisenberg and Good 1978]. For Tongan clients, listen for the four dimensions in Vaka's findings: fa'unga (tangible signs and causes), hu'unga (direction, the mind gone astray, 'āvea), tā'anga (pace and onset) and tu'unga (position, with images such as mahei "tilted", mafuli "overturned", motu tapili "broken propeller") [source: Vaka presentation]. For Fijian clients, ask about the place of the vanua, family protocols and any belief in a curse [source: https://www.mdpi.com/2071-1050/13/16/9003].
  • Example language (illustrative): "When this started, did anyone in the family say what it might be? What do you think it is?"
  • Watch for: metaphors of damaged objects, which matter in Tongan communication [source: https://researchfeatures.com/wp-content/uploads/2025/03/University-of-Waikato-2.pdf]; adopt the client's image in later sessions. It is working when the client uses their own word for the problem and links it to a hoped-for kind of help.

4.6 Asking about healers, church help and kava without judgement

  • Purpose: learn about all help being used, so care can be coordinated and risks seen. Use at assessment and at review.
  • Steps: (1) Normalise: many families use home care, healers and church help. (2) Ask who has helped, when, and what changed. (3) Ask whether the client wants you to know more or to be in contact. (4) Ask about yaqona/kava use in everyday and social life, how much it matters to them, and any remedies taken. (5) Record without evaluating; pass any question about combining kava or remedies with medicines to the prescriber. [source: home management and healer use, https://www.mdpi.com/2071-1050/13/16/9003; steps are synthesis]
  • Example language (illustrative): "Some families see a Tongan healer as well as coming here. That's fine with me. Has anyone else been helping with this?"
  • Watch for: reluctance to disclose because of expected disapproval; healer help sought in secret. It is working when the client tells you about all sources of help.

4.7 Distinguishing culturally normative spirit attribution from disorder

  • Purpose: avoid both pathologising a belief and missing a treatable illness. Use whenever the client or family describe spirits, 'āvanga, possession or a curse.
  • Steps: (1) Separate the belief (an explanation shared in the community) from the experience (what the person sees, hears, does). (2) Ask whether the family and community see the experience as expected or as unusual for this person. (3) Assess course, distress, impairment, risk and other symptoms. (4) Apply the diagnostic exclusions: DSM-5-TR dissociative identity disorder may show as possession, but is not diagnosed when the disturbance is a normal part of broadly accepted cultural or religious practice; dissociative trance (other specified dissociative disorder) carries the same exclusion; ICD-11 6B62 trance disorder and 6B63 possession trance disorder require that the state is involuntary, unwanted and not part of accepted cultural or religious practice [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574; https://umsystem.pressbooks.pub/aswbprep/?p=1299; https://www.findacode.com/icd-11/code-1807490186.html]. The DSM-5-TR culture note on beliefs that should not count as psychotic symptoms is [uncertain: not verified]. (5) Consult a Pacific cultural adviser or family member about what is normative.
  • Example language (illustrative): "In your family, when someone is affected like this, what usually happens? Is what he's going through like that, or different?"
  • Watch for: Vaka's thesis glosses 'āvanga motu'a as schizophrenia and 'āvanga fēmaleleaki as bipolar disorder [source: Vaka 2014 thesis], so the same Tongan word may cover what you would diagnose; do not assume a spirit frame excludes psychosis. It is working when your formulation names both the family's understanding and your clinical findings.

4.8 Family-inclusive formulation and shared decision-making (toutai)

  • Purpose: fit care to a collective culture. Use once the client has agreed who to involve.
  • Steps: (1) Agree with the client which family members, church members or others take part, and what may be shared. (2) Present your formulation in the client's terms first, then the clinical view. (3) Name decisions and who holds them; in ūloa the role of decision-maker (toutai) is shared, aiming for the service user to become toutai [source: https://researchfeatures.com/wp-content/uploads/2025/03/University-of-Waikato-2.pdf]. (4) Aim for household harmony as a goal of care (napanapangamalie in the source's spelling) [source: same]. (5) Write the plan down and give a copy.
  • Example language (illustrative): "We all want the same thing, for things to be calm at home again. Let's agree who does what."
  • Watch for: family members speaking over the client, or the client agreeing to please elders. Check with the client alone. It is working when the client says the plan is theirs.

4.9 Collaboration and referral with healers and church leaders (fakataha)

  • Purpose: coordinate care with community-recognised helpers when the client wishes. Use when the client already sees, or wants to see, a healer, minister or elder.
  • Steps: (1) Ask the client whether they want any contact between you and their healer or minister; never initiate it otherwise. (2) Get written consent stating what may be shared. (3) Approach through the client, family or a cultural liaison worker, respecting the community's protocols for approaching a healer or elder; in iTaukei practice a formal presentation of kava is described as part of approaching a healer [source: https://par.nsf.gov/servlets/purl/10511893]; follow the family's lead and do not perform protocol yourself. (4) Agree roles: what each helper is doing, and shared warning signs that mean urgent clinical review. (5) Keep in contact at agreed points. In ūloa, fakataha ("working together") describes practitioners and healers collaborating; healers are sometimes asked to live with the affected person or family during healing; community members want healers included in formal mental health structures [source: https://researchfeatures.com/wp-content/uploads/2025/03/University-of-Waikato-2.pdf]. For a curse understood as affecting a whole village, Aporosa and Perrin propose that a health worker build trust and work with the community, healers and Christian ministers through regular talanoa, recognising that community consensus that the curse has been "broken" matters [source: https://par.nsf.gov/servlets/purl/10511893].
  • Evidence context: collaboration has been tested in West Africa, not the Pacific. In COSIMPO (Gureje et al., The Lancet 2020; Nigeria and Ghana), collaborative shared care between traditional and faith healers and primary care gave a greater fall in psychosis symptoms and fewer harmful practices than usual care [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306; https://centreforglobalmentalhealth.org/node/839]. In a Ghana prayer-camp trial (Ofori-Atta et al., Br J Psychiatry 212(1)), adding psychiatric medication lowered symptoms but did not significantly reduce days in chains [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial]. Applying these to Tongan and Fijian settings is [synthesis].
  • Example language (illustrative): "If it would help, I'm happy to talk with your minister or the healer your family trusts, only with your permission and only about what you agree."
  • Watch for: healers or families asked to stop clinical treatment; conflicting advice about medicines (route to the prescriber); breaches of confidentiality in a small community. It is working when helpers know each other's roles and the client reports less conflict between them.

4.10 Kava (yaqona) and remedies: facts, not advice

  • Purpose: understand the cultural place of kava and flag medical questions safely. Use whenever kava or remedies come up.
  • Steps: (1) Recognise kava's place: in iTaukei village life yaqona is a culturally important crop and is usually present at gatherings and talanoa [source: https://www.mdpi.com/2071-1050/13/16/9003], and it is widely believed to carry mana [source: https://par.nsf.gov/servlets/purl/10511893]. (2) Know the liver-toxicity debate as sources state it: reports of liver failure with kava products in Europe led many countries to ban or warn against them; a WHO assessment (2007) found the risk may depend on dose, variety, plant part or extract type, with "the main problem" being the chemical composition of the product; most case reports involved alcohol-based extracts rather than water extracts, and an epidemiological study found no link between regular kava drinking in Oceania and liver disease [source: https://sciencebasedmedicine.org/kava-and-liver-damage/]. (3) Record use; do not advise on amounts, preparation, starting or stopping. (4) Pass any question about kava or remedies with prescribed medicines to the prescriber.
  • Example language (illustrative): "Kava is part of a lot of family and church life. Your doctor should know about it alongside your medicine, so can I let them know, or would you rather tell them?"
  • Watch for: heavy use as a way of coping with distress, or use alongside other sedating substances [synthesis]; raise with the prescriber. It is working when the prescriber has a full picture.

4.11 Ūloa-informed care planning (where a service uses the model)

  • Purpose: organise care for Tongan clients on Tongan concepts. Use in services adopting or testing the model; elsewhere, borrow its principles only.
  • Status: ūloa, named after a communal Tongan fishing technique, was developed by Sione Vaka from talanoa research as a model of practice for Tongan people in mental distress [source: https://hrc.govt.nz/resources/research-repository/effectiveness-uloa-model; https://www.proquest.com/docview/1852699714]. Its acceptability and effectiveness were studied with providers and service users in South Auckland (HRC grant, 2017), and a three-year "Ūloa in Action" project (announced June 2026) will design and test a care pathway with Counties Manukau mental health services and the Faletoa Cultural Liaison team, producing guidelines and training resources [source: https://www.waikato.ac.nz/news-events/news/putting-pacific-values-at-the-centre-of-mental-health-care/]. The model's detailed clinical steps are [uncertain: not verified]; do not invent them.
  • Steps (principles as published): (1) support the whole household, not only the individual; (2) attend to loto (soul), ongo (emotional context) and atamai (mind); (3) work together (fakataha) with healers and community; (4) share decision-making (toutai); (5) aim for household harmony [source: https://researchfeatures.com/wp-content/uploads/2025/03/University-of-Waikato-2.pdf].
  • Example language (illustrative): "We'd like to plan this together with your family and anyone else you want, so everyone is pulling the net the same way."
  • Watch for: using the model's name without Tongan staff, cultural liaison or community involvement. It is working when Tongan staff and the family recognise the plan as theirs.

4.12 Kakala-structured co-design and review

  • Purpose: plan and review shared care in a Pacific frame. Use for family meetings, service planning or evaluation.
  • Steps: Use the Kakala garland-making stages, as Te Tāhū Hauora describes them for engagement, co-design and evaluation: teu (conceptualise: what is the garland for), toli (gather what is needed), tui (weave it together), luva (gift it), mālie (was it well received) and māfana (did it give warmth and lasting benefit) [source: https://www.hqsc.govt.nz/assets/Consumer-hub/Publications-resources/Pacific-models-for-engagement_Kakala_final.pdf]. Kakala is attributed to Konai Helu Thaman (dated 1992 in one source and 1997 in another [uncertain]) and the Kakala Research Framework to Johansson Fua (2014). Clinical use of the stages for care plans is [synthesis].
  • Example language (illustrative): "Let's think of this plan like a kahoa: first what it's for, then who brings what, then how we put it together."
  • Watch for: imposing a Tongan metaphor on a Fijian or non-Tongan client; ask whether it fits. For iTaukei clients, the Vanua framework (Nabobo-Baba 2008), a Fijian research framework grounded in Indigenous values that expects research to bring change to the community, may be a closer reference [source: https://moanaroa.aut.ac.nz/__data/assets/pdf_file/0006/1060098/Moanaroa-Pacific-Research-Guidelines_Appendix.pdf]. Other Tongan models named there include the Popao outrigger-canoe mental health framework (Fotu and Tafa 2009) [uncertain: not verified in detail].

4.13 Interpreters and cultural liaison

  • Purpose: make sure meaning, not only words, is carried across. Use whenever the client or family prefer Tongan or Fijian, or when idioms are unclear.
  • Steps: (1) Offer a trained interpreter; avoid using children. (2) Brief the interpreter on confidentiality, especially in small communities. (3) Ask the interpreter or a cultural liaison worker to explain idioms after the session rather than translating them away. (4) Check with the client that they are comfortable with the interpreter's family or church links. [synthesis]
  • Example language (illustrative): "When your father said the mind was 'tilted', what does that mean in Tongan?"
  • Watch for: idioms of distress turned into English diagnostic words in translation. It is working when the client's own terms appear in your notes.

4.14 Integrating healing experiences into therapy

  • Purpose: help the client make sense of healer, church and clinical help together. Use after a healer consultation, church intervention or village reconciliation.
  • Steps: (1) Invite the client to describe what happened and what it meant, without asking for ritual detail. (2) Ask what changed in symptoms, relationships and hope. (3) Link gains to the therapy goals. (4) Address any guilt, fear or disappointment (e.g. if a curse is believed to persist). (5) Revisit the plan. [synthesis]
  • Example language (illustrative): "You don't need to tell me what happened there. What I'd like to know is how you've been since."
  • Watch for: pressure on the client to say they are healed; fear of blame for continuing symptoms. It is working when the client can hold both kinds of help without conflict.

4.15 Safeguarding and medical urgency

  • Purpose: protect the client and others when any practice, belief or family response causes harm or delays needed care. Use at every stage.
  • Steps: (1) Screen for risk of suicide and self-harm using your service's standard assessment; Vaka's presentation names suicide attempts and self-harm as concerns among Pacific peoples [source: Vaka presentation]. (2) Ask whether anyone has been restrained, confined, beaten, deprived of food, or kept from medical care because of a spirit or curse explanation. (3) Ask about children affected by accusations or by a parent's illness. (4) Where harm or urgent medical need is present, follow local safeguarding and emergency procedures; explain this to the family respectfully, separating the concern from their beliefs. (5) Document clearly. [steps are synthesis; COSIMPO and the Ghana trial show harmful practices such as chaining can persist alongside healing settings, source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306; https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial]
  • Example language (illustrative): "I respect how your family understands this. My job is to make sure everyone is safe, so I need to act on what you've told me about the locked room."
  • Watch for: the Tongan and Fijian sources cited here do not report specific harmful practices; do not assume them, but do not skip the questions. It is working when safety concerns are named early and the family stays engaged.

4.16 Addressing migration, stigma, history and service barriers

  • Purpose: place the client's distress in its social and historical context and reduce barriers to care. Use in formulation and when engagement falters.
  • Steps: (1) Ask about migration, generation and changes in family roles; migration, social networks and access to services shape Tongan understandings [source: Vaka presentation]. (2) Acknowledge that Pacific people in New Zealand are described as less likely to use mental health services despite high prevalence [source: Vaka 2014 thesis]. (3) Ask about stigma in church and community. (4) Recognise historical context: Vaka discusses how spirit possession was later reframed as mental illness [source: Vaka 2014 thesis]; Aporosa and Perrin trace one Fijian village's curse to a colonial-era boundary decision [source: https://par.nsf.gov/servlets/purl/10511893]. (5) Ask about practical barriers, including distance and transport, noted for rural Fiji, and use of home and healer care after disasters such as Cyclone Winston [source: https://www.mdpi.com/2071-1050/13/16/9003]. (6) Ask about experiences of racism or being misunderstood in services (CFI Q16).
  • Example language (illustrative): "Sometimes services haven't understood Tongan families well. Has that happened to you or anyone close to you?"
  • Watch for: shame about mental illness reflected in Tongan terms such as vale (which can mean ignorance as well as mental illness) [source: Vaka 2014 thesis]; avoid these words unless the client uses them. It is working when the client names barriers and you can address at least one.

5. Handling problems

Most of this section is [synthesis]; sources are cited where they apply.

  • The client or family see no point in therapy because the problem is spiritual. Do not argue. Ask what they hope the healer or church will change and what they would like from you meanwhile (sleep, family conflict, practical help). Offer to coordinate with the helpers they trust (4.9). [synthesis]
  • Family members disagree (e.g. a parent favours a healer, a young person favours clinical care). Hold separate and joint conversations; use the Informant Version and family-inclusive formulation (4.4, 4.8). Name shared goals such as household harmony [source: https://researchfeatures.com/wp-content/uploads/2025/03/University-of-Waikato-2.pdf]. Respect the client's own decision rights.
  • Stuck client, little change. Revisit the explanatory model (4.5): what does the client think is still unresolved? A belief that a curse persists can sustain powerlessness; in one Fijian village, lethargy and powerlessness were reported alongside a long-standing curse, and community consensus that a curse is "broken" was presented as important [source: https://par.nsf.gov/servlets/purl/10511893]. Ask whether community or church steps are planned and how you can work alongside them.
  • Short or deferential answers ("resistance"). Often respect for authority or discomfort with direct questions. Return to talanoa (4.2), meet with a cultural liaison worker, and check you are not rushing. [synthesis]
  • Non-adherence to medication or appointments. Ask what the client and family understand the medicine to be for, whether a healer or church leader has advised against it, and whether the prescriber knows. Do not advise on medicines yourself; arrange a joint review with the prescriber. [synthesis]
  • Overwhelm after a healing event or church intervention. Ground the session in the present, attend to sleep and safety, and integrate gradually (4.14). If there are signs of psychosis, mania or acute risk, arrange urgent clinical review. [synthesis]
  • Rupture: the client feels judged about beliefs or kava. Name it, apologise for anything that felt dismissive, and restate that their understanding matters to the plan (4.1). [synthesis]
  • Confidentiality in a small community. Agree in writing what can be shared with whom; check interpreters' and helpers' links to the family (4.13). [synthesis]
  • A healer or family asks you to stop clinical treatment. Explore their reasons with the client; seek a joint conversation with the prescriber; keep the client's choice and safety central. [synthesis]
  • Unclear whether an experience is normative or illness. Consult a Pacific cultural adviser and family; assess course and function; use the diagnostic exclusions (4.7). Avoid both labelling belief as delusion and dismissing a deterioration as "only cultural". [synthesis]
  • Clinician pressure to "do something cultural". Do not perform protocols, prayers or ceremonies; your role is to ask, listen and coordinate. If the service wants Pacific-led care, involve Pacific staff and cultural liaison teams (4.11). [synthesis]
  • Heavy kava use as coping. Explore its role non-judgementally; involve the prescriber for any medical question (4.10). [synthesis]
  • Harm discovered (restraint, beating, deprivation, child at risk, delayed urgent medical care). Follow safeguarding procedures at once (4.15). [synthesis]

Sources

Tongan and Fijian healing and Pacific models

Kava

Cultural assessment and diagnosis

Collaboration evidence

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