Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 132
Guide XI-132

Slavic znakharstvo

Ukraine and Russia
A 34 · L 54 · M 1215 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: East Slavic (chiefly Ukrainian and Russian) folk healing as ethnographers, folklorists and a national folk-culture museum document it (Ivan Honchar Museum 2021; Phillips 2004; Kliauz 2001; Agapkina 2022; Matveeva 2024), with the psychotherapist's own work structured by the DSM-5-TR Cultural Formulation Interview (APA).

What it is. Znakharstvo (Ukrainian знахарство, Russian знахарство) is the folk-healing tradition of the znakhar (male) or, far more often, the znakharka (female) healer. It is a historical and living folk practice, not a psychotherapy and not a codified medical system. The Ivan Honchar Museum (National Center of Folk Culture, Kyiv) describes Ukrainian folk medicine as dividing illness into two kinds: illnesses with an everyday explanation (colds, poisoning, cuts), treated at home with plant, animal and mineral remedies, and illnesses explained as "sent, made, cast/poured", which were taken to specialist healers who worked through rites, rituals and spoken charms (замовляння). In the tradition's own terms, illness can be a harmful substance sent by another person; the healer's task is to remove it. [source: https://honchar.org.ua/en/blog/folk-medicine-i178]

Who practises today. Fieldwork shows the tradition still alive in villages and in diaspora:

  • Rural western Ukraine (Phillips 2004): elderly women called babky treat mainly fear sickness (liak, prystrit) and the evil eye (uroky, porcha), with symptoms such as "nerves", insomnia, weakness, headaches, crying and infertility; children are often brought for fear sickness, stuttering and sleep problems; many patients come after conventional treatment has not helped. [source: https://journals.ku.edu/folklorica/article/download/3744/3583]
  • Siberian Russia (Kliauz 2001): women healers in Semeiskie villages of the Krasnochikoi district treat the evil eye (sglaz, porcha), described as an amorphous illness of sluggishness, low spirits and a sense of failure, plus fright and children's sleeplessness. [source: https://journals.ku.edu/folklorica/article/download/3707/3550]
  • Penza region, Russia (Matveeva 2024): a still-active village tradition of znakhari (healers) and kolduny (sorcerers), both understood locally as holders of a "gift" used to cure or to harm. [source: https://vestnik-pp.samgtu.ru/0236-2007/article/view/670837]
  • Ukrainian Canadians (Klymasz 1991): practice reduced almost entirely to wax pouring for the evil eye, done by a few women; folk and biomedical care coexist and are sometimes used by the same people; younger people are losing belief. [source: https://mspace.lib.umanitoba.ca/items/58b80261-8e27-4d28-bad3-04073eea9438]
  • Commercial and online "magic" services offering removal of porcha exist alongside village practice; in Russia, thousands of unaccredited practitioners are reported to operate online. [source: https://gxpnews.net/2025/06/kak-narodnaya-mediczina-stala-bolnym-mestom-zdravoohraneniya/]

Core idea of change (as the tradition holds it). Distress or illness caused by another's envy, gaze or deliberate harm is lifted when a healer with a gift or inherited knowledge removes it through word and rite, usually invoking God, the Mother of God and the saints. Ethnographers report that healers often say their ability is "a gift from God" and that, in folk belief, treatment does not help without the patient's gratitude. These are the tradition's beliefs, reported here without endorsement or dismissal. [source: https://honchar.org.ua/en/blog/folk-medicine-i178] [source: https://journals.ku.edu/folklorica/article/download/3744/3583]

The psychotherapist's role. The therapist does not practise znakharstvo, perform or imitate its rites, or teach charms. The therapist's work is culturally responsive assessment and therapy alongside whatever help the client chooses: understanding the client's explanatory model, separating culturally normative belief from illness, coordinating safely when the client also sees a healer, and safeguarding where harm or medical delay occurs. Change, on the therapist's side, comes from the ordinary mechanisms of the therapy being delivered, made usable by a formulation the client recognises as their own. [synthesis]

2. Framework

Znakharstvo has no published phases, session counts or treatment manuals that apply to psychotherapists; ethnographers describe visits to a healer as short, one-off or repeated home-based encounters, with knowledge passed from teacher to pupil, often within a family. [source: https://journals.ku.edu/folklorica/article/download/3707/3550] [source: https://ojs.folklore.ee/index.php/incantatio/article/view/143] The framework below is the therapist's own process. [synthesis, built on the CFI structure: source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]

Phase A: Cultural assessment (sessions 1–2, individual, 50–60 min).

  • Goals: hear the problem in the client's words (e.g. "someone put porcha on me", "the child has liak"); administer the core CFI (16 questions, four domains: cultural definition of the problem; cultural perceptions of cause, context and support; cultural factors in self-coping and past help seeking; cultural factors in current help seeking); ask openly about babky, znakharky, priests and online healers already consulted; screen risk and medical issues.
  • Duration: no official time is given for the core CFI; later interviews take less time once clinicians are familiar with it. [uncertain: no figure in minutes verified] [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]
  • Move on when: the client's explanatory model, help-seeking history, risks and any parallel healer contact are documented, and the client has said what they want from therapy.

Phase B: Shared formulation and plan (sessions 2–4).

  • Goals: build a formulation that holds both the client's explanation (envy, evil eye, sent illness) and the clinical picture (e.g. depression, anxiety, trauma, grief); agree goals in the client's language; decide with the client whether and how therapy coordinates with a healer, priest or doctor; complete any CFI supplementary modules needed.
  • Move on when: the client agrees a plan they describe as fitting their beliefs, and medical or safety needs have been routed.

Phase C: Therapy alongside (typically 8–20 sessions, set by the evidence-based therapy chosen for the disorder).

  • Goals: deliver the indicated therapy (e.g. CBT, trauma-focused work), adapted in language and metaphor; revisit the explanatory model as it shifts; integrate any healer visits; monitor safety, medical care and exploitation.
  • Move on when: target symptoms and functioning improve on routine measures and the client feels their cultural frame has been respected.

Phase D: Review and ending (1–2 sessions).

  • Goals: review change in both frames ("what helped, in your view and in mine"); plan relapse prevention that names the client's preferred supports (family, church, healer, doctor); agree when to return.

3. Guiding principles

  • Write and speak alongside the tradition, not inside it. Meaning: you never perform, imitate, recommend specific rites or charms; you work with what the client tells you. [synthesis]
  • Attribute, do not adjudicate. Meaning: say "in your family's understanding, this is porcha" rather than either affirming or debunking it. [synthesis]
  • Authority sits with the healers and communities, and is contested. Meaning: healers describe their authority as a gift from God, inheritance or learning from an older relative, sometimes received in dreams; Orthodox writers widely condemn consulting healers; the client may hold both views at once. Do not take sides; ask who the client trusts. [source: https://journals.ku.edu/folklorica/article/download/3744/3583] [source: https://azbyka.ru/sueverie/narodnye-celiteli-ekstrasensy-znaxarki.html]
  • Charms are not yours to reproduce. Meaning: do not ask the client to recite or write down a healer's charm; ethnographers report that key parts of charms are deliberately withheld and passed only to chosen pupils. [source: https://ojs.folklore.ee/index.php/incantatio/article/view/143]
  • Expect dual use, not either/or. Meaning: assume the client may see a doctor, a priest and a babka in the same month; ask about all three without implying a ranking. [source: https://mspace.lib.umanitoba.ca/items/58b80261-8e27-4d28-bad3-04073eea9438] [source: https://journals.ku.edu/folklorica/article/download/3744/3583]
  • Cultural explanation does not exclude illness. Meaning: a belief in porcha is not a delusion in itself, and it does not rule out depression, psychosis or medical disease; assess both. [synthesis, consistent with the CFI's statement that it supports but is not the sole basis for diagnosis: source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
  • Know the legal frame. Meaning: in Russia, folk medicine requires a regional health-authority permit and the law excludes occult-magic services and religious rites from it; in Ukraine, practice required a special permit under Article 74-1 of the Fundamentals of Health Legislation, which the Ministry of Health proposed abolishing in 2018 [uncertain: current status not verified]. A healer's legal status is a safety fact, not a judgment of the tradition. [source: https://www.advgazeta.ru/ag-expert/advices/tselitel-vrach-ili-sharlatan/] [source: https://zaxid.net/moz_initsiyuvalo_skasuvannya_dozvolu_na_zaynyattya_narodnoyu_meditsinoyu_i_tsilitelstvom_n1445775]
  • No advice on herbs or remedies. Meaning: folk medicine includes herbal, animal and mineral remedies; never comment on doses or use, never advise starting or stopping any medicine; route questions to the prescriber or pharmacist. [source: https://honchar.org.ua/en/blog/folk-medicine-i178]
  • Safety and safeguarding first. Meaning: delays to urgent care, harmful physical procedures, exploitation for money and any harm to children override the duty to respect belief. [synthesis]
  • Consent and confidentiality for any contact with a healer or priest. Meaning: written, specific, revocable consent; share only what the client agrees. [synthesis]
  • Use the client's words and language. Meaning: Ukrainian uroky, prystrit, liak/perelyak; Russian sglaz, porcha, ispug; use interpreters, not family members, for assessment. [source: https://journals.ku.edu/folklorica/article/download/3744/3583] [synthesis]
  • Respect generational and diaspora difference. Meaning: belief and practice vary by age, region, church and migration history; do not assume a Ukrainian or Russian client holds these beliefs. [source: https://mspace.lib.umanitoba.ca/items/58b80261-8e27-4d28-bad3-04073eea9438]
  • Political sensitivity. Meaning: Ukrainian and Russian traditions are related but distinct, and clients displaced by war may experience being grouped together as harmful; ask how the client names their own heritage. [synthesis]

4. Intervention inventory

All interventions below are the psychotherapist's own work. None reproduces or substitutes for a healer's rite. Steps and example wording are synthesis unless a source is tagged.

4.1 Cultural self-examination

  • Purpose / when: before and during work with any client who mentions porcha, the evil eye, fright or a babka; to catch your own reflexes (amusement, contempt, romanticising, or assuming all Eastern Europeans believe this). [synthesis]
  • Steps: (1) Write down your first reaction to the phrase "someone put porcha on me". (2) Note your own religious or secular commitments and how they colour that reaction. (3) Note what you know and do not know about Ukrainian and Russian village, Orthodox and Greek Catholic life. (4) Take this to supervision or peer consultation when a case stirs strong feeling. (5) Revisit after session 3.
  • Example language (illustrative, to yourself or in supervision): "Am I treating her explanation as a symptom or as information?"
  • Watch for: a pull to debunk, or to perform enthusiasm for folk magic; both shift the session away from the client's goals. It is working when you can restate the client's explanation accurately without editorialising.

4.2 Open, non-judgemental inquiry about healers and other help

  • Purpose / when: first session and whenever new symptoms appear; ethnographic reports show clients often consult a babka or znakharka after, or alongside, doctors. [source: https://journals.ku.edu/folklorica/article/download/3744/3583] [source: https://mspace.lib.umanitoba.ca/items/58b80261-8e27-4d28-bad3-04073eea9438]
  • Steps: (1) Normalise the question by asking everyone. (2) Ask about all sources of help together: doctors, pharmacists, priests, family elders, babky or znakharky, online healers. (3) Ask what each said the problem was and what they advised. (4) Ask what helped and what did not. (5) Ask about cost and how payment was made. (6) Record without evaluative language.
  • Example language (illustrative): "Many people I see have tried several kinds of help: doctors, the church, sometimes a babka or a healer in the family's village. Who have you turned to so far, and what did they say?"
  • Watch for: hesitation or a glance at a relative (shame, church disapproval, fear of being thought backward); reassure confidentiality and move on, returning later. It is working when the client volunteers healer contact unprompted in later sessions.

4.3 Core DSM-5-TR Cultural Formulation Interview

  • Purpose / when: structured cultural assessment at intake (Phase A); 16 questions in four domains: cultural definition of the problem; cultural perceptions of cause, context and support; cultural factors affecting self-coping and past help seeking; cultural factors affecting current help seeking, including the clinician–patient relationship (e.g. perceived racism, language barriers). It supports clinical understanding and decision-making and is not meant to be the sole basis for diagnosis. It "can be reproduced without permission by researchers and by clinicians for use with their patients"; modification or translation needs APA permission. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] APA describes it as for any clinician, any individual, any care setting. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]
  • Steps: (1) Download the official form; use it as published (or an APA-authorised translation; Ukrainian or Russian versions [uncertain: not verified]). (2) Introduce it as questions about how the client and the people around them understand the problem. (3) Work through the four domains in order, keeping the client's own terms (porcha, uroky, liak). (4) Where the client names a sent illness, use the cause and context questions to ask who, why and when in their view, without probing for the content of any rite. (5) In the help-seeking domain, record healer, church and medical contacts. (6) In the final domain, ask about language preference and any concerns about being judged. (7) Summarise back in the client's words and note which supplementary modules to add. (8) With a relative present and the client's consent, use the 17-question Informant Version (DSM-5 form). [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
  • Example language (illustrative): "I'd like to understand this the way you and your family understand it. If you were telling your mother or your neighbour what is happening, what would you call it?"
  • Watch for: the client switching to medical vocabulary to please you; gently ask whether there is another way people at home would describe it. Field-trial clinicians found the CFI feasible, acceptable and useful, and later interviews quicker. [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/] It is working when your summary is accepted without correction.

4.4 CFI supplementary modules

  • Purpose / when: deeper assessment as add-ons or standalone, at first evaluation or later, repeated if needed. The 12 modules are: Explanatory Model; Level of Functioning; Social Network; Psychosocial Stressors; Spirituality, Religion, and Moral Traditions; Cultural Identity; Coping and Help-Seeking; Patient–Clinician Relationship; School-Age Children and Adolescents; Older Adults; Immigrants and Refugees; Caregivers. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
  • Steps (which to choose for this context) [synthesis]: (1) Explanatory Model when porcha, the evil eye or fright is the client's main frame. (2) Spirituality, Religion, and Moral Traditions when Orthodox, Greek Catholic or other church involvement is present, especially if the client fears that consulting a healer is sinful. (3) Coping and Help-Seeking to map babka, priest and doctor use. (4) Immigrants and Refugees for clients displaced by war or migration. (5) Older Adults for elders who hold or practise the tradition. (6) School-Age Children and Adolescents when a child has been taken to a healer for fright, stuttering or sleep problems. (7) Caregivers (given to the caregiver) for parents or adult children. (8) Cultural Identity when Ukrainian, Russian, mixed or diaspora identity is a live issue.
  • Example language (illustrative): "You mentioned your priest and the babka see this differently. Could we spend some time on how faith and these traditions sit together for you?"
  • Watch for: module fatigue; spread modules over sessions. It is working when the module material changes your formulation or plan.

4.5 Explanatory-model inquiry (Kleinman)

  • Purpose / when: to understand the client's model of a sent illness, fright or evil eye in their own terms, and to negotiate a shared plan. Kleinman, Eisenberg and Good (1978) proposed eight questions, paraphrased: what do you call the problem; what caused it; why did it start when it did; what does it do to you and how does it work; how severe is it and will it last a short or long time; what treatment should you receive; what are the chief problems it has caused; what do you fear most about it. [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 questions conversationally across one or two sessions. (2) Map the answers onto the tradition's two kinds of illness the client may hold: "natural" illness for doctors and home remedies, and "sent" illness for a healer. [source: https://honchar.org.ua/en/blog/folk-medicine-i178] (3) Ask where the client places the current problem, and whether that has changed. (4) Ask what the client believes therapy can and cannot do. (5) Record the model verbatim in your notes. [synthesis]
  • Example language (illustrative): "Some people say there are illnesses for the doctor and illnesses that are sent, which need someone else. Where does this one sit for you?" • "What do you fear most about it?"
  • Watch for: fear of a named person (neighbour, in-law, ex-partner) as the sender; this can carry real conflict, threats or abuse that need attention in their own right. It is working when the client can say what part of the problem they want therapy for.

4.6 Working with East Slavic idioms of distress

  • Purpose / when: when the client describes the evil eye (uroky, sglaz), spoiling (porcha), or fear sickness (liak, prystrit; Russian ispug). Ethnographers record these as common complaints, with symptoms such as "nerves", insomnia, weakness, headaches, crying, low spirits, sluggishness and a sense of failure, and in children fright, stuttering and sleeplessness. [source: https://journals.ku.edu/folklorica/article/download/3744/3583] [source: https://journals.ku.edu/folklorica/article/download/3707/3550] These terms do not appear in the DSM-5-TR list of named cultural concepts of distress as reported (ataque de nervios, dhat syndrome, hikikomori, khyâl cap, kufungisisa, maladi dyab, nervios, shenjing shuairuo, susto, taijin kyofusho) [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf]; DSM-5-TR frames cultural concepts as "idioms, explanations or perceived causes, and syndromes", which is the usable lens here. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf] [uncertain: the DSM-5-TR list is from a secondary source]
  • Steps [synthesis]: (1) Ask whether the term is used as an idiom ("I feel as if I've been jinxed"), an explanation ("this happened because of her eye") or a syndrome ("I have liak"). (2) Elicit the symptom picture in detail. (3) Run standard screening for depression, anxiety, trauma, sleep and somatic disorders in parallel. (4) Note fright after a specific event (shelling, accident, assault): fear sickness may be the client's frame for a trauma reaction. (5) Present your clinical view as a second, compatible description, not a replacement.
  • Example language (illustrative): "Your grandmother would call this perelyak. What you describe, the jumping at noises and not sleeping since the bombing, is also something we know well in therapy as a reaction to terror. Could we work with both pictures?"
  • Watch for: the client hearing your clinical label as dismissal; check directly. It is working when the client uses both vocabularies comfortably.

4.7 Distinguishing culturally normative belief from disorder

  • Purpose / when: whenever beliefs about bewitchment, sorcerers or sent illness are intense, idiosyncratic or accompanied by unusual experiences. [synthesis]
  • Steps: (1) Ask whether family and community members share the belief and in the same form (shared and conventional supports cultural normativity). (2) Ask whether the client's account goes beyond what others in their community would accept (e.g. a fixed belief that a neighbour transforms at night to harm them specifically, with distress and behaviour change). (3) Look for other psychotic, mood or cognitive features. (4) Consult a cultural broker or community member, with consent. (5) For dissociative states, note that DSM-5 wording for dissociative identity disorder allows identity disruption to be described as possession in some cultures but excludes states that are a normal part of broadly accepted cultural or religious practice; dissociative trance is likewise excluded when part of accepted collective practice; ICD-11 6B62 (trance disorder) and 6B63 (possession trance disorder) require the state to be involuntary and unwanted. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://www.findacode.com/icd-11/code-1807490186.html] [uncertain: exact DSM-5-TR wording] Possession framing is not prominent in the cited ethnography of znakharstvo; consider these codes only where the client reports such states. [synthesis]
  • Example language (illustrative): "In your village, would most people see it the way you do, or is this something they'd find surprising?"
  • Watch for: two errors: pathologising a shared belief, and missing psychosis or dementia because "it's cultural". Ethnographers report that local belief also holds that "sorcerers" can shapeshift (Matveeva 2024), so such content is not by itself psychotic. [source: https://vestnik-pp.samgtu.ru/0236-2007/article/view/670837] It is working when your diagnostic decision rests on more than the belief content.

4.8 Exploring religious and moral conflict

  • Purpose / when: many clients are Orthodox or Greek Catholic. Babky in western Ukraine use Christian prayers and the sign of the cross, and some priests have tolerated or asked them to change practices [source: https://journals.ku.edu/folklorica/article/download/3744/3583], while widely read Orthodox writings call consulting healers a sin against the First Commandment and urge confession, the Church and qualified doctors instead. [source: https://azbyka.ru/sueverie/narodnye-celiteli-ekstrasensy-znaxarki.html] A client can feel helped by a babka and guilty about it at once.
  • Steps [synthesis]: (1) Ask what the client's church and family say about healers. (2) Ask how the client reconciles them. (3) Use the Spirituality, Religion, and Moral Traditions module. (4) Offer, without pressure, a conversation with the client's own priest if the conflict is central. (5) Do not give theological opinions.
  • Example language (illustrative): "It sounds as if going to her helped and also left you uneasy with your faith. Would you like to think that through here, or with your priest, or both?"
  • Watch for: scrupulosity or obsessive guilt about having consulted a healer, which may need its own treatment. It is working when guilt is discussable rather than secret.

4.9 Two-frame shared formulation

  • Purpose / when: end of Phase A or early Phase B, to agree a plan the client can accept without giving up their explanation. [synthesis]
  • Steps: (1) Write two columns with the client: "how you and your family understand it" and "how therapy understands it". (2) Find overlaps (e.g. envy in the family = ongoing conflict and stress; liak = startle, nightmares, avoidance). (3) Agree which problems therapy will work on and which the client takes elsewhere (church, healer, doctor). (4) Set two or three goals in the client's words. (5) Agree how you will both know progress has occurred.
  • Example language (illustrative): "You may still want to have the uroky taken off by someone you trust. In here, could we work on the sleep and the dread in the mornings?"
  • Watch for: a plan that silently assumes the client will drop the healer; it usually ends in drop-out. It is working when the client repeats the plan in their own words.

4.10 Coordinating with a healer, priest or elder (only if the client wishes)

  • Purpose / when: when the client is seeing a babka, znakharka or priest and wants care to be joined up. There is no institutional referral pathway to znakhari comparable to programmes in some other traditions. [uncertain: not verified] Analogous evidence from West Africa shows structured collaboration can help: in the COSIMPO cluster trial in Nigeria and Ghana (Gureje et al., The Lancet 2020), collaborative shared care between traditional and faith healers and primary health workers reduced psychosis symptoms more than usual care (adjusted mean PANSS difference −15.01), and harmful practices fell from 57% to 9% with the intervention against 42% to 10% in controls [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839]; in a Ghanaian prayer-camp trial (Ofori-Atta et al., Br J Psychiatry 212(1)), adding psychiatric care reduced symptoms, but days in chains were not significantly reduced. [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial] These are different traditions; transfer to East Slavic practice is [synthesis].
  • Steps [synthesis]: (1) Ask whether the client wants any contact at all; most often the answer is no, and the work is simply to discuss healer visits in session. (2) If yes, obtain written, specific consent naming what may be shared. (3) In Russia or Ukraine, ask whether the practitioner holds the relevant permit; note that Russian law excludes occult-magic services and religious rites from licensed folk medicine. [source: https://www.advgazeta.ru/ag-expert/advices/tselitel-vrach-ili-sharlatan/] (4) Limit contact to safety-relevant coordination: medical care continuing, no physical harm, no pressure to stop prescribed treatment. (5) Never ask about or record the content of rites or charms. (6) For clergy, ask the client to arrange contact through their parish.
  • Example language (illustrative, to the client): "Would it help if your priest and I were in touch, or would you rather keep these separate? Either is fine."
  • Watch for: a practitioner who advises stopping medication or avoiding doctors, charges escalating fees, or claims to treat cancer or other serious disease; both Russian rules and a Ukrainian draft order bar folk healers from treating cancer, infectious and other dangerous diseases. [source: https://gxpnews.net/2025/06/kak-narodnaya-mediczina-stala-bolnym-mestom-zdravoohraneniya/] [source: https://jurliga.ligazakon.net/news/138851_mnokhoronzdorovya-rozrobilo-nov-vimogi-do-narodnikh-tslitelv] It is working when the client reports no conflict between the helpers.

4.11 Routing medical and remedy questions

  • Purpose / when: folk medicine includes herbal, animal and mineral remedies and "charmed" water taken at home [source: https://honchar.org.ua/en/blog/folk-medicine-i178] [source: https://journals.ku.edu/folklorica/article/download/3707/3550]; clients may also stop or change prescribed medicines.
  • Steps [synthesis]: (1) Ask what the client is taking, including remedies. (2) Record without comment on content, dose or preparation. (3) Ask whether their doctor or pharmacist knows. (4) If not, encourage them to tell the prescriber; with consent, inform the prescriber yourself. (5) Never advise starting, stopping or changing any medicine or remedy. (6) For new physical symptoms, direct to medical assessment.
  • Example language (illustrative): "I can't advise on remedies or medicines, but your doctor needs the full picture. Would you be willing to tell them, or shall I with your permission?"
  • Watch for: delay of medical care for a physical illness attributed to porcha. It is working when the prescriber has a complete list.

4.12 Safeguarding and exploitation screening

  • Purpose / when: any time harm, coercion or exploitation is possible. Reported risks include unlicensed invasive procedures (a Russian deputy cited home bloodletting with heavy blood loss) and a large unaccredited online market. [source: https://gxpnews.net/2025/06/kak-narodnaya-mediczina-stala-bolnym-mestom-zdravoohraneniya/] Village babky are described as charging small, informal amounts. [source: https://journals.ku.edu/folklorica/article/download/3744/3583] Fraud and harm are criminal matters in Russia (e.g. Criminal Code arts. 159 and 235, as legal commentary describes). [source: https://www.advgazeta.ru/ag-expert/advices/tselitel-vrach-ili-sharlatan/]
  • Steps [synthesis]: (1) Ask about payments, debts, escalating fees, threats ("the curse will return if you stop"). (2) Ask about any physical procedure, cutting, restraint, fasting or isolation. (3) For children taken to healers for fright, stuttering or sleep problems, check that paediatric, developmental and speech assessment has also happened, and that no practice harms the child. (4) Apply your jurisdiction's adult and child safeguarding procedures; record facts, not beliefs. (5) Where fraud is suspected, help the client consider consumer-protection or police routes.
  • Example language (illustrative): "Has anyone asked for more money to keep the protection working, or warned you something bad will happen if you stop going?"
  • Watch for: confusing a harmless traditional visit with abuse, and abuse hidden as tradition. It is working when risks are named and a plan exists.

4.13 Integrating a healing visit

  • Purpose / when: after the client has seen a healer or priest and returns with relief, disappointment or new fears. [synthesis]
  • Steps: (1) Ask what the visit meant to them, not what was done. (2) Ask what changed in symptoms, mood, sleep, relationships. (3) Link any relief to agency the client can keep ("you went because you decided to act"). (4) If fear increased (e.g. a named sender), work on it as anxiety and conflict. (5) Fold insights into the plan.
  • Example language (illustrative): "You don't need to tell me what she did. What did it feel like afterwards, and what's different this week?"
  • Watch for: reliance on repeated visits to manage anxiety in a reassurance-seeking cycle; explore gently. It is working when the client describes coping they own.

4.14 Family, elders, diaspora and displacement

  • Purpose / when: knowledge is usually held by older women and passed within families [source: https://honchar.org.ua/en/blog/folk-medicine-i178] [source: https://ojs.folklore.ee/index.php/incantatio/article/view/143]; belief can differ sharply between generations, as in diaspora communities. [source: https://mspace.lib.umanitoba.ca/items/58b80261-8e27-4d28-bad3-04073eea9438]
  • Steps [synthesis]: (1) Map who in the family holds or believes the tradition. (2) Use the Informant Version or Caregivers module with consent. (3) Treat intergenerational disagreement as a family issue, not a test of truth. (4) For war-displaced clients, use the Immigrants and Refugees module and attend to loss of home healers, church and community. (5) Use trained interpreters, not relatives.
  • Example language (illustrative): "Your mother wants to take your son to a babka; you want him seen by a doctor. Could both happen, and what matters most to each of you?"
  • Watch for: the therapist becoming the family's referee. It is working when the family agrees on safety even if not on explanation.

4.15 Adapting the indicated psychotherapy

  • Purpose / when: Phase C; the evidence-based therapy for the diagnosed condition is delivered in a culturally fitting way. [synthesis]
  • Steps: (1) Use the client's idioms in psychoeducation (fright, nerves, heaviness). (2) Choose metaphors from the client's life (household, garden, faith). (3) Frame homework as something the client does for themselves, compatible with prayer or a healer's advice. (4) Re-check the explanatory model every few sessions. (5) Track outcomes with routine measures.
  • Example language (illustrative): "Whatever was sent, your body learned to stay on alert. These exercises teach it that it can stand down."
  • Watch for: homework framed as competing with the healer. It is working when symptoms fall and the client feels respected.

5. Handling problems

The sources describe the tradition, not psychotherapy alongside it; all responses below are [synthesis] unless tagged.

  • Client will not discuss the healer or the belief. Likely shame, church disapproval or fear of ridicule. Response: stop probing; state once that many clients use several kinds of help and that you will not judge; return to it after trust builds; keep the plan focused on what the client does want. (illustrative) "You don't have to tell me anything about that. The door stays open."
  • Client asks you to confirm the curse is real, or that it is nonsense. Response: decline both, warmly; reflect the importance of the question; ask what it would mean to them if it were one or the other. (illustrative) "I'm not the right person to judge that, but I can see how much hangs on it for you. What would change if you knew?"
  • Client asks you to recommend a good babka or znakharka, or to teach a charm or protection. Response: decline; explain that this is outside your role and that the tradition has its own ways of finding and choosing healers; if the client is in Russia or Ukraine, note that legal status can be checked with the regional health authority. [source: https://www.advgazeta.ru/ag-expert/advices/tselitel-vrach-ili-sharlatan/] Never supply rites, charms or objects.
  • Stuck: symptoms unchanged and the client attributes everything to an ongoing curse. Response: re-run the explanatory-model questions; look for real ongoing conflict, abuse or trauma behind the named sender; review diagnosis (depression, PTSD, OCD, psychosis); consider whether repeated healer visits function as reassurance; discuss in supervision; consider psychiatric review.
  • Resistance to a diagnosis or to medication. Response: present the clinical description as an additional lens; separate what therapy can offer from medication decisions; route medication questions to the prescriber; never pressure or advise on medicines.
  • Overwhelm or acute fear (e.g. after learning a relative is the alleged sender). Response: grounding and stabilisation; safety and risk assessment including harm to others where anger is high; pause formulation work; increase session frequency if needed.
  • Non-adherence to homework. Response: ask whether the task conflicts with prayer, a healer's instruction or family expectations; redesign it to fit; reduce size.
  • Rupture: client feels mocked or pathologised. Response: name it, apologise for the effect, ask what landed badly, restate the two-frame formulation; check your own reactions in supervision (4.1).
  • Moral or religious conflict causes guilt or scrupulosity. Response: use the Spirituality, Religion, and Moral Traditions module; offer a link with the client's own priest; assess for OCD-type scrupulosity. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
  • Medical delay or harmful practice. Response: name the safety concern plainly; encourage urgent medical care; follow safeguarding procedures; document facts. Folk healers in Russia are barred from treating cancer, infectious and other dangerous diseases. [source: https://gxpnews.net/2025/06/kak-narodnaya-mediczina-stala-bolnym-mestom-zdravoohraneniya/]
  • Financial exploitation by online or commercial "healers". Response: explore payments and threats; support the client to stop paying; inform about consumer-protection or police routes; treat fear of retaliation as an anxiety target.
  • Child taken for fright, stuttering or sleep problems. Response: respect the family's action while ensuring paediatric, speech and developmental assessment; involve caregivers through the CFI Caregivers and School-Age modules; escalate only on evidence of harm. [source: https://journals.ku.edu/folklorica/article/download/3744/3583]
  • Unusual experiences (seeing or hearing a sorcerer, transformations). Response: assess as in 4.7; consult a cultural broker; neither dismiss nor collude; seek psychiatric assessment if there are other psychotic or mood features. [source: https://vestnik-pp.samgtu.ru/0236-2007/article/view/670837]
  • War-displaced Ukrainian clients grouped with Russians, or vice versa. Response: ask how they name their heritage, language and church; use their terms; do not treat the traditions as one. [source: https://journals.ku.edu/folklorica/article/download/3744/3583]
  • Interpreter is a community member or relative. Response: request a professional interpreter, ideally from outside the client's immediate community, for confidentiality and to avoid stigma.

Sources

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