Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 141
Guide XI-141

Georgian folk medicine

Georgia
A 35 · L 56 · M 915 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: Georgian folk medicine (ხალხური მედიცინა) as Georgian ethnologists and folklorists document it: the Ivane Javakhishvili Institute of History and Ethnology (Mindadze 1981; Chirgadze 2020; Mindadze and Kalandarishvili 2025), regional fieldwork (Khachapuridze 2024, Lechkhumi), and the Folklore State Centre (Gelashvili, on batonebi). The therapist's own procedures follow the DSM-5-TR Cultural Formulation Interview (CFI) and its supplementary modules.

What it is. Georgian folk medicine is not a single therapy or a licensed profession. It is a body of household and community healing knowledge with two strands that ethnologists keep distinct: an empirical strand (plant, mineral and animal remedies, wound care, bone-setting, tooth extraction) and a magico-religious strand (incantations, called შელოცვები, prayers, appeals to saints, church and shrine rites, and beliefs about spirits). Georgian scholarship separates oral folk medicine from written traditional medicine. The written strand runs from the 11th-century medical almanac Ustsoro Karabadini through later karabadini compilations and the 16th-century encyclopedia Iadigar Daudi. Ethnographers report that healers drew on both strands. [source: https://dspace.nplg.gov.ge/bitstream/1234/268644/5/Qartuli_Xalxuri_Medicina_1981_Gateqstebuli.pdf] [source: https://en.wikipedia.org/wiki/Georgian_folk_medicine] [source: https://journals.atsu.edu.ge/index.php/Kartvelology/article/download/121/160/199]

How change is understood within the tradition (attributed). In the ethnographic record, illness can come from the body and environment, or from someone's harmful gaze (the evil eye), a great fright, the soul of a dead person whose rules were broken, evil spirits linked to space outside the home and the time between sunset and sunrise, or God, angels and saints punishing sin. Healing aims to remove the cause or win divine favour. Magico-religious means were used especially when the physical cause was unknown or other treatment failed. One Georgian ethnologist writes that charm-based treatment had a psychotherapeutic effect, especially when combined with herbal treatment. Infectious childhood rashes (measles, smallpox and others) were held to be visits of spirit beings called batonebi ("lords"), whom the household honours with calm and respectful conduct. These are the tradition's own accounts, not established fact, and they are not dismissed here. [source: https://openscience.ge/bitstreams/42fa0cc3-4beb-486e-934e-c6caa90f1c61/download] [source: https://geofolk.ge/en/article/qartvelta-codna-infeqciur-daavadeba-batonebze-da-mati-gamovlineba-folklorshi/304]

What remains today. Families still treat mild colds, sore throats and ear pain at home and take serious illness to qualified medicine. In Lechkhumi, rural depopulation and urbanisation are eroding the practice. Some families are still named as keepers of healing knowledge, including the Turmanidze medical family, first mentioned around the turn of the 10th and 11th centuries. In January 2023 Georgia's National Agency for Cultural Heritage Protection listed the batonebi rituals as intangible cultural heritage. [source: https://journals.atsu.edu.ge/index.php/Kartvelology/article/download/121/160/199] [source: https://en.wikipedia.org/wiki/Georgian_folk_medicine] [source: https://1tv.ge/lang/en/news/wheat-culture-vintage-meskhurian-cuisine-mtskheta-pie-making-batonebi-ritual-and-gelati-academy-added-to-intangible-cultural-legacy/]

The psychotherapist's role. The therapist does not practise this tradition: no remedies, incantations or rites. The therapist's work is to understand a Georgian or Georgian-heritage client's illness model, how they have used home remedies, family healers, clergy or shrines, and what those mean to them. The therapist then builds a culturally responsive formulation and plan, works alongside clergy, family or community figures when the client wishes, and keeps medical and safeguarding duties in view. Change in therapy, on this view, comes from a shared and respectful account of the problem that the client recognises, from coordinated help, and from removing barriers such as stigma. [synthesis]

2. Framework

This is a framework for the therapist's own culturally responsive work, not stages of the folk tradition. No source sets a session count for this work. Phases and timing are [synthesis] built on the APA's guidance on when to use the CFI and its modules.

Phase A: Engagement and cultural assessment (sessions 1-2).

  • Goals: build safety and trust; give the core CFI (16 questions in four domains: cultural definition of the problem; perceived cause, context and support; self-coping and past help-seeking; current help-seeking); if useful, interview a family member with the CFI Informant Version (17 questions). [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
  • Duration: the DSM-5 field trial reported that later interviews took less time after the first, but gave no minutes. An estimate of about 15-20 minutes for the core CFI is [uncertain: not verified]. [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]
  • Move on when you can state the problem in the client's own words, their causal ideas, which home, family, church or healer resources they have used, and any urgent medical or safety concern.

Phase B: Formulation and differential (sessions 2-4).

  • Goals: deepen with supplementary modules (Explanatory Model; Spirituality, Religion, and Moral Traditions; Coping and Help-Seeking; Cultural Identity; Immigrants and Refugees; Caregivers) as needed; separate culturally normative experience from disorder; write the cultural formulation. The modules can be used at the first evaluation, later in care, or repeatedly. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
  • Move on when the client agrees with a shared account of the problem and you have decided whether medical, psychiatric or safeguarding action is needed.

Phase C: Shared plan and collaboration (from about session 3, ongoing).

  • Goals: agree a therapy plan that fits the client's model; with consent, coordinate with the prescriber, family members, a priest or other religious leader, or a family healer; route any remedy or medicine question to the prescriber. [synthesis]
  • Move on when the roles of each helper are clear and the client knows what is shared with whom.

Phase D: Integration and review (throughout; formal review every 6-8 sessions).

  • Goals: help the client integrate church, shrine, family or healer experiences into their therapy story; repeat modules when circumstances change (e.g. migration, bereavement, a child's illness); re-check safeguarding. [synthesis]

Format. Individual sessions, with family sessions where the client wishes and where household roles matter (in the ethnographic record, mothers and grandmothers often hold healing knowledge and care roles). Use an interpreter when the client's first language is not the therapy language. [source: https://journals.atsu.edu.ge/index.php/Kartvelology/article/download/121/160/199] [synthesis]

3. Guiding principles

  • The tradition belongs to its holders. In practice: incantations, recipes and rites are kept within families and communities, and recipes were traditionally kept secret (in Lechkhumi, not taught to married daughters). Do not ask a client to recite or demonstrate them. [source: https://journals.atsu.edu.ge/index.php/Kartvelology/article/download/121/160/199]
  • Name who holds authority. In practice: no state body licenses folk healers. Authority sits with family lineages and named healing families, local healers and barber-healers (დალაქი), and, for religious rites, the Georgian Orthodox Church or, in Ajara, Muslim religious figures. Heritage status (for batonebi) is set by the National Agency for Cultural Heritage Protection. Ask the client whose word counts for them. [source: https://journals.atsu.edu.ge/index.php/Kartvelology/article/download/121/160/199] [source: https://openscience.ge/entities/publication/5d1f84b0-7065-4aee-a25c-28a1f661925e] [source: https://1tv.ge/lang/en/news/wheat-culture-vintage-meskhurian-cuisine-mtskheta-pie-making-batonebi-ritual-and-gelati-academy-added-to-intangible-cultural-legacy/]
  • Know the legal frame. In practice: under the Law of Georgia on Health Care, independent medical practice requires a state certificate and the matching medical education (Arts. 28, 33), and a physician may use only approved medicines and proven methods (Art. 51). No provision on folk or traditional medicine was found in the law's text; whether other Georgian rules regulate folk healers is [uncertain: not verified]. [source: https://www.matsne.gov.ge/en/document/view/29980]
  • Attribute, do not adjudicate. In practice: say "in your family, fright is understood to cause this" rather than "fright caused this" or "that is superstition". [synthesis, consistent with the CFI's patient-centred stance]
  • Healers as allies, not rivals. In practice: a Georgian ethnologist calls the folk healer an ally, not a competitor, of qualified medicine. Treat the client's home and family care as a resource unless it causes harm. [source: https://journals.atsu.edu.ge/index.php/Kartvelology/article/download/121/160/199]
  • Respect and kindness toward the mentally ill are part of the tradition. In practice: the ethnographic record describes a traditional ethic of kind, respectful treatment of people with mental illness and disability, with isolation only in urgent cases. Use this as common ground with families. [source: https://openscience.ge/bitstreams/42fa0cc3-4beb-486e-934e-c6caa90f1c61/download]
  • Stigma has a history. In practice: in Soviet times, seeing a therapist could be read as "insane" and lead to marginalisation, and psychiatric hospitals sometimes held undesirables. Expect wariness and explain confidentiality early. [source: https://eurasianet.org/georgia-psychotherapy-sheds-past-stigma]
  • The Church can be a bridge. In practice: the Georgian Orthodox Church has publicly backed psychology, and counsellors report priests referring parishioners to therapy (2012 report). Ask whether the client has a priest they trust. [source: https://eurasianet.org/georgia-psychotherapy-sheds-past-stigma]
  • Religious diversity within Georgia. In practice: in Ajara, Islam shaped pre-Islamic healing attitudes and methods. Do not assume Orthodox Christianity. [source: https://openscience.ge/entities/publication/5d1f84b0-7065-4aee-a25c-28a1f661925e]
  • The CFI aids judgement and does not replace it. In practice: use it to understand, not as the sole basis for diagnosis. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
  • Never advise on remedies or medicines. In practice: record what the client takes and send questions about interactions, starting or stopping to the prescriber or physician. [synthesis]
  • Medical urgency and safeguarding come first. In practice: a belief that a child's rash is a spirit visit, or that a mental illness needs only a rite, never delays urgent medical care. [synthesis]
  • Consent for every collaboration. In practice: written consent names who you may speak to (priest, healer, relative) and what you may share. [synthesis]

4. Intervention inventory

All interventions below are the psychotherapist's own work alongside the tradition. None of them is a folk-medicine practice, and none should be presented to the client as one. Example language is illustrative throughout.

4.1 Cultural humility and self-examination

  • Purpose / when: before and throughout work with a Georgian or Georgian-heritage client; whenever you notice an urge to label a belief as superstition, or to romanticise it. [synthesis]
  • Steps: (1) List your own assumptions about post-Soviet societies, Orthodox Christianity, Islam in Ajara, and folk healing. (2) Note any reflex to see incantations or saint appeals as either "irrational" or "exotic". (3) Learn the basics that ethnographers report: the two strands (empirical and magico-religious), batonebi, fright and evil-eye causation, and the role of family healers and clergy. (4) Remember the stigma history around therapy and psychiatry. (5) Bring cases to supervision or consultation with a Georgian-speaking colleague. [source: https://openscience.ge/bitstreams/42fa0cc3-4beb-486e-934e-c6caa90f1c61/download] [source: https://eurasianet.org/georgia-psychotherapy-sheds-past-stigma] [synthesis]
  • Example language (illustrative): "I know a little about how Georgian families look after health, but you are the expert on your own family. Please correct me when I get something wrong."
  • Watch for: the client testing whether you will mock their grandmother's remedies or their priest; your own curiosity turning into requests to hear incantations or recipes (do not ask). Working: the client volunteers home and church practices without being asked twice.

4.2 Core Cultural Formulation Interview

  • Purpose / when: first or second session; also whenever the presenting problem is framed in religious, spiritual or folk terms, or engagement is poor. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
  • Steps: (1) Explain that you ask everyone how they see their problem. (2) Work through the four domains in order: the client's own name and description of the problem (Q1-3); causes, stressors, supports and the role of cultural identity (Q4-10); self-coping, past help-seeking and barriers (Q11-13); current preferences and the clinician-patient relationship (Q14-16). (3) Use the client's words in your notes (e.g. the Georgian term they use). (4) Note where a supplementary module would help. (5) The APA states that clinicians may reproduce the form for use with their own patients; adapting or translating it needs APA permission. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
  • Example language (illustrative): "People describe the same problem in very different ways. How would you describe what is happening to you, in your own words, or in Georgian if that fits better?" "Besides doctors, who else have you turned to: family, a priest, someone in the village who knows remedies?"
  • Watch for: short, guarded answers about help-seeking, which may reflect fear of being judged or of psychiatric labels; a family member answering for the client. Working: the client names lay or religious help unprompted, and corrects your summary.

4.3 CFI supplementary modules and Informant Version

  • Purpose / when: when the core CFI shows a domain needs depth. For Georgian clients, the Spirituality, Religion, and Moral Traditions module and the Explanatory Model and Coping and Help-Seeking modules are often central. Use Cultural Identity for Ajaran, mountain or diaspora identities, Immigrants and Refugees for migrants and people displaced by the 1990s and 2008 conflicts, and Caregivers (given to the caregiver) when a relative carries care. The Informant Version (17 questions) is for a family member or friend. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf] [source: https://new.curatiofoundation.org/health-service-utilization-for-mental-behavioural-and-emotional-problems-among-conflict-affected-population-in-georgia]
  • Steps: (1) Choose one or two modules per session, not all. (2) Get consent before interviewing a relative, and agree what you will and will not share. (3) Repeat a module when life events change the picture (e.g. a child's infectious illness, a death, migration). [synthesis on sequencing]
  • Example language (illustrative): "You mentioned church and your grandmother's way of looking after illness. Could we spend some time on what faith means in your life and in getting through this?"
  • Watch for: fatigue from too many questions; differences between the client's and the relative's accounts (record both; do not adjudicate). Working: the modules produce concrete supports you can name in the plan.

4.4 Eliciting the explanatory model with Georgian idioms

  • Purpose / when: when the client's account of cause differs from a biomedical one, e.g. fright, the evil eye, spirits, the dead, God's punishment, or batonebi for children's rashes. [source: https://openscience.ge/bitstreams/42fa0cc3-4beb-486e-934e-c6caa90f1c61/download] [source: https://openscience.ge/entities/publication/5d1f84b0-7065-4aee-a25c-28a1f661925e]
  • Steps: (1) Ask Kleinman's questions, paraphrased: what they call the problem; what caused it; why it began when it did; what it does and how it works; how severe it is and how long it will last; what treatment they think they need; the main problems it has caused; what they fear most. (2) Record terms exactly (e.g. შეშინებული, "frightened", the term under which Lechkhumi fright incantations are recorded; ანგელოზები, "angels"; ბატონები). (3) Note where the client's model and yours overlap (e.g. fright as a stressor). (4) Feed it into the formulation in the client's terms. [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] [source: https://journals.atsu.edu.ge/index.php/Kartvelology/article/download/121/160/199]
  • Georgian concepts, attributed: in Ajaran ethnography, fright ("scaring") is named among the causes of some psychical illnesses, and the treatments described are mainly magico-religious. Fright in Georgian folk usage is not a DSM-5-TR cultural concept of distress; any likeness to susto is your own comparison, not an equivalence [synthesis]. Whether ნათვალევი always refers to the evil eye is [uncertain: not verified]. [source: https://openscience.ge/entities/publication/5d1f84b0-7065-4aee-a25c-28a1f661925e]
  • Example language (illustrative): "You said this started after a great fright. In your family, how does a fright make someone ill? What do people usually do about it?" "What worries you most about where this is going?"
  • Watch for: the client switching to "modern" language to please you; shame about "village beliefs". Working: you can summarise the model so that the client agrees, and they name what would show improvement in their own terms.

4.5 Non-judgemental inventory of home remedies, healers and religious help

  • Purpose / when: at intake and when new symptoms appear. Remedies may be taken alongside prescribed medicines, and some clients see family healers, barber-healers, priests or Muslim religious figures. [source: https://journals.atsu.edu.ge/index.php/Kartvelology/article/download/121/160/199] [source: https://openscience.ge/entities/publication/5d1f84b0-7065-4aee-a25c-28a1f661925e]
  • Steps: (1) Ask what the client takes or applies (names only; do not ask for recipes). (2) Ask who they have consulted and what they were told. (3) Ask what helped and what did not. (4) Pass any remedy-medicine question to the prescriber or physician, with consent; do not comment on safety, dose or stopping. (5) Record the information neutrally. [synthesis]
  • Example language (illustrative): "Many families have their own remedies, teas or ointments. Is there anything you take or use at home? I ask so your doctor has the full picture, not to judge it."
  • Watch for: concealment (remedy knowledge is traditionally private); a client stopping prescribed medication in favour of a remedy, which needs prompt routing to the prescriber. Working: the prescriber has an accurate list and the client feels respected.

4.6 Distinguishing culturally normative experience from disorder

  • Purpose / when: when a client or family describes possession, spirit trouble, intense fright states, unusual experiences after a rite, or a relative taken to church or a highland shrine for exorcism-style rites (described ethnographically for the mentally ill). [source: https://openscience.ge/bitstreams/42fa0cc3-4beb-486e-934e-c6caa90f1c61/download]
  • Steps: (1) Ask whether the experience is shared, expected and accepted in the client's religious or family setting, and whether it is voluntary. (2) Check the diagnostic anchors: DSM dissociative trance (under other specified dissociative disorder) excludes trance that is a normal part of broadly accepted collective cultural or religious practice; DID can present as possession in some cultures, and Criterion D excludes accepted cultural or religious practice; ICD-11 6B62 Trance disorder and 6B63 Possession trance disorder require that the state is involuntary and unwanted and not part of accepted practice. (3) Weigh distress, impairment, duration and recurrence. (4) Consult a cultural broker or the client's own priest or religious figure, with consent. (5) Screen for psychosis, mood disorder, PTSD, substance use and medical causes; avoid both pathologising and missing illness. The DSM-5-TR culture note on not counting culturally sanctioned beliefs as psychotic symptoms is [uncertain: not verified]. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299] [source: https://www.findacode.com/icd-11/code-1807490186.html]
  • Example language (illustrative): "In your church, or your village, would other people recognise what happened to you? Did it feel like something you chose, or something that happened against your will?"
  • Watch for: command hallucinations, self-neglect, suicidal thinking or loss of function hidden behind a religious frame; also the reverse, normal devotional experience labelled as illness. Working: the client and, where relevant, their religious adviser accept your account of what is and is not illness.

4.7 Mapping help-seeking pathways and barriers

  • Purpose / when: after the CFI help-seeking questions, to plan realistic care. In a study of conflict-affected adults in Georgia, barriers to formal mental health care included costs (especially medicines), a preference for self-treatment, weak referral pathways and low awareness. [source: https://new.curatiofoundation.org/health-service-utilization-for-mental-behavioural-and-emotional-problems-among-conflict-affected-population-in-georgia]
  • Steps: (1) Draw a simple map with the client: home care, relatives, healer, priest or religious figure, family doctor, psychiatrist, therapist. (2) Mark which are trusted, which cost money, and which are hard to reach. (3) Identify one feasible next step. [synthesis]
  • Example language (illustrative): "Let's draw who you go to when things get hard, and how easy each one is to reach. Then we can see where therapy fits."
  • Watch for: the cost of medicines driving non-adherence; reluctance to see a psychiatrist because of stigma. Working: the client takes a concrete step and reports back.

4.8 Collaboration with clergy, family healers and community figures

  • Purpose / when: when the client wants their priest, a Muslim religious figure, a family healer or a respected relative involved, or already uses them alongside therapy. [synthesis]
  • Context: the Georgian Orthodox Church has publicly supported psychology, and counsellors report priests referring parishioners to therapy (2012 report). Ethnography presents the folk healer as an ally of qualified medicine. Trials in other settings show what structured collaboration can do: in COSIMPO (Gureje et al., The Lancet 2020, Nigeria and Ghana), collaborative shared care between traditional and faith healers and primary care workers reduced psychosis symptoms more than enhanced usual care, and harmful practices fell; in a Ghanaian prayer-camp trial (Ofori-Atta et al., Br J Psychiatry 212(1)), adding psychiatric medication to prayer-camp care reduced symptoms, but days in chains were not significantly reduced. These are not Georgian studies; their relevance to Georgia is [synthesis]. WHO's Traditional Medicine Strategy 2014-2023 supports integrating traditional and complementary medicine, including practitioners, into health systems where safe. [source: https://eurasianet.org/georgia-psychotherapy-sheds-past-stigma] [source: https://journals.atsu.edu.ge/index.php/Kartvelology/article/download/121/160/199] [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839] [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial] [source: https://www.who.int/activities/implementation-of-the-WHO-traditional-medicine-strategy-2014-2023]
  • Steps: (1) Ask whether the client wants contact, with whom, and for what purpose. (2) Get written consent stating what may be shared. (3) Introduce yourself as working alongside, not supervising or assessing, the other helper. (4) Agree practical roles (e.g. the priest offers spiritual support; you offer therapy; the prescriber handles medicines). (5) Agree how to raise concerns, especially about urgent medical care or restraint. (6) Do not refer the client to rites or healers yourself; support the client's own choices through legitimate community or church pathways. [synthesis]
  • Example language (illustrative): To the client: "Would it help if I spoke with Father ___ so we are pulling in the same direction? You decide what I can tell him." To the helper: "I'm not here to replace what you offer. I'd like us to agree how we each support them."
  • Watch for: the client feeling caught between helpers; confidentiality slips in small communities; any helper advising the client to stop medicines. Working: the client reports consistent messages from all helpers.

4.9 Interpreters and cultural brokers

  • Purpose / when: when the client prefers Georgian or another language, or when idioms such as fright, the evil eye or batonebi carry meanings an outsider could miss. [synthesis]
  • Steps: (1) Use a trained interpreter, not a family member, for assessment. (2) Brief the interpreter to translate terms literally and flag idioms rather than "clean them up". (3) Check the interpreter's community ties with the client before the session (confidentiality in small diaspora communities). (4) Where needed, consult a cultural broker (e.g. a Georgian-speaking clinician) with the client's consent and without identifying details. [synthesis]
  • Example language (illustrative): To the interpreter: "If the client uses a word for an illness or a cause that has no English equivalent, please give me the Georgian word and its literal meaning."
  • Watch for: the interpreter softening religious or folk content; client reluctance in front of someone from their own community. Working: Georgian terms appear in your notes with agreed meanings.

4.10 Working with families and household care roles

  • Purpose / when: when relatives hold healing knowledge or caregiving roles (ethnography reports mothers and grandmothers as custodians of remedies and care), or disagree with the client about cause and treatment. [source: https://journals.atsu.edu.ge/index.php/Kartvelology/article/download/121/160/199] [source: https://geofolk.ge/en/article/qartvelta-codna-infeqciur-daavadeba-batonebze-da-mati-gamovlineba-folklorshi/304]
  • Steps: (1) With consent, invite the key relatives. (2) Use the Informant Version or the Caregivers module to hear their model. (3) Name shared values (care, calm, respect for the sick; the ethnographic record notes a traditional ethic of kind treatment of the mentally ill). (4) Negotiate a plan that keeps family care and adds what is missing. [source: https://openscience.ge/bitstreams/42fa0cc3-4beb-486e-934e-c6caa90f1c61/download] [synthesis]
  • Example language (illustrative): "Your family clearly cares a great deal and has its own ways of looking after people. I'd like to understand them and see how what we do here can fit alongside."
  • Watch for: a family view overriding the client's; isolation of the ill person beyond what the client wants. Working: the family reports a shared plan and less conflict about cause.

4.11 Integrating religious and healing experiences

  • Purpose / when: when the client has received a blessing, church rite, incantation from a relative, or visited a shrine, and wants to make sense of it in therapy. [synthesis]
  • Steps: (1) Invite the client to describe the meaning and the felt effect, not the procedure or words. (2) Link helpful effects (calm, hope, belonging) to therapy goals. (3) Explore any distress or confusion afterwards. (4) Do not interpret the experience's spiritual truth either way. [synthesis]
  • Example language (illustrative): "You don't need to tell me what was said. What did it leave you with: calmer, hopeful, unsettled?"
  • Watch for: guilt if the rite "did not work" (e.g. belief that illness is a punishment for sin); pressure from others to stop therapy. Working: the client holds both supports without feeling disloyal to either.

4.12 Childhood illness, batonebi beliefs and medical care

  • Purpose / when: when a parent describes a child's rash or fever in terms of batonebi, or a family follows batonebi customs. Ethnography reports that batonebi covered measles, rubella, chickenpox, whooping cough, smallpox, mumps and scarlet fever, which could cause serious complications or death, and that the household was expected to stay calm and respectful toward the spirits. [source: https://geofolk.ge/en/article/qartvelta-codna-infeqciur-daavadeba-batonebze-da-mati-gamovlineba-folklorshi/304]
  • Steps: (1) Respect the custom of calm and care; it is compatible with medical care. (2) Ask whether the child has been seen by a doctor. (3) If not, or if there are danger signs, advise urgent medical assessment. (4) If care is being withheld and a child is at risk, follow your safeguarding procedure. (5) No source links batonebi beliefs to delayed medical care or vaccine refusal today; this is a [synthesis] risk to check, not an assumption. [synthesis]
  • Example language (illustrative): "Keeping the home calm and gentle for her sounds important to your family. Alongside that, has a doctor seen her? Measles can become serious, and a doctor can check that."
  • Watch for: shame or defensiveness if the parent feels accused; a sick child not yet seen. Working: the child is seen medically and the family's customs are not dismissed.

4.13 Safeguarding where a practice may harm

  • Purpose / when: restraint or prolonged isolation of a mentally ill person, coercive exorcism-style rites, withholding of urgent medical care, ingestion or application of remedies with medical complications, or stopping prescribed medicine. [synthesis]
  • Steps: (1) Ask directly and neutrally about restraint, isolation, fasting or force. (2) Assess immediate risk. (3) Follow local adult and child safeguarding law; in Georgia, treatment of minors requires consent of a relative or legal representative (Health Care Law, Art. 11). (4) Route medical concerns to a physician urgently. (5) Document what you were told, in the client's words. [source: https://www.matsne.gov.ge/en/document/view/29980] [synthesis]
  • Example language (illustrative): "Sometimes families, out of worry, keep someone at home or hold them down when they are very unwell. Has anything like that happened?"
  • Watch for: minimisation; fear that reporting will bring shame on the family. Working: risk is reduced and the family stays engaged.

4.14 Addressing stigma and conflict-related trauma

  • Purpose / when: when wariness of therapy reflects Soviet-era stigma, or the client is among people displaced or affected by the 1990s or 2008 conflicts. [source: https://eurasianet.org/georgia-psychotherapy-sheds-past-stigma] [source: https://new.curatiofoundation.org/health-service-utilization-for-mental-behavioural-and-emotional-problems-among-conflict-affected-population-in-georgia]
  • Steps: (1) Name the stigma openly. (2) Explain confidentiality and what therapy is and is not. (3) Use the Immigrants and Refugees module where relevant. (4) Link to trauma-informed care for conflict-related experiences. [synthesis]
  • Example language (illustrative): "Some people grew up hearing that seeing a therapist meant you were 'mad'. Coming here doesn't mean that. It's a place to talk things through."
  • Watch for: missed sessions after disclosure; somatic presentations in place of emotional ones. Working: attendance stabilises and the client speaks about the problem more directly.

4.15 Writing the cultural formulation

  • Purpose / when: after Phase B, and again at reviews. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]
  • Steps: (1) Summarise cultural identity (including religion: Orthodox, Muslim, other). (2) Write the cultural concepts of distress in the client's terms (e.g. fright, evil eye, spirit causation), attributed. (3) Note stressors and supports, including family healers and clergy. (4) Describe cultural features of the client-therapist relationship (stigma, language, trust). (5) Conclude with implications for diagnosis and care. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf] [synthesis]
  • Example language (illustrative, to the client): "Here's how I understand what's happening, partly in your words and partly in mine. Tell me what I've got wrong."
  • Watch for: your biomedical model quietly replacing theirs in the write-up. Working: the client recognises themselves in the summary.

5. Handling problems

The Georgian sources describe the tradition, not therapy problems. All guidance in this section is [synthesis] unless a source is given.

  • Client asks you to perform, endorse or recommend a remedy, incantation or rite. Decline warmly and say why: this belongs to their family, healer or church. Offer to support their own choice through those pathways and to coordinate with the prescriber on anything they take. Illustrative: "That's not something I'm trained or entitled to do, but I'm glad to work alongside whoever you trust for it."
  • Client hides home remedies or healer visits. Remedy knowledge is traditionally kept private within families [source: https://journals.atsu.edu.ge/index.php/Kartvelology/article/download/121/160/199]. Normalise the question, explain you need names only for safety, and do not ask for recipes or words.
  • Client wants to stop medication for a remedy or rite. Do not advise on the medicine. Explore the reasons (cost, side effects, beliefs), and arrange a prompt contact with the prescriber with consent. Cost of medicines is a documented barrier in Georgia [source: https://new.curatiofoundation.org/health-service-utilization-for-mental-behavioural-and-emotional-problems-among-conflict-affected-population-in-georgia].
  • Stuck: the client holds a single external cause (evil eye, spirits, punishment) and sees no role for therapy. Do not argue. Work within their model: ask what would help them cope while that cause is addressed by those they trust, and target sleep, worry, family conflict or grief as shared goals.
  • Guilt and shame when illness is read as punishment for sin. Ethnography records punishment by God, angels or saints as one attributed cause [source: https://openscience.ge/bitstreams/42fa0cc3-4beb-486e-934e-c6caa90f1c61/download]. With consent, involve a trusted priest or religious figure, who may offer a less punitive reading within the faith; do not offer theology yourself.
  • Resistance rooted in stigma or fear of psychiatry. Name the Soviet-era history [source: https://eurasianet.org/georgia-psychotherapy-sheds-past-stigma], explain confidentiality and the voluntary nature of therapy, and go at the client's pace with any psychiatric referral.
  • Overwhelm during cultural assessment. Shorten: finish the core CFI over two sessions and defer modules. Return to grounding and the presenting concern.
  • Rupture: the client feels you dismissed or exoticised their beliefs. Acknowledge it specifically, apologise, and ask what would restore trust. Check whether your notes or language ("superstition", "magic") contributed.
  • Family conflict over cause or treatment (e.g. a parent favours church rites, the client wants a psychiatrist). Hold a family session with consent; use the Informant Version or Caregivers module; aim for a plan that includes both, with the client's own choice decisive if they are an adult with capacity.
  • Possible psychosis presented as spirit trouble, or the reverse. Use the steps in 4.6, consult a cultural broker and the client's own religious adviser, and get a psychiatric assessment where risk or impairment is significant. Do not let the cultural frame delay urgent care.
  • Restraint, isolation, coercive rites or withholding medical care (including for a child with an infectious rash). Assess risk and follow safeguarding procedures; see 4.12 and 4.13. Keep the family engaged by naming shared aims (safety, recovery).
  • A collaborator gives conflicting or risky advice. Raise it privately and respectfully with consent; restate agreed roles; if risk persists, prioritise the client's safety and tell them what you are doing.
  • Small-community confidentiality. In diaspora or rural settings, the interpreter, priest or healer may know the family. Agree in advance what is shared, and offer an interpreter from outside the client's circle.
  • The client is Muslim (e.g. from Ajara) or of another faith. Do not assume Orthodox Christian practice; ask about the religious figures the client trusts. Ajaran ethnography notes Islamic influence on healing attitudes [source: https://openscience.ge/entities/publication/5d1f84b0-7065-4aee-a25c-28a1f661925e].
  • The therapist feels out of depth. Seek consultation with a Georgian-speaking clinician or a cultural psychiatry service, and say openly to the client that you are learning.

Sources

Georgian folk medicine

Georgian health system and help-seeking

Cultural assessment, diagnosis and collaboration

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