Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 147
Guide XI-147

Home remedies and granny cures

A 33 · L 57 · M 1016 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: this is not a manualised therapy. Home remedies and "granny cures" are an everyday, lay tradition of family health knowledge. This guide describes the tradition as public-health agencies and scholars document it. The psychotherapist's own work follows the DSM-5-TR Cultural Formulation Interview (APA core CFI, with the DSM-5 Informant Version and Supplementary Modules) and Kleinman's explanatory-model questions. Product-safety facts follow the CDC page on lead in foods, cosmetics and medicines (last reviewed August 2025).

What it is. Home remedies are the teas, foods, rubs, powders, tonics and small rituals of care that households use for everyday illness, usually before or alongside formal health care. WHO's definition of traditional medicine starts with "the sum total of the knowledge, skill, and practices" based on theories, beliefs and experiences. Family remedies sit at the household end of that range [source: https://shgmgetatdb.saglik.gov.tr/EN-68917/who.html]. The knowledge often passes down the female line. In a study of Latino migrant workers in South Florida, a participant described a grandmother teaching her to use peppermint tea. Participants also consulted relatives, friends and lay healers (hierberos/as, sobadores/as, sanadores/as, curanderos/as). The author concludes that self-medication "is not merely a pharmacological process but a sociocultural one" [source: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2014.00108/pdf]. In Appalachia, "granny women" were older women who served as midwives and local healers, the people others came to "with their problems" [source: https://www.appalachianhistory.net/category/granny-women]. Migrant communities often keep their remedies after moving. Among Turkish migrants in Cologne, half the ingredients came from Turkey, and less than 10% of their plant uses overlapped with German evidence-based phytotherapy (Pieroni et al. 2005) [source: https://bradscholars.brad.ac.uk/entities/publication/696f48b8-3a2d-476d-88d8-a7220b9f6704].

Who holds authority. No licensing body or lineage governs household remedies. Authority sits with the family, typically elder women such as grandmothers and mothers, and with local lay healers whom the community recognises [source: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2014.00108/pdf] [source: https://www.appalachianhistory.net/category/granny-women]. Public-health bodies such as the CDC and state lead-poisoning programmes publish warnings about specific contaminated products [source: https://cdc.gov/lead-prevention/prevention/foods-cosmetics-medicines.html]. The psychotherapist does not prescribe, prepare or evaluate remedies, and is not a holder of this tradition.

How change happens in the therapist's work. The remedies themselves are the family's practice and are outside this guide. The therapist's contribution rests on three ideas. First, asking openly about remedies shows the client's explanatory model, coping and help-seeking pathway. Second, that understanding lets therapy build on the family's caring practices rather than compete with them. Third, open enquiry brings safety risks to the surface so they can be routed to the right professional: lead-contaminated products, interactions with prescribed medicines, delays in medical care, and risks to children [synthesis, building on the CFI's purpose of clarifying the problem, its meaning, sources of help and expectations of services: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].

2. Framework

This is a framework for the therapist's culturally responsive work. It is not a staged protocol from any source, so the phases below are [synthesis]. The tools named in each phase are sourced in section 4.

Phase A: Opening the topic (session 1, continuing).

  • Goal: make it normal and safe to talk about home remedies and family health knowledge.
  • Format: a few questions inside intake, plus one routine line on any medication or substance review.
  • Move on when the client has named at least whether they or their family use remedies, or has clearly declined the topic.

Phase B: Cultural formulation (sessions 1–3).

  • Goal: understand the problem in the client's terms.
  • Tools: the core CFI and, where useful, the Explanatory Model, Coping and Help-Seeking, Spirituality, Cultural Identity, Immigrants and Refugees, Older Adults or Caregivers modules, plus Kleinman's questions.
  • APA states that 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].
  • Time needed for the core CFI: no figure in minutes was verified [uncertain]. The DSM-5 field trial found that later interviews "required less time" [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/].
  • Move on when you can state the client's name for the problem, the cause they believe in, what they do about it at home and whom they consult, and the client agrees with that summary.

Phase C: Safety and coordination (as needed, any time).

  • Goal: route any product, interaction, medical-delay or child-safety concern to the prescriber, GP, paediatrician or safeguarding lead.
  • Format: one focused conversation, with consent for any liaison.
  • Move on when the concern is handed to the right professional and documented. A safeguarding concern overrides all phases.

Phase D: Integration in ongoing therapy (rest of treatment).

  • Goal: use the family's caring practices, relationships and meanings as resources, and work with conflicts about them (for example between generations).
  • Format: woven into whatever therapy you are delivering.
  • Move on when there is no fixed endpoint. Revisit when symptoms, medicines, pregnancy, children's care or migration status change.

Phase E: Review.

  • Goal: check whether the cultural formulation still fits.
  • APA allows repeated use of the modules during treatment [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].

3. Guiding principles

  • The tradition belongs to the family. In practice: ask and learn; never prescribe, prepare, dose or rate remedies [synthesis].
  • Cultural humility. In practice: treat yourself as the learner about this family's knowledge, and notice your own family's remedies and attitudes to them [synthesis].
  • The client is the expert on meaning. In practice: the CFI clarifies the problem "from the perspective of the individual" and their social network, so record their words, not your translation [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].
  • The CFI informs but does not decide. In practice: it supports understanding and decisions and is not the only basis for a diagnosis [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].
  • Attribute, don't adjudicate. In practice: report concepts such as "wind" in the blood, empacho or nervios as the family holds them, neither as fact nor as superstition [source: https://cchp.ucsf.edu/sites/g/files/tkssra181/f/Coining_En_new.pdf] [synthesis].
  • Belief is not pathology. In practice: a shared family belief about a remedy is not a delusion. Assess function, distress and impairment instead (DSM-5-TR wording on this point [uncertain]) [synthesis].
  • Never advise on medicines or remedies. In practice: do not suggest starting, stopping or changing a medicine or remedy. Pass interaction and product questions to the prescriber or pharmacist [synthesis].
  • Safety facts are public-health facts. In practice: share agency warnings, such as the CDC on lead in some traditional medicines, as information and refer for testing through a clinician. Never test or judge a product yourself [source: https://cdc.gov/lead-prevention/prevention/foods-cosmetics-medicines.html].
  • Children: safeguarding both ways. In practice: some healing practices leave marks that look like abuse, and some remedies harm children. Do not assume abuse from culture, and do not dismiss harm as culture [source: https://calio.dspacedirect.org/items/16a199fb-4ff5-4a98-bd91-639e002967a0/full] [synthesis].
  • Consent for every liaison. In practice: talk to the GP, prescriber, family members or lay healers only with the client's consent, except where safeguarding law requires otherwise [synthesis].
  • Strengths first. In practice: remedies often carry love, memory and agency, so treat them as coping resources before treating them as risks [synthesis].
  • Language access. In practice: remedy names are often in the heritage language, so use trained interpreters, never children, and keep the original names in notes [synthesis].

[source for CFI principles: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]

4. Intervention inventory

All interventions below are the psychotherapist's own culturally responsive work. None of them involves preparing, recommending or administering a remedy. Example language is illustrative unless quoted.

4.1 Cultural humility and self-examination

  • Purpose / when: before and throughout the work. It reduces the risk of dismissing remedies as "old wives' tales" or idealising them as harmless [synthesis].
  • Steps: (1) List your own family's remedies and how you feel about them now. (2) Note which client groups' remedies you find odd, funny or alarming. (3) Bring any strong reaction to supervision. (4) Before a session, check that you know a client's heritage-language name for an illness only from them, not from a reference list [synthesis].
  • Example language (illustrative): to yourself or in supervision: "I laughed when she mentioned her grandmother's onion poultice. What was that about for me?"
  • Watch for: feeling superior or nostalgic; assuming every member of a group uses the same remedies. Working: you can ask about remedies in a neutral, curious tone and clients say more over time.

4.2 Routine, non-judgemental enquiry about home remedies

  • Purpose / when: at intake and whenever symptoms, medicines or life stage change. Many families use home remedies and lay healers before or alongside services [source: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2014.00108/pdf]. Patients may not tell their doctor about herbal use, a pattern studied in research such as "What I don't tell my doctor" (Belliard et al. 2007), though those results are not reported here [uncertain] [source: https://apha.confex.com/apha/135am/webprogram/Paper157406.html].
  • Steps: (1) Normalise first. (2) Ask in plain categories: teas and foods, rubs and oils, powders and pills from home or from shops abroad, things given to children, people consulted. (3) Ask who taught them. (4) Ask what they use for the problem that brings them to you. (5) Thank them and record names in the client's own words. (6) Do not evaluate in the same breath [synthesis].
  • Example language (illustrative): "Lots of families have their own ways of looking after health: teas, foods, things grandma swore by. What does your family do when someone is stressed, can't sleep or feels low?" / "Is there anything you bring from home or buy in specialist shops for health, for you or the children?"
  • Watch for: brief, guarded answers, which may signal fear of judgement or of child-protection involvement. Note mention of powders for children's stomach upsets or teething, or of eye cosmetics (see 4.8). Working: the client volunteers remedies later without prompting.

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

  • Purpose / when: the structured way to elicit the problem in the client's terms. APA describes it as usable "by any clinician providing services to any individual in any care setting" [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]. It is especially useful when remedies are part of how the client copes.
  • Steps: cover the four APA domains in order, paraphrasing questions in your own words. Clinicians may reproduce the APA form for use with their patients without permission; modification and translation need APA permission [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].
    1. Cultural definition of the problem (Q1–3).
    2. Cultural perceptions of cause, context and support (Q4–10).
    3. Cultural factors affecting self-coping and past help seeking (Q11–13). This is where home remedies usually appear.
    4. Cultural factors affecting current help seeking (Q14–16), including the clinician–patient relationship.
  • Example language (illustrative): "Sometimes people try things on their own to feel better. What have you done yourself, or what has your family suggested?" / "Has anything you've tried made things better, worse, or made no difference?"
  • Watch for: answers that shrink when you take notes visibly. Clients may hide lay healers if earlier clinicians dismissed them. Working: you can write a brief formulation in the client's terms and they recognise it.

4.4 CFI Supplementary Modules and Informant Version

  • Purpose / when: for depth, as add-ons or standalone, at first evaluation, later, or repeatedly [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]. Modules most relevant to home remedies:
    • Explanatory Model: to understand why the remedy is thought to work.
    • Coping and Help-Seeking: to map remedies, lay healers and services.
    • Spirituality, Religion, and Moral Traditions: where remedies are paired with prayer or blessing.
    • Cultural Identity.
    • Immigrants and Refugees: for remedies brought from or sourced in the home country.
    • Older Adults: for elders who hold the family knowledge.
    • Caregivers: given to the caregiver, for example a parent giving remedies to a child.
    • School-Age Children and Adolescents.
    • 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-Informant.pdf].
  • Steps: (1) Choose a module from the core CFI subtopic that opened up. (2) Explain why you are asking more. (3) Ask in your own words. (4) Summarise back. (5) Record which module you used [synthesis].
  • Example language (illustrative): "You mentioned your mother always made you a particular drink when you were upset. Could we spend some time on how your family understands and looks after this kind of trouble?" / to a grandparent, with consent: "What do you think is happening to your grandson, and what would you do about it at home?"
  • Watch for: the informant's view overriding the client's. Hold both views and note where they differ. Working: you understand who in the family decides about remedies and care.

4.5 Kleinman's explanatory-model questions

  • Purpose / when: a short alternative or complement to the CFI Explanatory Model module. It comes from Kleinman, Eisenberg and Good (1978), Annals of Internal Medicine 88:251–258 [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader].
  • Steps: cover, in your own words, eight areas [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf]:
    1. What the client calls the problem.
    2. What caused it.
    3. Why it started when it did.
    4. What it does to them and how it works.
    5. How severe it is and how long it will last.
    6. What treatment they think they should receive.
    7. What problems it has caused.
    8. What they fear most. Then add one remedy-specific question about what they already do [synthesis].
  • Example language (illustrative): "What do you call this in your family?" / "What do you think should help, and is that something you do at home already?"
  • Watch for: a mismatch between the client's expected treatment (for example a tonic, a cleanse, rest with special foods) and talking therapy. Name it and negotiate rather than override. Working: you can describe the client's model and your own side by side, and agree a shared plan.

4.6 Recognising cultural concepts of distress and folk illness names

  • Purpose / when: when the client uses a named illness that comes with its own home treatments. DSM-5-TR says cultural concepts of distress "include idioms, explanations or perceived causes, and syndromes" [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf].
    • DSM-5-TR examples, from a secondary source: 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]. The exact DSM-5-TR list is [uncertain].
    • Folk illnesses treated with home remedies include empacho, a stomach complaint for which Mexican and Central American families have used powders such as greta and azarcon [source: https://cdc.gov/lead-prevention/prevention/foods-cosmetics-medicines.html] [source: https://dph.georgia.gov/sites/dph.georgia.gov/files/EnvHealth/Lead/lead.folkremedies.pdf]. Another is the Southeast Asian concept of "wind" treated by coining (cao gio) [source: https://cchp.ucsf.edu/sites/g/files/tkssra181/f/Coining_En_new.pdf].
  • Steps: (1) Ask the client to describe the illness in their words. (2) Ask what it means about the cause. (3) Ask how the family treats it. (4) Assess separately for any DSM or ICD disorder. (5) In the formulation, record the folk term as the client's idiom, not as a diagnosis [synthesis].
  • Example language (illustrative): "When you say your nerves are bad, what does that feel like, and what do people in your family do for nervios?"
  • Watch for: using a glossary term the client never used; equating an idiom with a disorder; missing a disorder behind an idiom. Working: the client uses their own term freely with you.

4.7 Mapping family health knowledge (remedy map) [synthesis]

  • Purpose / when: when remedies carry family history, grief, migration or gender roles, for example a grandmother's cures after her death. It is a variant of a genogram focused on who cared for whom and how. No source describes it as a named technique, so it is [synthesis].
  • Steps: (1) Draw the family with the client. (2) Mark who held health knowledge and what they did. (3) Mark what was lost or kept after migration. (4) Mark the client's own use now. (5) Ask what the remedies mean, beyond the effect they are meant to have.
  • Example language (illustrative): "Who in your family was the one people went to when they were ill?" / "When you make that tea now, what goes through your mind?"
  • Watch for: grief, guilt about not keeping traditions, or conflict between generations. Do not collect recipes; record people and meanings. Working: the map opens material on attachment, loss or identity.

4.8 Safety screening for contaminated products (lead and other metals)

  • Purpose / when: whenever a client or their child uses imported powders, tonics, teething or stomach remedies, or eye cosmetics. CDC names several traditional products that may contain lead [source: https://cdc.gov/lead-prevention/prevention/foods-cosmetics-medicines.html]:
    • Greta and azarcon (also called alarcon, coral, luiga, maria luisa or rueda): Hispanic traditional medicines used for upset stomach (empacho), constipation, diarrhoea and vomiting, and on teething babies. Lead content is as high as 90%.
    • Ghasard: an Indian brown powder used as a tonic.
    • Kajal, also called kohl or surma: an eye product used in parts of Africa and the Middle East.
    • Ba-baw-san: a Chinese remedy used for colic or to calm young children.
    • Daw tway: a digestive aid from Thailand and Myanmar.
    • Sindoor: a cosmetic and religious powder.
    • A state list credited to Florida's lead programme adds further named items, such as bali goli, bint al dahab, kandu, kushta and pay-loo-ah. It notes that such products may also contain arsenic and mercury [source: https://dph.georgia.gov/sites/dph.georgia.gov/files/EnvHealth/Lead/lead.folkremedies.pdf].
    • CDC: most exposed people have no symptoms, a blood lead test is the best way to tell, lead cannot be seen or tasted, sellers may not know, and only laboratory testing confirms it [source: https://cdc.gov/lead-prevention/prevention/foods-cosmetics-medicines.html].
  • Steps: (1) Ask neutrally whether any powders, tonics or eye cosmetics are used, especially for children or in pregnancy. (2) If a product is named, say plainly that some traditional products have been found to contain lead and that this is a public-health finding, not a judgement on the family. (3) Encourage the client to contact their own or their child's doctor, as CDC advises, to discuss a blood lead test. Offer, with consent, to write to or call the GP or paediatrician. (4) Do not tell the client to stop or keep using the product; the medical clinician advises. (5) Document the product name as given [synthesis on steps; CDC on contacting the child's health care provider].
  • Example language (illustrative): "Some powders that families use for stomach upsets or teething have been tested by health authorities and found to contain lead, which you can't see or taste. Would you be willing to mention it to your child's doctor? I can help you with what to say."
  • Watch for: shame or fear of being reported. Make clear that the conversation is about safety, and be honest about your safeguarding duties (4.15). Also watch for loyalty conflicts if the product came from a grandparent. Working: the family contacts the doctor, and you hear the outcome without having to chase it.

4.9 Liaison with the prescriber about remedy–medicine interactions

  • Purpose / when: when a client on prescribed psychotropics or other medicines also uses herbal or home remedies. For example, NCCIH states that St John's wort "can weaken the effects of many medicines," including some antidepressants, birth control pills and warfarin. With some antidepressants it "may lead to increased serotonin-related side effects, which can be serious." NCCIH advises talking with a health care provider before using herbal products if you take medicine [source: https://nccih.nih.gov/health/stjohnswort/ataglance.htm].
  • Steps: (1) Ask which remedies are taken by mouth and how often, using the client's words. Do not ask about or record preparation detail beyond the name. (2) Explain that some plant remedies can interact with medicines and that only the prescriber or pharmacist can judge this. (3) Encourage the client to tell the prescriber, or with consent, inform the prescriber yourself. (4) Never advise starting, stopping or changing a medicine or remedy [synthesis].
  • Example language (illustrative): "Your doctor needs the full picture, including the teas and herbs, because some can change how medicines work. Would you like to tell them, or shall I let them know with your permission?"
  • Watch for: the client stopping their medicine in favour of the remedy, or the reverse, after your conversation. Check that this is not a reaction to how you raised it. Working: the prescriber has the information, and the client feels both practices were respected.

4.10 Distinguishing normative practice from illness, and spotting harmful delay

  • Purpose / when: when beliefs about remedies or folk illnesses seem unusual to you, or when a remedy is used in place of urgent care.
  • Steps: (1) Check whether the belief is shared in the client's family or community, by asking the client, an informant (Informant Version) or a cultural broker. (2) Assess distress, impairment and change from baseline, not the content of the belief. In DSM-5 wording, possession and trance phenomena are not counted as disorder when they are a "normal part of a broadly accepted cultural or religious practice." Whether DSM-5-TR uses the same wording is [uncertain], and the analogous note for psychotic symptoms was not verified [uncertain] [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299]. (3) Separately ask about red-flag physical symptoms and whether medical care is being delayed. With consent, encourage medical review. (4) No remedy should be framed as treating cancer or other physical disease [synthesis].
  • Example language (illustrative): "Is this something others in your family would also do or believe?" / "How long have you been treating the fever at home? I'd like you to get it checked by a doctor as well, alongside what you're doing."
  • Watch for: two errors. One is pathologising a common family belief. The other is missing psychosis, mania, an eating disorder or self-neglect presented in remedy terms, such as extreme "cleansing" or refusing food as a cure [synthesis]. Working: your diagnostic reasoning separates the belief from the impairment.

4.11 Integrating remedies as coping resources [synthesis]

  • Purpose / when: when remedies are part of the client's self-care, for example a calming tea ritual, a family food for low mood, or a grandmother's blessing with a cure. CFI domain 3 (self-coping) supplies the material [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].
  • Steps: (1) Ask what the practice does for the client: soothing, connection, a sense of being cared for, structure. (2) Link those functions to therapy goals, such as a self-soothing routine, behavioural activation or a sleep routine. (3) Leave the content of the remedy to the client and family. Do not add, adjust or recommend ingredients. (4) Where remedies are paired with charms or prayers, acknowledge them without asking the client to recite or teach them.
  • Example language (illustrative): "It sounds like making your grandmother's soup is one of the few times you feel looked after. Could we build on that time in your evening routine?"
  • Watch for: your endorsement being heard as a medical recommendation. Clarify that you value the meaning and are not judging the effect. Working: the client uses the practice intentionally, as part of a wider coping plan.

4.12 Working with families, elders and generational differences [synthesis]

  • Purpose / when: when family members disagree about remedies, for example an elder insisting on a cure while a young adult wants only clinical care. Also when the family elder is the client's main source of help. Use the Informant Version, and the Older Adults or Caregivers modules [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]. Migrants may keep remedies by importing ingredients, while use in the new country diverges from local practice [source: https://bradscholars.brad.ac.uk/entities/publication/696f48b8-3a2d-476d-88d8-a7220b9f6704]. Such divergence can set up generational differences.
  • Steps: (1) With the client's consent, invite the relevant relative. (2) Ask each person's view of the problem and of what helps. (3) Reflect the shared aim, such as recovery or the child's wellbeing. (4) Negotiate a plan in which family practices and clinical care sit side by side, with any safety issues routed as in 4.8–4.9.
  • Example language (illustrative): "You both want her to get better. Grandma, what have you seen help in the family? And what would you like the doctor and me to do?"
  • Watch for: the clinician taking sides; elders feeling displaced; the client being caught between loyalty and autonomy. Working: the family can talk about remedies openly in the room.

4.13 Interpreters and cultural brokers [synthesis]

  • Purpose / when: when remedy names, illness terms or family roles need the heritage language, or when you cannot judge whether a belief is normative.
  • Steps: (1) Use a trained interpreter, never a child. (2) Brief the interpreter to translate remedy and illness names as spoken, not to interpret them. (3) With consent, consult a cultural broker or community member about what is ordinary in that community, without identifying the client. CFI domain 4 covers language barriers in the clinician–patient relationship [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].
  • Example language (illustrative): to the interpreter: "Please give me the word she uses for the illness and for the remedy, then a rough meaning."
  • Watch for: an interpreter from the same small community, which raises confidentiality concerns, or one who adds their own opinion of folk remedies. Working: the terms in your notes match the client's.

4.14 Collaboration and referral with community-recognised lay healers, when the client wishes

  • Purpose / when: when the client already sees a respected local healer (for example hierbero/a, sobador/a or curandero/a, as named in research with Latino migrants [source: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2014.00108/pdf]) and wants care coordinated.
    • Formal evidence on collaboration comes from faith and traditional healers working with psychosis services, not from household remedies, so applying it here is [synthesis].
    • COSIMPO (Gureje et al., The Lancet 2020), a cluster trial in Nigeria and Ghana, found that collaborative shared care between healers and primary care reduced symptoms more than control. Harmful practices fell in both arms (57% to 9% with the intervention, 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 medication to usual camp care lowered 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].
    • Lesson [synthesis]: collaboration can help clinically, but does not by itself remove harmful practices, which need explicit safeguarding.
  • Steps: (1) Ask whether the client wants you to know about or contact the healer. (2) Obtain written consent and agree what will be shared. (3) Approach respectfully, as a fellow helper, focusing on the client's safety and goals. (4) Agree on red flags that need medical referral. (5) Never send a client to a healer the community does not recognise, or to commercial "traditional" services outside community pathways [synthesis].
  • Example language (illustrative): "Would it help if I spoke with the sobadora you see, so we're not pulling in different directions? You decide what I can share."
  • Watch for: the healer being asked to change practice by you (not your role); remedies or practices that cause harm (restraint, deprivation, delay of urgent care), which need safeguarding responses (4.15). Working: the client reports that both helpers know about each other and there is no conflicting advice.

4.15 Safeguarding children and adults at risk; consent and assent

  • Purpose / when: whenever remedies or healing practices involve children or adults at risk.
    • Two errors to avoid. First, practices such as coining (cao gio), cupping (hijama), gua sha, moxibustion and caida de mollera treatments can leave marks that resemble abuse, so accurate assessment needs cultural knowledge [source: https://calio.dspacedirect.org/items/16a199fb-4ff5-4a98-bd91-639e002967a0/full]. Second, some practices and products do cause harm.
    • California's childcare health programme lists reported complications of coining, including burns, bruising, brain bleeding, camphor poisoning and kidney injury [source: https://cchp.ucsf.edu/sites/g/files/tkssra181/f/Coining_En_new.pdf].
    • Lead-containing products have been given to babies for teething and colic [source: https://cdc.gov/lead-prevention/prevention/foods-cosmetics-medicines.html].
  • Steps: (1) Know your jurisdiction's reporting duties before you ask. (2) If marks or remedies are mentioned, ask the family to describe the practice and its purpose, calmly. (3) Consult your safeguarding lead or paediatric colleagues rather than deciding alone. (4) Act on harm whatever its cultural framing: injury, ingestion of toxic products, withholding of urgent medical care, restraint, deprivation. (5) With children, seek assent in age-appropriate language alongside parental consent. Never use a child as interpreter. Never name the child in shared notes beyond what records require [synthesis].
  • Example language (illustrative): to a parent: "I noticed you mentioned rubbing her back when she had a fever. Can you tell me about it? I ask because some home treatments can leave marks that doctors and teachers misread, and I'd like to understand." / to a child: "Is it okay if I ask you a bit about when you feel ill and what your family does?"
  • Watch for: your own bias in either direction. Look for injuries not explained by the described practice, burns, a child afraid to talk, or a pattern of delayed care. Working: a decision documented with safeguarding consultation, and a family that stays engaged.

4.16 Documentation and confidentiality [synthesis]

  • Purpose / when: every time remedies or healers are discussed.
  • Steps: (1) Record remedy and illness names in the client's words, with source and purpose. (2) Do not record preparation methods, doses or charm wording. (3) Note any consented liaison and its outcome. (4) Record safety advice given as "advised to discuss with GP or prescriber", not as an instruction about the remedy.
  • Example language (illustrative): "I'll write down that you use this for sleep and that your grandmother taught you, so other clinicians understand. Is that okay?"
  • Watch for: notes that read as mocking or exoticising. Working: the client would be comfortable reading their record.

5. Handling problems

No primary source addresses therapy problems specific to home remedies. All responses below are [synthesis] unless a source is cited.

  • Client denies using any remedies, then mentions them later.
    • Response: treat the late disclosure as trust, not inconsistency. Thank them, and re-ask the CFI self-coping and help-seeking questions at review [source for repeated use: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
  • Fear of judgement or of child-protection involvement (guardedness, "resistance").
    • Response: be transparent early about what you would need to act on, and what you would not. Separate curiosity from evaluation. Say plainly that most family remedies raise no concern for you, and that you will tell them first if something does, unless the law prevents it.
  • The client wants you to endorse or recommend a remedy.
    • Response: decline clearly and warmly. Value the meaning, and refer questions about effect or safety to the GP, prescriber or pharmacist.
    • Example (illustrative): "I can't advise on herbs or medicines, but I can help you put the question to your doctor."
  • The client stops prescribed medicine in favour of a remedy, or vice versa.
    • Response: do not advise either way. Explore the reasons using the explanatory model (4.5), then encourage prompt contact with the prescriber, or with consent inform them. Assess risk if symptoms are returning. NCCIH notes that interactions can "weaken the effects of life-saving medicines" [source: https://nccih.nih.gov/health/stjohnswort/ataglance.htm].
  • Rupture after you raised a safety warning, such as lead.
    • Response: name the rupture, acknowledge that the remedy came from someone they love, and restate that the warning comes from health authorities' product testing, not from you judging the family [source: https://cdc.gov/lead-prevention/prevention/foods-cosmetics-medicines.html]. Return to their goals.
  • The client is overwhelmed or grieving when talking about a deceased grandparent's cures.
    • Response: slow down, contain, and treat the material as grief work. Schedule the remedy map (4.7) for when the client feels steadier.
  • Generational conflict brought into therapy.
    • Response: see 4.12. Keep the client's autonomy central for adults, and keep the child's safety central for minors. Avoid being recruited as an ally against the elder.
  • Non-adherence to therapy homework because the family's practice "is the treatment."
    • Response: use Kleinman's treatment-expectation question to negotiate. Frame homework as working alongside the family practice, and agree a small trial. Accept that some clients will choose fewer sessions.
  • You suspect the remedy story is masking harm, or harm is being called culture.
    • Response: consult your safeguarding lead, using culturally informed assessment [source: https://calio.dspacedirect.org/items/16a199fb-4ff5-4a98-bd91-639e002967a0/full]. Act on injury, toxic ingestion, deprivation or delayed urgent care whatever the explanation.
  • Belief content seems delusional to you.
    • Response: check community normativity with an informant or cultural broker (4.10, 4.13) before inferring psychosis. Assess change from baseline, distress and impairment, and seek a second opinion where unsure. The DSM-5-TR note on culturally sanctioned beliefs was not verified [uncertain].
  • Remedy-related eating restriction, purging or "cleansing."
    • Response: screen for an eating disorder and for medical risk without engaging with remedy detail, and refer for medical review.
  • A client asks you to find a healer or ceremony for them.
    • Response: support them in finding one through their own family or community. Do not broker contacts outside legitimate community pathways.
  • Your own discomfort, such as the urge to correct beliefs or to romanticise them.
    • Response: take it to supervision (4.1).
  • Interpreter or community confidentiality problems.
    • Response: change the interpreter, or use a remote interpreter from outside the local community (4.13).

Sources

Web sources

Books and articles cited

  • American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).
  • Kleinman A, Eisenberg L, Good B (1978). Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88:251–258.
  • Gureje O, Appiah-Poku J, et al. (2020). Effect of collaborative care between traditional and faith healers and primary health-care workers on psychosis outcomes in Nigeria and Ghana (COSIMPO). The Lancet. Full title [uncertain].

Not verified [uncertain]: a time estimate for the core CFI; the exact DSM-5-TR list of cultural concepts of distress; the DSM-5-TR culture note on psychotic symptoms; the results of Belliard et al. on non-disclosure.

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