Naturopathy · Atlas

1. Introduction

Version followed: naturopathic medicine as described by its North American professional organisations (Institute for Natural Medicine with the American Association of Naturopathic Physicians; Canadian Association of Naturopathic Doctors), with practitioner types and regulation as NCCIH, NABNE, the UK National Careers Service and Australian government sources describe them. This guide describes the method as its organisations publish it and sets out the psychotherapist's own work alongside it: the psychotherapist does not practise, sell, prescribe or recommend naturopathy or any naturopathic product; sections 4 and 5 describe the therapist's own work with clients who use it.

What it is. Naturopathy is a whole medical system that, in NCCIH's description, grew out of traditional practices and health approaches popular in 19th-century Europe and aims to prevent and treat disease by addressing underlying causes, treating symptoms as the body's signals of a problem [source: NCCIH]. In North America the profession traces itself to Benedict Lust, who used the term for a practice combining herbal medicine, homeopathy, nutrition, manual therapy, acupuncture and lifestyle counselling; his American School of Naturopathy in New York graduated its first class in 1902 [source: CAND history page]. Merck describes it as becoming a formal US health system in the early 1900s [source: Merck Manual].

Core idea of how change happens (as practitioners hold it). The organising belief is vis medicatrix naturae, "the healing power of nature": the body is held to have self-healing processes, and treatment aims to remove obstacles to health and support those processes, moving from gentle to more forceful interventions only as needed (the "therapeutic order") [source: INM principles; INM therapeutic order]. These are the profession's own explanatory concepts, described here as practitioners hold them.

Evidence status (one line). Merck states that few well-designed studies of naturopathic therapies exist and that some practitioners promote practices without scientific support; NCCIH links to the literature without summarising it and notes that licensure does not guarantee safe, effective treatment [source: Merck Manual; NCCIH]. No naturopathic method is presented here as a treatment for cancer or any physical disease.

Regulatory status (one line). A licensed health profession in many US states and territories and several Canadian provinces; voluntary registration in the UK; statutory registration in Australia [uncertain: not verified] (details in section 2).

2. Framework

2a. The method as its organisations describe it

Who practises it. NCCIH distinguishes (1) licensed naturopathic physicians with an N.D. or N.M.D. from a four-year graduate programme at a school accredited by the Council on Naturopathic Medical Education (CNME, established 1978); (2) traditional naturopaths trained in non-accredited programmes, who are not eligible for licensing; and (3) other providers offering some naturopathic services [source: NCCIH]. In NCCIH's figures, licensed practitioners roughly doubled between 2000 and 2016 to about 5,000 in the US and more than 2,000 in Canada, and US adult use rose from 0.2% (2002) to 1.3% (2022) [source: NCCIH].

What a client experiences. INM describes a first appointment of roughly 60–120 minutes and follow-ups of 30–60 minutes. The naturopathic doctor reviews the person's health story and its impact on daily life, all body systems, medicines and supplements, diet, movement, sleep, stress and relationships, and identifies stressors and supports; a focused physical exam may follow, tests may be ordered, and the visit ends with a customised care plan based on the person's values, lifestyle and readiness for change. INM notes that mood is a common reason people consult [source: INM first appointment]. Modalities named by the organisations and NCCIH include diet and lifestyle change, stress reduction, herbs and other supplements, clinical nutrition, homeopathy, hydrotherapy, manipulative therapies, exercise therapy, acupuncture/traditional Chinese medicine, practitioner-guided detoxification, and psychotherapy and counselling; Merck adds supplements sometimes given by infusion and physical therapies such as heat, cold, ultrasound and massage [source: NCCIH; CAND; Merck Manual]. In the UK, the National Careers Service describes naturopaths taking health, family, social and lifestyle histories, examining, arranging blood and other tests, advising on diet and lifestyle, and referring to a GP when needed [source: National Careers Service].

The therapeutic order. INM attributes the therapeutic order to Henry Lindlahr, modernised by Jared Zeff and Pamela Snider, and gives seven steps in order: (1) establish the foundations for health and remove obstacles; (2) stimulate the healing power of nature; (3) strengthen weakened systems; (4) restore structural integrity; (5) use natural substances to restore and regenerate; (6) use pharmacological substances when needed; (7) use higher-force interventions such as surgery [source: INM therapeutic order]. This guide names the steps only; it gives no remedies, substances or procedures.

Training, licensing and regulation by jurisdiction.

United States: requirements vary by state and territory; where licensing exists, candidates must graduate from an accredited programme, pass national board exams and complete continuing education, and scope varies by state [source: NCCIH]. The licensing exams (NPLEX) are administered by the North American Board of Naturopathic Examiners (NABNE), which lists regulatory contacts for 25 US jurisdictions including DC and Puerto Rico [source: NABNE].
Canada: CAND lists regulation in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia and the Northwest Territories (the same page also says "five provinces" elsewhere) [source: CAND] [uncertain: source internally inconsistent]. NABNE lists Alberta, British Columbia, Manitoba, Nova Scotia and Saskatchewan among its regulatory contacts [source: NABNE]; Ontario's examination route [uncertain: not verified].
United Kingdom: registration is voluntary; practitioners can join accredited registers run by the Complementary and Natural Healthcare Council (CNHC) or the Federation of Holistic Therapists; the General Council and Register of Naturopaths advises a course of at least three years with in-person attendance [source: National Careers Service]. A "General Naturopathic Council" exists as a professional body [uncertain: not verified].
Australia: naturopathy was among 16 natural therapies excluded from private health insurance rebates from 1 April 2019; after the Natural Therapies Review (NHMRC evidence evaluations submitted January 2025), naturopathy was one of seven therapies whose rebates were reinstated, as reported in April 2025 [source: NHMRC; NICM]. Statutory registration status [uncertain: not verified].
Vaccination positions: Merck reports that some practitioners discourage childhood vaccinations, while the Association of Accredited Naturopathic Medical Colleges encourages vaccination per authoritative guidelines, including for COVID-19 [source: Merck Manual].

2b. The psychotherapist's framework alongside naturopathy [synthesis]

There are no separate sessions; the work is woven into ordinary therapy and revisited as needed.

Phase 1 – Ask and record (intake and periodic review): goal is an accurate, non-judgemental record of who the client sees, what kind of practitioner they are, and what they are using. Move on once the picture is recorded.
Phase 2 – Understand (early in the work): goal is to understand meaning, hopes, expectations and the client's explanatory model. Move on when the client feels understood and the therapist can state the client's model in the client's terms.
Phase 3 – Decide and coordinate (as decisions arise): goal is informed, values-based choices and, with consent, contact with the doctor or pharmacist. Move on when the client has the information they want and prescribers know what they need to know.
Phase 4 – Monitor risk (throughout): check for delayed or stopped medical care, medicine changes, restrictive eating, children's care, pregnancy, financial strain and pressure. A positive risk finding interrupts any phase.

3. Guiding principles

Naturopathy's own principles (as INM publishes them, so the therapist understands the client's frame) [source: INM principles]:

First do no harm (primum non nocere): gentlest effective methods. Practical meaning: clients may expect "gentle" to mean "safe"; this is a useful opening to discuss interactions with the prescriber.
Healing power of nature (vis medicatrix naturae): support self-healing. Practical meaning: the client may value agency and trust in the body; honour that while keeping medical monitoring in view.
Identify and treat the cause (tolle causam). Practical meaning: clients may be seeking an explanation their doctors have not given; explore that need.
Doctor as teacher (docere). Practical meaning: the client may be used to long, explanatory consultations; contrast with brief medical visits can shape trust.
Treat the whole person (tolle totum), including mental, emotional, social and spiritual factors. Practical meaning: roles can overlap with psychotherapy; clarify who does what.
Prevention (preventare). Practical meaning: lifestyle goals may be shared ground for therapy.

Principles for the psychotherapist's stance [synthesis unless cited]:

Curiosity without judgement. Ask as you would about any health practice; disclosure falls when clients expect disapproval.
Not my remedy, not my referral. Never perform, sell, prescribe, recommend or advise against a specific naturopathic product or practitioner; route questions to the prescriber or pharmacist.
Never advise on medicines. Starting, stopping or changing medicines, herbs or supplements is for the prescriber and pharmacist; NCCIH itself urges people to tell all their providers [source: NCCIH; NCCIH St John's wort].
Autonomy with information. Adults decide; the therapist supports a decision process, not a preferred outcome.
Attribute, don't adjudicate. Describe naturopathic concepts as practitioners hold them; neither assert nor mock them.
Credential literacy. Know the difference between a licensed naturopathic doctor and a traditional naturopath, and that a licence does not guarantee safe, effective care [source: NCCIH].
Coordination by consent. Share information with doctors or pharmacists only with consent, except where safeguarding law requires otherwise.
Risk overrides neutrality. Delayed medical care, harm to children, restrictive eating, pregnancy risks and exploitation move the therapist from neutrality to active safety work.
No conflicts of interest. No sales, affiliate links or referral fees; disclose any personal involvement with the field. Profession's ethics code [uncertain: not verified].

4. Intervention inventory

All interventions below are the psychotherapist's own work alongside naturopathy. None involves performing, selling, prescribing or recommending naturopathic care or products. Unless cited, the procedures are [synthesis] built on general psychotherapy practice and the cited facts.

4.1 Routine, non-judgemental inquiry and recording

Purpose / when: at intake and at periodic reviews, and whenever new physical symptoms, medicines or mood changes come up. NCCIH urges people to tell all providers about complementary approaches; the therapist's matter-of-fact question makes that easier [source: NCCIH].
Steps: (1) Ask as part of the standard health-history list, after medicines. (2) Ask who they see, how often and since when. (3) Ask what the practitioner calls themselves (naturopathic doctor, N.D./N.M.D., naturopath, nutritionist) and whether they know if that person is licensed or registered. (4) Ask, in general terms, what the care involves (e.g. diet changes, supplements, herbs, homeopathy, tests, detox, counselling) without asking for or recording doses. (5) Ask whether their doctor and pharmacist know. (6) Record facts neutrally in the notes, including what the client chose not to share.
Example language (illustrative): "Alongside any prescriptions, do you see anyone else for your health, such as a naturopath, herbalist, acupuncturist or nutritionist? I ask everyone, because it helps me see the whole picture."
Watch for: hesitation or apology (signals expected judgement; slow down); vague answers about the practitioner's training; the client not knowing whether their GP knows. Working: the client volunteers updates later without prompting.

4.2 Clarifying practitioner type and role overlap

Purpose / when: when the naturopath also provides counselling or treats mood. NCCIH lists psychotherapy and counselling among naturopathic tools, and INM notes mood is a common reason people consult [source: NCCIH; INM first appointment].
Steps: (1) Ask what the naturopath is helping with, especially mood, anxiety, sleep or trauma. (2) Ask whether they give talk-based counselling and what the client takes from it. (3) Map overlaps and contradictions with the therapy plan (e.g. different explanations for low mood). (4) Agree with the client how to handle differences: name them in session, not as a contest. (5) Provide public information on practitioner types (licensed naturopathic physician vs traditional naturopath) if the client asks, and suggest they check the regulator's register themselves in licensed jurisdictions [source: NCCIH; NABNE].
Example language (illustrative): "It sounds like your naturopath is also helping with your mood. What do they suggest, and how does it fit with what we're doing here? I'd like us not to pull you in two directions."
Watch for: the client being told to stop psychiatric medicine or therapy; a client caught between two authorities. Working: the client can describe each provider's role clearly.

4.3 Exploring meaning, hopes, expectations and explanatory model

Purpose / when: once use is known, or when the client is drawn to naturopathy during a difficult medical or emotional period.
Steps: (1) Ask what led them to it (long appointments, being listened to, wanting a cause, distrust after a bad medical experience, family or community tradition, identity, wish for control). (2) Elicit their model: what they believe causes their problem and how naturopathy is meant to help, in their words (e.g. "healing power of nature", "root cause" [source: INM principles]). (3) Ask what they hope will change and by when, and how they will know. (4) Ask what they fear about conventional care. (5) Reflect back without endorsing or disputing; note needs (being heard, agency, hope) that therapy can also meet.
Example language (illustrative): "What does your naturopath give you that you haven't found elsewhere?" / "If this works the way you hope, what will be different in three months?"
Watch for: hope tied to a single outcome; anger at doctors that could drive avoidance of needed care; shame. Working: the client articulates needs in their own words and becomes more able to weigh options.

4.4 Supporting informed, values-based decisions

Purpose / when: when the client is deciding whether to start, continue, combine or stop naturopathic care, or faces a choice between it and recommended medical care.
Steps: (1) Clarify the decision and who must be involved (prescriber, pharmacist, specialist). (2) Help the client list questions to take to those professionals and to the naturopath (e.g. training and licence, evidence for this use, interactions, costs, what happens if it doesn't help, how it will be coordinated with the GP). (3) Explore values: what matters most (safety, autonomy, natural approach, cost, time). (4) Reflect any gaps in information without supplying medical answers. (5) Check that the decision is the client's own, free of pressure from the therapist, practitioner or family. (6) Revisit after the client has spoken to the professionals. No published decision aid specific to naturopathy is cited here.
Example language (illustrative): "I'm not the right person to say whether this supplement is safe with your medication, but your pharmacist is. What would you want to ask them?"
Watch for: the therapist drifting into persuasion either way; the client feeling they must choose sides. Working: the client reports having asked the questions and made a decision they can explain.

4.5 Coordinating with the client's doctor or pharmacist (with consent)

Purpose / when: when the client takes prescribed medicines, is pregnant or planning pregnancy, has a serious medical condition, or reports changes to medicines. NCCIH warns that St John's wort can weaken many important medicines, including some antidepressants, oral contraceptives, transplant, seizure, heart, HIV, cancer and anticoagulant drugs, and that combining it with serotonergic drugs may increase serious serotonin-related side effects; it may be unsafe in pregnancy [source: NCCIH St John's wort].
Steps: (1) Explain why coordination matters, using interactions as a general example. (2) Encourage the client to bring a full list of products to the prescriber or pharmacist. (3) Obtain written consent before contacting anyone; agree what will be shared. (4) Share only what the client agreed (e.g. "is using herbal products and supplements from a naturopath"), without commenting on their merit. (5) Record the contact and outcome. (6) Never advise starting, stopping or changing a medicine, herb or supplement.
Example language (illustrative): "Some herbal products can change how prescribed medicines work. Would you be willing to show your pharmacist everything you're taking, or would you like me to let your doctor know, with your permission?"
Watch for: reluctance driven by fear of being scolded by the doctor (work on this first); new side effects or worsening mood after changes. Working: prescriber aware and the client feels supported rather than reported.

4.6 Recognising and responding to risk

Purpose / when: throughout; especially when the client has a serious or progressive medical condition, takes psychiatric or other essential medicines, is pregnant, cares for children, has an eating-disorder history, or is spending heavily.
Steps: (1) Screen for: delaying or stopping medical investigation or treatment; stopping or changing prescribed medicines without the prescriber; restrictive diets or "detox" (NCCIH lists practitioner-guided detoxification among naturopathic methods [source: NCCIH]) in someone with eating-disorder risk; pregnancy or breastfeeding with herbal use (NCCIH flags St John's wort [source: NCCIH St John's wort]); children's medical care and vaccination (Merck reports some practitioners discourage childhood vaccination [source: Merck Manual]); costs of consultations, tests and products; pressure from practitioners, online groups or family. (2) For each positive, ask what the client knows and intends. (3) Encourage prompt contact with the doctor or pharmacist, and offer to coordinate (4.5). (4) For eating-disorder risk, assess restriction, weight and compensatory behaviour using standard tools and refer for medical review; no dietary advice from the therapist. (5) Where a child's medical care, vaccination or nutrition may be compromised, follow local safeguarding procedures (4.9). (6) Document risk, actions and the client's decisions.
Example language (illustrative): "You mentioned you've stopped the tablets your psychiatrist prescribed. Before anything else, can we talk about letting them know? Stopping some medicines suddenly can cause problems, and they're the right person to plan any change."
Watch for: new physical symptoms being reframed as "detox" or "healing reactions" without medical review [synthesis]; escalating spending; isolation from people who disagree. Working: risks are known to the medical team and the client stays engaged with therapy.

4.7 Health anxiety and somatic symptom presentations

Purpose / when: when use of naturopathy is part of a pattern of reassurance seeking, repeated testing, symptom checking, or searching for a single hidden cause. Cross-reference Domain II for full protocols.
Steps: (1) Formulate the cycle: symptom, threat appraisal, checking or test-seeking, short-term relief, renewed doubt. (2) Treat consultations and test-seeking (from any provider) as possible safety behaviours, without singling out naturopathy. (3) Use established CBT for health anxiety or somatic symptom approaches (Domain II): psychoeducation, behavioural experiments around checking and reassurance, attention training, values-based activity. (4) Coordinate with the GP to agree a single medical point of contact and planned reviews.
Example language (illustrative): "Each new test seems to bring relief for a few days, then the worry comes back. Shall we map that pattern together and see what keeps it going?"
Watch for: the client experiencing the formulation as dismissal of their symptoms; genuine medical issues being missed (ensure medical review). Working: fewer checking and test-seeking episodes; more time in valued activity.

4.8 Managing the therapist's own stance and conflicts of interest

Purpose / when: at all times; especially if the therapist has personal views, relationships or training in naturopathy.
Steps: (1) Notice your own reactions (enthusiasm or contempt) and take them to supervision. (2) Do not sell, recommend or refer to specific naturopathic products or practitioners, or accept any referral payments. (3) Disclose relevant dual roles and decline them where they could harm the client. (4) Check that interest in the topic in session serves the client's goals.
Example language (illustrative): "I don't recommend or advise against particular practitioners or products. What I can do is help you think through what you want and what questions to ask."
Watch for: the client asking you to arbitrate between their naturopath and their doctor; your own wish to persuade. Working: the client experiences you as steady and neutral but clear about safety.

4.9 Children: consent, assent and safeguarding

Purpose / when: when a client is a parent using naturopathic care for a child, or a young person in therapy is receiving it.
Steps: (1) Ask what care the child is receiving and whether the child's doctor is involved. (2) Explore the parent's hopes and fears with the same respect as for adults. (3) Involve the young person according to their age and capacity: their understanding, assent and views. (4) Treat as safeguarding concerns: a child kept from needed medical care, given substances that cause harm, kept on inadequate nutrition, or not vaccinated where local public-health and safeguarding guidance treats this as a concern [synthesis; local guidance not verified here]. (5) Consult your safeguarding lead and follow local procedures; document.
Example language (illustrative): "I can see how much you want her to feel better. Does her doctor know about the new plan? I'd like to make sure everyone looking after her is working together."
Watch for: weight loss, untreated symptoms, missed medical appointments. Working: the child's medical team is informed and involved.

4.10 Reporting routes

Purpose / when: when the client reports possible harm, misleading advertising, unprofessional conduct or practice beyond scope, and wants to act, or when safeguarding requires it.
Steps: (1) Support the client to decide whether and where to report; respect their choice unless a mandatory duty applies. (2) Identify the route: in licensed US jurisdictions and Canadian provinces, the naturopathic regulator (NABNE lists regulatory contacts by jurisdiction) [source: NABNE]; in the UK, the accredited register the practitioner belongs to (e.g. CNHC) [source: National Careers Service]. Product adverse effects go to the national product regulator (e.g. FDA in the US, MHRA in the UK, TGA in Australia, Health Canada); misleading advertising goes to consumer or advertising regulators (e.g. FTC in the US, ASA in the UK) [uncertain: not verified]. (3) Safeguarding concerns go to local child or adult safeguarding services. (4) Record what was reported and when.
Example language (illustrative): "Would you like to look at whether the regulator in your area handles complaints like this? It's your choice, and I can help you think it through."
Watch for: fear of retaliation or of losing a valued relationship; shame at having been misled. Working: the client makes an informed choice about reporting.

4.11 Working with disillusionment, regret and changed beliefs

Purpose / when: when a client leaves naturopathic care feeling misled, regrets choices, or is a former practitioner reconsidering their training. Public accounts exist: STAT reported that Britt Hermes practised as a naturopathic doctor for about three years, left after discovering a supervisor importing an unapproved cancer drug, reported it to the state board, and became a public critic of naturopathic training and practice [source: STAT].
Steps: (1) Validate the original reasons for choosing it. (2) Explore shame, anger, regret and losses (money, time, community, identity). (3) Distinguish responsibility from self-blame. (4) Support rebuilding trust with medical care. (5) If there was harm, consider reporting (4.10).
Example language (illustrative): "You made that choice for reasons that made sense to you at the time. What do you wish you'd known?"
Watch for: depression, grief, loss of community. Working: the client can talk about it without collapse into blame.

5. Handling problems

The sources describe naturopathy itself, not psychotherapy alongside it, so all guidance in this section is [synthesis] unless cited.

Client won't disclose or minimises use. Normalise ("many people use more than one kind of care"), explain why you ask (interactions, the whole picture), and do not press. Return to it at the next review. If disclosure comes, thank them rather than react.
Client asks "Do you think it works?" or "Should I see a naturopath?" Do not recommend for or against. Say that the evidence status is a question for the medical team; Merck notes that few well-designed studies exist [source: Merck Manual]. Turn to what they hope for and what questions they would ask (4.4).
Client asks the therapist to advise on a supplement, herb or dose. Decline clearly and kindly; route to the prescriber or pharmacist; offer coordination (4.5).
Client has stopped prescribed psychiatric medicine on a naturopath's advice. Treat as a clinical risk: assess mental state and withdrawal-related symptoms, encourage immediate contact with the prescriber, offer to coordinate with consent, and increase monitoring. Do not argue with the naturopath through the client.
Client is delaying investigation or treatment of a serious physical condition. Explore fears (diagnosis, side effects, loss of control, past medical trauma) with empathy; support the client to keep medical appointments alongside other care; involve the GP with consent; document the discussion and the client's decision. With capacity, the adult decides; without capacity or where a child is affected, follow capacity and safeguarding procedures.
Rupture: the client hears the therapist's questions as hostility to their choices. Acknowledge, apologise for how it landed, restate that you ask about all health care, and reaffirm their autonomy. Repair before continuing risk work if risk allows.
Rupture: the client feels the therapist is too accepting while their family is alarmed. Clarify your role: you neither endorse nor oppose; your aim is informed decisions and safety. Offer a family session focused on communication, not on the method.
Competing authority: the naturopath gives a different account of the client's mood or anxiety. Name the difference, ask what fits the client's experience, and invite consent for professional coordination where helpful.
Overwhelm from conflicting health information. Slow the pace, reduce to one decision at a time, use a written list of questions, and set boundaries on online searching if it fuels anxiety (cross-ref Domain II).
Non-adherence to medical plans or therapy homework. Explore whether time, money or energy is going into the naturopathic plan, and whether plans conflict; problem-solve collaboratively without making the client choose.
Financial strain. Ask about costs openly (consultations, tests, products); explore whether spending fits the client's values and means; flag pressure to buy products as a concern and consider reporting routes if marketing was misleading (4.10).
Restrictive eating framed as health. Screen for eating-disorder risk; refer for medical and specialist eating-disorder assessment; avoid giving any dietary advice.
Pregnancy. Encourage the client to tell the midwife or obstetrician about everything they use; NCCIH states St John's wort may be unsafe in pregnancy [source: NCCIH St John's wort].
Group or online pressure (e.g. communities opposed to vaccination or conventional medicine). Explore belonging needs and the cost of disagreeing; support the client in keeping relationships and making their own decisions.
The therapist's own strong views. Use supervision; check whether your interventions serve the client's goals or your opinions.

Sources

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