Siberian shamanhood (Evenki, Sakha, Tuvan and others)

1. Introduction

Version followed: no single canon exists. For the tradition, this guide uses accounts published by or about Siberian communities and their institutions (Tuvan shamanic societies, the Sakha Aar Aiyy faith, Tungus-Manchu and Oroqen ethnography, 2005 to 2023). For the therapist's own work it follows the DSM-5-TR core Cultural Formulation Interview (APA, 2022) with the DSM-5 (2013) Informant Version and Supplementary Modules, and Kleinman's explanatory-model questions (1978).

Siberian shamanhood is not one therapy. It is a set of living, revived and partly lost spiritual and healing traditions among peoples including the Evenki, Even, Sakha (Yakut), Tuvan, Nanai, Nenets, Enets, Selkup, Khanty, Nivkh and Oroqen. [source: Lavrillier & Sem 2021; Zabiyako & Wang 2023; Leete 2005] A Russian reference entry describes the shaman, as communities hold it, as a person "chosen by spirits" to safeguard the community. It also notes that the word itself is usually traced to an Evenki term. [source: bigenc.ru entry "Шаманизм"; Al Jazeera 2015] Within the tradition, change and healing are understood to come from relationships with spirits, ancestors and the community, mediated by people whom the community recognises. This guide states those concepts as the communities hold them. It does not assert them as fact or dismiss them.

A psychotherapist does not practise shamanhood. Authority rests with communities, elders, lineages and, in some republics, registered shamanic and faith organisations. The therapist's work, which this guide covers, runs alongside the tradition. It includes culturally responsive assessment (the Cultural Formulation Interview, the client's explanatory model and local idioms of distress), telling a culturally recognised calling apart from psychiatric illness without pathologising either, collaboration and referral when the client wishes, integration, and safeguarding. Two histories shape this work and are central here. The first is Soviet and Chinese state suppression of shamans. The second is the documented use of psychiatry against a shaman in present-day Russia. [source: Leete 2005; Zabiyako & Wang 2023; RFE/RL 2022]

This guide gives no ceremony procedure, songs, prayers, sacred objects, initiation steps or divination methods.

2. Framework

Shamanhood has no therapist-facing phase model. The framework below has two parts. Part A describes how authority and practice are organised as sources report them. Part B gives phases for the therapist's own work.

A. The tradition as sources describe it: who holds authority

Historical suppression. In 1924, Soviet rules banned shamanic healing and the taking of fees. [source: Leete 2005] Shamanism was officially classed as a "religious survival" to be eradicated, yet in Tuva it persisted on the margins. [source: Laboratorium, "Vertical of Shamanic Power"] Shamans were accused of agitating against Soviet schools and were among the leaders of the Khanty and Nenets Kazym uprising of the early 1930s. [source: Leete 2005; Leete 2009] In eastern Siberia most collective Evenki rituals stopped in the 1950s. [source: Lavrillier & Sem 2021] In China, the Oroqen were subject to a 1952 policy that "banned shamanism." [source: Zabiyako & Wang 2023] In Sakha, many shamans were killed in the Soviet period. [source: Moscow Times 2014]
Tuva. Shamanic societies are registered organisations. The first, Düŋgür ("Drum"), was registered in 1993. Sources differ on its founder: one names the ethnographer Mongush Kenin-Lopsan, who is not himself a shaman, and another names the shaman Dugar-Syuryun Oorzhak [uncertain]. [source: Laboratorium; Moscow Times 2016] Other societies include Tos Dėėr, Adyg Ėėren (founded 2001) and Ush-Möörük. By 2009 there were eight societies. Shamans in organised societies hold certificates that confirm their title and permit official work. Kenin-Lopsan held the title "president for life of all Tuvan shamans," and in 2009 a rival "supreme shaman" election caused a dispute. A 1995 Tuvan law recognised shamanism as a "traditional confession" alongside Buddhism and Orthodoxy. [source: Laboratorium] Commercialisation is contested within the community. [source: Moscow Times 2016]
Sakha (Yakutia). The Aar Aiyy faith gained formal registration in 2014. Its beliefs combine shamanism, animism and Tengrianism. [source: Moscow Times 2014] Fieldwork in Yakutsk and eight uluses describes healers, (neo)shamans and algyschyts, who are specialists in the blessing tradition (algys). These practitioners are increasingly institutionalised and commercialised. [source: Mekkyusyarova 2022]
Evenki, Even and Nanai. The ethnographers report that traditional shamans "have now disappeared, as far as we know." They date the last Evenki shamans' deaths to 1996 and 2012. Shamanic status is confirmed by community results, not self-declared, and it can be revoked. Today's practitioners include elders who lead revivalist rituals, healers, budding shamans, people they call pseudo-shamans, prophets and performers. Evenki and Even have historically rejected urban neo-shamans. [source: Lavrillier & Sem 2021]
Oroqen (China). The shaman Guan Kouni (1935 to 2019) returned to practice after the late-1980s reforms. Since the 2000s, state policy has treated shamanism as intangible cultural heritage. [source: Zabiyako & Wang 2023]
Nenets, Enets, Selkup, Khanty, Nivkh. Present-day institutional arrangements and authority holders for these peoples are [uncertain: not verified]. Ask the client and community; do not assume.
The calling ("shamanic illness"). Communities describe election by spirits as a spiritual process that is often marked by suffering. Reported signs include "shamanic attacks", altered mental states, violent crises and absences, most often reported among young women. A shamanic ancestor is common. The ethnographers report that some people chosen in the late 1970s and early 1980s became mentally disturbed and died by suicide after failing to come to terms with the spirits. [source: Lavrillier & Sem 2021] The Russian reference entry describes the calling as a psychophysiological state that the tradition treats as spiritual initiation. [source: bigenc.ru] Early outsider ethnography, citing Bogoras, called the calling "generally equivalent to being afflicted with hysteria". This is a historical psychiatric lens, not the communities' own view. [source: Czaplicka, Shamanism in Siberia] A 19th-century label, "hysterical-demonic", was applied to conditions such as menerik. Local belief also links some mental conditions to spirits, punishment or being chosen. [source: Sodnompilova 2021]

B. Phases of the therapist's work [synthesis, built on the CFI sources]

Preparation (before or at first contact). Goal: examine your own assumptions, such as the "hysteria" lens, Soviet "survival" framing or romanticised neo-shamanism, and identify interpreters and cultural consultants. Move on once you can name your likely biases and have a plan for language.
Engagement and cultural assessment (sessions 1 to 3, 50 to 60 minutes each). Goal: complete the core CFI, add relevant supplementary modules and the Informant Version, and map the client's explanatory model and who they regard as legitimate healers. Move on when you can state the problem in the client's own terms and know their help-seeking preferences.
Differential formulation (sessions 2 to 4). Goal: decide, with consultation, whether the experiences fit a culturally recognised process, a disorder, both, or neither, and assess risk. Move on when risk is assessed, your formulation is shared with the client, and medical review is arranged if indicated.
Collaborative plan. Goal: agree on the client's goals. Where the client wishes, include contact with community-recognised practitioners, with consent and confidentiality agreed. Move on once the plan is written and agreed.
Ongoing therapy and integration (variable length). Goal: treat any disorder with standard care while supporting meaning-making, family relationships and identity. Revisit the CFI modules as needed; APA allows repeated use. [source: CFI Supplementary Modules]
Review and ending. Goal: review outcomes in both the client's terms and clinical measures, and leave a relapse and safety plan.

3. Guiding principles

Alongside, not instead. You do not shamanise, divine or perform healing. Practical meaning: your role is assessment, therapy and coordination; any spiritual work stays with people the community recognises. [synthesis; source: Lavrillier & Sem 2021]
Authority sits with the community. Status is confirmed by community results and can be revoked; in Tuva, by registered societies and certificates. Practical meaning: ask the client and their family whom they recognise, and never vouch for a practitioner yourself. [source: Lavrillier & Sem 2021; Laboratorium]
Plurality and contest are normal. Hereditary shamans, neo-shamans, Aiyy faith clergy, healers, Buddhist lamas and Orthodox clergy coexist and dispute legitimacy. Practical meaning: do not assume any single figure speaks for a people. [source: Lavrillier & Sem 2021; Laboratorium; Mekkyusyarova 2022]
Attribute, do not adjudicate. Spirits, ancestors and election are described as the client and community hold them. Practical meaning: use phrases such as "in your family's understanding" rather than asserting or debunking. [synthesis]
Neither pathologise nor miss illness. DSM-5 dissociative criteria exclude experiences that are part of broadly accepted cultural or religious practice. Calling-related distress can still involve suicidality or disorder. Practical meaning: assess function, distress, risk and cultural fit separately. [source: PMC9199574; Lavrillier & Sem 2021]
Remember psychiatry's history of misuse. A Sakha shaman, Aleksandr Gabyshev, was ordered into forced psychiatric treatment after being found "mentally unfit". Memorial recognised him as a political prisoner. [source: RFE/RL 2022] Practical meaning: name your independence, explain confidentiality and its limits plainly, and expect distrust.
Historical and intergenerational trauma is clinically relevant. Bans, killings, boarding-school conflict and loss of practitioners are part of many families' histories. Practical meaning: ask about family history of repression and lost knowledge. [source: Leete 2005, 2009; Moscow Times 2014]
Do not open sacred content. Practical meaning: never ask for ritual details, songs, objects or initiation steps. Listen if the client volunteers them, but do not record procedures. [synthesis]
Language and identity. Many clients are bilingual, for example in Sakha, Tuvan or Evenki and Russian. Practical meaning: offer an interpreter and ask which language feels right for which topics. [synthesis]
Medical safety first, without overriding meaning. Practical meaning: you never advise on medicines or substances, you route those questions to the prescriber, and you make sure urgent medical care is never delayed. [synthesis]
Consent and touch. Practical meaning: use no touch in your own work unless it is explicit, consented to and non-sexual. Explain that clients may decline any referral. [synthesis]
Guard against commodification. Sources note commercial shamanism and contested fees. Practical meaning: do not direct clients, especially outsiders seeking experiences, towards ceremonies outside legitimate community pathways. [source: Moscow Times 2016; Lavrillier & Sem 2021]

4. Intervention inventory

Every item below is the psychotherapist's own work. None of it is a shamanic practice. Example language is illustrative wording, not quoted from any source.

4.1 Cultural humility and self-examination

Purpose / when: Use this before and throughout work with clients from Siberian Indigenous peoples, and with clients drawn to Siberian or neo-shamanic practice. It reduces the risk of either pathologising or romanticising. [synthesis]
Steps:
1. List the lenses you may bring. These may include the early-ethnographic "hysteria" reading of the calling [source: Czaplicka], Soviet "religious survival" framing [source: Laboratorium], exoticising tourist narratives [source: Al Jazeera 2015; Moscow Times 2016], or assumptions that one people's practice stands for all.
2. Note what you do not know. For example, community positions for Nenets, Enets, Selkup, Khanty and Nivkh clients are [uncertain: not verified] here.
3. Learn the client's people, language, home region and religious affiliation from the client, not from stereotypes.
4. Bring cases to supervision or consultation with someone who knows the community.
Example language (illustrative): "I know a little about Sakha traditions from reading, but you and your family are the experts on what they mean for you. Please correct me when I get it wrong."
Watch for: Curiosity that turns into extracting sacred detail. Your own excitement or scepticism about spirits. It is working when the client corrects you freely and brings more of their own framework.

4.2 Core DSM-5-TR Cultural Formulation Interview (CFI)

Purpose / when: Use at intake, or whenever spirits, ancestors, election or healers come up. The CFI is a structured set of questions about the problem's meaning, sources of help and expectations of care. It has 16 questions in four domains. It supports judgement and is not the only basis for diagnosis. APA describes it as for "any clinician" in "any care setting." [source: APA CFI pdf; APA Section III pdf]
Steps:
1. Use the official APA form. Clinicians may reproduce it for their patients; translation or modification needs APA permission. [source: APA CFI pdf]
2. Domain 1, Cultural definition of the problem: get the client's own words for what is happening, including any term in their language.
3. Domain 2, Cultural perceptions of cause, context and support: ask about causes, which may include spirits, ancestors, a family shamanic line, punishment or stress. Ask about stressors and supports, and about how identity matters (people, clan, language, faith).
4. Domain 3, Self-coping and past help-seeking: ask about everything tried, including healers, shamans, algyschyts, lamas, priests, doctors and psychiatry, and about the barriers met.
5. Domain 4, Current help-seeking: ask about preferences, and about the clinician-patient relationship, including perceived racism and language.
6. Paraphrase the problem back in the client's terms and confirm it.
7. Time required: field-trial estimates are [uncertain]; allow most of a session.
Example language (illustrative): "People describe problems like this in different ways. How would you describe it, and how would people in your family or village describe it?" / "Have you or your family asked anyone outside medicine for help, such as an elder, healer or shaman? I ask so I can work alongside that, not against it."
Watch for: Short or guarded answers about healers. These can reflect fear of being judged mentally ill, given the history (see 4.12). It is working when the client uses their own terms and links the problem to family or community events.

4.3 CFI Supplementary Modules and Informant Version

Purpose / when: Use these for a deeper look at specific areas. They can be added to the core CFI or used alone, at any point, and repeated. [source: APA Supplementary Modules pdf] The Informant Version (17 questions, labelled DSM-5 2013) is for family members or friends. [source: APA Informant pdf]
Steps:
1. Spirituality, Religion and Moral Traditions: use when the calling, spirits or Aiyy, Buddhist, Orthodox or mixed affiliations matter.
2. Explanatory Model: use when the client's account differs from yours (see 4.4).
3. Cultural Identity: covers people, clan, language, urban or rural life and mixed heritage.
4. Coping and Help-Seeking: maps every healer and service consulted.
5. Social Network and Psychosocial Stressors: useful when family fears or community reputation are involved.
6. Patient-Clinician Relationship: use where distrust of psychiatry or the state is present.
7. Immigrants and Refugees: use for clients who left Russia or China, or [synthesis] adapt the questions for internal migrants to cities.
8. School-Age Children and Adolescents / Older Adults / Caregivers: use as relevant.
9. Use the Informant Version with a relative, with consent, when the client is acutely unwell or the family holds key knowledge about a family shamanic line.
Example language (illustrative): "Would it help if I also spoke with your grandmother about the family history you mentioned, with your permission and with you present?"
Watch for: Family accounts that contradict the client. Record both views rather than choosing one. Watch also for confidentiality pressures in small communities.

4.4 Eliciting the explanatory model (Kleinman)

Purpose / when: Use to understand the client's own model of the problem and to negotiate a shared plan. [source: Kleinman, Eisenberg & Good 1978, as cited by Dinos et al. 2017; Tanenbaum handout]
Steps: Ask, in your own words, the eight areas: the name for the problem; its cause; why it started when it did; what it does and how it works; how severe it is and how long it will last; what treatment the client thinks they should get; the main problems it has caused; and what the client fears most. [source: Tanenbaum handout] Then lay your model beside theirs and look for overlap. For example, the two models may agree on sleep, safety and family support even where they differ on cause. [synthesis]
Example language (illustrative): "What do you fear most could happen if this goes on?" / "You see this as the spirits of your mother's line choosing you. I also see signs of exhaustion and very low mood. Can we work on both?"
Watch for: Fear about relatives. Communities may believe uncontrolled spirits or wrong consultations endanger kin. [source: Lavrillier & Sem 2021] It is working when the client says the plan makes sense in their terms.

4.5 Local idioms and cultural concepts of distress

Purpose / when: Use to record distress in the client's idiom rather than forcing it into a category. DSM-5-TR defines cultural concepts of distress as idioms, explanations or perceived causes, and syndromes. Its named examples (e.g. susto, khyâl cap, kufungisisa) do not include Siberian terms. [source: APA Section III pdf; UNMC slides; uncertain: example list from secondary slides, not verified against the DSM-5-TR text]
Steps:
1. Note the client's term, such as their word for the calling, "shamanic attacks" [source: Lavrillier & Sem 2021], or menerik, described in the literature as a historically labelled condition mainly affecting women [source: Sodnompilova 2021].
2. Ask what the term implies about cause, course and who can help.
3. In the formulation, record the term as an idiom or perceived cause. Do not treat it as a diagnosis.
4. Then assess separately for any DSM-5-TR or ICD-11 disorder.
Example language (illustrative): "When you say this is the 'call', what does that mean in your family? What usually happens to someone who has it?"
Watch for: Using a historical outsider label (for example "hysterical-demonic") as if it were the client's own term. It is working when your notes record the idiom accurately and stay neutral.

4.6 Asking about healers without judgement

Purpose / when: Use in every assessment. Clients may consult several people at once: shamans, healers, algyschyts, neo-shamans, lamas, priests and doctors. [source: Mekkyusyarova 2022; Lavrillier & Sem 2021]
Steps:
1. Normalise the question.
2. Ask who, when, what the client understood the practitioner to say, and how the client felt afterwards. Do not ask for ritual content.
3. Ask whether anything was recommended that affects medical care, such as stopping medicines, fasting or avoiding a doctor. If so, route it to the prescriber or GP.
4. Note costs and any pressure, given commercialisation. [source: Moscow Times 2016]
Example language (illustrative): "Many people see both a doctor and a traditional healer. Have you seen anyone like that? I won't ask about what happens there, only how it has been for you."
Watch for: Shame, secrecy, or a client checking whether you will report them as "mad". It is working when the client discloses consultations voluntarily.

4.7 Telling a culturally recognised calling apart from psychiatric illness

Purpose / when: Use when the client or family describes election, spirit contact, voices, visions, trance or a family shamanic line, and when a referrer queries psychosis or a dissociative disorder.
Steps:
1. Establish the cultural reference point. Do the client's family and community recognise this pattern? Does it fit their account of election, for example a shamanic ancestor, suffering and dreams? [source: Lavrillier & Sem 2021; Czaplicka]
2. Apply the manuals' cultural exclusions. DSM-5 dissociative identity disorder (possession form) and other specified dissociative disorder (dissociative trance) exclude states that are a normal part of broadly accepted cultural or religious practice. DSM-5-TR keeps these exclusions in substance [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299]; whether it keeps identical wording is [uncertain]. [source: PMC9199574] ICD-11 6B62 Trance disorder and 6B63 Possession trance disorder require the state to be involuntary and unwanted, and outside accepted cultural or religious practice. 6B62 also requires recurrent episodes or a single episode lasting several days, plus significant distress or impairment. [source: findacode ICD-11 mirror; PMC9199574] A DSM-5-TR note that culturally sanctioned experiences should not count as psychotic symptoms is [uncertain: not verified].
3. Assess independently: mood, sleep, substance use, medical causes (including neurological causes and epilepsy), thought disorder, functioning, and risk.
4. Consult a cultural broker or community member (4.8) before finalising, with the client's consent.
5. Hold possibilities together. Calling-related distress and a disorder can co-occur. The ethnography reports suicides among people who were chosen. [source: Lavrillier & Sem 2021]
6. Share the formulation in both languages: the client's terms and clinical terms.
Example language (illustrative): "In your family's understanding this may be a calling. Separately from that, I want to make sure you're sleeping, eating and safe, because those matter whatever the cause."
Watch for: Two opposite errors. One is labelling a recognised calling as psychosis. The other is accepting "it is the spirits" while missing mania, psychosis, severe depression or suicidality. Watch also for a community that does not recognise this person's claim; status can be contested or revoked. [source: Lavrillier & Sem 2021] It is working when the formulation is agreed and risk is managed.

4.8 Cultural brokers, community consultants and interpreters

Purpose / when: Use when the formulation depends on community norms, or when language limits the assessment. [synthesis]
Steps:
1. Ask the client whom they trust to explain their community's view. This may be an elder, a relative, an Indigenous cultural organisation or a faith leader.
2. Obtain written consent for what may be shared. In small communities, share the minimum and consider whether the client wants to stay unidentified.
3. Use professional interpreters for Sakha, Tuvan, Evenki or other languages where possible. Brief them on confidentiality, and ask how terms for spirits or the calling translate.
4. Avoid using family members as interpreters for risk or trauma questions.
5. Note that consultants may disagree; legitimacy is contested. [source: Lavrillier & Sem 2021; Laboratorium]
Example language (illustrative): "Is there someone, an elder or someone from your community, whose view you'd trust on whether this fits what your people call a calling? I'd only speak to them with your permission."
Watch for: A consultant with a commercial or factional interest. Watch also for interpreter discomfort with spiritual topics. It is working when the client feels represented rather than discussed.

4.9 Collaboration and referral with community-recognised practitioners (only when the client wishes)

Purpose / when: Use when the client wants spiritual help alongside therapy, or when the explanatory model requires a community response the therapist cannot give. Formal state referral programmes linking Russian mental-health services to shamans are [uncertain: not verified]. International evidence on collaboration with traditional and faith healers comes from other regions [source: WHO strategy 2014 to 2023 page]. The COSIMPO cluster randomised trial in Nigeria and Ghana (Gureje et al., The Lancet 2020) found that collaborative care between traditional or faith healers and primary health care workers reduced psychotic symptoms (PANSS) and harmful practices more than usual care [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839].
Steps:
1. Let the client and their family identify the practitioner through their own community pathways. Examples are a hereditary line, elders, a registered Tuvan society whose shamans hold certificates, or the Aar Aiyy faith in Sakha. [source: Laboratorium; Moscow Times 2014; Lavrillier & Sem 2021] Do not recommend individuals yourself.
2. Agree on consent: what, if anything, you share, and in which direction.
3. Clarify roles. Spiritual matters go to the practitioner. Assessment, therapy, risk and medical liaison stay with you and the medical team.
4. Ask the client afterwards how it went and what was advised. Route anything touching medicines, food, fasting or medical care to the prescriber or GP.
5. Respect a client's choice not to involve anyone.
6. WHO's traditional medicine strategy frames integration of traditional practitioners into health systems as a policy aim, with safety and regulation. [source: WHO strategy 2014 to 2023 page]
Example language (illustrative): "If you want your family to arrange a visit to someone your community trusts, that's your decision. I'll keep doing our work alongside it. Afterwards, would you tell me anything that affects your health care?"
Watch for: Commercial practitioners outside community recognition [source: Moscow Times 2016; Lavrillier & Sem 2021]. Instructions to stop medical treatment. Family conflict over which practitioner to use. Belief that a wrong consultation endangers relatives [source: Lavrillier & Sem 2021]. It is working when the plans fit together without contradiction.

4.10 Suicide and risk assessment in the context of the calling

Purpose / when: Use in every case involving the calling, spirit affliction or intense family pressure. The ethnography reports suicides among people who were chosen and could not resolve the calling. [source: Lavrillier & Sem 2021]
Steps:
1. Use your standard structured risk assessment: ideation, intent, plan, history, protective factors.
2. Ask directly and in the client's frame. For example, ask whether the spirits or voices tell them to harm themselves, and whether they feel there is no way out of the calling.
3. Do lethal-means counselling, limited to storage and removal.
4. Build a safety plan that includes culturally meaningful supports and named people.
5. Escalate urgently through your service's pathway if risk is high. Explain why, given the history of coercive psychiatry (4.12).
Example language (illustrative): "Some people who feel chosen describe feeling trapped, as if there's no way out. Have you ever felt that way, or had thoughts of ending your life?"
Watch for: Fatalism framed as spiritual inevitability. Commands to self-harm. Isolation from family. It is working when the client can name reasons for living and people to contact.

4.11 Integration of calling or healing experiences

Purpose / when: Use after a client has been through calling-related distress or a community healing, to help them make meaning and return to daily life. [synthesis]
Steps:
1. Invite the client's account of what changed, in their terms, without probing ritual content.
2. Explore effects on identity, family roles, work and relationships.
3. Reinforce sleep, routine and social connection.
4. Notice any emerging symptoms, and review them with the CFI modules if needed. [source: APA Supplementary Modules pdf]
5. Support decisions, including a decision to decline or delay the role. The ethnography notes the role is described as very painful. [source: Lavrillier & Sem 2021]
Example language (illustrative): "What feels different since then? What do you want to carry forward into your everyday life?"
Watch for: Grandiosity, sleeplessness or new risky behaviour, which may signal a mood episode. Retraumatisation. Pressure from others to take on the role. It is working when daily functioning holds or improves.

4.12 Working with historical, political and intergenerational trauma

Purpose / when: Use when family histories include bans, killings, arrests, boarding schools or lost practitioners, or when the client distrusts psychiatry and the state. [source: Leete 2005, 2009; Moscow Times 2014; Zabiyako & Wang 2023]
Steps:
1. Ask about family history of repression and suppressed practice: who was lost, and what was hidden.
2. Validate the realistic basis for distrust. A Sakha shaman, Aleksandr Gabyshev, was placed in forced psychiatric treatment, and Memorial and Amnesty International campaigned against it. [source: RFE/RL 2022]
3. State your independence, the limits of confidentiality and how decisions about hospitalisation are made in your setting.
4. Address present-day racism and language barriers through the CFI domain 4 questions. [source: APA CFI pdf]
5. Link grief for lost traditions to the client's current distress where the client sees that link.
Example language (illustrative): "Given what happened to shamans and their families, and even recently, it makes sense to be careful about telling a psychologist about spirits. What would help you feel safe enough here?"
Watch for: Collusion with a political narrative you cannot assess. Your own defensiveness about your profession. It is working when trust increases and disclosure deepens.

4.13 Working with families and communities

Purpose / when: Use when the family holds the explanatory model, carries a shamanic line, or fears harm from the client's state. Communities fear individuals who cannot control their spirits. [source: Lavrillier & Sem 2021]
Steps:
1. With consent, hold a family meeting using the Informant Version questions. [source: APA Informant pdf]
2. Map views on cause, legitimacy and appropriate help.
3. Reduce stigma and blame.
4. Agree who supports the client, and how, without coercion.
5. Address exclusion or fear-driven isolation of the client.
Example language (illustrative): "Each of you sees this a little differently. What do you all agree would help her get through this safely?"
Watch for: Scapegoating. Pressure to accept or refuse the role. Confidentiality breaches. It is working when family support increases and conflict decreases.

4.14 Safeguarding and medical boundaries

Purpose / when: Use when any practice or situation causes harm. This includes financial exploitation, sexual exploitation, restraint, deprivation, delay of urgent medical care, harm to children, or a recommendation to stop prescribed treatment. [synthesis]
Steps:
1. Ask about harm factually and without attacking the tradition.
2. Follow your jurisdiction's adult and child safeguarding procedures.
3. Never advise starting, stopping or changing medicines. Route such questions to the prescriber.
4. Do not give information on preparing or using any substance or plant. Where the reference literature lists hallucinogens among general means of trance [source: bigenc.ru], do not explore methods. Assess substance use as you would in any case.
5. Ensure urgent physical symptoms are medically assessed. No practice is a treatment for physical disease.
6. Children: ensure safeguarding assessment, consent and assent. Never name minors in notes shared outside the team.
Example language (illustrative): "I respect that you've gone to someone your family trusts. I'm worried about the chest pain, though, and that needs a doctor today, alongside whatever else you choose."
Watch for: Large or escalating fees, isolation from family, demands for secrecy, or sexual contact presented as healing. Any of these calls for a safeguarding response.

4.15 Clients outside the community who are drawn to Siberian shamanism

Purpose / when: Use with non-Indigenous or urban clients who are seeking shamanic experiences, travelling to Siberia, or identifying with neo-shamanism. Sources describe foreign interest and commercialisation [source: Al Jazeera 2015; Moscow Times 2016], and Evenki and Even rejection of urban neo-shamans [source: Lavrillier & Sem 2021].
Steps:
1. Explore the motive: meaning, loss, dissatisfaction or a crisis.
2. Assess vulnerability, including trauma, psychosis risk and dissociation.
3. Discuss respect for community authority and contested legitimacy.
4. Do not encourage seeking ceremonies outside legitimate community pathways.
5. Support meaning-making within the client's own traditions and resources.
Example language (illustrative): "What are you hoping this would give you? Let's think about where else that could come from, and what being a respectful visitor would mean."
Watch for: Spiritual bypassing of grief or trauma. Exploitation. Destabilisation after intense experiences. It is working when the client's needs are met without appropriation or harm.

4.16 Documentation and coding

Purpose / when: Use in every record, to keep the formulation accurate and non-stigmatising.
Steps:
1. Record the cultural formulation, the client's idioms and explanatory model, and any consultations, all in neutral attributed language.
2. Use a diagnosis only when criteria are met after cultural exclusions are applied, for example ICD-11 6B62 or 6B63 only for involuntary, unwanted states outside accepted practice. [source: findacode; PMC9199574]
3. The ICD-11 traditional medicine chapter covers East Asian and related systems, not Siberian shamanhood. [source: WHO traditional medicine FAQ]
4. Avoid recording sacred content.
Example language (illustrative), in the note: "Client describes experiences she and her family understand as a calling from ancestral spirits. No evidence of psychosis on mental state examination. Low mood noted; plan as below."
Watch for: Words such as "delusional belief in spirits" written into the record. It is working when the client could read the note and recognise themselves.

5. Handling problems

Most guidance in this section is [synthesis]. Source-based points are tagged.

Client will not talk about spirits or healers. This is often fear of being labelled mad, which has a real basis [source: RFE/RL 2022]. Response: state that many people use both kinds of help, and explain what you record and why. Do not push. Revisit later with the Patient-Clinician Relationship module. [source: APA Supplementary Modules pdf]
The client says you cannot understand because you are an outsider. Response: agree that there are limits, ask what you need to understand to be useful, and offer a cultural consultant (4.8). Do not argue your credentials.
Referrer wants a psychosis diagnosis confirmed; family says it is the calling. Response: complete the cultural formulation and an independent mental state examination (4.7). Consult a cultural broker. Write a formulation that holds both views. Diagnose only on criteria applied after cultural exclusions. [source: PMC9199574; findacode]
Family says it is the calling, but you see mania, psychosis or severe depression. Response: name the clinical concern in non-dismissive terms, focus on safety, sleep and medical review, and propose a both/and plan. Escalate if there is risk. The ethnography records deaths by suicide among people who were chosen. [source: Lavrillier & Sem 2021]
Acute overwhelm (trance-like states, terror, voices) in session. Response: slow the pace, orient to the room, reduce stimulation, and ask what usually helps in their family. Contact supports, and assess risk and medical causes afterwards. Do not attempt any spiritual or ritual response yourself.
Spiritual emergency framing. If the client or a colleague uses the term, treat it as their framing. Assess risk and functioning in the usual way, and do not use it to avoid diagnosis or treatment.
Community does not recognise the client's claimed calling, or recognition is contested. Status can be contested or revoked. [source: Lavrillier & Sem 2021] Response: explore the impact on the client's identity and relationships. Do not adjudicate the claim. Support the client through the social consequences.
The client is consulting a commercial or unrecognised practitioner and paying heavily. Response: explore the costs and pressures, give factual concern, and screen for exploitation (4.14). Leave the choice of practitioner to the client and community pathways. [source: Moscow Times 2016]
A practitioner advised stopping medication or avoiding doctors. Response: never countermand or endorse it yourself. Arrange urgent prescriber contact and keep the client engaged. Document clearly.
Non-attendance and non-adherence. These may reflect distance, seasonal herding and nomadic life, cost, or conflicting advice. Response: offer remote sessions where safe and flexible scheduling, and ask directly about competing obligations.
Rupture after you used clinical language that felt dismissive. Response: acknowledge it promptly, ask what it meant to the client, re-explain in their terms, and invite correction. Use the Patient-Clinician Relationship module. [source: APA Supplementary Modules pdf]
Confidentiality in small communities and with interpreters. Response: agree in advance what is shared. Choose interpreters from outside the client's immediate circle where possible.
The client asks you to take part in, attend or arrange a ceremony. Response: decline warmly and explain your role, and leave arrangements to the client's community. Do not record or reproduce what happens.
Mixed or conflicting religious affiliations (Orthodox, Buddhist, Aiyy, shamanic). These are common. [source: Laboratorium; Moscow Times 2014; Mekkyusyarova 2022] Response: map each with the Spirituality module and avoid treating any one of them as "real".
The client wants to leave the tradition, or to refuse the role. Response: support autonomy and explore family and spiritual fears about refusing. Do not take a side.
Peoples for whom little is documented here (Nenets, Enets, Selkup, Khanty, Nivkh). Present-day authority structures are [uncertain: not verified]. Response: rely on the client and family, Indigenous organisations they name, and cultural consultants.

Sources

Tradition, history and ethnography:

Clinical and cultural-assessment references:

Books and papers cited:

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.
American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).

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