Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 041
Guide XI-041

Sami noaidi

Sápmi (Norway, Sweden, Finland)
A 40 · L 49 · M 1115 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: the noaidi as Sámi institutions and the Church of Sweden's historical account describe him (a pre-Christian ritual specialist, now historical), and contemporary Sámi healing ("helpers", "reading") as described in Sámi-area clinical research from northern Norway (Sexton 2009; Miller 2007) and in the published service model of SANKS, the Sámi national competence service for mental health and substance use in Norway. The psychotherapist's own tools follow the DSM-5-TR Cultural Formulation Interview (CFI). Sweden and Finland are covered only where sources allow.

What this entry is, and is not. This is not a therapy and not a method the psychotherapist can use. The noaidi (Northern Sámi; South Sámi noajdie, Lule Sámi noajdde) was the ritual specialist of pre-Christian Sámi religion. Sexton uses the term only for that historical tradition and notes that it is sometimes used pejoratively today [source: Sexton 2009, pp. 25–26, 32]. Miller's study of two Coastal Sámi healers in Porsanger concludes that today's healers are historically linked to the noaidi "but cannot be identified with them" (paraphrase of the thesis abstract) [source: Miller 2007]. Contemporary Sámi healing is a living, mostly quiet, community practice. Its practitioners are called "helpers" or "healers" (Norwegian hjelpere; Sexton gives the Northern Sámi form guvlláriid; the singular guvhllár is commonly cited [uncertain: not verified]). They are known for "reading" (læsing/lesing: spoken formulas known only within the tradition) and for "stopping blood" [source: Sexton 2009, pp. 2, 9, 10, 22, 42]. Most healers Miller studied are Christian and understand their gift as a special connection to God, close to Laestadian ideas [source: Miller 2007].

Core idea of change (as the tradition holds it, and for the therapist). Within the tradition, healers are understood to hold a gift, often running in families, that gives "inside" knowledge of a person through thoughts, images or shifts in awareness; Miller describes the principle as needing a "correct connection" [source: Sexton 2009, pp. 31–32; Miller 2007]. These are the tradition's own understandings, described here as held, neither asserted nor dismissed. For the psychotherapist, change comes from culturally safe care: understanding the client's own explanatory model, respecting help the client already gets from healers, church community and family, not repeating the historical suppression of Sámi tradition, and coordinating with healers only when the client asks [source: Sexton 2009, pp. 16–17, 46–47] [synthesis].

Who holds authority. Healing ability is recognised inside the community: through a gift, family lines, being told by an existing healer that one has the ability, and the offer of formulas to an heir, which not all accept [source: Sexton 2009, p. 32]. There is no licensing body, register or council for Sámi healers [source: Sexton 2009, pp. 12–13, 16]. Collective authority over Sámi cultural heritage, including the return of confiscated drums, is exercised by Sámi institutions: the Sámediggi (Sámi Parliament) in Norway and Sámi museums such as RiddoDuottarMuseat and Saemien Sïjte, which a Sámediggi plenary leader described in 2026 as the rightful owners and managers of Sámi heritage on behalf of the Sámi people [source: Sámediggi, Ruoktot speech 2026]. That same speech left open "who holds the authority to determine what is appropriate" for ceremonial matters and called for collective Sámi deliberation [source: Sámediggi, Ruoktot speech 2026]. Sámi parliaments also exist in Sweden and Finland [uncertain: not verified]. In mental health care in Norway, SANKS (part of Sámi klinihkka, Finnmarkssykehuset, based in Karasjok) holds the national mandate for culturally adapted Sámi services [source: SANKS 2022 input; SANKS annual report 2024].

Historical context the therapist needs. In the Church of Sweden's historical account, priests condemned drumming and joik in ritual settings, called the drum "the devil's bible", brought cases to court, and seized and destroyed sacred objects and sites. In 1726–1727 the missionary Jens Kildal burned 17 drums, and Lars Nilsson was executed in 1692/93 after his drum was burned [source: Svenska kyrkan, Westman Kuhmunen]. In Norway the Poala-Ándde drum was confiscated at a 1692 trial in Vadsø and sent to Copenhagen, and its owner died in custody; it is now held in Sápmi by RiddoDuottarMuseat, and the Freavnantjahke gievrie drum returned from Meiningen, Germany, in 2023 [source: Sámediggi, Ruoktot speech 2026]. Sexton describes the church's suppression of Sámi religion in the 1700s and long periods when healing traditions were illegal and punished [source: Sexton 2009, pp. 4–5, 24]. Norway's Truth and Reconciliation Commission reported on 1 June 2023 that Norwegianisation was a systematic, structural assimilation policy with continuing loss of language and culture [source: Altinget 2023]. This guide gives no ritual, drum, joik, formula or healing procedure; those belong to the communities and are not reproduced.

2. Framework

The framework is the psychotherapist's own culturally responsive work alongside Sámi tradition. Phases are [synthesis] built on the sources cited in each.

Phase 0. Preparation (before any Sámi client, then ongoing).

  • Goal: know the history above, your own assumptions about "shamanism", healing and Laestadian Christianity, and the Sámi service pathways available (SANKS, Sámi interpreting) [source: Sexton 2009, p. 46; SANKS annual report 2024] [synthesis].
  • Format: self-study (SANKS offers a short e-learning introduction, E-SANKS, on Sámi history, culture and "the Sámi patient"), supervision, consultation with Sámi colleagues [source: SANKS annual report 2024].
  • Move on when: you can name the client's likely language and region, and know how to reach SANKS and interpreters [synthesis].

Phase 1. Engagement and language (session 1).

  • Goal: offer care in the client's language; agree on an interpreter if wanted. In 2024 the Sámi interpreting service covered only North Sámi, only within the Helse Nord area [source: SANKS annual report 2024].
  • Move on when: the client has chosen a language arrangement and knows they may raise culture, faith and healers [synthesis].

Phase 2. Cultural assessment (sessions 1–3).

  • Goal: the core CFI, with the Explanatory Model; Spirituality, Religion, and Moral Traditions; Cultural Identity; Social Network; and Coping and Help-Seeking modules as needed. Use the Informant Version with a family member if the client agrees [source: APA CFI; APA supplementary modules; APA Informant Version].
  • Duration: the DSM-5 field trial found later CFI interviews "required less time" but no minutes are given; any time estimate is [uncertain].
  • Move on when: you can state the client's own name for the problem, their view of its cause, who they already turn to (including healers, church fellowship, family), and what they want from you [synthesis].

Phase 3. Formulation and differential (sessions 2–4).

  • Goal: separate culturally normative experience (dreams with Sámi symbolic meaning, a healer's account of the client, religious experience) from disorder, using DSM-5-TR criteria that exclude broadly accepted cultural or religious practice, and ICD-11 6B62 and 6B63 criteria [source: Dissociative disorders review (PMC9199574); ICD-11 6B62 text; Sexton 2009, p. 33].
  • Move on when: the formulation is written in terms the client recognises, and cultural consultation has been sought if the picture is unclear [synthesis].

Phase 4. Treatment alongside tradition (variable, as the presenting problem requires).

  • Goal: deliver the evidence-based treatment the problem needs, culturally adapted; coordinate with a healer only at the client's request; link with SANKS family, adolescent or ambulant services where relevant [source: Sexton 2009, pp. 16–17, 33; Heatta 2016].
  • Format: individual, family or network sessions; nature-based settings where the service provides them [source: Heatta 2016; Sexton 2009, pp. 46–47].
  • Move on when: goals set in the client's terms are met or care is handed on [synthesis].

Phase 5. Integration, ending and follow-up.

  • Goal: help the client make sense of what helped across all sources of help; plan follow-up, often digitally given distance (over half of SANKS consultations in 2024 were digital) [source: SANKS annual report 2024] [synthesis].

Safeguarding runs through every phase (violence, abuse, suicide risk) [synthesis; SANKS annual report 2024 on violence and suicide research].

3. Guiding principles

  • The therapist does not practise Sámi healing. Practical meaning: never "read", imitate, or describe yourself as using Sámi or "noaidi" methods; healing ability is recognised inside the community [source: Sexton 2009, p. 32] [synthesis].
  • Today's healers are not "noaidi". Practical meaning: do not call a client's helper a shaman or noaidi unless the client does; the term is historical and sometimes pejorative [source: Sexton 2009, pp. 25–26, 32; Miller 2007].
  • Do not echo the suppression. Practical meaning: silence or neglect of Sámi tradition in a service can repeat colonial history; ask about it openly [source: Sexton 2009, p. 46].
  • Expect quiet use, assume nothing. Practical meaning: in Sexton's survey of psychiatric patients, 50% of the Sámi group had used traditional or complementary help for psychological problems, and some did not report it because it was ordinary daily life or stigmatised; ask, without assuming every Sámi client uses healers [source: Sexton 2009, pp. 40, 44–45].
  • Respect secrecy norms. Practical meaning: healers have often asked people not to talk about treatment; never press for a healer's name, formulas or details [source: Sexton 2009, pp. 5, 10, 24–25] [synthesis].
  • Faith matters, in its local forms. Practical meaning: many healers and clients are Christian, often Laestadian; religiosity was the strongest predictor of healer use among Sámi patients, and religious attendance was linked to less frequent use of mental health services in SAMINOR 2 [source: Miller 2007; Sexton 2009, pp. 32–33, 41; Kiærbech et al. 2023].
  • Client choice governs collaboration. Practical meaning: contact with a healer happens only when the client asks; healer practice stays independent of the service [source: Sexton 2009, pp. 16–17, 47].
  • Language is clinical, not cosmetic. Practical meaning: offer Sámi-language care or an interpreter; know the gaps (South and Lule Sámi interpreting not yet available in 2024) [source: SANKS annual report 2024; SANKS 2022 input].
  • Family, network and land. Practical meaning: think in networks and consider nature-based and family formats, as SANKS and Sámi-area therapists do [source: Heatta 2016; Sexton 2009, pp. 34–35, 46–47].
  • Avoid both pathologising and missing illness. Practical meaning: cultural or religious normativity excludes certain diagnoses, but does not rule out a disorder that also meets criteria [source: Dissociative disorders review (PMC9199574); ICD-11 6B62/6B63] [synthesis].
  • Sámi authority over heritage. Practical meaning: drums and ceremonial heritage are matters for Sámi institutions; do not use or display Sámi sacred items in therapy, and do not steer clients to commercial "Sámi shamanism" offerings outside community pathways [source: Sámediggi, Ruoktot speech 2026] [synthesis].
  • Name history as a mental health issue. Practical meaning: Norwegianisation, language loss and discrimination belong in the formulation where the client sees them [source: Sexton 2009, p. 46; Altinget 2023].

4. Intervention inventory

All interventions below are the psychotherapist's own. None is a Sámi healing practice. Example language is illustrative. [source per item]

4.1 Cultural humility and historical self-examination

  • Purpose / when: before and throughout work with Sámi clients; essential where the clinician is non-Sámi, as most staff in Sámi-area clinics have been [source: Sexton 2009, pp. 11, 16, 46].
  • Steps: (1) Learn the history of mission, trials, drum confiscation and Norwegianisation (Section 1). (2) List your own associations with "shaman", "reading", Laestadianism and Sámi identity, and how they could show in your questions. (3) Complete E-SANKS or equivalent training and, where possible, training that includes time with traditional healers, as Sexton recommends for services [source: SANKS annual report 2024; Sexton 2009, p. 47]. (4) Bring Sámi cases to supervision with a Sámi colleague or SANKS consultation [synthesis].
  • Example language (illustrative): "I am not Sámi, and there will be things about your life and background I don't know. Please correct me when I get something wrong."
  • Watch for: curiosity that turns the client into a cultural informant; romanticising "shamanism"; assuming all Sámi clients are traditional, rural or reindeer herders. Working: the client corrects you freely and brings up culture without prompting [synthesis].

4.2 Language choice and interpreters

  • Purpose / when: first contact, and whenever emotional or bodily experience is discussed.
  • Steps: (1) Ask which language the client prefers for talking about feelings, family and faith. (2) Offer Sámi-speaking staff or SANKS where available; otherwise book the Sámi interpreting service (North Sámi only, within Helse Nord, in 2024; a national, multi-language service was being assessed) [source: SANKS annual report 2024]. (3) Prefer in-person interpreting where video quality would compromise the session; SANKS reports health personnel are reluctant to use remote interpreting and that this affects patient safety [source: SANKS 2022 input]. (4) Check that key terms (for the problem, for helpers) are understood the same way; SANKS notes Sámi health terminology still needs development [source: SANKS 2022 input]. (5) In small communities, ask whether the client knows the interpreter and is comfortable [synthesis].
  • Example language (illustrative): "Some people find it easier to talk about the heavy things in Sámi. Would you like an interpreter, or a Sámi-speaking clinician, for some of our sessions?"
  • Watch for: a fluent Norwegian speaker who still prefers Sámi for inner experience; South or Lule Sámi speakers left without an option; concerns about the interpreter knowing the family. Working: richer detail, more emotional language [synthesis].

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

  • Purpose / when: initial assessment of any Sámi client, and later when treatment stalls. It clarifies the problem from the perspective of the person and their network, possible sources of help, and expectations; it is not the sole basis of a diagnosis [source: APA CFI].
  • Steps: follow the 16-question APA form, in your own phrasing where needed, across four domains: (1) cultural definition of the problem; (2) perceptions of cause, context and support, including the role of cultural identity; (3) self-coping and past help-seeking, including barriers; (4) current help-seeking preferences and the clinician–patient relationship, including perceived racism and language [source: APA CFI]. Clinicians may reproduce the form for use with their patients; translation or modification needs APA permission [source: APA CFI]. For Sámi clients, make sure domain 3 explicitly covers help from family, church fellowship and healers (see 4.7) and domain 4 covers past experiences of discrimination in services [source: Sexton 2009, p. 40; SANKS 2022 input] [synthesis].
  • Example language (illustrative): "People sometimes get help from many places: family, the congregation, someone in the village who helps, doctors. Who have you turned to so far, and what did they say or do?"
  • Watch for: brief, cautious answers at first (stigma, secrecy norms); answers that change after trust builds. Working: the client describes the problem in their own words and names their own supports [synthesis].

4.4 CFI supplementary modules

  • Purpose / when: add-ons or standalone tools at first evaluation, later in care or repeatedly [source: APA supplementary modules].
  • Steps: choose by need. (a) Spirituality, Religion, and Moral Traditions when faith, Laestadian membership or a healer is mentioned. (b) Explanatory Model when the client's view of cause differs from yours. (c) Cultural Identity when Sámi identity is mixed, reclaimed, hidden or contested (relevant after Norwegianisation). (d) Social Network and Psychosocial Stressors for siida, family and reindeer-herding pressures. (e) Coping and Help-Seeking. (f) School-Age Children and Adolescents, Older Adults, Caregivers by life stage. (g) Informant Version (17 questions) with a family member, with the client's consent [source: APA supplementary modules; APA Informant Version; SANKS annual report 2024 on reindeer-herding crises] [synthesis for Sámi-specific selection].
  • Example language (illustrative): "You mentioned your faith and the prayer house. Could we take some time on what your faith means for how you understand what is happening?"
  • Watch for: turning the module into a checklist; asking about faith in a way that sounds like doubt. Working: the client links faith, family and land to the problem and to recovery [synthesis].

4.5 Kleinman explanatory-model questions

  • Purpose / when: when the client's or family's understanding of cause and cure differs from the clinical one.
  • Steps: ask, in your own words, the eight areas Kleinman and colleagues describe: what the client calls the problem; its cause; why it started when it did; what it does and how it works; how severe and how long; what treatment they think they should receive; the main problems it has caused; what they fear most [source: Tanenbaum handout; Kleinman, Eisenberg and Good 1978]. Record the client's terms verbatim in the notes. Negotiate a shared plan that fits both models [synthesis].
  • Example language (illustrative): "What do you call what's been happening? And what do you think started it?"
  • Watch for: explanations involving God, sin, envy or another person's influence, given cautiously; do not treat these as delusional on content alone. Working: the client sees their own model reflected in the plan [synthesis].

4.6 Taking history and identity into account

  • Purpose / when: where the client links distress to language loss, boarding school or family history, discrimination, land conflict or hidden Sámi identity.
  • Steps: (1) Ask about family history of language and identity without assuming. (2) Use the Cultural Identity module (4.4). (3) Name historical suppression as part of the context where the client does [source: Sexton 2009, p. 46; Altinget 2023]. (4) In family work, consider the SANKS model of talking about family history in a setting the family chooses (Heatta describes talk around a fire during family stays on remote land) [source: Heatta 2016].
  • Example language (illustrative): "Some families lost the Sámi language a generation or two ago. Is that part of your family's story, and does it matter to you now?"
  • Watch for: shame or anger at the clinician as representative of the majority; grief about lost language. Working: the client can name losses without collapsing into shame [synthesis].

4.7 Asking about healers and "reading" without judgement

  • Purpose / when: at assessment and whenever the client mentions a helper, a dream, a bleed that was "stopped", or prayers. Many Sámi psychiatric patients use such help, and some keep it to themselves [source: Sexton 2009, pp. 40, 44–45].
  • Steps: (1) Normalise: say that many people in the north use helpers alongside services. (2) Ask whether the client has seen anyone, what they hoped for, and what it meant. (3) Do not ask for the helper's identity, formulas or methods; the tradition is often kept quiet and healers may ask clients not to speak of it [source: Sexton 2009, pp. 5, 10, 24–25]. (4) Ask whether the client wants you to take this into account and whether they want you and the helper to be in contact (4.10). (5) Record in the notes only what the client agrees to [synthesis].
  • Example language (illustrative): "Lots of people up here go to someone who reads, or ask someone to pray for them, as well as coming here. You don't have to tell me anything about it, but if it's been part of your help, I'd like to respect it."
  • Watch for: fear that you will judge or report; dissatisfaction with services, which Sexton found more common among Sámi healer users [source: Sexton 2009, p. 40]. Working: the client mentions the helper again spontaneously later [synthesis].

4.8 Working with faith communities, including Laestadianism

  • Purpose / when: when the client belongs to a congregation, including Laestadian ones, or relies on prayer and fellowship.
  • Steps: (1) Use the Spirituality, Religion, and Moral Traditions module. (2) Ask how the congregation supports or burdens the client; religious attendance was associated with less frequent service use and with fewer mental health problems in SAMINOR 2 [source: Kiærbech et al. 2023]. (3) Recognise that in this tradition healing and Christian faith are often joined [source: Sexton 2009, pp. 32–33; Miller 2007]. (4) With the client's consent, consider contact with a trusted pastor or the Sámi church structures [synthesis].
  • Example language (illustrative): "How does your congregation see what you've been going through? Is there anyone there who is a support for you?"
  • Watch for: fear of the community's view of psychiatric care or medication; your own assumptions about conservative faith. Working: the client can hold faith and treatment together [synthesis].

4.9 Distinguishing culturally normative experience from disorder

  • Purpose / when: when a client reports dreams with Sámi symbolic meaning, a sense of being influenced, visions or a felt "inside knowing", or a calling to heal.
  • Steps: (1) Ask whether these experiences are known and accepted in the client's family and community; healers themselves describe inner knowledge through thoughts, images or shifts in awareness, and Sexton found therapists suggesting a healer when dreams carried Sámi meaning [source: Sexton 2009, pp. 32–33]. (2) Apply DSM-5-TR exclusions: possession-form identity disruption and dissociative trance are not diagnosed when they are a normal part of broadly accepted cultural or religious practice (DSM-5 wording; DSM-5-TR retains the substance, exact wording [uncertain]) [source: PMC9199574; Lewis 2023 study guide]. (3) For ICD-11, trance disorder (6B62) and possession trance disorder (6B63) require that the state is involuntary, unwanted, not part of accepted cultural or religious practice, and causes significant distress or impairment [source: ICD-11 6B62 text; PMC9199574]. (4) Assess for psychotic, mood and substance-use disorders on functional criteria: disorganisation, decline, risk, distress. (5) Where unsure, seek cultural consultation from SANKS or a Sámi colleague, and, with consent, the family's view (Informant Version) [synthesis].
  • Example language (illustrative): "In your family, are dreams like this something people talk about and understand? Does this one feel like those, or does it feel different, frightening, out of your control?"
  • Watch for: both errors, labelling accepted experience as psychosis, and missing a psychosis because it is framed in cultural terms. Note: no Sámi-specific condition appears in the DSM-5-TR cultural concepts examples [uncertain: not verified]; do not invent one. Working: a formulation the client and family accept, with risk addressed [synthesis].

4.10 Collaboration and referral with healers, at the client's request

  • Purpose / when: only when the client asks for contact with, or advice about, a helper. In Sexton's study, 75% of patients with any Sámi affiliation wanted traditional healing integrated with services; no formal cooperation between clinics and healers was found, and therapists were unsure what was allowed because institutions had no policy [source: Sexton 2009, pp. 12–13, 16, 42, 45].
  • Steps: (1) Check your service's position; where there is none, consult your manager and record the decision (Sexton calls for written guidelines) [source: Sexton 2009, pp. 13, 16–17]. (2) Clarify what the client wants: to have the helper respected, to be told about one, or for you and the helper to talk. (3) Practices Sexton found in clinics: giving a helper's contact details when the patient asked, and recording this in the journal; suggesting a helper when experiences had Sámi symbolic meaning [source: Sexton 2009, p. 33]. Do not choose or vet a healer yourself; recognition rests with the community, and the client or family usually knows whom to approach [source: Sexton 2009, p. 32] [synthesis]. (4) Any contact between you and a helper needs the client's written consent covering what may be shared; share the minimum [synthesis]. (5) Keep the helper's practice independent: do not bring healing into the service's own sessions, as Sexton recommends healer practice remain outside services as an independent option [source: Sexton 2009, p. 47]. (6) Continue standard treatment; collaboration adds to it and does not replace it. Collaborative-care trials with traditional and faith healers elsewhere (COSIMPO in Nigeria and Ghana) reduced psychotic symptoms and harmful practices, but they are not Sámi evidence [source: COSIMPO abstract; Centre for Global Mental Health].
  • Example language (illustrative): "You'd like your helper to know you're coming here. We can do that in whatever way suits you. What would you like them to know, and what should stay between us?"
  • Watch for: the client's worry that the helper or community will learn more than intended; small-community confidentiality; any helper advice to stop treatment (see Section 5). Working: the client feels both sources of help are respected [synthesis].

4.11 Family, network and land-based formats

  • Purpose / when: when family relations, siida or herding life are central, or when the clinic room itself is a barrier.
  • Steps: (1) Use network-oriented, systemic approaches; Sámi-area therapists in Sexton's study valued systemic therapy, especially Tom Andersen's work, for its attention to the wider network [source: Sexton 2009, pp. 34–35]. (2) Consider settings outside the office where your service allows; Sexton recommends adapting the physical setting, including nature [source: Sexton 2009, pp. 46–47]. (3) Refer to or consult SANKS for its published formats: family wilderness therapy (meahcceterapiija) on remote land for two to three days in a lavvu or cabins, and adolescent milieu therapy built on five Sámi values, including luondo eallin (living in harmony with nature), with seasonal activities [source: Heatta 2016]. These are SANKS services delivered by its staff, not methods to copy. (4) For herding crises, SANKS's national low-threshold team is used [source: SANKS annual report 2024].
  • Example language (illustrative): "Would it be easier to meet somewhere other than this office, or to bring the people who matter to you into a session?"
  • Watch for: confidentiality inside a family meeting; pressure on the client from family. Working: family members take part and the client speaks freely in their presence [synthesis].

4.12 Integrating healing and spiritual experiences in therapy

  • Purpose / when: after the client has received help from a healer, a prayer or a significant dream, and wants to make sense of it.
  • Steps: (1) Invite the client to describe what the experience meant, not what was done. (2) Reflect the meaning in the client's terms (protection, connection, being "set right") without endorsing or disputing it. (3) Link meaning to therapy goals: what the client now wants to do differently. (4) Watch for any distress the experience stirred (fear, guilt, a sense of having done wrong) and work with it [synthesis].
  • Example language (illustrative): "You said you felt lighter after you went to her. What has that lightness made possible this week?"
  • Watch for: asking for details of formulas or methods; the client feeling tested. Working: the client draws on the experience as a resource [synthesis].

4.13 Respecting Sámi authority over sacred heritage

  • Purpose / when: when a client (Sámi or not) or a colleague wants to use Sámi drums, "noaidi" practices or "Sámi shamanism" in healing, or when sacred heritage comes up in therapy.
  • Steps: (1) Explain that drums and ceremonial heritage are matters for Sámi institutions, which are now managing the return of confiscated drums [source: Sámediggi, Ruoktot speech 2026]. (2) Do not use Sámi ceremonial objects, imagery or joik as therapeutic tools [synthesis]. (3) For a Sámi client reconnecting with heritage, support contact with Sámi museums, language centres, cultural institutions and their own community, not commercial offerings presented as noaidi practice [synthesis]. (4) For a non-Sámi client drawn to "Sámi shamanism", explore what they seek (meaning, nature, belonging) and how to meet that without taking from Sámi tradition [synthesis].
  • Example language (illustrative): "The drums are very important to Sámi people, and decisions about them belong to Sámi institutions. What is it you're hoping to find there? Let's look at where you can get that."
  • Watch for: a Sámi client's grief or anger about confiscated heritage; a colleague offering "noaidi" methods. Working: heritage is discussed with respect and the client's need is addressed [synthesis].

4.14 Safeguarding and risk

  • Purpose / when: throughout; especially with violence, suicidality, substance use, or delayed medical care.
  • Steps: (1) Assess suicide risk with your standard protocol; SANKS research on Sámi men's suicidality and recovery shows this is a recognised concern [source: SANKS annual report 2024]. Use lethal-means counselling (safe storage and removal), which is especially relevant where firearms and isolation are part of herding life [synthesis]. (2) Ask about violence and abuse directly; SANKS runs research on violence and abuse in Sámi communities and intimate-partner violence in reindeer-herding settings (VEAHKA) [source: SANKS annual report 2024]. (3) Follow statutory reporting duties for children and adults at risk, whatever the cultural context [synthesis]. (4) Bleeding, injury or acute illness need medical care first, whether or not a helper has been contacted [synthesis]. (5) Never advise starting, stopping or changing medicines; route medication questions to the prescriber [synthesis].
  • Example language (illustrative): "I ask everyone about safety at home. Has anyone hurt you, or made you afraid?"
  • Watch for: fear that disclosure will expose the family or community; closeness of services in small places. Working: the client discloses risk and accepts a safety plan [synthesis].

4.15 Supporting Sámi involvement in service development

  • Purpose / when: for therapists in services with Sámi users.
  • Steps: (1) Involve Sámi users, families and community carriers of tradition in planning [source: Sexton 2009, pp. 45, 47]. (2) Press for written guidance on contact with healers [source: Sexton 2009, pp. 16–17]. (3) Use and promote Sámi-language services and helplines; SANKS noted in 2022 that no general helpline or chat service offered Sámi languages [source: SANKS 2022 input].
  • Example language (illustrative, to a manager): "Our Sámi patients ask about contact with helpers and we have no policy. Could we develop one with SANKS and local people?"
  • Watch for: tokenism. Working: Sámi users shape the service [synthesis].

5. Handling problems

Sources describe service barriers; the responses are mainly [synthesis].

  • Client will not discuss culture, faith or healers. Respect it. Secrecy norms and stigma explain much non-disclosure [source: Sexton 2009, pp. 24–25, 44–45]. Say once that the topic is welcome, then return to it only if the client opens it [synthesis]. Illustrative: "If it ever matters, you can bring it up. If not, that's fine too."
  • Mistrust of services and the clinician. Sámi healer users were less satisfied with services and reported poorer therapist relationships [source: Sexton 2009, p. 40]. Use CFI domain 4, ask about past discrimination, acknowledge it, and offer a Sámi-speaking clinician or SANKS [source: APA CFI; SANKS 2022 input] [synthesis].
  • Stuck treatment. Re-run the Explanatory Model module; the plan may not fit the client's model. Bring in the family (Informant Version) or move to a network format [source: APA supplementary modules; Sexton 2009, pp. 34–35] [synthesis].
  • Client asks you to "read" or to do something "Sámi". Decline warmly; say this is for those recognised in the tradition, and offer to respect or coordinate with their helper [source: Sexton 2009, p. 32] [synthesis]. Illustrative: "That's not something I can do, it belongs to people with that gift. But I can work with the help you get there."
  • A helper or congregation advises stopping treatment or medication. Do not argue the tradition. Explore the client's own view; ask, with consent, whether the client wants a joint conversation; refer medication questions to the prescriber [synthesis].
  • Overwhelm from historical or intergenerational material. Slow down, focus on stabilisation, and return to the history when the client is ready [synthesis].
  • Rupture after a perceived dismissal of belief. Name it, apologise for the specific comment, and invite correction [synthesis]. Illustrative: "When I asked whether the dream could be stress, I think it sounded like I didn't take it seriously. I'm sorry. Can you tell me how you understand it?"
  • Uncertain diagnosis (possession, influence, visions). Do not decide alone: seek SANKS or Sámi-colleague consultation, the family's view and longitudinal observation, and act on risk regardless (4.9) [synthesis].
  • Small-community confidentiality. Clients may know staff, interpreters or helpers. Discuss confidentiality explicitly and offer alternatives, including digital sessions from SANKS [source: SANKS annual report 2024] [synthesis].
  • Non-attendance or long distances. Use video and phone sessions, which made up over half of SANKS consultations in 2024 [source: SANKS annual report 2024].
  • Clients in Sweden or Finland. SANKS has cooperation agreements with regions in both countries [source: SANKS annual report 2024]; local Swedish and Finnish services and their arrangements with healers are [uncertain: not verified].
  • Client seeks "noaidi" courses or commercial "Sámi shamanism". See 4.13. Explore the need and point to Sámi cultural institutions [synthesis].

Sources

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