Shona n'anga · Atlas

1. Introduction

Version followed: Zimbabwe's Traditional Medical Practitioners Act [Chapter 27:14] as consolidated on ZimLII to 31 December 2016, the Ministry of Health and Child Care (MoHCC) traditional medicine page, and attributed scholarship and community accounts of Shona healing (Zvarevashe 1970 essay; Arntsen; Jakarasi 2024; Taruvinga 2016; Patel et al. 1995). The psychotherapist's tools follow the DSM-5-TR Cultural Formulation Interview (CFI) and its supplementary modules.

What it is. N'anga is the Shona word for a traditional healer, and hun'anga is the Shona name for the practice [source: The Conversation, "Traditional versus contemporary medicine: mental illness in Zimbabwe"]. This is a living healing tradition with its own practitioners, spiritual authorities and, in Zimbabwe, a statutory regulator. It is not a psychotherapy. A psychotherapist does not practise it, does not imitate it, and does not offer its diagnosis, ceremonies or remedies. This guide is about the therapist's own culturally responsive work with Shona-speaking clients (in Zimbabwe or the diaspora) who consult, or may consult, n'anga, spirit mediums (svikiro) or faith healers.

How the tradition understands illness (attributed). As Shona writers and scholars describe it, life is held within relationships with God (Mwari), family ancestral spirits (vadzimu, singular mudzimu), group or territorial spirits (mhondoro) and wandering spirits (mashavi, singular shavi) [source: Zvarevashe, Zimbabwe Field Guide]. Ancestors protect their descendants but may signal neglect through illness; avenging spirits (ngozi) of people who were badly wronged are associated with sudden deaths or illness that does not respond to treatment [source: Arntsen, PostColonialWeb]. In one Zimbabwean community study, people attributed mental illness to sorcery, witchcraft, broken taboos, and aggrieved or avenging spirits, alongside psychosocial and physical causes; Shona terms for mental illness include chirwere chepfungwa and kupenga [source: Jakarasi 2024]. Within the tradition, the n'anga identifies the cause and the fitting response; one Shona essayist states that "Only a n'anga has the power to diagnose such an illness" when a spirit is held responsible [source: Zvarevashe]. These are the tradition's own concepts, described here neither as fact nor dismissed.

How change happens in the therapist's work. For the psychotherapist, change comes from understanding the problem in the client's own terms (the explanatory model), agreeing a plan that fits those terms, supporting the client's chosen mix of help (many Zimbabweans combine healers with doctors, psychologists and psychiatrists [source: Jakarasi 2024]), collaborating with legitimate healers when the client wishes, and watching for illness or harm that needs other care [synthesis, built on the CFI's stated purpose of clarifying the problem's meaning, sources of help and expectations of services; source: APA DSM-5-TR CFI].

2. Framework

There is no published phase model for psychotherapists working alongside n'anga. The phases below are a [synthesis] organising the CFI, explanatory-model work and collaboration evidence cited in each phase.

Who holds authority (know this before you start).

Statutory regulator: the Traditional Medical Practitioners Council, a 12-member body (chair and vice-chair appointed by the Minister, five registered practitioners appointed by the Minister, five elected by registered peers). It registers practitioners if satisfied of "sufficient skill and ability" and good character, keeps the Register, issues certificates, holds disciplinary inquiries into "improper or disgraceful conduct" or gross incompetence, and can cancel, suspend, censure or impose conditions [source: Traditional Medical Practitioners Act, ZimLII].
Titles: registered practitioners may use "Registered Traditional Medical Practitioner" or R.T.M.P.; spirit-medium titles are tied to that qualification being recorded in the Register. The Act's definition of practice covers treating or diagnosing illness of body or mind by traditional methods "without the application of operative surgery" [source: ZimLII]. The offences for practising unregistered (s. 31(2)-(3)) had not been brought into force in that consolidation [source: ZimLII]; current status [uncertain: not verified].
Ministry: MoHCC has a Director of Traditional Medicine. Its page recognises eleven practitioner categories, including herbalists, faith healers, traditional birth attendants, spirit mediums and herbal ingredient sellers, and describes the Council as the "regulating and controlling authority" [source: MoHCC]. ZimLII lists the Act as Act 38 of 1981 and this guide follows that date; the Ministry page's date of 1996 for Chapter 27:14 is [uncertain: possibly a revised-edition date].
Association: the Zimbabwe National Traditional Healers Association (ZINATHA), formed after independence in the 1980s [source: Jakarasi 2024]. Following the 1981 Act, the Minister of Health approved the association on 13 July, and the sociologist Gordon Chavunduka, then Dean of Social Science at the University of Zimbabwe, became its first president [source: Shoko 2020]; he was still its president when he died in January 2013 and had been the University's vice-chancellor from 1992 to 1996 [source: VOA Zimbabwe 2013]. The year of the approval is not stated in that source, so the exact founding year remains [uncertain]. In 2005 ZINATHA reported its own inspectors checking registered healers against its regulations [source: The New Humanitarian 2005].
Spiritual authority (as the tradition holds it): family vadzimu over their descendants, mhondoro over the wider group, the n'anga as diagnostician, mediums as hosts of their spirit, and families as responsible for honouring ancestors [source: Zvarevashe]. Families and senior relatives therefore often hold decision-making authority over help seeking [synthesis]. The relationship of chiefs to mhondoro mediums [uncertain: not verified].
History: the Rhodesian Witchcraft Suppression Act of 1899 and missionary pressure drove healing underground; after independence the law was amended so healers were no longer treated as witches [source: Jakarasi 2024].

Phases [synthesis].

Phase	Goal	Typical format	Move on when
A. Preparation	Examine your own assumptions; learn the regulatory and historical context; arrange an interpreter if needed	Before first contact; supervision	You can name your own likely biases and the local authorities above
B. Cultural assessment	Core CFI (16 questions, four domains), Informant Version with family, relevant supplementary modules, explanatory-model questions	1-2 sessions; time for the CFI [uncertain: not verified]; field-trial clinicians found later interviews "required less time" [source: Lewis-Fernández et al. 2017]	You can state the problem in the client's words, the causes they hold, who they have consulted and what they expect from you
C. Differential formulation	Separate culturally normative experience (e.g. spirit calling, possession within accepted practice) from disorder; screen risk; consult cultural brokers	1 session plus consultation	Formulation agreed with client (and family if client wishes); risk plan in place
D. Shared plan	Decide what you offer, what the n'anga or other healer offers, what medical care is needed; consent for any contact	1 session	Written plan; signed consent for any information sharing
E. Parallel work and integration	Your therapy (e.g. problem-focused work for kufungisisa), integrating meanings from healing consultations, coordinating with prescriber	Weekly or fortnightly, 6-12+ sessions depending on condition	Symptoms and functioning improve on client's own terms and standard measures
F. Review	Re-run CFI modules if things change; safeguarding check; ending	Every 4-6 sessions and at ending	Client satisfied; no unresolved risk

Cross-reference: the Friendship Bench, a Zimbabwean lay-health-worker problem-solving therapy for common mental disorders, uses about six structured 45-minute sessions [source: Centre for Global Mental Health; KCL 2016]; it is a separate modality, not part of hun'anga.

3. Guiding principles

Alongside, never in place of. You do not diagnose spirit causes, divine, perform or advise on ceremonies, or recommend remedies; you work with the meaning the client brings [synthesis].
The client's model first. Ask what they call the problem and what caused it before offering your own terms [source: Kleinman et al. 1978 via Tanenbaum handout].
Neither confirm nor dismiss spirits. Speak of vadzimu, ngozi or mashavi as the client's or tradition's understanding ("as your family understands it"), not as fact or superstition [synthesis].
Combined help seeking is normal. Many people use healers and biomedical care together, and some hide traditional consultations to avoid judgement; ask openly so they need not hide [source: Jakarasi 2024].
Remember the history. Colonial law treated healers as criminals, and clinic staff have been reported to denigrate healers; expect wariness and earn trust [source: Jakarasi 2024; The Conversation].
Culture shapes, but does not rule out, illness. Spiritual explanations are common in Zimbabwean primary care, and patients holding them were less likely to meet case criteria [source: Patel et al. 1995]; yet psychosis and severe depression still need treatment [synthesis].
Distress may arrive in the body. Distress commonly presented as physical complaints in Harare primary care [source: Patel et al. 1995]; ask about bodily symptoms and "thinking too much".
Family is a unit of care. Ancestral concerns are family matters and are said to be most active around marriage, migration, divorce and childbirth [source: Zvarevashe]; involve family when the client wants.
Collaborate only with legitimate, consenting partners. Contact a healer only at the client's request, with written consent, and preferably one registered with the Council [source: ZimLII registration provisions; synthesis].
Medicines go to the prescriber. Never advise starting, stopping or combining medicines or traditional remedies; route questions to the prescriber [synthesis; concern about combined remedies reported by nurses in Zanzibar: Solera-Deuchar et al. 2020].
Safety overrides deference. Restraint, chaining, beating, deprivation, sexual contact or delay of urgent medical care are safeguarding matters whoever performs them [source: harmful practices measured in COSIMPO, Gureje et al. 2020; chaining in Ghanaian prayer camps, Ofori-Atta et al.; synthesis].
Use the community's words. Use n'anga, svikiro, hun'anga, never colonial or pejorative English labels [synthesis].

4. Intervention inventory

All interventions below are the psychotherapist's own. None of them is hun'anga, and none gives or implies any ceremony, divination, initiation or remedy. Example language is illustrative unless quoted.

4.1 Cultural humility and self-examination

Purpose / when: before and throughout work with Shona clients, and whenever you notice certainty, discomfort or curiosity about spirits, healers or witchcraft.
Steps: (1) Write down what you were taught about African healing and where it came from (school, church, media, clinical training). (2) Read the local history: the 1899 Witchcraft Suppression Act and the post-independence change in healers' legal position [source: Jakarasi 2024]. (3) Note any reflex to call beliefs "superstitious", the colonial framing reported in that history [source: Jakarasi 2024]. (4) Take one case a month to supervision or consultation with a Shona-speaking colleague. (5) Repeat after any rupture [synthesis].
Example language (illustrative): "I was trained mostly in one way of understanding distress. You may see it differently, and I would like to learn how you and your family see it."
Watch for: you treating the client as a cultural representative rather than an individual; over-romanticising healers; hiding your own discomfort. It is working when the client corrects you freely and tells you about healer visits without being asked [synthesis].

4.2 Language, interpreters and cultural brokers

Purpose / when: whenever the client's first language is Shona (or Ndebele, or another Zimbabwean language) or when key concepts lack an English match.
Steps: (1) Ask the client's preferred language for talk about feelings and spirits, which may differ from the language of work. (2) Use a trained interpreter, not a family member, for assessment; brief them that terms such as kufungisisa, kupenga, chirwere chepfungwa, ngozi and vadzimu should be kept, then explained, not translated away. (3) Check the interpreter's own church or healer affiliations do not create judgement or conflict. (4) For cultural questions beyond the interpreter's role, consult a cultural broker (a Shona-speaking clinician, community elder or chaplain the client agrees to), with consent [synthesis; terms from Patel et al. 1995 and Jakarasi 2024].
Example language (illustrative): "If there is a Shona word that fits better than my English one, please use it, and tell me what it means to you."
Watch for: interpreter shame or editing (shortened answers after spiritual questions), confidentiality fears in small diaspora communities. It is working when the client uses their own terms with you [synthesis].

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

Purpose / when: at intake, or whenever the presentation, a diagnosis or the plan seems to clash with the client's view. APA describes it as for "any clinician" with "any individual in any care setting" [source: APA DSM-5-TR Section III]. It supports, but is not the sole basis for, diagnosis [source: APA CFI].
Steps: Work through its 16 questions in four domains, in your own words where needed: (1) cultural definition of the problem (Q1-3); (2) perceptions of cause, context and support, including stressors, supports and cultural identity (Q4-10); (3) self-coping and past help seeking, including barriers (Q11-13); (4) current help seeking, preferences and the clinician-patient relationship, e.g. language barriers or perceived racism (Q14-16) [source: APA CFI]. Use the official APA form; clinicians may reproduce it for use with their own patients, but modifying or translating it needs APA permission [source: APA CFI]. For Shona clients, in domain 3 ask specifically about n'anga, svikiro, prophets or church healers, and herbal remedies [synthesis].
Example language (illustrative): "People often describe problems in their own way. How would you describe what is happening, and how would your family describe it?" / "Have you seen anyone else for this, such as a n'anga, a prophet, a pastor or a doctor? What did they tell you?"
Watch for: short, guarded answers on cause (often fear of being judged); naming a cause only after trust builds. Time needed [uncertain: not verified]. It is working when the client's account becomes longer and more specific and when it changes your formulation [synthesis].

4.4 CFI Informant Version with family

Purpose / when: when relatives took the help-seeking decisions, hold the explanation (e.g. an ancestral or avenging-spirit cause concerns the whole family), or the client is too unwell to give an account.
Steps: (1) Get the client's consent about which relative and what can be discussed. (2) Use the Informant Version: 17 questions, starting with the informant's relationship to the patient, then the four domains [source: APA CFI Informant]. (3) Interview separately first if there may be conflict, coercion or a witchcraft accusation within the family. (4) Compare the two accounts and note differences in cause and in preferred help [synthesis].
Example language (illustrative): "What does the family think has caused this, and what does the family think should be done?"
Watch for: a relative speaking over the client; disagreements between relatives about the cause; pressure on the client to follow one path. It is working when you can name whose view drives which decision [synthesis].

4.5 CFI supplementary modules

Purpose / when: for in-depth assessment after the core CFI, or standalone, at first evaluation or repeatedly during care [source: APA Supplementary Modules].
Steps: choose from the 12 modules [source: APA Supplementary Modules]. For Shona clients the most relevant are usually: Explanatory Model (cause, course, fears); Spirituality, Religion and Moral Traditions (relationship to Mwari, vadzimu, churches, including apostolic and Pentecostal churches, and any tension between them); Coping and Help-Seeking (sequence of healers and clinics); Cultural Identity (urban/rural, clan, generational and diaspora identity); Social Network; Immigrants and Refugees (for clients outside Zimbabwe); Caregivers (given to the carer) [synthesis on selection].
Example language (illustrative): "Some families keep both church and ancestral traditions, and some feel these clash. How is it in your family, and how does it touch this problem?"
Watch for: the client feeling tested on belief; conflict between Christian commitments and family ancestral expectations as a source of distress in itself [synthesis]. It is working when the plan reflects which sources of help the client actually trusts.

4.6 Explanatory-model questions (Kleinman)

Purpose / when: any time, briefly, to keep the client's model in view, especially before proposing a diagnosis or treatment.
Steps: ask, in your own words, the eight areas: what they call the problem; what caused it; 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 they should receive; what the chief problems are; what they fear most [source: Kleinman, Eisenberg and Good 1978, paraphrased via Tanenbaum handout]. Record the answers in their words. Then share your own model briefly and look for overlap [synthesis].
Example language (illustrative): "Why do you think it started now, at this point in your life?" / "What do you fear most about it?"
Watch for: a cause linked to a life transition (marriage, migration, divorce, childbirth) that the client sees as an ancestral matter [source: Zvarevashe, on when vadzimu are most active]; fear of a family death linked to ngozi [source: Arntsen]. It is working when you and the client can name a shared goal even with different causal models [synthesis].

4.7 Asking about healer consultations without judgement

Purpose / when: at intake and at intervals, because some clients keep traditional consultations private to avoid judgement [source: Jakarasi 2024].
Steps: (1) Normalise: say many people combine sources of help. (2) Ask who they have seen (n'anga, svikiro, herbalist, faith healer or prophet, church), what explanation was given and what was advised, without asking for details of any ceremony or divination. (3) Ask whether anything was taken by mouth or applied, only so the prescriber can be told; do not ask for or record preparations [synthesis]. (4) Ask how they felt about it and whether they plan to return. (5) Record neutrally.
Example language (illustrative): "Many people I see use both healers and clinics. You don't need to tell me anything private about what happened there. What I'd like to know is what the healer said the problem was, and whether it helped."
Watch for: relief at being asked (a good sign); worry you will report them; remedies the prescriber needs to know about. It is working when the client tells you about later consultations unprompted [synthesis].

4.8 Working with kufungisisa and bodily idioms of distress

Purpose / when: when a client says they are "thinking too much" or presents with physical complaints. In Harare primary care, kufungisisa ("thinking too much") was the closest Shona match to the Euro-American idea of neurotic illness, and distress usually presented in the body [source: Patel et al. 1995]. The DSM-5 glossary of cultural concepts of distress lists kufungisisa with the gloss "thinking too much" [source: Cummings 2015, FPR; UNMC DSM-5-TR slides]; the exact DSM-5-TR wording is [uncertain].
Steps: (1) Ask what the client is thinking about, how much, and what it does to body, sleep and work. (2) Treat it as an idiom: it may sit alongside depression, anxiety or trauma, or none [synthesis]. (3) Screen with standard measures; in Zimbabwean research the locally developed Shona Symptom Questionnaire has been used alongside PHQ and GAD [source: KCL 2016]; use only versions you are licensed or permitted to use. (4) Agree goals in the client's language (e.g. "thinking less, sleeping better"). (5) Offer problem-focused work, behavioural activation or other evidence-based therapy; for clients in Zimbabwe, consider referral to Friendship Bench services where available [source: Centre for Global Mental Health; synthesis].
Example language (illustrative): "When you say you are thinking too much, what are the thoughts about? What happens in your body when they come?"
Watch for: suicidal thinking behind "thinking too much" (the Friendship Bench trial tracked suicidal ideation as an outcome [source: KCL 2016]); medically unexplained symptoms needing medical review. It is working when the client reports less "thinking too much" in their own words and measures improve [synthesis].

4.9 Distinguishing culturally normative experience from disorder

Purpose / when: when a client reports possession, voices or visions of ancestors, being troubled by a spirit, or behaviour that relatives explain spiritually; to avoid both pathologising and missing illness.
Steps: (1) Establish the tradition's frame: in Shona accounts a person possessed by a mudzimu or shavi becomes its medium (svikiro); a mudzimu "cannot be refused", while a shavi may be rejected [source: Zvarevashe]. Do not judge which spirit it is; that is not your role. (2) Ask whether family and community see the experience as expected and meaningful or as an illness. (3) Apply the diagnostic exclusions: DSM-5 states that identity disruption in DID "may be described in some cultures as an experience of possession" and excludes disturbance that is "a normal part of a broadly accepted cultural or religious practice" [source: DSM-5 wording quoted in PMC9199574; DSM-5-TR retains the substance per Lewis 2023] [uncertain: exact DSM-5-TR wording not verified]. ICD-11 6B62 trance disorder and 6B63 possession trance disorder require the state to be involuntary, unwanted and not part of accepted cultural or religious practice, with distress or impairment [source: findacode ICD-11 mirror; PMC9199574]. (4) Screen independently for psychosis, mania, severe depression, substance effects, epilepsy and other medical causes; Shona healers themselves link epilepsy (pfari) to mental illness [source: Taruvinga 2016 abstract], so ask about seizures and refer for medical assessment. (5) Consult a cultural broker or the client's own community members (with consent) about whether the experience fits local norms. (6) Hold uncertainty openly in the formulation [synthesis].
Example language (illustrative): "In your family, is this something people would recognise as part of the tradition, or does it worry them as an illness? What do they say?"
Watch for: distress or impairment the client and family themselves call illness; experiences outside any accepted context; loss of functioning, self-neglect, risk to self or others; spiritual frames used by others to override the client's own wishes. It is working when client, family and you agree on what needs treatment and what needs respect [synthesis].

4.10 Supporting a client who believes they are being called to a spiritual role

Purpose / when: when illness is understood by the client or family as a sign that a spirit wants a host or that the client should become a healer or medium. Within the tradition, recognition of possession and the fitting response rests with the n'anga [source: Zvarevashe]; any training or initiation belongs to that tradition and is not described here.
Steps: (1) Explore what the calling means to the client, what they want, and any conflict with church, career or family. (2) Keep assessing for disorder (4.9) in parallel. (3) If the client wants guidance within the tradition, they and their family decide whom to consult; you may share that registered practitioners appear on the Council's Register [source: ZimLII]. (4) Support decision-making, not the outcome [synthesis].
Example language (illustrative): "It sounds like this could change your life a great deal. What part of you wants this, and what part of you is unsure?"
Watch for: coercion by family or a practitioner; financial exploitation; worsening symptoms during uncertainty. It is working when the client feels free to choose [synthesis].

4.11 Working with witchcraft, sorcery and avenging-spirit explanations

Purpose / when: when a client attributes illness or misfortune to witchcraft, sorcery, bad spirits (mweya yakaipa, mamhepo), zvidhoma or ngozi [source: terms reported by Jakarasi 2024; ngozi in Arntsen].
Steps: (1) Explore the attribution as meaning: who is held responsible, what relationship has broken, what wrong (if any) the family believes must be addressed. (2) Assess fear, hypervigilance, sleep and safety. (3) Ask whether anyone has been accused, and whether the accused (often a relative, an older woman, or a child) is at risk [synthesis]. (4) Work on the relational and practical stressors underneath without contradicting the belief. (5) If a person is at risk of violence, expulsion or abuse because of an accusation, follow safeguarding (4.15).
Example language (illustrative): "You've said someone may be behind this. What has happened between you and that person? How is that affecting you day to day?"
Watch for: paranoid ideation versus a shared cultural explanation (does it fit what family and community hold, or is it fixed, idiosyncratic and expanding?) [synthesis]; accusations against children. It is working when fear reduces and relationships become safer [synthesis].

4.12 Collaboration and referral with community-sanctioned healers

Purpose / when: only when the client wishes it; to coordinate care, reduce conflicting advice and keep the client safe. Evidence for collaboration comes from West Africa: in COSIMPO (Nigeria and Ghana), collaborative shared care between traditional and faith healers and primary care workers produced a greater fall in psychosis symptoms and fewer harmful practices than usual care [source: Gureje et al. 2020, PubMed 32861306]; in a Ghanaian prayer-camp trial, adding psychiatric medication reduced symptoms but did not significantly reduce days in chains [source: Ofori-Atta et al.]. Zimbabwe-specific collaboration trials [uncertain: not verified].
Steps: (1) Ask whether the client wants you to have any contact with their healer, and what for. (2) Get written, specific consent: who, what information, for how long; agree what stays private. (3) Where relevant, the client can check that a practitioner is registered (certificate, R.T.M.P. title, recorded spirit-medium qualification) with the Traditional Medical Practitioners Council [source: ZimLII]; outside Zimbabwe, ask the client how their community recognises a legitimate healer [synthesis]. (4) Contact respectfully, as a colleague in a different system: share your concerns about safety and medical needs, ask what the healer advises the family about cooperating with clinic care, and agree how to reach each other if risk rises. (5) Never ask the healer to explain or perform any practice for you. (6) Lessons from a Zanzibar pilot: both sides valued clear two-way referral routes and a named clinical contact, while nurses worried about combining remedies with medicines [source: Solera-Deuchar et al. 2020].
Example language (illustrative, to the healer): "[Client] has asked me to be in touch. I am supporting her with the stress and sleep problems. I would value knowing anything you think I should be aware of, and I want to make sure we both know who to call if she becomes unwell."
Watch for: conflicting messages about stopping medication; financial pressure; the client feeling caught between you. It is working when the client experiences one coordinated plan [synthesis].

4.13 Routing medicine and remedy questions to the prescriber

Purpose / when: whenever a client takes, or is considering, traditional remedies alongside prescribed medicines, or is considering stopping medicines on a healer's advice.
Steps: (1) Note what the client says they are taking, without asking about preparation or amounts. (2) Do not advise starting, stopping, changing or combining anything. (3) With consent, inform the prescriber or GP, and encourage the client to tell them directly. (4) Flag urgent symptoms (vomiting, confusion, jaundice, seizures, severe weakness) for immediate medical review [synthesis].
Example language (illustrative): "I'm not the right person to say whether that mixes safely with your tablets. Can we tell your doctor today, so they can check?"
Watch for: the client stopping medication quietly; delayed medical care. It is working when the prescriber is informed and the client feels respected [synthesis].

4.14 Integrating healing experiences into therapy

Purpose / when: after a client has consulted a n'anga, svikiro or church healer and wants to make sense of it, or when a spiritual explanation has given relief or added fear.
Steps: (1) Invite the client to share only what they wish; never ask for ritual details. (2) Ask what changed: in symptoms, in family relationships, in how they see the cause. (3) Link those meanings to therapy goals (e.g. repairing a family relationship, honouring a deceased relative in ways the client chooses). (4) If the experience was frightening or harmful, process it as you would any distressing event and assess for safeguarding [synthesis].
Example language (illustrative): "What did you take away from seeing the healer? Has anything shifted in how you or your family see the problem?"
Watch for: relief that you can build on; new fears; family pressure following the consultation. It is working when the client experiences both kinds of help as part of one story [synthesis].

4.15 Safeguarding

Purpose / when: whenever any practice, by anyone (healer, prophet, church, family), harms or endangers the client or others. Harmful practices are a recognised concern: COSIMPO measured them as an outcome [source: Gureje et al. 2020], and chaining was the focus of the Ghanaian prayer-camp trial [source: Ofori-Atta et al.]. Zimbabwe-specific harm data [uncertain: not verified].
Steps: (1) Ask directly, without accusation, about restraint, being kept somewhere against one's will, beating, food or water deprivation, sexual contact, financial exploitation, and delay of urgent medical care. (2) For children, older people and people lacking capacity, follow your jurisdiction's reporting rules; witchcraft accusations against children are a safeguarding matter [synthesis]. (3) Distinguish a practice from abuse hidden as tradition; consult a cultural broker and your safeguarding lead. (4) In Zimbabwe, complaints of improper or disgraceful conduct by a registered practitioner can go to the Council, which holds disciplinary inquiries [source: ZimLII]; criminal matters go to police. (5) Document.
Example language (illustrative): "I ask everyone this: has anyone, while trying to help you, ever held you down, kept you somewhere, hurt you, or touched you in a way that wasn't okay?"
Watch for: fear of retaliation or of spiritual consequences for disclosing; family loyalty. It is working when the client is safe and still feels their tradition is respected [synthesis].

4.16 Addressing historical suppression, racism and migration

Purpose / when: when mistrust of services, shame about tradition, or racism shapes the work; with diaspora clients separated from family and healers.
Steps: (1) Acknowledge the colonial criminalisation of healing and denigration by health staff where relevant [source: Jakarasi 2024]. (2) Use CFI Q16 on the clinician-patient relationship, and the Immigrants and Refugees module [source: APA CFI; Supplementary Modules]. (3) Explore losses from migration, including distance from ancestral home and family obligations. (4) Name and address racism in services [synthesis].
Example language (illustrative): "Sometimes people worry that someone like me won't understand or will look down on their beliefs. Is that a worry for you?"
Watch for: polite agreement masking disengagement. It is working when the client can disagree with you [synthesis].

4.17 Working with families and communities

Purpose / when: when decisions, explanations or obligations are held by the family; around marriage, migration, divorce and childbirth, when ancestral concerns are said to be most active [source: Zvarevashe].
Steps: (1) Map the family and who decides about help seeking. (2) With consent, hold a family meeting to agree a shared plan that respects the family's understanding and includes medical safety. (3) Address conflicts between relatives who favour church, n'anga or clinic. (4) Keep the client's own wishes central [synthesis].
Example language (illustrative): "Each of you may see this differently. Could we find a plan that respects what matters to the family and keeps her safe and well?"
Watch for: the client silenced; blame on one member. It is working when the family supports the agreed plan [synthesis].

4.18 Documentation and diagnosis

Purpose / when: at formulation and in records.
Steps: (1) Record the cultural formulation and the client's terms. (2) Record healer consultations neutrally. (3) Use dissociative, trance or possession diagnoses only where criteria and the cultural exclusion are met (4.9). (4) Record consent for any contact with healers [synthesis].
Example language (illustrative, record): "Client describes kufungisisa ('thinking too much'), attributes onset to family conflict; has consulted a n'anga and wishes to continue alongside therapy."
Watch for: stigmatising language; overstated certainty. It is working when another clinician could understand the client's view from your note [synthesis].

5. Handling problems

Published sources on hun'anga do not address therapy difficulties; everything in this section is [synthesis] unless a source is named.

Client will not discuss cause or healers (guardedness). Likely fear of judgement, given reported denigration by health staff and private consultations [source: Jakarasi 2024]. Respond: normalise combined help seeking, say you will not ask about private practices, return to the question later. "Some people prefer not to talk about this at first. That's fine. The door is open."
Client asks you to say whether the spirits are real or whether the n'anga is right. Do not adjudicate. "I'm not able to judge that, and it isn't my place. What I can do is help with how this is affecting you, alongside whatever help you choose."
Client asks you to recommend a healer, ceremony or remedy. Decline that role; the choice belongs to the client, family and the tradition's own authorities. Where relevant, mention that the Council keeps a Register of practitioners [source: ZimLII].
Stuck: client's model and yours do not meet. Shift to shared goals (sleep, work, family peace) rather than shared causes; re-run the Explanatory Model module [source: APA Supplementary Modules]; consult a cultural broker.
Non-adherence to therapy or medication because a healer or prophet advised stopping. Avoid a contest of authority. Explore the client's reasons, tell the prescriber with consent (4.13), and, if the client agrees, contact the healer to coordinate (4.12). If stopping creates serious risk (psychosis, mania, suicidality, epilepsy), escalate medical review promptly.
Overwhelm or fear about ngozi, witchcraft or a spirit. Ground first (sleep, safety, support); assess for psychosis and suicidality; involve trusted family or faith supports the client names. Do not reassure that "it isn't real".
Rupture after a perceived dismissal. Name it, apologise specifically, ask what felt dismissive, and show you have changed (e.g. using their terms). CFI Q16 can open the conversation [source: APA CFI].
Family pressure overriding the client. See the client alone, clarify their wishes, then meet the family with agreed limits; safeguard if pressure becomes coercion or abuse (4.15).
Conflict between church and ancestral traditions. Some clients feel torn between Christian commitments and family expectations about vadzimu. Explore both loyalties with the Spirituality, Religion and Moral Traditions module; avoid siding [source: APA Supplementary Modules; synthesis].
Severe illness framed only spiritually. Where psychosis, mania, severe depression or a medical condition (such as possible seizures, linked by healers to mental illness as pfari [source: Taruvinga 2016 abstract]) is present, explain respectfully that medical care can go alongside the family's chosen spiritual help; collaborative models show the two can coexist [source: Gureje et al. 2020].
Harmful practice disclosed. Follow safeguarding (4.15) even if the client values the practitioner; explain why and keep the relationship.
Suspected false or unregistered practitioner, or exploitation. In Zimbabwe, the client can check registration and raise conduct complaints with the Council [source: ZimLII]; financial exploitation or abuse may be a police matter.
Diaspora client with no access to family healers. Explore what connection with tradition they want, help them talk with family at home, and avoid steering them towards anyone outside legitimate community pathways.
Your own discomfort or over-identification. Use supervision; revisit 4.1.

Sources

Web sources

Books and articles cited by reference

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.
Chavunduka GL (1978). Traditional Healers and the Shona Patient. Gwelo: Mambo Press (Zambeziana vol. 3). Contents not drawn on here.
Chavunduka GL (1994). Traditional Medicine in Modern Zimbabwe. Publisher [uncertain]; contents not drawn on here.
Shoko T (2020). Religion, gullibility, health and well-being: the case of traditional healers in Harare, Zimbabwe. Alternation Special Edition 35:146–159.

← Previous · XI-052Sangoma and inyanga (Southern Africa)Next · XI-054 →Ndau healers