Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 056
Guide XI-056

Akan okomfo

southern Ghana
A 37 · L 52 · M 1118 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: Akan akom priesthood as Akan shrine communities and practitioner-scholars describe it (the Akonnedi shrine house and the Asuo Gyebi shrine, both in Larteh, Ghana, and an affiliated shrine house in Maryland, USA), with academic ethnography (Wita 2011, drawing on Rattray, Field, Opoku, Ephirim-Donkor and others) as attributed outsider context. The Ghanaian regulatory frame follows the Traditional Medicine Practice Act, 2000 (Act 575) and the Mental Health Act, 2012, as reported. The therapist's own assessment follows the DSM-5-TR Cultural Formulation Interview (APA 2022).

What it is. An okomfo (plural akomfo) is a priest or priestess of the Akan religious tradition of southern Ghana who serves one or more abosom (deities). Akan cosmology, as reported, holds that the abosom receive their power from the supreme creator, Onyame (Nyame), and are mostly associated with natural features such as rivers, rocks and forest. It also honours the nsamanfo (ancestors) [source: Wikipedia, Akan religion, citing Vecsey 1981 and Opokuwaa 2005] [uncertain: Wikipedia only]. Akom is the Twi term for possession. In Akan usage it is a positive state in which a deity takes control of the priest, and the priest is understood as a channel rather than becoming the deity. Ethnography reports a saying that there is no priesthood without possession [source: Wita 2011, Studia Religiologica 44, in Polish, paraphrased in translation]. A practitioner-scholar describes akom as an all-encompassing prophetic and ceremonial lifestyle. It is used to address health, spiritual attack and everyday problems, including sunsum yare (spiritual diseases) that are held to resist biomedical treatment [source: Okomfo Boakyewa, dissertation abstract on Nana Oparebea and the Akonnedi Shrine Pantheon, academia.edu]. Akan priestly communities also exist in the United States, among African American and Caribbean American practitioners linked to Ghanaian shrines [source: Coyle Rosen 2024, Law in Light, UC Press page].

The psychotherapist's position. A psychotherapist does not practise akom, possession, divination or shrine healing, and does not refer clients to ceremonies outside the pathways that shrine communities themselves sanction. The therapist's work runs alongside the tradition. It covers culturally responsive assessment, understanding the client's explanatory model, telling a culturally normative calling or possession apart from illness, collaborating with recognised priests or with Ghana-regulated practitioners when the client wishes, integrating what the client brings back, and safeguarding [synthesis].

How change happens (therapist's frame). Change comes from making the client's own meaning of the problem central. That meaning may be spiritual, ancestral, relational or medical, or several at once. The therapist then builds a plan the client can accept, which may combine shrine care, church, family and biomedical or psychological care. This is safer and more acceptable than asking the client to choose one system [synthesis; collaborative-care rationale: COSIMPO trial, Gureje et al. 2020; CFI purpose: APA DSM-5-TR CFI].

2. Framework

This is a living religious and healing tradition, not a therapy. The phases below describe the psychotherapist's own work with an Akan client who consults, or is, an okomfo. The phases are [synthesis] built on the CFI's structure.

Who holds authority in the tradition.

  • Within the shrine community: the authority is the deity's selection, shown through possession and confirmed over time by experienced priests or diviners. Ethnography distinguishes true priests (akomfo), who communicate through possession and divination, from temple servants (asomfo), who do not enter trance, and from healers (asumankwafo). Among priests it distinguishes senior priests (akomfopanyin), established priests and trainees. Lineage elders may arrange succession, a chief may appoint a shrine custodian, and a spokesperson (okyeame) interprets for the community [source: Wita 2011]. Ethnography of Larteh describes shrine governance by queen mothers, chief priests and priestesses (Okomfohene), eldest priestesses (Okomfopanyin) and shrine elders [source: Coyle Rosen 2024, UC Press page and chapter titles]. Training, as reported, takes several years at a shrine under experienced priests [source: Wita 2011]. This guide gives no further detail of calling, training or initiation.
  • The state in Ghana: the Traditional Medicine Practice Council (TMPC), set up under Act 575, exists to "promote, control and regulate traditional medicine practice" (s.2(1)). It registers practitioners, licenses practice premises (registration certificates and licences expire annually), sets a code of ethics with the recognised practitioners' Association, and approves training curricula. Registration requires proof of proficiency and endorsement by two of: the district Association chairman, the traditional ruler, or the District Co-ordinating Director (s.10). Deaths on licensed premises must be reported to a coroner within 24 hours (s.28) [source: GhaLII, Act 575]. The Act defines traditional medicine as practice based on "beliefs and ideas recognised by the community" that uses herbs and other naturally occurring substances. It does not expressly regulate spiritual or psychiatric treatment [source: GhaLII, Act 575]. Whether a given okomfo is TMPC-registered therefore varies [uncertain: not verified]. The TMPC reports a category of "spiritual herbalists" among its 27,103 registrants as of December 2023 [source: GNA, 30 March 2024]. It has also reported that fewer than 15 per cent of more than 100,000 practitioners are registered. The Ghana Federation of Traditional Medicine Practitioners Associations (GHAFTRAM) advises the public to use licensed practitioners whose displayed licence carries a scannable QR code [source: Rainbow Radio, 8 September 2026].
  • Mental health law: the Mental Health Act, 2012 bars torture, cruelty, forced labour and inhuman treatment, including shackling, of people with psychosocial disabilities. It also provides for regional Visiting Committees and a Mental Health Tribunal [source: HRW, 30 October 2023]. As reported, the Act allows a traditional centre to receive an involuntary patient for up to 48 hours, where admission to a mental health facility is impracticable, before transfer. It also directs the Mental Health Authority to collaborate with the traditional medicine regulator [source: Schuck 2018, Groningen Centre for Health Law blog]. The Act number (often given as Act 846) and the exact section numbers are [uncertain: not verified].

Phases of the therapist's work [synthesis unless tagged]:

  1. Preparation and cultural self-examination (before and during the first session). Goal: notice your own assumptions about possession, shrines and "fetish" stereotypes. Move on once you can hold the client's account without needing to rule on it.
  2. Engagement and core cultural assessment (sessions 1–2). Goal: the client's definition of the problem, their perceived causes, stressors and supports, cultural identity, coping and past help seeking, and current preferences. The tool is the 16-question core CFI, which APA intends to inform clinical understanding rather than to serve alone as the basis for a diagnosis [source: APA DSM-5-TR CFI]. How long it takes is [uncertain]; the field trial found that later administrations took less time [source: Lewis-Fernández et al. 2017]. Move on once the client's explanatory model and their help-seeking map (shrine, church, prayer camp, herbalist, clinic) are clear.
  3. In-depth modules as needed (sessions 2–4, or later). Use the Spirituality, Religion and Moral Traditions; Explanatory Model; Cultural Identity; Coping and Help-Seeking; Immigrants and Refugees; and Social Network modules, and the Informant Version with family [source: APA CFI Supplementary Modules; Informant Version]. Move on once you can write a cultural formulation.
  4. Differential formulation (alongside phases 2–3). Goal: decide whether the experience is a culturally normative akom or calling, an illness, both, or unclear. Consult cultural brokers. Move on once a working formulation is shared with the client, with its uncertainty stated.
  5. Shared plan and, if the client wishes, collaboration (from session 3–5). Goal: agree on the roles of therapy, any prescriber, the family and any priest or practitioner the client chooses, with written consent for any contact. Move on once the roles are agreed and safety is in place.
  6. Ongoing therapy and integration (weekly or fortnightly, often 8–20 sessions; the number is [synthesis]). Goal: treat the agreed problems, help the client make sense of shrine or church experiences within their own frame, and review the plan. Repeat CFI modules when circumstances change [source: APA CFI Supplementary Modules].
  7. Safeguarding (throughout). Goal: act on restraint, chaining, forced fasting, witchcraft accusation, abuse or delayed urgent care.

3. Guiding principles

  • Write and speak alongside, never as, the tradition. Practical meaning: you never divine, interpret a deity's will or recommend a ceremony. Questions about spiritual causes go to the authorities the client recognises [synthesis].
  • Attribute, do not adjudicate. Practical meaning: say "in your tradition, akom is…" or "your family understands this as…". Do not treat spirits or deities as fact, and do not dismiss them [synthesis].
  • Use the community's own terms. Practical meaning: say okomfo or akomfo, priest or priestess. Avoid "fetish priest" and "juju man" except when quoting, even though clients, churches and the press may use them. The HRW report quotes a prayer-camp leader using "fetish priests" [source: HRW 2023; synthesis].
  • Possession can be a vocation, not a symptom. Practical meaning: in Akan usage, akom is a positive sign of selection. A calling may begin with illness-like crises that, as reported, only an experienced priest or diviner can read [source: Wita 2011]. Do not code it as pathology on its form alone.
  • The diagnostic manuals carve out cultural practice. Practical meaning: DSM-5-TR possession-form identity disruption and dissociative trance count as disorder only when not part of a broadly accepted cultural or religious practice, and ICD-11 6B62 and 6B63 require the state to be involuntary, unwanted and outside accepted practice [source: PMC9199574; Lewis 2023; findacode ICD-11 6B62]. The exact DSM-5-TR wording is [uncertain].
  • Do not miss illness either. Practical meaning: a client within the tradition can also have psychosis, mania, depression, epilepsy or a medical illness. Assess as fully as for anyone else [synthesis].
  • Plural help seeking is normal. Practical meaning: many Akan Christians also use indigenous practice, often privately [source: Okomfo Boakyewa dissertation abstract]. Ask without judgement and expect partial disclosure at first.
  • Shrine knowledge is not yours to extract. Practical meaning: never ask a client who is a priest or trainee to describe ceremonies, sacred objects, training or the deity's instructions. Ask only about effects on their life and wellbeing [synthesis].
  • The client decides about collaboration. Practical meaning: no contact with a priest, shrine, prayer camp or family without specific, informed, revocable consent [synthesis].
  • Legitimacy comes from the community and the regulator. Practical meaning: for collaboration in Ghana, a shrine's standing comes from its own hierarchy. Where the practitioner offers herbal treatment, check TMPC registration and licensing [source: Act 575; Rainbow Radio 2026]. In the diaspora, standing comes from recognised shrine houses and their elders [source: Coyle Rosen 2024].
  • Human rights are non-negotiable. Practical meaning: chaining, shackling and forced fasting are prohibited under Ghanaian law and policy and are safeguarding concerns wherever they occur [source: HRW 2023; Schuck 2018].
  • Remedies and medicines go to the prescriber. Practical meaning: you never advise starting, stopping or combining herbal remedies or medicines. You route those questions to the prescriber [synthesis].
  • Remember history. Practical meaning: the tradition has been stigmatised by colonial and missionary discourse, and Christianity dominates public life in Ghana [source: Okomfo Boakyewa abstract]. Clients may expect contempt from you, so earn trust [synthesis].
  • Physical boundaries. Practical meaning: touch only with explicit consent, never sexual, and none is needed for any intervention here [synthesis].

4. Intervention inventory

All of the interventions below are the psychotherapist's own culturally responsive work. None of them is akom, shrine healing or divination. Example language is illustrative throughout.

4.1 Cultural humility and self-examination

  • Purpose: to reduce the risk of pathologising or exoticising the client. Use it before the first session and whenever you notice strong reactions (fear, fascination, religious disapproval) [synthesis].
  • Steps:
    1. Write down what you have absorbed about "fetish priests", juju, possession and shrines, and where it came from (media, church, training).
    2. Note your own religious commitments and how they might colour your view of a deity's claim on a client.
    3. Learn the basic terms (okomfo, abosom, akom, nsamanfo, sunsum) from the sources in this guide, as attributed accounts.
    4. Decide in advance what you will do if asked whether you "believe": acknowledge that the question matters, and keep the focus on the client.
    5. Bring the case to supervision or consultation with someone who knows Akan communities.
  • Example language (illustrative): "I'm not from your tradition, so I'll be asking you to teach me what things mean for you. Please correct me when I get it wrong."
  • Watch for: curiosity that turns into fishing for ceremonial detail, rescue fantasies about "freeing" the client from the shrine, and avoidance of the topic. It is working when the client corrects you freely and brings spiritual material without prompting.

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

  • Purpose: to learn the problem's meaning, causes, context, supports, coping, help seeking and current preferences from the client's perspective. Use it at intake with any Akan client, or whenever spiritual causation is raised [source: APA DSM-5-TR CFI].
  • Steps:
    1. Introduce it as questions about the client's own view, with no right answers.
    2. Work through the four domains in order: cultural definition of the problem; perceptions of cause, context and support (including the role of cultural identity); self-coping and past help seeking, including barriers; and current help seeking, preferences and the clinician–patient relationship [source: APA DSM-5-TR CFI].
    3. Use the client's own words for the problem in every later session.
    4. Note which subtopics need a supplementary module; the core form flags these.
    5. Use the form with your own patients without permission, but do not modify or translate it without APA permission [source: APA DSM-5-TR CFI]. Do not reproduce it here or in handouts beyond that permission.
  • Example language (illustrative): "How would you describe what's been happening, in your own words?" "What do the people close to you think is going on?" "Is there anything about your background or faith that you think I need to understand?"
  • Watch for: answers that shift between "spiritual" and "medical" depending on how they think you will react. It is working when the client gives a local name or cause, such as an abosom, the ancestors or witchcraft, without testing you first.

4.3 Spirituality, Religion and Moral Traditions module

  • Purpose: to map the client's religious life in depth. An Akan client may hold Akan, Christian and Muslim commitments at once and disclose them unevenly [source: APA CFI Supplementary Modules; plural practice: Okomfo Boakyewa abstract].
  • Steps:
    1. Ask about affiliations past and present, including church membership, shrine connections and family deities, as the client defines them.
    2. Ask what role these play in coping and in their understanding of the problem.
    3. Ask whether any religious community is a source of stress, such as a church that condemns shrine consultation, or a deity's or family's expectation.
    4. Record without ranking one practice above another.
  • Example language (illustrative): "Some people I work with go to church and also have family links to a shrine. Is that part of your life, or your family's?"
  • Watch for: shame or secrecy where the client has been taught that indigenous practice is evil. It is working when the client can describe tensions between their commitments.

4.4 Exploring the explanatory model (Kleinman; CFI Explanatory Model module)

  • Purpose: to learn what the client calls the problem, its cause and timing, how it works, its severity and course, the treatment wanted, its main effects and what they fear most [source: Kleinman, Eisenberg and Good 1978, via Tanenbaum handout; APA CFI Supplementary Modules].
  • Steps:
    1. Ask the eight questions in your own words, spread across the conversation.
    2. Listen for Akan causal categories as the client holds them: spiritual illness (sunsum yare), a deity's call, ancestral displeasure, witchcraft, curses, broken taboos, alongside natural or medical causes [source for sunsum yare: Okomfo Boakyewa abstract; for calling: Wita 2011; other categories as clients raise them, synthesis].
    3. Ask who has already named the cause, such as an okomfo, a pastor, a prayer-camp leader or a doctor, and whether the client agrees.
    4. Summarise the client's model back to them and write it into the formulation in their terms.
  • Example language (illustrative): "What do you think caused this?" "Why do you think it started when it did?" "What are you most afraid it will lead to?"
  • Watch for: fear of a spiritual cause can drive avoidance of all care, or acceptance of harmful treatment elsewhere. It is working when the client's model and yours can sit side by side in a plan.

4.5 Cultural identity exploration (CFI Cultural Identity module)

  • Purpose: to understand ethnicity, language, religion, generation, migration and gender as they bear on the problem. Use it for Akan clients in Ghana and in the diaspora, and for African American or Caribbean American clients who have joined Akan shrine communities [source: APA CFI Supplementary Modules; diaspora: Coyle Rosen 2024].
  • Steps:
    1. Ask which identities matter most, such as Asante, Akuapem, Fante, Guan-Akan, Christian, diaspora, or a priestly role.
    2. Ask about language preference for emotional topics (Twi or other Akan languages, English).
    3. Explore matrilineal family obligations and lineage expectations as the client describes them [synthesis].
    4. For diaspora converts, explore what joining the tradition means: ancestral reconnection, healing from racism and historical trauma, as the community frames it [source: Coyle Rosen 2024, publisher description].
  • Example language (illustrative): "Which parts of who you are feel most important to what you're going through right now?"
  • Watch for: your own assumptions that a convert's practice is less "authentic". It is working when you can name the identities in the client's own order of importance.

4.6 Asking about consultation with akomfo and other healers (CFI Coping and Help-Seeking module)

  • Purpose: to get a complete, non-judgemental map of all the help the client has sought: shrine, prayer camp, church deliverance, herbalist, hospital. Use it at intake and on review [source: APA CFI core and Supplementary Modules].
  • Steps:
    1. Normalise the question before asking it.
    2. Ask what each source of help said the problem was, what it advised, and how helpful it was.
    3. Ask specifically about anything taken by mouth or applied (remedies, medicines), only in order to inform the prescriber. Never ask for recipes.
    4. Ask about restrictions experienced: restraint, chaining, fasting, being kept from leaving, beatings. Ask plainly.
    5. Ask what they want from you in relation to the other help.
  • Example language (illustrative): "Many people from Ghana see a priest, a pastor, a herbalist and a doctor, sometimes all at once. Who have you seen about this?" "Was anyone ever kept somewhere against their wishes, or not allowed to eat, as part of treatment?"
  • Watch for: under-reporting out of fear that you will disapprove or report the healer. It is working when the client tells you about help they had previously hidden.

4.7 Informant Version and work with family and social network

  • Purpose: decisions about care, including shrine consultation and calling, are often made by the family and the lineage. Use this when family members attend, or with the client's consent [source: APA CFI Informant Version and Social Network module; family role: Wita 2011 on lineage elders].
  • Steps:
    1. Get the client's consent about who is involved and what may be shared.
    2. Use the Informant Version (17 questions; Q1 covers the relationship) with a relative [source: APA CFI Informant Version].
    3. Map where client and family disagree, such as a family that wants the client to accept a calling, or a church family that opposes the shrine.
    4. Hold joint sessions to agree on a plan, keeping the client's own choice central.
  • Example language (illustrative): "Your mother sees this as a call from a deity, and you're not sure. Can we talk about how the family makes decisions like this?"
  • Watch for: family pressure toward restraint or toward a witchcraft explanation that targets a relative. It is working when the client feels heard in the family conversation.

4.8 Using cultural concepts of distress and local idioms

  • Purpose: to use local idioms of distress, explanations and syndromes to improve communication and to avoid misdiagnosis, as DSM-5-TR intends [source: APA DSM-5-TR Section III].
  • Steps:
    1. Learn the client's idioms, such as sunsum yare (spiritual illness) and expressions of spiritual attack, and use them as the client does [source: Okomfo Boakyewa abstract].
    2. Note that DSM-5-TR lists examples (such as kufungisisa, susto and khyâl cap) but no Akan-specific entry appears in the secondary list cited [uncertain: not verified]. Do not force a listed concept onto an Akan client [source: Szepe and Fritson slides; DSM-5-TR list [uncertain]].
    3. Record the idiom alongside any DSM or ICD diagnosis rather than replacing one with the other.
    4. Check what the idiom implies for help seeking. A spiritual illness may call for the shrine or church first.
  • Example language (illustrative): "When you call it sunsum yare, what does that mean for what should be done about it, and by whom?"
  • Watch for: treating an idiom as a diagnosis, or a diagnosis as disproving the idiom. It is working when the client sees their language in your notes and plan.

4.9 Distinguishing a normative calling or akom from disorder

  • Purpose: to avoid both pathologising a culturally sanctioned possession or calling and missing psychosis, mania, a dissociative disorder or a medical cause. Use it when a client reports possession, a deity's call, hearing ancestors, or an illness that someone has read as a calling [source: Wita 2011 on calling crises; DSM-5-TR and ICD-11 as cited in 4.9 steps 2–3].
  • Steps:
    1. Establish context. Did the experience occur within a recognised shrine setting, and has an experienced okomfo or the shrine community recognised it as akom? As reported, only an experienced priest or diviner can identify a calling [source: Wita 2011].
    2. Ask whether it is voluntary and wanted, or involuntary and unwanted, and whether it occurs outside accepted practice. These are the ICD-11 6B62 and 6B63 thresholds [source: findacode ICD-11 6B62; PMC9199574 for 6B63].
    3. For dissociative presentations, apply the DSM-5-TR exclusion for broadly accepted cultural or religious practice, both to possession-form identity disruption and to dissociative trance [source: PMC9199574; Lewis 2023; exact DSM-5-TR wording [uncertain]].
    4. Screen across settings for features that point to disorder: functional decline outside the religious context, distress the client does not see as meaningful, disorganisation, sleeplessness with elation, command hallucinations to harm, substance use, seizures, fever, head injury, the postpartum period. Arrange a medical review where indicated [synthesis].
    5. Note that the calling crises described in ethnography (persistent illness, convulsions, refusing food, loss of speech) overlap with medical and psychiatric emergencies. Medical assessment is never replaced by a spiritual reading [source for the description: Wita 2011; the assessment rule is synthesis].
    6. With consent, consult a cultural broker or a recognised member of the client's shrine or community about whether the experience fits the tradition's norms (see 4.10).
    7. Share the formulation with its uncertainty stated. It may be both: a calling and an illness needing treatment.
  • Example language (illustrative): "In your tradition, akom can be a sign of being chosen. I'd also like to check that nothing medical is going on alongside it. Would that be all right?" "When this happens, does it feel like something you accept, or something that is happening against your will?"
  • Watch for: your own bias in either direction, and older ethnography that read Akan possession through a psychiatric lens. Wita reports Field's view that possession gave status to people with personality disorders, which is an outsider interpretation of its time [source: Wita 2011]. It is working when the formulation is accepted by the client and, where consulted, would make sense to the community.

4.10 Working with cultural brokers and interpreters

  • Purpose: to get accurate language and community context. Use it whenever the client prefers Twi or another Akan language, or when normativity is unclear [synthesis].
  • Steps:
    1. Use a trained interpreter, not a family member, for clinical content. Check the interpreter's religious stance and community ties, since confidentiality matters in small diaspora communities.
    2. Brief the interpreter on terms, and agree that they will flag culture-specific words rather than translate them away.
    3. For cultural brokering, with the client's consent, consult someone the client's community recognises, such as an elder, a recognised priest, or a Ghanaian clinician familiar with shrine practice. Share only what is needed.
    4. Debrief the interpreter after emotionally heavy sessions.
  • Example language (illustrative): "If a word has a special meaning in Twi, please say the word and tell me what it means, rather than finding an English word for it."
  • Watch for: interpreters editing out spiritual content, or bringing religious disapproval into the room. It is working when key terms stay in the client's language in your notes.

4.11 Collaboration and referral with community-sanctioned priests and regulated practitioners

  • Purpose: to coordinate care with an okomfo, shrine or regulated traditional practitioner whom the client already uses or wishes to use. Collaborative care between healers and health workers in Ghana and Nigeria reduced psychosis symptoms and harmful practices more than usual care [source: COSIMPO, Gureje et al. 2020, via PubAnnotation]. Training and regular visits by community psychiatric nurses to healers were reported to improve collaboration and end chaining [source: Badimak et al. 2021, via APHRC repository].
  • Steps:
    1. Raise collaboration only if the client wishes it. Never initiate a shrine referral yourself. Shrine pathways belong to the community.
    2. Establish legitimacy through the client's own community: the shrine's standing, its senior priests or elders. In Ghana, where herbal treatment is involved, check that the practitioner is TMPC-registered and the premises licensed, with the licence displayed (s.20) or verifiable by QR code [source: Act 575; Rainbow Radio 2026].
    3. Get specific written consent naming who may be contacted, what may be shared and for what purpose. Confirm that consent can be withdrawn.
    4. Agree on roles. The priest handles the spiritual dimension as the tradition defines it. You and the medical team handle assessment, psychological treatment, medicines and safety. Agree on how to communicate about red flags.
    5. State non-negotiables respectfully: no restraint, chaining or forced fasting, and urgent medical problems go to hospital [source: HRW 2023; Mental Health Act 2012 as reported].
    6. Review the arrangement regularly with the client.
  • Example language (illustrative): to the client: "Would it help if I spoke with the priest you trust, so we're not pulling you in two directions? You decide what I can share." To a priest, with consent: "I'm the client's therapist. I don't work with the spiritual side, which is your area. I'd like us to agree how we'll each help, and what we'd do if they became unwell or unsafe."
  • Watch for: requests for you to take part in or endorse ceremony (decline courteously), pressure to stop medicine (route to the prescriber), and any sign of detention or deprivation. It is working when the client experiences the two forms of care as compatible.

4.12 Coordinating with prescribers about remedies and medicines

  • Purpose: to make sure herbal remedies and prescribed medicines are known to the prescriber. Use it whenever the client takes or is offered remedies from a shrine, herbalist or prayer camp [synthesis].
  • Steps:
    1. Record that remedies are used, without collecting recipes, sources or amounts.
    2. With consent, tell the prescriber or GP that remedies are being used.
    3. If the client asks whether to stop or combine anything, say that this decision belongs to the prescriber, and help them prepare questions.
    4. In Ghana, the TMPC and the Food and Drugs Authority oversee herbal products. Act 575 refers to the Food and Drugs Board [source: Act 575]. The current name of the agency is [uncertain: not verified].
  • Example language (illustrative): "That's an important question for your doctor. Shall we write it down so you can ask them this week?"
  • Watch for: a client who stops medicine because a spiritual cause has been named. Work with their explanatory model and alert the prescriber. It is working when the prescriber has a full picture.

4.13 Integrating shrine, church and healing experiences

  • Purpose: to help the client make sense of what happened in shrine consultation, possession or deliverance, within their own frame. Use it after the client has sought such help, or when experiences conflict, as with a Christian client who also consulted a shrine [synthesis].
  • Steps:
    1. Invite the client to share whatever they choose, focusing on meaning, feelings and consequences rather than ritual content.
    2. Explore what changed: hope, relationships, obligations such as taboos or ongoing service, and sense of protection.
    3. Address distress such as guilt, fear of spiritual consequences, or conflict with church or family, using ordinary therapeutic methods within the client's values.
    4. Link any helpful change to the goals already agreed.
  • Example language (illustrative): "You don't need to tell me what happened at the shrine. I'm interested in how you've felt since, and what it means for you."
  • Watch for: retraumatisation if the experience involved coercion. It is working when the experience is woven into a coherent story the client owns.

4.14 Working with a client who is an okomfo, a trainee, or under a calling

  • Purpose: to provide therapy that respects the client's religious role and the shrine's authority. This applies to priests and trainees in Ghana and in diaspora shrine houses [source: Coyle Rosen 2024; Okomfo Boakyewa abstract; synthesis].
  • Steps:
    1. Clarify at the start that you will never ask about ceremonies, training content, sacred matters or the deity's instructions.
    2. Treat the shrine hierarchy, its senior priests and elders, as the authority on religious questions. Do not position yourself as an arbiter of the calling.
    3. Work on the problems the client brings: role strain, family conflict over the calling, stigma, grief, burnout, trauma, and mental or physical illness.
    4. Where the client is weighing whether to accept or refuse a calling, help them think it through with their elders. As reported, refusal is believed to carry consequences and release by sacrifice is possible [source: Wita 2011]. The decision and the process belong to the tradition.
  • Example language (illustrative): "Questions about what the deity wants belong with your elders. Here we can look at how all of this is affecting you, your sleep, your family and your work."
  • Watch for: confidentiality pressures in small communities, and dual relationships. It is working when the client uses therapy without feeling disloyal to the shrine.

4.15 Immigrants and refugees module and diaspora context

  • Purpose: to address migration history, separation from shrine and lineage, legal status and acculturation. Use it with Ghanaian-born clients abroad [source: APA CFI Supplementary Modules].
  • Steps:
    1. Ask about pre-migration life, the migration journey and post-migration stressors.
    2. Ask how distance from the family shrine, lineage or ancestral land affects the problem and the help available.
    3. Identify legitimate diaspora resources the client recognises, such as shrine houses, churches and community associations [source: Coyle Rosen 2024].
  • Example language (illustrative): "Being far from home can change who you can turn to. Who would you have turned to in Ghana, and who is there for you here?"
  • Watch for: obligations to send money or perform family duties at a distance as a source of stress. It is working when practical and relational supports are identified.

4.16 Addressing stigma, religious conflict, colonial history and racism

  • Purpose: to acknowledge the suppression and stigma of indigenous practice, the dominance of Christianity in public life, and racism in services. Use it when mistrust, shame or concealment shapes the work [source: Okomfo Boakyewa abstract; Coyle Rosen 2024 on healing from historical trauma; synthesis].
  • Steps:
    1. Name, without lecturing, that clients often expect services to look down on shrine practice.
    2. Ask about experiences of discrimination in health care (CFI clinician–patient relationship) [source: APA DSM-5-TR CFI].
    3. Work on internalised shame where the client wants this, without pushing any religious position.
  • Example language (illustrative): "Some people have been made to feel ashamed of their family's traditions by schools, churches or doctors. Has that been part of your experience?"
  • Watch for: your own organisation's practices that reproduce stigma, such as forms or colleagues using "fetish" or "juju" language. It is working when concealment drops.

4.17 Acute risk and spiritual crisis

  • Purpose: to respond safely when a possession-like or calling experience comes with risk, such as suicidal thoughts, inability to eat or drink, aggression, or confusion [synthesis].
  • Steps:
    1. Carry out a standard risk assessment, including suicide and self-harm risk, with safety planning and lethal-means counselling (safe storage and removal).
    2. Arrange urgent medical review for confusion, fever, seizures, dehydration or refusal of food and fluids.
    3. Engage the family and, with consent, the client's recognised religious authority, to support safety rather than replace care.
    4. Use emergency and legal pathways where needed. In Ghana, involuntary care follows the Mental Health Act. A traditional centre may receive an involuntary patient only briefly, pending transfer, as reported [source: Schuck 2018].
  • Example language (illustrative): "Whatever the spiritual meaning of this, right now I'm worried about your safety, and I want us to make sure your body is looked after."
  • Watch for: delays while waiting for a spiritual resolution. It is working when immediate safety is secured without the client's framework being dismissed.

4.18 Safeguarding: restraint, chaining, forced fasting and witchcraft accusations

  • Purpose: to protect clients and others, especially women, older people and children, from harm done in the name of treatment or spiritual protection. Use it whenever these are disclosed or suspected [source: HRW 2023; GNA 2024; JURIST 2023].
  • Steps:
    1. Know the facts. In October 2023, HRW found people chained in prayer camps despite the 2017 ban on shackling, and reported forced fasting as "treatment" [source: HRW 2023]. Ghana's Parliament passed a Criminal Offences (Amendment) Bill on 28 July 2023. It prohibits declaring, accusing, naming or labelling a person a witch, and practising as a "witch doctor" or "witch finder" [source: GNA 2024; JURIST 2023]. As of April 2024 the bill awaited presidential assent, and its current legal status is [uncertain: not verified]. Accused women may be sent to "witch camps", and some have been labelled because of mental health problems [source: GNA 2024].
    2. Ask directly about restraint, chaining, deprivation of food or water, beatings, sexual contact, being kept from leaving, and accusations against the client or a relative, including children.
    3. If harm is current or a child is at risk, follow your jurisdiction's safeguarding and reporting duties. In Ghana, relevant bodies include the Mental Health Authority, regional Visiting Committees, CHRAJ, the police and social welfare services [source for Visiting Committees: HRW 2023; CHRAJ role: GNA 2024; other bodies: synthesis].
    4. Separate the tradition from the abuse. Report the harmful act, not the religion. Recognised priests and shrine elders may be allies in stopping it.
    5. For children, never name the minor in correspondence beyond what reporting requires. Seek child-protection advice early [synthesis].
  • Example language (illustrative): "I respect that you sought help from people you trust. Some things are never acceptable as treatment, in any tradition, such as being chained or kept from food. Has anything like that happened to you or anyone in your family?"
  • Watch for: fear of retaliation, spiritual threats and family loyalty can silence disclosure. It is working when the client is safe and still connected to the parts of their community they value.

5. Handling problems

Except where a source is tagged, the guidance here is [synthesis]. The sources on akom do not address psychotherapy problems directly.

  • Client tests you or withholds spiritual material. Respond: name it as common, say plainly that you will not judge or try to convert them, and return to it later. Do not push. Concealment of indigenous practice is reported as widespread in a Christian-dominated public life [source: Okomfo Boakyewa abstract].
  • Client asks you to say whether the deity or the witchcraft is real. Respond: "I can't answer that for you. Your elders and your faith speak to that. What I can do is help with what it's doing to your life." Keep the attributed stance (principle 3).
  • Client wants you to find them a priest, or to come to a ceremony. Respond: decline ceremony attendance. If they want spiritual help, they should approach the pathway their family or community recognises, and you can coordinate with consent (4.11). Do not refer to shrines or "healers" you have found online.
  • Stuck: two explanatory models in deadlock (for example, a family certain it is a calling, and a team certain it is psychosis). Respond: reframe as "both may be true". Agree on shared observable goals, such as sleep, eating, safety and function. Revisit after a defined period. Consider consulting a cultural broker (4.9, 4.10).
  • Non-adherence to medicine or therapy because a spiritual cause has been named. Respond: explore the client's fears using the explanatory model. Alert the prescriber with consent. Ask whether the client's recognised religious authority would support continued medical care. Collaborative models in Ghana report healers accepting medication alongside their care [source: Ofori-Atta et al. prayer-camp trial; COSIMPO]. Never advise on stopping or starting medicines yourself.
  • Overwhelm or dissociation in session (including a possession-like state). Respond: slow down, orient to the room, and ask permission before any grounding. Ask afterwards how the client understands what happened. Do not interpret it spiritually. If it recurs outside accepted practice and is unwanted, reassess (4.9).
  • Rupture after a perceived insult, such as a colleague calling the priest a "fetish priest", or a form that pathologises possession. Respond: acknowledge it directly, apologise for the harm, describe what you will change, and ask what would repair trust (CFI clinician–patient relationship).
  • Family pressure for restraint, deliverance with fasting, or blaming a relative as a witch. Respond: safeguarding first (4.18). Then work with the family's underlying fear and need for protection. Offer alternatives they can accept, and involve community allies who reject harm.
  • Client is accused of witchcraft, or accuses someone else. Respond: treat this as a safety issue for the accused person. Assess the client's distress and any risk to others. Note that accusations are prohibited under the bill Ghana's Parliament passed in 2023, whose current legal status is [uncertain: not verified] [source: GNA 2024; JURIST 2023].
  • A priest or trainee client in role strain or burnout. Respond: work on workload, family and stigma. Leave questions about the calling to their elders (4.14).
  • Confidentiality in small diaspora communities. Respond: agree explicitly on what you will do if you meet the client's shrine elders or church members, and check whether the interpreter has conflicts of interest.
  • A practitioner tells the client to stop seeing you, or a church tells the client to stop seeing the priest. Respond: support the client's own choice. Explore the costs and benefits of each option. Keep the door open.
  • Mistaking a medical emergency for a calling, or a calling for psychosis. Respond: medical review whenever there is fever, seizures, confusion, refusal of fluids or postpartum onset. Hold the formulation with its uncertainty stated (4.9, 4.17).
  • Your own discomfort or fascination. Respond: take it to supervision. Do not seek out ceremonial knowledge to manage your discomfort (4.1).

Sources

Web sources:

Cultural assessment, diagnostic and collaboration sources:

Books and papers cited:

  • Coyle Rosen, L. (2024). Law in Light: Priestesses, Priests, and the Revitalization of Akan Spirituality in the United States and Ghana. University of California Press.
  • Kleinman, A., Eisenberg, L., and Good, B. (1978). Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88: 251–258.
  • Gureje, O., Appiah-Poku, J., et al. (2020). Collaborative shared care for psychosis in Nigeria and Ghana (COSIMPO). The Lancet.
  • Field, M. J. (1960). Search for Security (as cited by Wita 2011; title and year [uncertain: not verified]).
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