Ewe and Fon vodun

1. Introduction

Version followed: vodun (Fon, Benin) and vodu (Ewe, Togo, south-eastern Ghana, south-western Benin) as Beninese and Togolese religious leaders, the Beninese state and official reports describe them, with outsider ethnography (Rosenthal 1998; Falen 2018) as attributed context; the psychotherapist's own work follows the DSM-5-TR Cultural Formulation Interview (CFI) and its supplementary modules.

What it is. Vodun is a living religious tradition, not a therapy. In Benin it was officially declared a religion in 1996, and a National Voodoo Board was created that year under President Kérékou, after a period of suppression during his earlier Marxist-Leninist government (1972–1991) and rehabilitation under President Soglo [source: Wikipedia, Fête du Vodoun; AP via The Journal, 2026]. The national Vodun holiday falls on 10 January, with the main celebration in Ouidah; one source says Soglo initiated it and links the first celebration to the UNESCO "Ouidah 92" Slave Route festival, another says it has been celebrated since 1996 [source: Afrik.com 2005; AP via The Journal, 2026] [uncertain: sources differ on the founding year]. In the 2013 census 11.6% of Benin's population identified with Vodun and 2.6% with other Indigenous religions, and many Christians and Muslims also take part in Vodun [source: US State Department, 2023 Report on International Religious Freedom: Benin]. In Togo, press estimates cited in an official refugee-board report put vodu practice at 52–60% of the population [source: IRB Canada, TGO104139.FE, 2012] [uncertain: press estimates].

Healing and possession within the tradition. Vodun communities attribute illness, misfortune and conflict partly to relations with deities, ancestors and other spiritual forces. Within the tradition, healing, protection and dispute settlement are among what shrines and their priests provide. Ethnographer Judy Rosenthal, an outsider who notes her own position, describes Ewe Gorovodu as "medicine Vodu" orders in which trance brings spirits of "bought people" from the northern savanna into Ewe communities to protect worshippers, heal the sick and settle disputes [source: University of Virginia Press, Rosenthal 1998]. Douglas Falen's ethnography of southern Benin stresses that practice is plural and "forever evolving" (reviewer's words), and that participation is restricted and guarded [source: Lawrance, review of Falen 2018]. These are the tradition's own understandings as reported, not claims this guide makes or rejects.

Core idea for the psychotherapist. Change, in your work, comes from understanding the client's distress in the client's own terms (explanatory model, cultural identity, spiritual obligations, family and shrine relationships), telling culturally normative experience apart from illness, and building care that the client can accept: alongside vodun practitioners when the client wishes, and with safeguarding wherever a practice harms someone [source: APA DSM-5-TR CFI; synthesis]. You do not perform, recommend or arrange vodun ceremony, divination or initiation.

2. Framework

This is a framework for the psychotherapist's culturally responsive work with clients who practise, grew up in, or are affected by vodun. It is not a vodun method. Session counts are [synthesis]; no source sets them.

Who holds authority in the tradition. Authority rests with the tradition's own hierarchy, not with clinicians:

Benin: the Daagbo Hounon, seated in Ouidah, is described as the supreme Vodun spiritual leader (currently Daagbo Hounon Houna II) [source: AP via The Journal, 2026; Afrik.com 2005]; vodounon (priests) lead the individual cults [source: Afrik.com 2005]; the bokɔnɔ (diviner) is a community figure [source: Lawrance review of Falen 2018]; a National Voodoo Board was created in 1996 [source: AP via The Journal]; in 2023 a presidential decree set up a committee of nine Vodun priests and specialists on Vodun-based religious tourism, including the "formalization" of rites and practices in convents [source: US State Department 2023 report].
Togo: a national president of vodu priests speaks for priests, and told a journalist it was "very difficult" to explain certain matters to an outsider [source: IRB Canada TGO104139.FE].
Healing as health care (Benin): the Ministry of Health's Programme National de la Pharmacopée et de la Médecine Traditionnelle (PNPMT) leads the traditional medicine sector, which has a national policy, regulatory framework and code of ethics and conduct; practitioners are represented by ANAPRAMETRAB (Association Nationale des Praticiens de la Médecine Traditionnelle du Bénin) [source: WHO AFRO 2017]. Not every vodun priest is a registered traditional-medicine practitioner [uncertain: not verified].
Ghana (Ewe areas): state bodies (the Commission on Human Rights and Administrative Justice, the Department of Social Welfare) work with traditional leaders on trokosi [source: IRB Canada GHA28806.E, 1998; Report Women 2019].

Phases of the psychotherapist's work [synthesis, built on the APA CFI materials]:

Phase	Goal	Typical format	Move on when
A. Engagement and cultural assessment	Hear the problem in the client's terms; core CFI; key modules (Spirituality, Religion and Moral Traditions; Explanatory Model; Cultural Identity; Coping and Help-Seeking); safety screen	Sessions 1–2 (modules may be spread over sessions 2–4); interpreter if needed; informant version with family if the client agrees	You can state the client's explanation, current help-seeking (shrines, churches, clinics), main stressors and any risk
B. Formulation and differential	Separate normative religious experience (possession trance in ritual, spirit calling, obligations to a deity) from disorder; check medical causes	1–3 sessions; consultation with a cultural broker or community member if the client agrees	A shared formulation the client recognises; diagnosis only where criteria are met outside accepted practice
C. Shared plan	Agree goals, roles of each helper, information sharing	1 session, revisited	Written consent for any contact with a priest, healer or family
D. Ongoing therapy and integration	Evidence-based therapy for the agreed problem, adapted to the client's meanings; integrate religious experience; family work	Usual course for the condition treated	Goals met; the client can use both religious and clinical help without conflict
E. Safeguarding track (any time)	Respond to harm: trokosi or ritual servitude, children kept from school or harmed in convents, abuse, chaining, witchcraft accusations, delayed urgent medical care	Immediate, following local law and policy	Risk addressed, referral made, record complete

The CFI supplementary modules can be used at the first assessment, later in care, or repeatedly during treatment [source: APA CFI Supplementary Modules]. No APA form states how long the core CFI takes; the field trial found later interviews took less time [source: Lewis-Fernández et al. 2017 via University of Minnesota] [uncertain: no time in minutes].

3. Guiding principles

You work alongside the tradition, not in it. Never perform, imitate or arrange ceremony, divination, initiation or healing; your role is assessment, therapy, coordination and safeguarding [synthesis].
Authority belongs to the community. Questions about what a deity requires, whether a ritual is needed, or who may treat whom belong to the client's priests and community hierarchy (see Framework) [source: AP via The Journal; IRB Canada 2012].
Neither affirm nor dismiss. Describe spirits, possession and sorcery as the client and tradition hold them; your stance is curious and respectful, not a verdict on their reality [synthesis].
Retire "voodoo" stereotypes. Clients may carry stigma from film, missionary and colonial portrayals and from state suppression; use "vodun" or "vodu", or the client's own word [source: AP via The Journal; synthesis].
Restricted knowledge stays restricted. Initiates may be bound not to disclose; do not ask for what the client may not share, and never record ritual detail beyond what care needs [source: Lawrance review of Falen 2018; IRB Canada 2012].
Practice is plural. Many clients combine vodun with Christianity, Islam, clinics and herbal care; do not assume one exclusive identity [source: US State Department 2023; Lawrance review of Falen 2018].
Culture informs, it does not diagnose. The CFI supports clinical decisions and is not the only basis for a diagnosis [source: APA DSM-5-TR CFI].
Possession within accepted practice is not a disorder. DSM and ICD-11 exclude trance and possession that are part of broadly accepted cultural or religious practice; disorder needs involuntary, unwanted states with distress or impairment [source: PMC article PMC9199574; findacode ICD-11 6B62].
Avoid both errors. Do not pathologise devotion; do not miss psychosis, mania, depression, trauma or medical illness behind a spiritual explanation [synthesis].
Client consent governs every contact. Speak with healers, priests, families or brokers only with the client's informed consent and agreed limits [synthesis].
Safeguarding overrides tradition. Ritual servitude (trokosi), sexual abuse, children kept from school, chaining and delayed urgent care are harms whatever the rationale [source: Report Women 2019; IRB Canada 2012; synthesis].
Do not generalise from harm. Trokosi is a specific shrine practice in parts of the Ewe area; it does not describe vodun as a whole [source: Report Women 2019; IRB Canada GHA28806.E; synthesis].
No advice on remedies or medicines. Do not discuss doses, preparation or use of herbal or ritual substances; route medicine questions to the prescriber [synthesis].
History is in the room. Ouidah was a major slave-trading port; colonial and post-independence suppression and Western ridicule shape trust in services [source: AP via The Journal; synthesis].
Self-examination is ongoing. Check your own religious, secular or racial assumptions before and during the work [source: APA CFI Patient-Clinician Relationship module; synthesis].

4. Intervention inventory

Every item below is the psychotherapist's own work. None is a vodun practice. Example language is illustrative unless quoted and cited.

4.1 Cultural humility and self-examination

Purpose / when: before and throughout the work, especially if your picture of vodun comes from film, horror tropes or missionary framing [synthesis].
Steps: (1) Note your own reactions to words such as spirit, sacrifice, fetish or possession. (2) Learn the basics the community publishes: the tradition is a recognised religion in Benin, it has its own hierarchy, and practice is often mixed with Christianity or Islam [source: US State Department 2023; AP via The Journal]. (3) Name the power gap: you hold diagnostic authority in a system that once ridiculed or suppressed the client's religion. (4) Bring these reactions to supervision. (5) Use the CFI Patient-Clinician Relationship module to reflect on how the relationship is going [source: APA CFI Supplementary Modules].
Example language (illustrative): "I know vodun has often been misrepresented. I would rather learn from you what it means in your life and your family."
Watch for: curiosity that slides into voyeurism about ritual; reassuring the client that it is "just culture"; signs the client is sanitising their account to avoid judgement. Working: the client corrects you freely and brings religious material without prompting.

4.2 Core Cultural Formulation Interview (16 questions)

Purpose / when: at intake for every client, and whenever the explanation of distress seems to differ between you and the client [source: APA DSM-5-TR CFI].
Steps: Work through the four APA domains in your own words: (1) cultural definition of the problem (Q1–3); (2) perceptions of cause, context and support, including stressors, supports and the role of 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 (Q14–16). Ask open questions, use the client's terms back, and note where the core form points to a module [source: APA DSM-5-TR CFI]. The CFI may be reproduced by clinicians for use with their patients; changing or translating it needs APA permission [source: APA DSM-5-TR CFI].
Example language (illustrative): "How would you describe what is happening, in your own words?" "Who in your family or community would you usually go to with something like this?" "Have you been to a shrine, a church, a healer or a clinic about it?"
Watch for: the client answering in biomedical words to please you; the problem defined differently by the client and the family. Working: you can state the problem, its cause and the preferred help in the client's own vocabulary.

4.3 CFI Informant Version

Purpose / when: when a family member, spouse or community member is closely involved, as is common where illness is seen as a family or lineage matter [source: APA CFI Informant Version; synthesis].
Steps: (1) Get the client's consent and agree limits. (2) Use the 17-question informant form: relationship to the client first, then the same four domains [source: APA CFI Informant Version]. (3) Interview separately if there is any sign of coercion. (4) Compare accounts and note where family obligations to a shrine or deity shape the family's view.
Example language (illustrative): "From your side, what do you think has caused this, and what do you think should happen?"
Watch for: a relative who speaks for the client; pressure for a ritual, a church deliverance or a shrine placement the client does not want; any hint of a child or young woman being pledged to a shrine (see 4.13). Working: the family sees you as an ally to their concern, not an opponent of their religion.

4.4 Spirituality, Religion and Moral Traditions module

Purpose / when: whenever vodun, a deity, ancestors, a shrine or a convent is part of the client's life or story [source: APA CFI Supplementary Modules].
Steps: (1) Ask what religious or spiritual traditions the client and family belong to, including several at once. (2) Ask what role these play in daily life and in the current problem. (3) Ask whether the tradition helps, harms or both. (4) Ask about conflict with family members of other faiths (for example Pentecostal relatives who view vodun as harmful) [synthesis]. (5) Do not ask about content the client says is secret.
Example language (illustrative): "Is there anything about your religion that you are not able to talk about? That is fine; tell me only what you can." "Does your vodun see this as something that concerns a deity or the ancestors?"
Watch for: shame from a conversion that broke with family vodun; fear of spiritual consequences for speaking. Working: the client can say how faith helps and where it adds pressure.

4.5 Explanatory Model module and Kleinman's questions

Purpose / when: to understand what the client believes is wrong and what should be done, especially when sorcery, a broken obligation to a deity or ancestral anger is named [source: APA CFI Supplementary Modules; Tanenbaum handout on Kleinman et al. 1978].
Steps: Ask, in your own words, Kleinman's eight questions: what the client calls the problem; its cause; why it started when it did; what it does and how it works; how severe it is and how long it will last; what treatment the client should receive; the chief problems it has caused; and what the client fears most [source: Tanenbaum handout]. Then summarise the model back and ask what parts of clinical care fit with it.
Example language (illustrative): "If this came from a quarrel with a relative, or a deity being unhappy, what would need to happen for it to settle?" "What part of that could our sessions help with?"
Watch for: fear of a named person (risk of accusation; see 4.13); a model that rules out any clinical help; a model that drives delay of urgent medical care. Working: a shared plan that respects the model and includes the clinical piece.

4.6 Cultural Identity, Social Network, Coping and Help-Seeking, and Immigrants and Refugees modules

Purpose / when: for diaspora clients (for example in France, North America or Ghana) and for anyone whose identity spans Fon, Ewe, Mina, Christian and national identities [source: APA CFI Supplementary Modules; synthesis].
Steps: (1) Map the client's identities and languages (Fon, Ewe, Gen/Mina, French, English, Twi). (2) Map who supports and who pressures (lineage, shrine, church, peers). (3) List past help: shrines, churches, prayer, herbal care, clinics, and what helped. (4) For migrants, ask about migration stresses, loss of contact with a home shrine or priest, and status [source: APA CFI Supplementary Modules].
Example language (illustrative): "Since you came here, how has it been to keep up your religious obligations, or not?"
Watch for: guilt over unmet obligations at home; isolation from diaspora religious networks; fear that disclosure affects immigration status. Working: the client names who can help, at home and here.

4.7 Asking about healers, shrines and remedies without judgement

Purpose / when: at assessment and on review; many families turn first to traditional or religious care for mental illness in Benin [source: IRB Canada BEN104449.FE, 2013].
Steps: (1) Ask routinely and neutrally whether the client sees a vodounon, bokɔnɔ, herbalist, pastor or imam. (2) Ask what was advised and whether anything was taken by mouth or applied. (3) Record names of remedies only as the client reports them. (4) Do not advise on doses, preparation or stopping or starting anything; pass medicine questions to the prescriber, with consent. (5) Note whether the care involved restraint, fasting or keeping the person away from treatment (see 4.13).
Example language (illustrative): "Many people see a healer or a priest as well as coming here. Is that true for you? I ask so that we can work together, not to judge." "Your doctor will want to know about anything you take, so the medicines work safely."
Watch for: secrecy for fear of disapproval; remedies combined with psychiatric medicines; urgent physical illness waiting on ritual. Working: the client tells you about other care openly.

4.8 Cultural concepts of distress: local idioms

Purpose / when: to understand the words and explanations the client uses for distress, which DSM-5-TR calls cultural idioms, explanations and syndromes [source: APA DSM-5-TR Section III].
Steps: (1) Ask what the client calls the problem in Fon, Ewe or French, and what people at home would say it is. (2) Ask how such problems are normally handled and by whom. (3) Use the term in sessions with the client's permission. (4) Do not borrow a DSM concept from another culture (for example maladi dyab, which is Haitian) as if it fitted. DSM-5-TR lists no concept of distress specific to Fon or Ewe vodun [uncertain: not verified; the DSM-5-TR list is itself uncertain in the sources].
Example language (illustrative): "What would your grandmother call this? What would she say should be done?"
Watch for: idioms of sorcery or spiritual attack that carry accusation risk; you assuming a term means the same thing across Fon and Ewe communities. Working: the idiom becomes a shared word for tracking change.

4.9 Distinguishing normative possession and spiritual experience from disorder

Purpose / when: when a client reports trance, possession by a deity, being called by a vodun, hearing ancestors, or unusual experiences linked to religion.
Steps: (1) Establish context: did the experience occur within ritual, expected and accepted by the community? Rosenthal describes trance in Gorovodu as a recognised part of the religion [source: UVA Press, Rosenthal 1998]. (2) Check DSM-5-TR and ICD-11 exclusions: possession-form identity disruption and dissociative trance are not disorders when part of a broadly accepted cultural or religious practice; ICD-11 trance disorder (6B62) and possession trance disorder (6B63) require states that are involuntary and unwanted, with significant distress or impairment [source: PMC9199574; findacode ICD-11 6B62]. (3) Ask whether the client's own community sees the episode as normal or as a problem; with consent, ask a community member or priest. (4) Screen for features that point to illness in any culture: states outside ritual, loss of function, sleep loss, disorganisation, mood elevation, suicidality, substance use, medical causes, trauma. (5) Formulate; diagnose only if criteria are met outside accepted practice.
Example language (illustrative): "When this happens, is it during a ceremony, when people expect it, or at other times as well?" "Do the priests or elders see this as normal, or are they also worried?"
Watch for: pathologising devotion; missing psychosis because "it is cultural"; a community also treating the state as abnormal, which is a strong sign of illness. Working: the client and, where involved, the community recognise your formulation.

4.10 Cultural brokers, community consultation and interpreters

Purpose / when: when language, religious context or community norms are beyond your knowledge [synthesis].
Steps: (1) With consent, find a broker the client trusts (someone from the community, not necessarily a priest). (2) Use professional interpreters for Fon, Ewe, Gen/Mina or French; avoid family members, and especially children, as interpreters. (3) Brief the interpreter on confidentiality and on keeping religious terms as the client says them. (4) Ask the broker about norms, not about ritual secrets. (5) Check with the client what they want shared.
Example language (illustrative): "Would it help to have someone from your community explain things to me, so I understand you better? You choose who, and what they hear."
Watch for: a broker with a stake in the dispute; interpreters who soften or omit religious content; confidentiality in a small diaspora community. Working: fewer misunderstandings and a client who feels better understood.

4.11 Collaboration and referral with community-sanctioned practitioners

Purpose / when: when the client wants their priest, traditional-medicine practitioner or religious community involved in care. Evidence from neighbouring Ghana and Nigeria supports structured collaboration: in the COSIMPO cluster trial, collaborative shared care between traditional and faith healers and primary health workers for psychosis gave a larger symptom reduction and fewer harmful practices than usual care [source: PubAnnotation PMID 32861306; Centre for Global Mental Health]; in a Ghanaian prayer-camp trial, adding psychiatric medication reduced symptoms but did not significantly reduce days in chains [source: Mental Health Data Prize Africa repository, Ofori-Atta et al.]. Neither trial was of vodun shrines specifically [synthesis].
Steps: (1) Ask whether the client wants anyone from their religious life involved, and who; never initiate contact with a shrine yourself. (2) Respect the community's own pathway: the client, or their family, approaches the priest through the usual hierarchy; you do not "refer to a ceremony". (3) In Benin, practitioners of traditional medicine are organised through the Ministry of Health's PNPMT and ANAPRAMETRAB; ask whether the practitioner is recognised there or by their own community [source: WHO AFRO 2017]. (4) Get written consent stating what may be shared, with whom, for what purpose. (5) Agree roles: the clinician covers assessment, therapy, risk and medical liaison; the practitioner covers the religious dimension. (6) Agree red lines in advance: no restraint, no withholding food, water or medicines, no keeping a child from school, urgent medical care never delayed. (7) Review together at set intervals, with the client present where possible.
Example language (illustrative): "You said your vodounon has helped your family for years. Would you like me to be in touch with them, or would you rather keep the two separate?" "We can both help in different ways. What I need to agree with everyone is that your medicines and medical care continue."
Watch for: the client agreeing under family pressure; a practitioner or relative asking you to endorse a placement, initiation or remedy; information flowing beyond consent. Working: the client experiences care as joined up, not as a forced choice.

4.12 Integrating religious and healing experience into therapy

Purpose / when: after a client has undergone ritual healing, possession, a calling or a period in a convent, or is weighing an obligation to a deity [synthesis].
Steps: (1) Invite the client to describe, at the level they choose, what it meant to them, not what was done. (2) Explore what changed in relationships, identity, obligations and symptoms. (3) Link these meanings to therapy goals (for example a sense of protection used as a coping resource). (4) Where the experience was distressing, treat it as you would any distressing event, with the client's own meaning in view. (5) Support decisions about future involvement as the client's own, made with their community.
Example language (illustrative): "You do not have to tell me what happened inside. What has it been like for you since?" "What would you like to carry forward from that, and what has been hard?"
Watch for: distress after possession states outside the client's control; conflict between a religious obligation and the client's wishes; traumatic material (see 4.13–4.14). Working: the experience becomes part of a coherent story rather than a source of shame or fear.

4.13 Safeguarding: ritual servitude, children in convents, accusations and harmful care

Purpose / when: at any time a practice harms an adult or child. Documented harms in the region include: trokosi, a shrine practice in Ghana's Volta Region (an Ewe-language term) in which girls, sometimes very young, are sent to a shrine to atone for a relative's offence, with reported sexual abuse, forced labour, loss of schooling and stigma; it was abolished by Ghana's Criminal Code (Amendment) Act 1998 (Act 554) yet reportedly continues in hidden forms [source: Report Women 2019, from Ghana Business News]; the specific section number is [uncertain: not verified]. A 1998 report cited estimates of about 4,500 trokosi women and 16,000 children in the Volta Region and press reports that the practice extends into Togo, Benin and Nigeria [source: IRB Canada GHA28806.E] [uncertain: dated estimates]. In Togo, the government acknowledged convent initiation rites "prejudicial" to children's development and physical integrity in the Maritime and Plateaux regions, initiation was moved into school holidays with local child protection committees involved, and in 2012 the UN Committee on the Rights of the Child said the harmful practice of training girls for the vodu priesthood persisted [source: IRB Canada TGO104139.FE]. Mental illness in Benin is often attributed to possession or witchcraft, and families commonly turn first to traditional or religious care [source: IRB Canada BEN104449.FE].
Steps: (1) Ask directly, in plain terms, about any obligation for the client or a child to live at or serve a shrine, leave school, or work without pay. (2) Ask about restraint or chaining, beatings, withheld food or medicines, sexual contact demanded by anyone in authority, and accusations of sorcery against the client or a child. (3) For a child: follow your jurisdiction's child-protection procedure immediately; involve the child's views (assent) and the non-abusing carer; never name the child in shared records beyond what the procedure needs. (4) For an adult: assess capacity, coercion and risk; support the client's own choices unless law requires action. (5) Report as the law of your setting requires (for example child protection, trafficking or forced-marriage pathways). (6) Use specialist services; in Ghana, the Department of Social Welfare and district child protection have been named as routes, and NGOs such as International Needs have negotiated releases [source: Report Women 2019; IRB Canada GHA28806.E]. (7) Keep the response about the harm, not about vodun as a whole.
Example language (illustrative): "Some families are asked to send a girl to a shrine to settle a family matter. Has anything like that been asked of your family?" "I respect your religion. I also have to make sure no child is being harmed, and that is a legal duty for me."
Watch for: fear that leaving or speaking will bring spiritual punishment (a 1998 report quotes fear that "something evil will happen") [source: IRB Canada GHA28806.E]; family pressure to keep silent; mistaking an ordinary religious affiliation for abuse. Working: the person is safe, informed and still able to keep the parts of their faith they choose.

4.14 Supporting survivors of ritual servitude

Purpose / when: for women and adults who were placed at a shrine as girls, and for their children [synthesis based on harms reported in Report Women 2019].
Steps: (1) Stabilise: safety, housing, documents, health care including sexual and reproductive health. (2) Assess for trauma, depression and the effect of lost schooling. (3) Address spiritual fear without challenging belief: ask what the client believes may happen and who in their community could speak to that. (4) Use evidence-based trauma therapy when the client is ready, adapted to their meanings. (5) Support education and livelihood (reintegration programmes have used vocational training) [source: Report Women 2019]. (6) Address stigma within family and community.
Example language (illustrative): "What you went through was not your fault, and it was not your offence that you were paying for." "When you think about the shrine now, what do you fear?"
Watch for: retraumatisation through repeated retelling; pressure from family or shrine to return; children born at the shrine facing stigma. Working: reduced fear, more choice, renewed contact with supportive kin.

4.15 Working with families and communities

Purpose / when: when illness, obligation or blame is shared across a lineage, or family members of different faiths are in conflict [source: Lawrance review of Falen 2018; synthesis].
Steps: (1) With consent, meet key family members. (2) Map each person's explanation and preferred help. (3) Find common goals (the client's recovery, peace in the family). (4) Reduce blame; where a named person is accused of sorcery, assess risk to that person. (5) Agree a plan that includes both religious and clinical help where the client wants it.
Example language (illustrative): "Everyone here wants her to get better. Let us look at what each of you thinks will help, and where we agree."
Watch for: scapegoating; coercion between Christian and vodun branches of a family; elders overruling an adult client. Working: family conflict lowers and the client keeps a voice.

4.16 Historical trauma, suppression and racism in services

Purpose / when: whenever mistrust of services, shame about religion or racism shapes the encounter [synthesis].
Steps: (1) Acknowledge the history the client raises: the slave trade through Ouidah; colonial and missionary hostility; state suppression of vodun under Kérékou's first government and its later rehabilitation [source: AP via The Journal]. (2) Ask about experiences of discrimination in health services, including ridicule of "voodoo". (3) Use the CFI clinician-patient relationship question to ask about barriers such as racism and language [source: APA DSM-5-TR CFI]. (4) Repair any rupture openly.
Example language (illustrative): "Has anyone in a hospital or clinic made you feel your religion was something to hide?"
Watch for: your own defensiveness; a client minimising racism to protect you. Working: the client raises difficult experiences and stays in care.

5. Handling problems

The sources do not set out problem-handling for this context; everything below is [synthesis] unless cited.

Client asks you to perform, recommend or arrange a ritual, divination or a remedy. Decline warmly and redirect to their own priest or community: "That belongs with your vodounon, not with me. I can help with how you are feeling while that is going on." Do not suggest a particular shrine or practitioner.
Client will not discuss religion, or says it is secret. Accept the limit; ask only about effects on mood, sleep, relationships and safety. Initiates may be bound to restrict what they share [source: Lawrance review of Falen 2018].
Stuck: the client believes therapy cannot help a spiritual problem. Return to the explanatory model (4.5): ask what part of the problem is about daily stress, sleep or relationships, and offer help with that part while respecting the spiritual explanation.
Family insists the illness is sorcery and wants deliverance, a shrine stay or exorcism. Hold both concerns: respect the meaning, set red lines (no restraint, food or medicine withheld, no child kept from school), and act under safeguarding if any are crossed (4.13). Chaining has persisted even alongside added medical care in Ghanaian prayer camps [source: Ofori-Atta et al. via Mental Health Data Prize Africa repository].
Overwhelm or distress after possession, or a state outside ritual. Ground and assess safety; screen for psychosis, mania, dissociation, substances and medical causes (4.9); involve psychiatry promptly if the state is involuntary, unwanted and impairing. Ask, with consent, whether the community also sees it as abnormal.
Non-adherence to medication because a priest or relative advised stopping, or because remedies are used instead. Do not argue the remedy's merits or give any advice on substances. Explore the client's view, inform the prescriber with consent, and invite a joint discussion.
Rupture after a perceived insult to the religion. Name it, apologise for the specific comment, ask what it meant to them, and use the CFI relationship question (4.16).
Disclosure of trokosi or servitude in the family, with the client asking you to keep it secret. Explain the limits of confidentiality early; where a child is at risk, follow child protection procedure even if the client objects, and tell them what you are doing and why (4.13).
Your own discomfort (fear, disgust, fascination). Take it to supervision; review 4.1. Do not let it change the clinical plan.
Collaborating practitioner oversteps (claims to cure psychosis without medicine, or asks for clinical records). Revisit the agreed roles and consent; share nothing beyond the consent form; if a harm red line is crossed, safeguarding applies.
Diaspora client cut off from their home community and distressed about unmet obligations. Explore options the client can pursue through family or diaspora religious networks; avoid steering them to anyone outside legitimate community pathways.
Children and adolescents. Gain parental consent and the young person's assent; use the CFI School-Age Children and Adolescents module [source: APA CFI Supplementary Modules]; ask about schooling and any time spent in a convent, without asking about initiation content; never name minors in shared notes beyond what procedures require.
Interpreter or broker conflict of interest. Change interpreter; check that the broker has no role in the family dispute.

Sources

Web sources:

Books and papers cited:

Rosenthal, J. (1998). Possession, Ecstasy, and Law in Ewe Voodoo. University of Virginia Press.
Falen, D. J. (2018). African Science: Witchcraft, Vodun, and Healing in Southern Benin. University of Wisconsin Press (cited via Lawrance's review).
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.
Lewis-Fernández, R., Aggarwal, N. K., Lam, P. C., et al. (2017). Feasibility, acceptability and clinical utility of the Cultural Formulation Interview. British Journal of Psychiatry, 210(4), 290–297.
Gureje, O., Appiah-Poku, J., et al. (2020). COSIMPO cluster randomised trial of collaborative shared care for psychosis. The Lancet [uncertain: full title not verified].
Ofori-Atta, A., Attafuah, J., Jack, H., Baning, F., Rosenheck, R., et al. Joining psychiatric care and faith healing in a prayer camp in Ghana: randomised trial. British Journal of Psychiatry, 212(1) [uncertain: year 2018 or 2019].

← Previous · XI-056Akan okomfo Next · XI-058 →Kongo nganga