Kongo nganga · Atlas

1. Introduction

Version followed: Kongo healing as described in outsider (non-Kongo) ethnography, chiefly John M. Janzen's The Quest for Therapy in Lower Zaire (UC Press edition dated 1982) and Ngoma: Discourses of Healing in Central and Southern Africa (1992), the University of Kansas "Central African Healing Traditions" exhibit panels, and Simon Bockie's Death and the Invisible Powers (1993), a Kongo-born author's account (as summarised in MIT OpenCourseWare notes). The clinician's own procedures follow the DSM-5-TR Cultural Formulation Interview (CFI). Safeguarding follows UNICEF, Human Rights Watch, EASO and UK Department for Education sources. [source: Janzen 1982 UC Press page; Janzen 1992 UC Press e-book; KU panels; MIT OCW 21A.460J notes]

What it is. Nganga (plural commonly banganga) is the Kikongo term for a healer and ritual specialist among the BaKongo of the lower Congo River: Kongo Central and Kinshasa in the Democratic Republic of the Congo (DRC), with related communities in the Republic of the Congo and northern Angola [uncertain: the Angolan and Republic of Congo extent is not verified]. The Encyclopedia of World Cultures entry says BaKongo consult nganga "for illness and life problems" and that families often seek both a diviner and a hospital for the same problem. Most BaKongo today are Christian, mainly Catholic, and 10-15% belong to churches tracing to the prophet Simon Kimbangu, who healed and preached in 1921 and was imprisoned for life by the Belgian authorities. [source: Encyclopedia of World Cultures, vol. 9, Africa and the Middle East (1995), "Kongo"] [uncertain: secondary, unverified] Scholars describe several named kinds of nganga: some work mainly with plants, some with minkisi (named, personified containers of spiritual power), some with cupping, and a separate inspired diviner (ngunza) may be consulted in family matters. [source: KU panels] This guide does not describe how minkisi are made or used, or any rite. That knowledge belongs to its holders.

How affliction and its resolution are understood (attributed). In Bockie's account, wellbeing depends on right relations between the living, the ancestors, the clan, the lineage and the individual: "Affliction results when web between levels is disrupted" (course notes paraphrasing Bockie). Causes can include incest, unresolved marriage disputes and harmful powers. [source: MIT OCW notes] The KU panels state that "Impurities result from broken social codes and relational observances," so healing aims to restore right relationships. In this view kindoki, held by a ndoki, is the power of words and will, also held by chiefs and orators. The panels add that "With colonialism, ndoki took on a negative connotation" of witch. [source: KU panels] The encyclopedia entry notes that afflictions sent by God count as "natural," while those involving witchcraft form a separate category. [source: Encyclopedia of World Cultures, "Kongo"] [uncertain: secondary, unverified] Janzen's central finding is that decisions about therapy are made not by the patient alone but by a "therapy managing group" of kin and associates, who diagnose, choose among healers, prophets and hospitals, and judge the results. [source: Janzen 1982 UC Press page; MIT OCW notes]

What this guide is. This is not a therapy a psychotherapist can perform. It is a guide to the psychotherapist's own culturally responsive work with clients who use, have used, or fear Kongo healing, church deliverance, or witchcraft accusation, in Central Africa or in the diaspora. Change, in the therapist's frame, comes from understanding the client's and family's explanatory model, reducing conflict between systems of care the client already uses, keeping the client and any children safe, and working with community-sanctioned healers only where the client wishes. [synthesis]

2. Framework

No source sets phases or session counts for this work. The structure below is [synthesis], built around the CFI. The CFI is "designed to be used by any clinician providing services to any individual in any care setting" (APA), and its modules can be used at first evaluation, later, or repeatedly. [source: APA DSM-5-TR Section III; APA Supplementary Modules]

Phase	Goals	Typical format	Move on when
1. Engagement and safety screen	Build trust; screen for immediate risk (suicide, psychosis, physical illness, child protection)	Session 1, 50-90 min; interpreter booked in advance if needed	No unmanaged acute risk, or risk is being handled through standard pathways
2. Cultural assessment	Core CFI; explanatory model; who is in the therapy managing group; current and past use of nganga, prophets, churches and hospitals	Sessions 1-3; Informant Version with a relative if the client agrees	You can state the problem in the client's own terms and know who decides about care
3. Formulation and differential	Normative experience vs disorder; cultural concepts of distress; safeguarding judgement	Sessions 2-4; consult a cultural broker or colleague	Working formulation shared with and corrected by the client
4. Shared plan	Agree goals; decide with the client whether and how to coordinate with healers, pastors or prescribers	1-2 sessions; written consent for any contact with others	Client has chosen a plan and consent is documented
5. Treatment and integration	Evidence-based treatment for any disorder, adapted to the model; integrate healing or church experiences	Weekly or fortnightly, about 8-20 sessions depending on the condition	Goals met, or a change of plan is agreed
6. Review and ending	Review CFI themes; relapse plan naming all the helpers the client uses	1-2 sessions	Plan agreed

[synthesis: phase structure, durations and counts are suggested here, not taken from a Kongo or APA source]

3. Guiding principles

Clinician, not nganga. Authority in Kongo healing comes from ancestral or spiritual sources and is revealed to someone, bought from them, passed down a family, or taught by a master nganga to an apprentice (KU panels, paraphrased). Practical meaning: never offer, imitate or interpret Kongo healing; ask the client who holds authority for them. [source: KU panels]
The family decides, too. Therapy choices are made by a kin "therapy managing group". Practical meaning: ask early who will be consulted about this treatment and what they think. [source: Janzen 1982; MIT OCW notes]
Pluralism is normal. Families commonly use a diviner and a hospital for the same problem. Practical meaning: assume parallel care, ask about it plainly, and do not demand the client choose. [source: Encyclopedia of World Cultures, "Kongo"] [uncertain: secondary, unverified]
Attribute, don't adjudicate. Ancestors, kindoki and minkisi are described as the client and their tradition hold them, neither confirmed nor dismissed. Practical meaning: use the client's words ("the trouble from the family", "kindoki") and reflect them back as theirs. [synthesis]
Relationships are the frame of illness. Kongo accounts tie affliction to broken relations. Practical meaning: explore family conflict, obligations and ancestral duties as possible meanings, alongside biological and psychological factors. [source: MIT OCW notes; KU panels; synthesis for the clinical use]
Children first. Child witchcraft accusation is a documented harm in Kinshasa and in the diaspora. Practical meaning: a child named as a witch or "possessed" is a safeguarding concern whatever the family's faith. [source: EASO 2021; GOV.UK 2012]
Belief is not abuse; harm is. UK guidance stresses that only a small minority who believe in witchcraft or spirit possession abuse children, and that abuse of this kind is not confined to one faith or community. Practical meaning: act on harm and risk, not on belief. [source: National FGM Centre]
Colonial history in the room. Missionaries confiscated and destroyed minkisi as "fetishes", and the colonial state imprisoned Kimbangu. Practical meaning: expect wariness of Western helpers, name it, and avoid words such as "fetish" or pejorative labels for healers. [source: Smarthistory; Encyclopedia of World Cultures, "Kongo"]
No medicine advice. Remedies (bilongo) may contain plant or pharmacological materials (KU panels). Practical meaning: never advise starting, stopping or combining remedies and prescribed medicines; route these questions to the prescriber. [source: KU panels; synthesis]
Consent governs every contact. Practical meaning: no contact with a healer, pastor or relative without the client's specific, documented consent, except where the law requires a safeguarding disclosure. [synthesis]
Not the sole basis for diagnosis. The CFI supports clinical understanding and is not meant to be the only basis for a diagnosis. Practical meaning: combine it with a standard assessment. [source: APA CFI]

4. Intervention inventory

All interventions below are the psychotherapist's own. None is a Kongo healing practice. Kongo-specific applications of general tools are marked [synthesis].

4.1 Cultural humility and self-examination

Purpose / when: Before and throughout work with Kongo or Congolese clients, especially if you hold views about "witchcraft" or "traditional healers" formed by media or missionary history. [synthesis]
Steps: (1) Note your reactions to words such as kindoki, nganga, deliverance and prophet. (2) Learn the basic history: the destruction of minkisi by missionaries, the imprisonment of Kimbangu, and the colonial shift of ndoki toward "witch". (3) Learn the client's languages of distress (Kikongo, Lingala, French, Portuguese) and book interpreters. (4) Take any strong reaction to supervision. [source: Smarthistory; Encyclopedia of World Cultures; KU panels; synthesis for steps]
Example language (illustrative): "I know only a little about Kongo ways of understanding illness. Where I get something wrong, I'd like you to correct me."
Watch for: Fascination (asking about rites out of curiosity) or dismissal (calling beliefs superstition). It is working when the client starts correcting you and adds detail without being asked.

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

Purpose / when: At intake for any client, and especially when distress is framed in terms of ancestors, kindoki, family conflict or church. The CFI has 16 questions in four domains: cultural definition of the problem; cultural perceptions of cause, context and support; cultural factors affecting self-coping and past help seeking; and cultural factors affecting current help seeking, including the clinician-patient relationship. [source: APA CFI]
Steps: (1) Use the free APA form; clinicians may reproduce it for use with their own patients, but translating or modifying it needs APA permission. (2) Introduce it as questions about how the client and the people around them understand the problem. (3) Work through the four domains in order, using the client's own terms. (4) In domain 2, ask about family, ancestors, church and any sense that someone has caused harm. (5) In domain 3, ask about consulting nganga, prophets, prayer groups and hospitals (see 4.6). (6) In domain 4, ask about language, discrimination and racism in services. (7) Summarise the problem back in the client's words. Time required: the field trial found later interviews took less time, but published minutes are [uncertain: not verified]. [source: APA CFI; Lewis-Fernandez et al. 2017 abstract]
Example language (illustrative): "People understand problems like this in different ways. In your own words, what is going on?" / "Is there anyone in your family or community who sees this differently from you?"
Watch for: Short, guarded answers about causes, which may signal fear of being judged or of the accusation spreading. It is working when the client uses their own terms ("it comes from the family") instead of borrowing yours.

4.3 CFI Informant Version with family members

Purpose / when: When kin make decisions about care (the therapy managing group), or when a child or an acutely unwell adult is the client. It has 17 questions; the first asks about the informant's relationship to the patient, then the four domains follow. [source: APA Informant Version; Janzen 1982]
Steps: (1) Get the client's consent for which relative is interviewed and what may be shared. (2) Interview the relative separately where safe. (3) Compare the two accounts of cause and of who is to blame. (4) If the relative's account names a child as the source of harm, move to 4.10 at once.
Example language (illustrative): "You know [name] well. What do you think is happening, and what do you think would help?"
Watch for: A relative whose account names a culprit inside the household. That is a risk marker for accusation (see 4.10). It is working when the family's view and the client's view are both on the table without escalation.

4.4 CFI supplementary modules

Purpose / when: To go deeper on one theme. The 12 APA modules include Explanatory Model; Spirituality, Religion, and Moral Traditions; Coping and Help-Seeking; Cultural Identity; Social Network; Immigrants and Refugees; School-Age Children and Adolescents; and Caregivers. They can be used as add-ons to the core CFI or on their own. [source: APA Supplementary Modules]
Steps: (1) Choose by what the core CFI raised. Spirituality is the usual choice when church, ancestors or deliverance feature; Immigrants and Refugees for diaspora clients; School-Age Children for any minor; Caregivers when a parent or guardian is carrying the burden. (2) Use one module per session if time is short. (3) Record answers in the client's words. [synthesis for the selection]
Example language (illustrative): "You mentioned your church and your grandmother's village. Could we spend some time on the part faith and family traditions play for you?"
Watch for: Overload. Several modules at once can feel like interrogation. It is working when a module produces information that changes the plan.

4.5 Explanatory model (Kleinman)

Purpose / when: To learn what the client calls the problem, what caused it, why it began when it did, how it works, how severe it is and how long it will last, what treatment they think they should get, what problems it has caused, and what they fear most. Kleinman, Eisenberg and Good set out these eight questions in 1978. [source: Tanenbaum handout; Dinos et al. 2017]
Steps: (1) Ask the questions conversationally, not as a list. (2) Ask separately for the client's view and the family's view. (3) Note any theory of a human cause (kindoki, jealousy, a curse), and whom it names. (4) Write the model down and check it with the client. (5) Use it to explain your own treatment in terms that fit, without claiming it does what the client's healers do. [synthesis for steps 2-5]
Example language (illustrative): "What do you call this trouble?" / "Why do you think it started when it did?" / "What are you most afraid it will lead to?"
Watch for: A model naming a person as the cause. Note who, and assess risk to that person (see 4.10 and 4.11). It is working when the client can see where your treatment sits beside theirs.

4.6 Asking about nganga, prophets, churches and hospitals without judgement

Purpose / when: In every assessment. Families commonly use a diviner and a hospital for the same problem. Janzen describes patients and kin moving between Kongo healers, prophets and cosmopolitan medicine. [source: Encyclopedia of World Cultures, "Kongo"; Janzen 1982]
Steps: (1) Ask an open, normalising question. (2) Ask what each helper said the problem was and what they advised. (3) Ask whether anything they advised worried the client (fasting, isolation, stopping medicines, accusing someone). (4) Ask whether the client wants you to know about or coordinate with those helpers. (5) Do not ask about the content of rites or remedies beyond what affects safety. [synthesis]
Example language (illustrative): "Many families I work with see a healer, a pastor or a prophet as well as a doctor. Has anyone else been helping with this?" / "Did anyone suggest something that didn't feel right to you?"
Watch for: Concealment, which shows as vague replies after a question about healers. Reassure the client that using other help does not end your care. It is working when the client tells you about parallel care unprompted.

4.7 Mapping the therapy managing group

Purpose / when: When treatment decisions are clearly not the client's alone. Janzen's "therapy managing group" of kin and associates diagnoses, selects therapies and evaluates treatment. [source: Janzen 1982 UC Press page] Using it as a clinical genogram is [synthesis].
Steps: (1) Draw a genogram with the client. (2) Mark who has a say about care, who pays, who escorts, and who has been consulted (healer, pastor, elder). (3) Mark alliances and conflicts, including accusations. (4) Identify who the client trusts most. (5) Decide with the client whom, if anyone, to invite to a session. [synthesis]
Example language (illustrative): "When someone in your family is unwell, who usually decides what to do next?"
Watch for: The client deferring every decision. Respect the family's role while confirming the client's own consent. It is working when the plan has the backing of the people who matter to the client.

4.8 Working with kindoki and other idioms of distress

Purpose / when: When the client explains suffering as kindoki, a curse, ancestral displeasure or family jealousy. DSM-5-TR treats cultural concepts of distress as idioms, explanations or perceived causes, and syndromes. [source: APA DSM-5-TR Section III] Kindoki is not one of the named DSM examples [uncertain: the full DSM-5-TR list is not verified]. The DSM-5 glossary did include maladi moun ("humanly caused illness", Haitian), which is a comparable explanation by human causation. [source: Teodoro and Afonso 2020] Treat kindoki as an explanation or perceived cause, not a diagnosis. [synthesis]
Steps: (1) Ask what kindoki means for this client. Kongo usage spans the power of words and will, also held by chiefs and orators, and in colonial and later usage, witchcraft (KU panels). (2) Ask who is thought to hold it and whether that person is in danger. (3) Separate the explanation from the symptoms, and assess the symptoms on their own terms (sleep, mood, psychosis, trauma). (4) Agree a shared description that leaves the client's explanation intact ("the trouble in the family and the low mood"). (5) Offer treatment for the symptoms without asking the client to give up their explanation. [source: KU panels for step 1; synthesis for the rest]
Example language (illustrative): "When you say kindoki, what does that mean for you and your family?" / "Whatever its cause, the sleeplessness is wearing you down. Can we work on that together?"
Watch for: An explanation that is hardening into an accusation of a specific child, spouse or elder (see 4.10, 4.11). It is working when the client can hold the explanation and still engage with symptom work.

4.9 Normative experience versus disorder

Purpose / when: When the client reports ancestors in dreams, possession, an affliction understood as a call to heal, or voices. Janzen describes ngoma healing associations in which misfortune is read as spirit-caused and the afflicted person may join and sometimes become a healer. In Kinshasa, such associations (for example Nkita and Bilumbu) are tied to lineage life. [source: Janzen 1992]
Diagnostic anchors: DSM-5 DID allows identity disruption to be described as possession, and excludes a disturbance that is "a normal part of a broadly accepted cultural or religious practice" (DSM-5 wording; DSM-5-TR keeps the substance, exact wording [uncertain]). Dissociative trance under other specified dissociative disorder does not apply when trance is part of accepted collective cultural or religious practice. ICD-11 6B62 Trance disorder and 6B63 Possession trance disorder require the state to be involuntary and unwanted and not part of accepted cultural or religious practice, with significant distress or impairment. [source: PMC9199574; findacode ICD-11 mirror; UM System Pressbooks] The DSM-5-TR note on culturally sanctioned beliefs versus delusions is [uncertain: not verified].
Steps: (1) Ask whether the experience is expected in the client's community and church, and who else has it. (2) Ask whether it is voluntary, bounded in time and place, and recognised by community authorities (elders, a recognised nganga, church leaders). (3) Ask whether it is distressing, impairing or dangerous. (4) Screen independently for psychosis, mania, substance use, epilepsy and other medical causes. (5) With consent, consult a cultural broker or a member of the client's community. (6) Record both the cultural meaning and your clinical findings. [synthesis built on DSM/ICD criteria]
Example language (illustrative): "In your family or church, is this something others have experienced too? Do people see it as a sign of something?" / "Apart from what it means, is it frightening you, or making it hard to sleep, work or look after the children?"
Watch for: Pathologising (diagnosing psychosis from belief alone) and missing illness (calling a first psychotic episode "spiritual"). Both cause harm. It is working when the client and family agree with the distinction you have drawn, or can say clearly where they differ.

4.10 Safeguarding children: witchcraft accusation

Purpose / when: Whenever a child is described as a witch, ndoki, possessed, or the cause of family misfortune. This is a documented harm in Kinshasa and the diaspora. Accusations rose in towns from the early 1990s. Accused children are often orphans, children with disabilities or illness, or children whose behaviour is seen as unusual. UNICEF (2010) reports that children with mental health conditions are at particular risk. Revivalist and prophetic churches have spread and legitimised these fears, and "deliverance" has involved beating, denial of food and water, isolation, forced purgatives and forced confession. Human Rights Watch (2006) found that up to 70% of Kinshasa street children had been accused at home. [source: EASO 2021, citing UNICEF 2010, HRW 2006, Save the Children, US State Department 2021]
Law (as sources report): In the DRC, Loi n° 09/001 of 10 January 2009 on child protection makes accusing a child of witchcraft an offence carrying one to three years' imprisonment and a fine; the US State Department reported that authorities did not implement the law in 2020. [source: EASO 2021] In England, the 2012 National Action Plan on child abuse linked to faith or belief was drawn up after a 15-year-old was killed in Newham in 2010 by relatives who accused him of kindoki. [source: GOV.UK 2012] UK guidance says to follow normal safeguarding procedures and state that the concern is abuse linked to faith or belief. [source: National FGM Centre]
Steps: (1) Ask directly whether any child in the household has been called a witch or blamed for misfortune. (2) Ask about deliverance, fasting, isolation, beating, being sent away, or a child being kept from school. (3) If any of these is present or threatened, follow your local child protection procedure the same day. Do not first test the family's belief. (4) Name the concern as abuse linked to faith or belief in the referral, and explain the reasons. (5) Never name the child in notes shared outside the safeguarding route. (6) For a child client, use the School-Age Children module, get the parent's consent and the child's assent for therapy, and tell the child in plain words what you must pass on. (7) Continue to support the adult client where safe. [source: National FGM Centre; GOV.UK 2012; APA modules; synthesis for steps 1-3, 5-7]
Example language (illustrative): "Sometimes when a family has a lot of bad luck, a child gets blamed. Has anything like that happened in your family?" / "I believe your faith matters to you. My job is to make sure no child gets hurt, so I need to involve the child protection team."
Watch for: A child described as "difficult", disabled or ill alongside talk of spiritual danger, or a planned church or healer session "for the child". It is working when the child is safe and the family stays in contact with services.

4.11 Safeguarding adults and harmful practices

Purpose / when: When an adult is accused (in DRC sources, widows, single women and elders have been targets), or a practice involves restraint, beating, starvation, sexual contact, or delay of urgent medical care. EASO cites reports of women killed in South Kivu after accusations, and of public health responses (meningitis, Ebola) delayed by witchcraft beliefs. [source: EASO 2021, citing HRW 2006, CEDAW 2013, Guardian 2021, Devex 2021]
Steps: (1) Ask whether the client, or anyone they know, has been accused, and what happened. (2) Ask whether any healer or church advised stopping prescribed medicine or avoiding hospital. (3) Never advise on starting, stopping or combining remedies or medicines yourself. Route medicine questions to the prescriber, with the client's consent. (4) Act under adult safeguarding procedures for abuse, and arrange urgent medical care where needed. (5) Respect the client's choices where they have capacity and no one else is at risk, and document your advice. [synthesis]
Example language (illustrative): "Has anyone advised you to stop the tablets from the doctor? Let's talk to your doctor together about that so you can decide safely."
Watch for: Rapid loss of weight, injuries, missed medical appointments, or a client hiding where they are staying. It is working when the client can tell you about risky advice and accepts medical review.

4.12 Collaboration and referral with community-sanctioned healers and churches

Purpose / when: Only when the client wishes it and where a legitimate channel exists. In Burns and Tomita's 2015 meta-analysis of 14 African studies, 17% of people seeking care for mental disorders first contacted traditional healers and 26% religious healers; the authors call for collaboration between biomedical services and community healers. [source: Burns and Tomita 2015 record] In the DRC, traditional medicine is recognised in the constitution, the health framework law and two ministerial orders, one regulating the practice of tradipraticiens and one creating the National Programme for the Promotion of Traditional Medicine and Medicinal Plants (PNMT-PM). A pilot in three Kinshasa health zones (Kasa-Vubu, Masina 1, Selembao) collected monthly data from practitioners, with expansion planned for 2018. [source: Mavungu Landu et al. 2017 abstract] Whether the expansion took place is [uncertain]. In the COSIMPO trial in Nigeria and Ghana, collaborative shared care between traditional and faith healers and primary care workers reduced psychosis symptoms more than usual care, and harmful practices fell from 57% to 9% with the intervention, against 42% to 10% in controls. [source: COSIMPO, PubMed 32861306; Centre for Global Mental Health] In a Ghanaian prayer camp, adding psychiatric medication reduced symptoms but did not significantly reduce days in chains. [source: Ofori-Atta et al.]
Steps: (1) Ask whether the client wants their healer, pastor or elder involved, and in what role. (2) Ask who in their community recognises that person's authority (lineage, church, a practitioners' association, PNMT-PM registration where in the DRC). (3) Get specific written consent naming the person, the purpose and what may be shared. (4) Keep contact to shared goals: safety, symptom monitoring, medicine adherence agreed with the prescriber, and a plan for crises. (5) Do not attend, observe or endorse any rite. (6) Withdraw from collaboration if harm (4.10, 4.11) emerges, and act on safeguarding. [source: Mavungu Landu et al. 2017; synthesis for steps]
Example language (illustrative): "Would it help if I spoke with your pastor or your healer about how we are each supporting you? You decide what I can and can't share."
Watch for: Pressure from the family to collaborate against the client's wish, and healers or churches who ask the client to choose between them and you. It is working when the client experiences their helpers as working on the same side.

4.13 Interpreters and cultural brokers

Purpose / when: When the client's main language is Kikongo, Lingala, French or Portuguese, or when community meanings are unclear. [synthesis]
Steps: (1) Book a trained interpreter, not a relative, and never a child. (2) Check before the session that the interpreter is not from the client's church or extended family, since accusations travel through these networks. (3) Brief the interpreter to translate terms such as kindoki, ndoki and nganga as spoken, not to gloss them as "witchcraft" or with pejorative labels for healers. (4) Use a cultural broker (a community member or colleague with relevant knowledge) only with the client's consent, for meaning, not for diagnosis. (5) Debrief the interpreter after sessions that touched on accusations or violence. [synthesis]
Example language (illustrative): "Please tell me the word your client used before you translate it." / to the client: "Our interpreter keeps everything confidential and doesn't know your family."
Watch for: The client toning down answers when the interpreter is known to them. It is working when key terms are kept in the client's own language in your notes.

4.14 Integrating healing, church and deliverance experiences

Purpose / when: After a client has consulted a nganga, joined a healing association, or been through prayer or deliverance, whether it helped, harmed, or left confusion. [synthesis]
Steps: (1) Ask what the experience meant to the client, without asking for ritual details. (2) Separate what helped (relief, belonging, family reconciliation) from what harmed (fear, injury, shame, accusation). (3) Validate the helpful parts in the client's terms. (4) Treat harmful parts as possible trauma: assess for PTSD and use standard trauma-focused care where indicated. (5) If the client was accused or ran away as a child, recognise this as a childhood trauma history. (6) Help the client decide how they want to relate to that community now. [synthesis]
Example language (illustrative): "What was it like for you, and what has stayed with you since?" / "It sounds as if part of it brought your family together, and part of it frightened you badly. Both can be true."
Watch for: Shame or loyalty that stops the client naming harm. Do not push for disclosure. It is working when the client can speak about the experience without being flooded, and makes their own choices about the community.

4.15 Working with families and churches

Purpose / when: When the therapy managing group or a church is central to the client's life and decisions. [source: Janzen 1982 for the role of kin; synthesis for the steps]
Steps: (1) Invite family members only with the client's consent. (2) Open with the family's own explanation of the problem (Informant Version, 4.3). (3) Look for shared goals: the client's recovery, peace in the family, keeping children safe. (4) With consent, engage church leaders as partners for support and attendance, not as diagnosticians. (5) State plainly the limits you will hold (no accusation of a child, no stopping prescribed medicine without the prescriber, no restraint). [synthesis]
Example language (illustrative): "Everyone here wants [name] to get well. Can we agree on the things we will all do, and the things none of us will do?"
Watch for: A family meeting turning into a hearing about who caused the illness. Stop the meeting and see members separately. It is working when the family can agree on a plan without naming a culprit.

4.16 Colonial history, migration and racism in services

Purpose / when: Throughout, and especially when a client is wary of services, mentions missionaries or police, or has been through migration or asylum processes. Scholars report that missionaries confiscated and destroyed minkisi in the late 19th century, that the colonial state imprisoned the prophet Kimbangu for life, and that ndoki took on its negative sense of witch with colonialism. [source: Smarthistory; Encyclopedia of World Cultures; KU panels]
Steps: (1) Use the Immigrants and Refugees and Cultural Identity modules for diaspora clients. (2) Ask in domain 4 of the CFI about discrimination and past experiences with services. (3) Acknowledge where services have dismissed or criminalised Kongo practices. (4) Watch your own institution for racial bias in risk judgements, for example equating African belief with danger. [source: APA modules; synthesis]
Example language (illustrative): "Some people from Congo have had doctors or officials dismiss their beliefs. Has that happened to you? I want to make sure it doesn't happen here."
Watch for: Over-referral to child protection based on belief alone, and the opposite, failure to act because harm is framed as culture. It is working when the client experiences you as both respectful and safe.

4.17 Diaspora and related traditions

Purpose / when: With clients in Europe, the Americas and the Caribbean. Kongo-derived traditions survived in the Americas, including Palo Monte in Cuba (see entry 082 on Palo). [source: Smarthistory] Congolese diaspora clients may hold Kongo, Pentecostal and Kimbanguist frames at once. [synthesis]
Steps: (1) Ask which tradition, lineage or church the client belongs to now, and who holds authority there. (2) Do not assume a Cuban, Brazilian or Haitian tradition is the same as Kongo healing in Central Africa. (3) Apply 4.2-4.16 in the client's current context, including local safeguarding law. [synthesis]
Example language (illustrative): "Which traditions are part of your life now, here, and which belong more to your parents or grandparents?"
Watch for: Generalising from one tradition to another. It is working when you can name the client's own community and its leaders.

5. Handling problems

The Kongo and safeguarding sources do not address therapy process problems. Everything in this section is [synthesis] except where a source is given.

Client asks you to say whether kindoki is real. Do not confirm or dismiss it. Say that you take seriously what it means to them and their family, and that your part is the sleep, fear and conflict it brings. Then return to the shared description (4.8).
Client asks you to recommend or find a nganga. Decline to recommend any practitioner. Explore who in their family, lineage or church they trust, and, in the DRC, mention that the national programme (PNMT-PM) works with practitioners [source: Mavungu Landu et al. 2017]. Do not steer clients toward healers or rites outside their own community's recognised pathways.
Client wants to stop prescribed medicine on a healer's or pastor's advice. Do not advise either way. Arrange a prompt review with the prescriber, with consent, and offer to include the healer's or pastor's concerns in that conversation (4.11, 4.12).
Stuck: the client sees therapy as pointless because the cause is spiritual. Agree that the cause may lie outside your work, and ask what would show them that things are improving. Offer a short trial of symptom-focused work (sleep, worry, grief) measured against their own markers.
Resistance from the family. Expect it where kin act as the therapy managing group [source: Janzen 1982]. Invite a family member to give their view (4.3). Reframe your role as one helper among several, not a replacement.
Overwhelm during discussion of accusations or deliverance. Slow down, ground the client in the present, and move from detail to meaning. Do not take a trauma narrative before stabilisation and consent. For childhood accusation or street life, plan trauma work in phases.
Non-attendance. Check whether a healer, church, or relative has advised against coming; whether travel, work or cost is the barrier; and whether the client fears being reported. Reach out with an open invitation, and reassure the client that consulting others does not end your care.
Rupture over a safeguarding referral. Be honest that you acted to protect a child, not to judge the family's faith (GOV.UK 2012: "not our job to challenge people's beliefs"). Repair by acknowledging the client's anger, explaining what happens next, and staying available. [source: GOV.UK 2012 for the quote]
Rupture over perceived disrespect. If you used "fetish", "superstition" or a pejorative label for a healer, or you laughed, name it, apologise and ask how to put it right. Take it to supervision.
Diagnostic uncertainty (calling, possession or psychosis). Keep both possibilities open. Arrange medical and psychiatric review, consult a cultural broker with consent (4.9), and review over time rather than deciding at one meeting.
The client is the accuser. If an adult client believes a child or relative is harming them through kindoki, assess risk to that person immediately. Work on the client's fear and distress, keep the explanation separate from any action against the person, and make a safeguarding referral if anyone is at risk (4.10, 4.11).
The client is an accused adult or a former "child witch". Treat the experience as trauma and loss of belonging. Avoid any implication that the accusation might be true. Explore safe ties with family, church or community, if the client wants them (4.14).
Conflict between a church and a healer. Some Pentecostal and revivalist churches frame nganga as demonic, while families may use both [source: EASO 2021 on churches; Encyclopedia of World Cultures on parallel use] [uncertain: secondary, unverified]. Do not take sides. Help the client weigh what each helper offers against their own goals and safety.
Interpreter or broker breach. If confidentiality is broken, inform the client, change interpreter, and review risk if the breach could expose the client or a child to accusation.
Your own fear or fascination. Take it to supervision. Keep curiosity tied to the client's goals, not to the rites.

Sources

Web sources:

Books and reports cited:

Janzen, J. M. (1982, UC Press edition). The Quest for Therapy in Lower Zaire. University of California Press. (Original edition date [uncertain].)
Janzen, J. M. (1992). Ngoma: Discourses of Healing in Central and Southern Africa. University of California Press.
Bockie, S. (1993). Death and the Invisible Powers: The World of Kongo Belief. Indiana University Press. [uncertain: cited via course notes; subtitle and publisher not verified]
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.
UNICEF (2010). Children Accused of Witchcraft: An anthropological study of contemporary practices in Africa. (Cited via EASO 2021.)
Human Rights Watch (2006). What Future? Street Children in the Democratic Republic of Congo. (Cited via EASO 2021.)
Gureje, O., Appiah-Poku, J., et al. (2020). COSIMPO cluster randomised trial. The Lancet.
Burns, J. K., & Tomita, A. (2015). Social Psychiatry and Psychiatric Epidemiology, 50(6).

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