Bori (Hausa) · Atlas

1. Introduction

Version followed: bori as described in published ethnography from northern Nigeria (Besmer 1983, fieldwork 1972–73) and from Dogondoutchi in southern Niger (Masquelier 2001 and later papers), plus Okagbue 2008 on bori groups in northern Nigeria. These are outsiders' scholarly accounts. No clinical guidance published by bori communities or their leaders was located [uncertain: not verified]. The psychotherapist's own procedures follow the APA DSM-5-TR Cultural Formulation Interview (CFI) and its supplementary modules.

What it is. Bori is a Hausa spirit-possession tradition found in northern Nigeria and southern Niger. As Masquelier's publisher summary puts it, among the Mawri of Niger the word names both the invisible, mischievous spirits that live in the bush and the practice of taming them through possession ceremonies [source: Duke University Press, Masquelier 2001]. Besmer calls it a "cult of possession-trance". He describes its adepts (trancers) and its musicians, and says trance events serve both curing and initiation functions [source: eHRAF record, Besmer 1983]. The spirits are called bori, iska (plural iskoki) or aljan. Many Muslim Hausa prefer aljan, from the Arabic jinn, because iska has a non-Muslim connotation [source: Wikipedia, Hausa animism] [uncertain: tertiary source, not verified]. Within the tradition, spirits are held to cause illness, including madness, infertility, paralysis and other ailments, and also to be a source of wellbeing. Okagbue calls bori a "cult of affliction" [source: Okagbue 2008; Wikipedia, Hausa animism]. These are the tradition's beliefs as scholars report them. This guide neither affirms nor dismisses them.

Who holds authority. Authority lies inside bori and its local groups, not with outside clinicians. Scholars report a hierarchy of titles. A Sarkin Bori (male) or a Magajiya (female, sometimes glossed "Mother of the Compound" or "heiress of the bori") leads a group. Possessed devotees are 'yan bori or masu bori ("spirit owners"). Male musicians are central to trance events [source: Okagbue 2008; Adelugba, Ufahamu; Wikipedia, Hausa animism; Besmer 1983]. Historically a royal priestess, the Inna, led networks of priestesses at court. This largely disappeared under the Sokoto Caliphate and colonial rule [source: Wikipedia, Hausa animism] [uncertain: tertiary source, not verified]. Muslim religious authorities officially condemn bori, and devout Muslim leaders have often persecuted it [source: Okagbue 2008; Wikipedia, Hausa animism]. Many Hausa clients will therefore also, or instead, consult Islamic healers. No statutory regulator of bori practitioners was identified in Nigeria or Niger [uncertain: not verified].

How change happens (as the sources frame it). In the tradition's own terms, affliction is read as a sign that a spirit has chosen the person. A lasting relationship with that spirit, managed within the bori group, turns the affliction into a role and a community [source: Wikipedia, Hausa animism; Besmer 1983]. Scholars also describe bori as giving women and other marginalised people social identity, standing, refuge and a voice [source: Besmer 1983; Adelugba; Okagbue 2008]. For the psychotherapist, change comes through culturally responsive work. That means understanding the client's explanatory model, telling culturally normative possession apart from disorder, and supporting whatever combination of bori, Islamic, medical and psychological help the client chooses, safely [source: APA CFI; synthesis]. The psychotherapist does not perform, prescribe or arrange bori practices.

2. Framework

Bori is a religious and healing tradition, not a psychotherapy. It has no phases a therapist could deliver. The framework below is the psychotherapist's own culturally responsive work alongside it [synthesis, built on the APA CFI].

Phase A: Preparation (before and between sessions). Goal: examine your own assumptions about spirits, Islam, gender, sexuality and West African healing, and learn the basic terms (bori, iskoki, aljan, 'yan bori, Sarkin Bori, Magajiya). Move on when you can ask about spirits without dismissing them and without claiming expertise [synthesis].

Phase B: Cultural assessment (sessions 1–2, usually woven into intake). Goal: the client's own account of the problem. Use the 16-question core CFI, in four domains: definition of the problem; perceptions of cause, context and support; self-coping and past help seeking; current help seeking. Add supplementary modules as needed (Explanatory Model; Spirituality, Religion and Moral Traditions; Cultural Identity; Coping and Help-Seeking; Immigrants and Refugees; Social Network). Use the 17-question Informant Version with a family member when the client agrees [source: APA CFI; APA Supplementary Modules; APA Informant Version]. The CFI supports clinical understanding. It is not to be the only basis for a diagnosis [source: APA CFI]. APA's forms give no administration time. The DSM-5 field trial found that later interviews took less time but reported no figure. A figure of about 15–20 minutes for the core CFI is [uncertain]. Move on when you can state the problem in the client's terms, as well as your own.

Phase C: Differential understanding (sessions 1–3, revisited later). Goal: decide whether the experience is culturally normative possession or trance within bori or Muslim practice, a disorder (psychotic, mood, dissociative, substance-related), a medical condition, or more than one of these. Use the DSM-5-TR culture chapter, the DID possession-form criteria and other specified dissociative disorder (dissociative trance), and ICD-11 6B62 and 6B63 [source: APA DSM-5-TR Section III; PMC9199574; findacode ICD-11]. Move on once you have a working formulation that you have checked with the client, the family and, where possible, a cultural broker.

Phase D: Shared plan (session 2–4). Goal: agree which help the client wants (psychotherapy, medical or psychiatric care, Islamic healing, bori, family support) and how they will fit together. Agree on consent to any contact with healers or community members. Move on once there is a written plan the client understands, including safety steps [synthesis].

Phase E: Ongoing therapy and integration (weekly or fortnightly, length set by the presenting problem). Goal: treat the presenting problem with the evidence-based therapy that fits it, adapted to the client's explanatory model. Help the client make sense of spirit-related experiences in a way that strengthens rather than splits their identity. Repeat CFI modules when the picture changes [source: APA Supplementary Modules, on repeating modules; synthesis].

Phase F: Safeguarding (throughout). Act at once if there is restraint, chaining, beating, forced fasting, sexual exploitation, harm to a child, or delay of urgent medical care in any setting [source: HRW 2019; synthesis].

No session count is published for this work. The figures above are [synthesis].

3. Guiding principles

Write and work alongside the tradition, not inside it. Practical meaning: you never perform, simulate, prescribe or arrange bori practices. Bori authority sits with its own leaders [source: Okagbue 2008; synthesis].
Attribute, do not adjudicate. Practical meaning: say "in bori, iskoki are understood to…". Do not state that spirits caused something, and do not say they do not exist [synthesis].
Use the client's words. Practical meaning: ask whether the client says iska, aljan, bori or something else, and use that word. For a devout Muslim, aljan may be acceptable where "bori" signals something forbidden [source: Wikipedia, Hausa animism] [uncertain: tertiary source, not verified].
Expect religious tension and plural help seeking. Practical meaning: a client may go to the mosque and also consult bori practitioners, or may feel shame about either. Many Hausa attend Friday prayer and consult bori on other days [source: Okagbue 2008]. Never force a choice.
The CFI informs and does not decide. Practical meaning: combine cultural information with full clinical assessment. No single answer settles a diagnosis [source: APA CFI].
Avoid both errors: pathologising and missing illness. Practical meaning: possession within an accepted cultural or religious practice is excluded from DID and dissociative trance diagnoses. Involuntary, unwanted, distressing possession can still meet criteria [source: PMC9199574; Lewis 2023 study guide; findacode ICD-11].
Rule out the medical. Practical meaning: bori attributes conditions such as meningitis, relapsing fever, leprosy, sleeping sickness and mental illness to spirits [source: Adelugba]. In northern Nigerian survey data, drug misuse was the most commonly named cause of mental illness, and spirit possession or magic was named by 18% [source: Kabir et al. 2004]. Ask for medical and substance screening when indicated.
Respect marginalised identities. Practical meaning: bori groups have offered belonging to women and to people who are stigmatised for sexuality, gender expression, illness or poverty [source: Okagbue 2008; Adelugba]. Ask about this with care, and keep disclosures confidential.
Consent governs every contact with healers. Practical meaning: contact a bori leader, Islamic healer or family member only with the client's explicit, specific, revocable consent [synthesis].
Safety overrides deference. Practical meaning: if any healing setting restrains, beats, starves or sexually exploits someone, or keeps them from urgent care, safeguarding comes first [source: HRW 2019; synthesis].
Stay humble about your sources. Practical meaning: most of what is published on bori comes from outside observers, some of it decades old. Treat the client and their community as the authority on their own practice [source: Besmer 1983, fieldwork 1972–73; synthesis].
Do not steer clients towards ceremonies. Practical meaning: never suggest a client seek bori, or any ceremony, outside the client's own community pathways and wishes [synthesis].
No advice on remedies or medicines. Practical meaning: do not comment on doses or preparations of herbs or remedies. Questions about medicines go to the prescriber [synthesis].

4. Intervention inventory

The items below are the psychotherapist's own interventions. None of them is a bori practice. Bori's ceremonies, music, initiation, offerings and divination are outside the psychotherapist's role and are not described here.

4.1 Cultural self-examination and humility

Purpose / when: before the first session with a Hausa client, or any client from Nigeria or Niger who mentions spirits, and again whenever you notice strong reactions in yourself [synthesis].
Steps: (1) Write down what you assume about spirit possession, about Islam in West Africa, and about women's and sexual minorities' lives in northern Nigeria and Niger. (2) Note which assumptions come from media or from colonial-era framing. (3) Read at least one ethnographic account (e.g. Masquelier 2001 or Besmer 1983) as context, remembering that both are outsiders' accounts. (4) Bring cases to supervision or consultation with a clinician who knows the region [synthesis].
Example language (illustrative): to a supervisor: "I notice I want to call this hysteria. I'd like to check whether that's my frame or the client's."
Watch for: reaching for the word "hysteria". Masquelier argues that diagnosing schoolgirls' possession as hysteria or conversion disorder does not explain how it spreads between people [source: Masquelier, Academia page, 2022 chapter abstract]. The opposite error is romanticising bori. It is working if you can ask about spirits with curiosity and without either dismissing them or performing belief.

4.2 Core Cultural Formulation Interview

Purpose / when: at intake, for every client. It is especially useful when spirits, aljan or iska are mentioned, when the client has consulted healers, or when your cultural background differs from the client's [source: APA CFI].
Steps: (1) Introduce it as a way to understand the problem in the client's own terms. (2) Go through the four domains in order: what the problem is; causes, stressors, supports and the role of cultural identity; how the client has coped and whom they have consulted, and what got in the way; what help they want now and how they see you. (3) Use the client's words for the problem in your notes. (4) Flag the subtopics that call for a supplementary module. (5) Summarise back and check [source: APA CFI; synthesis for steps 3–5]. You may reproduce the APA form for use with your own clients. Modifying or translating it needs APA permission [source: APA CFI].
Example language (illustrative): "People explain troubles like this in different ways: as illness, stress, God's will, spirits, or a mix. How do you and your family understand what is happening?"
Watch for: the client giving the "clinic answer" (e.g. "stress") and holding back a spirit explanation for fear of ridicule, or because bori is condemned in their community. It is working if the client's own terms and help-seeking history come out by the end.

4.3 CFI Informant Version (family members)

Purpose / when: when a family member brings the client, when the client cannot give an account (e.g. during an acute episode), or when family views will shape treatment [source: APA Informant Version].
Steps: (1) Get the client's consent to involve the informant. (2) Use the 17-question Informant Version, which starts with the informant's relationship to the client and then covers the same four domains. (3) Note where the family's view differs from the client's, e.g. the family may favour Islamic healing and the client bori, or the reverse. (4) Keep the client's private disclosures out of family sessions unless the client agrees [source: APA Informant Version; synthesis for steps 3–4].
Example language (illustrative): "You know her well. In your view, what is causing this, and who has the family asked for help so far?"
Watch for: a family view that justifies restraint or confinement (see 4.14). Also watch for the client going quiet when a relative is present. It is working if you can describe each person's model and where they agree.

4.4 Explanatory model inquiry (Kleinman; CFI Explanatory Model module)

Purpose / when: whenever the client or family attributes the problem to spirits, sorcery, God's will, drugs or stress [source: Kleinman et al. 1978 via Tanenbaum handout; APA Supplementary Modules].
Steps: (1) Ask, in paraphrase of Kleinman's eight questions: what they call the problem; what caused it; why it started when it did; what it does to them and how it works; how severe it is and whether it will be short or long; what treatment they think they should get; what problems it has caused; what they fear most. (2) Record the answers in the client's words. (3) Note whether the model is spirit-based (bori, aljan), Islamic, biomedical, social, or mixed. (4) Use the model to frame treatment goals [source: Tanenbaum handout; synthesis for steps 3–4].
Example language (illustrative): "What do you call this when it happens? … And what do you fear most about it?"
Watch for: fear of being "chosen", fear of madness, or fear of religious censure. These are often the real treatment targets. It is working if the client hears their own model reflected accurately before you add yours.

4.5 Spirituality, Religion and Moral Traditions module

Purpose / when: when the client identifies as Muslim and also has a bori connection, or when religious conflict is part of the distress [source: APA Supplementary Modules]. Masquelier describes Muslim preachers in Niger portraying spirits as "Satan's servants" and urging prayer and exorcism rather than possession [source: Masquelier, Academia page, 2019 chapter abstract].
Steps: (1) Ask about the client's religious identity, practice and community. (2) Ask how their religion views spirits and bori, and how the client personally views them. (3) Ask whether religious or community leaders have advised them. (4) Explore guilt, shame or fear of sanction. (5) Name any conflict between the client's values and the help they want, without taking a side [source: APA Supplementary Modules for the domain; synthesis for steps].
Example language (illustrative): "Some people feel pulled between the mosque and the bori, or between what family and imam say. Is any of that true for you?"
Watch for: spiritual distress that looks like depression. Watch also for fear of disclosure: bori can be condemned, and historically it was punished [source: Okagbue 2008]. It is working if the client can talk about both affiliations without having to defend either.

4.6 Cultural Identity module: gender, sexuality and social position

Purpose / when: when gender, marriage, sexuality, gender expression, illness stigma or poverty are part of the picture. Scholars describe bori membership as drawn largely from women, sex workers, gay, lesbian and gender-nonconforming people, people with mental or stigmatised illness, and the poor [source: Okagbue 2008]. Adelugba describes bori as a temporary refuge for women leaving unhappy marriages and a space for women's authority [source: Adelugba].
Steps: (1) Ask about the identities that matter to the client. (2) Ask what bori, or the client's community, means for their belonging and safety. (3) Assess the risks attached to disclosure (legal, family, community). (4) Keep notes sparing on sensitive identities and share them only with consent [source: APA Supplementary Modules for the domain; synthesis].
Example language (illustrative): "For some people the bori community is where they feel accepted. What has it meant for you?"
Watch for: assuming every client in bori is marginalised. Villagers take part "with varying levels of enthusiasm" [source: Duke University Press, Masquelier 2001]. Watch also for safety risks around sexuality or a marriage. It is working if the client names their own sources of belonging and risk.

4.7 Coping and help-seeking inquiry, including healers

Purpose / when: at intake and whenever treatment stalls. Plural help seeking is common: in a northern Nigerian village survey, 46% preferred orthodox care, 34% spiritual healing and 18% herbal medicine [source: Kabir et al. 2004].
Steps: (1) Ask, without judgement, whom the client has consulted: bori practitioners, Islamic healers, herbalists, churches, doctors. (2) Ask what each said and did in general terms. Do not ask for ritual details. (3) Ask what helped and what did not. (4) Ask about any remedies or substances taken, and pass this to the prescriber or GP without commenting on doses. (5) Ask whether the client wants you to know about, or coordinate with, any of these helpers [source: APA CFI, Coping and Help-Seeking domain; synthesis for steps 2–5].
Example language (illustrative): "Many people here see a malam, a bori leader or a herbalist as well as a doctor. Who else has been helping you? I won't judge it. I just want our work to fit with it."
Watch for: concealment, because the client expects disapproval. Watch also for remedies that may interact with prescribed medicines; route these to the prescriber. It is working if the client freely lists all their sources of help.

4.8 Immigrants and Refugees module (diaspora clients)

Purpose / when: for Hausa clients living outside Nigeria or Niger, or displaced within the region [source: APA Supplementary Modules].
Steps: (1) Explore migration history, losses and legal status. (2) Ask what access the client has to their own religious and healing communities where they now live. (3) Ask how the host country's services and attitudes affect disclosure. (4) Note any racism experienced in services, using the CFI's clinician–patient relationship question [source: APA CFI; APA Supplementary Modules; synthesis].
Example language (illustrative): "Back home, who would you have gone to for this? What's it like not having that here?"
Watch for: a client seeking unvetted "healers" online or locally because they have lost their own community's pathways. Help them think through safety, without directing them to any ceremony. It is working if the plan reflects the support actually available to them.

4.9 Distinguishing culturally normative possession from disorder

Purpose / when: whenever the client reports possession, trance, spirit visitation or being "chosen" by a spirit, or when others report these about the client.
Steps: (1) Establish context. Did the experience happen within an accepted collective practice (e.g. a bori event the person takes part in) or outside it? DSM-5 DID Criterion D excludes disturbance that is "a normal part of a broadly accepted cultural or religious practice". Dissociative trance under other specified dissociative disorder is likewise excluded when it is part of such practice [source: PMC9199574, quoting DSM-5; DSM-5-TR keeps the substance per Lewis 2023 study guide, exact wording [uncertain]]. (2) Establish whether it is voluntary and wanted. ICD-11 6B63 possession trance disorder requires a state that is "involuntary and unwanted", in which an external possessing identity replaces the customary identity. 6B62 trance disorder covers trance without an alternate identity, again involuntary, unwanted and outside accepted practice, with recurrent episodes or one lasting several days and significant distress or impairment [source: PMC9199574; findacode ICD-11 mirror]. (3) Ask how the client's own community, and ideally someone knowledgeable from it, judges the experience: as expected within bori, or as something wrong. (4) Screen for psychotic, mood, trauma-related and substance-related disorders in the usual way. The DSM-5-TR note that culturally shared beliefs should not count as psychotic symptoms is [uncertain: not verified], so apply ordinary clinical judgement about shared versus idiosyncratic beliefs. (5) Arrange medical screening (see 4.10). (6) Write a formulation that may hold both: for example, a spirit-related calling as the client understands it, together with a depressive episode [source: APA CFI; synthesis for steps 3–6].
Example language (illustrative): "When this happens, is it something that happens at gatherings you choose to attend, or does it come on you when you don't want it? How do people in your community see it?"
Watch for: distress, impairment, loss of time outside ritual contexts, self-harm, aggression, or the community itself saying "this is not bori, this is sickness". It is working if your formulation makes sense to the client and fits the clinical facts.

4.10 Medical and substance screening referral

Purpose / when: at first presentation of possession, trance, confusion, headache, paralysis, seizures or a sudden change in behaviour. The tradition attributes conditions such as meningitis, relapsing fever, leprosy, sleeping sickness and mental illness to spirits [source: Adelugba]. Spirits are also linked with headaches, paralysis, blindness and stomach trouble [source: Wikipedia, Hausa animism] [uncertain: tertiary source, not verified].
Steps: (1) Explain that a medical check sits alongside, not against, the client's own understanding. (2) Refer to a physician for assessment (neurological, infectious, metabolic, medication-related). (3) Screen for alcohol, cannabis and other drug use. In northern Nigerian survey data, drug misuse was the most commonly named cause of mental illness [source: Kabir et al. 2004]. (4) Do not advise starting, stopping or changing any medicine or remedy. Route those questions to the prescriber [synthesis].
Example language (illustrative): "Whatever else is going on, I'd like a doctor to check your body too, so nothing physical is missed. Would that be all right?"
Watch for: fever, neck stiffness, a first seizure, new neurological signs, or a sudden change in older adults. These need urgent medical care whatever the explanation. Watch also for anyone delaying that care. It is working if medical causes are ruled in or out promptly.

4.11 Interpreters and cultural brokers

Purpose / when: when the client's main language is Hausa (or Zarma, Fulfulde or French in Niger), or when you need help judging whether an experience is normative [synthesis].
Steps: (1) Use a trained interpreter, not a family member, for clinical content. (2) Brief the interpreter beforehand on the terms (iska, aljan, bori). Ask them to translate rather than soften, and to tell you if a term carries religious charge. (3) Ask the client whether they are comfortable with this interpreter. Community overlap matters, because bori involvement can be stigmatised. (4) With consent, consult a cultural broker, such as a community health worker or a clinician from the region, about what is normative [synthesis].
Example language (illustrative): to the client: "The interpreter keeps everything confidential. If you'd rather have someone from outside your community, tell me and I'll arrange it."
Watch for: interpreter judgement leaking in, e.g. translating iska as "devil". Watch also for the client censoring because the interpreter is a co-religionist. It is working if the client's own terms reach you intact.

4.12 Collaboration and referral with community-sanctioned practitioners (only if the client wishes)

Purpose / when: when the client wants their bori group, a bori leader or an Islamic healer involved in their care alongside psychotherapy or psychiatry. The best evidence for collaborative models in this region comes from neighbouring traditional and faith-healing contexts, not from bori itself. In the COSIMPO trial in Nigeria and Ghana, collaborative shared care between traditional and faith healers and primary care workers reduced psychotic symptoms more than usual care (adjusted mean PANSS difference -15.01). Harmful practices fell from 57% to 9% with the intervention, against 42% to 10% in controls [source: Gureje et al. 2020, The Lancet, via PubMed 32861306]. In a Ghanaian prayer-camp trial, adding psychiatric care lowered symptoms but did not significantly reduce days in chains [source: Ofori-Atta et al., Br J Psychiatry, year [uncertain]].
Steps: (1) Ask whether the client wants any contact, with whom, and for what purpose. (2) Get specific written consent naming the person, the information to be shared and its limits. Confirm the client can withdraw it. (3) Keep the contact about coordination: what each party is doing, safety, and medical needs. Do not ask the practitioner to explain or demonstrate their practice. (4) Agree on red lines with the client in advance: no restraint, no beating, no withholding of food or medical care. (5) Record the arrangement. (6) Review it with the client regularly. Recognise that the bori leader's authority comes from within bori. You are not vetting or licensing them. No regulator exists to refer to [uncertain: not verified] [synthesis for steps].
Example language (illustrative): "You've said the Magajiya has helped you. Would it be useful for us to talk, with your permission, just about how we can both support you safely?"
Watch for: the client feeling pressured by you, by family or by the group. Watch also for confidentiality leaks within a small community, or the practitioner advising the client to stop prescribed medicine. In that case talk to the client and the prescriber; do not instruct the client yourself. It is working if the client experiences their helpers as working together rather than competing.

4.13 Working with families and religious leaders

Purpose / when: when family members, an imam or a malam hold strong views about bori or about the client's condition. Bori both "competes with and borrows from Islam" [source: Duke University Press, Masquelier 2001]. Muslim preachers may urge prayer and exorcism instead of possession [source: Masquelier, 2019 chapter abstract].
Steps: (1) With consent, invite family members to share their model (4.3). (2) Find common goals: the client's safety, functioning and dignity. (3) Do not side with "religion" against "tradition", or the reverse. (4) Where religious practice is a resource for the client, support it as the client wishes. (5) Where family conflict over bori endangers the client, e.g. threats of expulsion or forced confinement, move to safeguarding (4.14) [synthesis].
Example language (illustrative): to the family: "You and she may see the cause differently, but you all want her well and safe. Let's plan around that."
Watch for: the client being blamed for "bringing" spirits, or shamed for bori involvement. It is working if conflict drops and practical support rises.

4.14 Safeguarding: restraint, beating, starvation, sexual exploitation, minors, delayed care

Purpose / when: whenever any healing setting, family or institution (religious, traditional or psychiatric) uses or threatens harm. Human Rights Watch visited 28 facilities in eight Nigerian states and the Federal Capital Territory, including Kano and Kaduna. It documented people chained, sometimes for years, the youngest aged 10. It also documented whipping in Islamic rehabilitation centres, "fasting" (food denied for days) in Christian healing centres, forced administration of medication and herbs, and unlawful detention in 27 of the 28 facilities [source: HRW 2019]. These findings are not specific to bori.
Steps: (1) Ask directly and neutrally about restraint, confinement, beating, food or water withholding, and sexual contact in any setting. (2) If an adult is at risk, make a safety plan and follow your jurisdiction's adult-safeguarding procedures. (3) If a child is involved, follow child-protection procedures without delay, and never name minors in shared records beyond what the procedure requires. (4) If urgent medical care is being delayed, escalate. (5) In Nigeria, the mental health law replacing the Lunacy Act of 1958 prohibits forced treatment, seclusion and restraint in mental health facilities. It was reported as signed in early January 2023 (another report gives 6 January 2022 [uncertain]) [source: ICIR; Dataphyte]. Whether it covers traditional or religious healing centres is [uncertain: not verified]. (6) Document carefully [synthesis for steps 1–4, 6].
Example language (illustrative): "In some places people are tied, locked in or kept from food as part of treatment. Has anything like that happened to you, or do you worry it might?"
Watch for: minimisation ("it was for my own good"). Watch also for retaliation risk if you report, and for your own reluctance to act out of cultural deference. Safety comes first. It is working if the person is safe and their wider care continues.

4.15 Consultation on group possession episodes (schools, institutions)

Purpose / when: when a school or institution asks for help with clusters of possession, especially among girls. Masquelier and Maïdouka describe schoolgirls' spirit possession in Niger as relational and "contagious", and argue that labels like "hysteria" miss how emotions spread. Masquelier links such episodes to schools built on spirit-associated ground and to tensions between Islam and older practice [source: Masquelier, Academia page, 2020 and 2022 abstracts].
Steps: (1) Ensure medical assessment for each affected student. (2) Meet staff, parents and, with their agreement, respected community and religious figures, to hear how the episodes are understood. (3) Reduce stressors and stigma. Avoid public spectacle and avoid punishing affected students. (4) Offer individual psychological support where students want it. (5) Agree a plan with the school that respects families' choices about religious or traditional help and keeps safeguarding standards [synthesis].
Example language (illustrative): to staff: "Families will have their own explanations. Our job is to keep the girls safe, calm the environment and make sure no one is shamed."
Watch for: blaming individual girls, harsh discipline, or unsafe interventions on school premises. It is working if episodes become less frequent and students return to learning.

4.16 Integrating spirit-related experiences into therapy

Purpose / when: when a client wants to make sense of a possession experience, a calling, or a change in role or identity linked to bori, or of leaving bori for religious reasons [synthesis].
Steps: (1) Invite the client to tell the experience in their own framework, without asking for ritual details. (2) Explore what it has meant for their relationships, status, body and faith. (3) Identify strengths: belonging, voice, relief. Identify costs: stigma, conflict, fear. (4) Help the client decide what they want from the relationship with the tradition going forward. (5) Use standard evidence-based methods for any co-occurring condition, framed in the client's terms [synthesis].
Example language (illustrative): "You've described the spirit as part of your life now. What has changed for you since then, good and hard?"
Watch for: pressure from you towards either embracing or abandoning the tradition, and experiences that feel fragmented or out of control (re-check 4.9). It is working if the client tells a coherent story that they own.

4.17 Addressing historical suppression and racism in services

Purpose / when: when mistrust of services, or shame about bori, shapes engagement. Bori has been banned and persecuted since the early nineteenth-century jihad, at one point on pain of death. Later it was taxed and licensed, and in places public performances were banned [source: Okagbue 2008]. Colonial administrations also eroded bori's institutional roles [source: Wikipedia, Hausa animism] [uncertain: tertiary source, not verified].
Steps: (1) Ask, using the CFI's clinician–patient relationship item, whether the client has met racism, language barriers or disrespect in services. (2) Acknowledge that the suppression of practices is real history. (3) Explicitly invite disagreement with you. (4) Review whether your service's forms and language pathologise spirit-related experience [source: APA CFI; synthesis].
Example language (illustrative): "Some people have been laughed at or lectured by professionals about spirits. If anything I say feels like that, please tell me."
Watch for: polite compliance that hides disengagement. It is working if the client corrects you or asks questions openly.

4.18 Documentation and diagnostic writing

Purpose / when: after assessment and at each review [synthesis].
Steps: (1) Record the client's terms and explanatory model alongside clinical findings. (2) State why possession was or was not judged culturally normative, citing the relevant DSM-5-TR or ICD-11 exclusion. (3) Avoid stigmatising labels. (4) Record consents for any contact with healers or family. (5) Limit sensitive identity information to what care requires [source: APA Section III, on non-stigmatising language; synthesis].
Example language (illustrative): note: "Client attributes episodes to iska and is an active member of a local bori group; episodes occur only during chosen gatherings and cause no distress. Not considered dissociative disorder."
Watch for: records that later prejudice housing, immigration or custody decisions. It is working if another clinician reading the note would understand the client in their own terms.

5. Handling problems

The sources give no therapist-facing guidance on problems in this context. Everything in this section is [synthesis] unless a source is tagged.

Client will not discuss spirits ("it's just stress"). Do not push. Normalise plural explanations once (4.2), leave the door open, and return to it after trust builds. Concealment may reflect real stigma, since bori is condemned by Muslim authorities [source: Okagbue 2008; Wikipedia, Hausa animism].
Client asks whether you believe in spirits. Answer honestly and briefly, then return to the client's experience. Example (illustrative): "I don't hold that framework myself, but I take seriously that it's real in your life and your community, and I want to understand it." Never claim belief you do not hold, and do not debate.
Client asks you to recommend a bori leader or ceremony, or to attend one. Decline to recommend or attend. Explain that this belongs to the client's own community and its leaders. Help them think through safety and consent if they choose to go.
Family or religious leader demands you "cure" the client of bori. Restate your role: the client's wellbeing and choices. Use 4.13. If coercion appears (confinement, threats, forced religious treatment), move to 4.14.
Bori group or healer advises stopping prescribed medicine. Do not instruct the client yourself. Explore what the client wants, inform the prescriber with consent, and if the client agrees, invite coordination (4.12).
Acute possession or trance in session. Keep everyone safe: give space, reduce stimulation, stay calm, and do not restrain unless there is immediate danger and only within lawful procedures. Afterwards, ask the client how they understand what happened and whether it was wanted. If it was involuntary, unwanted, recurrent or prolonged, reassess against 6B62 and 6B63 and arrange medical review [source: findacode ICD-11 mirror; PMC9199574; synthesis].
Overwhelm when exploring a calling or affliction. Slow down, ground in the present, focus on current coping and supports, and postpone detailed exploration. Screen for suicidality and self-harm with standard risk assessment.
Rupture after a perceived dismissal. Name it, apologise for the impact, and ask what would have been more respectful (4.17). Invite correction going forward.
Non-attendance. Check for practical barriers (cost, transport, gender norms, religious calendar), conflicting advice from helpers, or fear of being seen at a mental health service. Offer flexible formats.
Small-community confidentiality. Check for overlap with interpreters, staff and other clients. Offer alternatives. Never confirm a client's bori involvement to anyone without consent.
Client in bori for reasons of sexuality or gender identity. Treat disclosures as highly sensitive given possible legal and social risks. Keep records minimal. Focus on safety and affirmation [source: Okagbue 2008, on bori membership].
Your own discomfort or fascination. Take it to supervision (4.1). Watch for voyeuristic questioning about ritual details. Ritual details are not needed for your work and are not yours to collect.
Diagnostic uncertainty persists. Hold a provisional dual formulation (4.9). Gather longitudinal information, consult a cultural broker and a colleague with regional expertise, and review regularly rather than forcing an early label.
Evidence of chaining, beating or starvation anywhere in the client's care. Safeguarding takes precedence (4.14) [source: HRW 2019].

Sources

Web sources:

Books and articles cited:

Besmer, F. E. (1983). Horses, Musicians & Gods: The Hausa Cult of Possession-Trance. South Hadley, MA: Bergin & Garvey.
Masquelier, A. (2001). Prayer Has Spoiled Everything: Possession, Power, and Identity in an Islamic Town of Niger. Durham, NC: Duke University Press.
Masquelier, A. (1987). "Cooking the Bori Way: The Logic of Healing in the Hausa Cult of Possession." Chicago Anthropology Exchange 16: 96–103 (record only).
Masquelier, A. (2019). "Are Spirits Satanic? The Ambiguity of Evil in Niger." In Engaging Evil: A Moral Anthropology (abstract only).
Masquelier, A. (2020). "A Disenchanted Landscape? Jinn, Schoolgirls, and the Demonization of the Past in Niger." Preternature (abstract only).
Masquelier, A., & Maïdouka, A. (2022). "'These Spirit Attacks Are Like an Epidemic': Spirit Possession as Affective Contagion in Niger." In Configuring Contagion: Ethnographies of Biosocial Epidemics (abstract only).
Okagbue, O. (2008). "Deviants and Outcasts: Power and Politics in Hausa Bori Performances." New Theatre Quarterly 24(3).
Adelugba, D. "Trance and Theatre: The Nigerian Experience." Ufahamu (year [uncertain]).
Kabir, M., Iliyasu, Z., Abubakar, I. S., & Aliyu, M. H. (2004). BMC International Health and Human Rights 4: 3.
Kleinman, A., Eisenberg, L., & Good, B. (1978). "Culture, illness, and care." Annals of Internal Medicine 88: 251–258.
Lewis-Fernández, R., Aggarwal, N. K., Lam, P. C., et al. (2017). British Journal of Psychiatry 210(4): 290–297.
Gureje, O., Appiah-Poku, J., et al. (2020). COSIMPO trial. The Lancet.
Ofori-Atta, A., Attafuah, J., Jack, H., Baning, F., Rosenheck, R., et al. British Journal of Psychiatry 212(1) (year [uncertain]: 2018 or 2019).

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