Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 065
Guide XI-065

San healing trance dance

Namibia and Botswana
A 37 · L 51 · M 1217 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the Ju/'hoan (formerly written "!Kung") healing dance of the Nyae Nyae area (Namibia) and the Dobe and /Kae/kae areas (Botswana), as described by Richard Katz and Megan Biesele (Cultural Survival Quarterly 27-2, archived online 2010; Katz 1982, Boiling Energy) and by Jan Platvoet (1999). This is read alongside the San Code of Research Ethics (South African San Institute and San Council, 2017) for how San bodies ask outsiders to engage. Spellings differ by source: n/um (Lorna Marshall, Platvoet) and n/om (Katz and Biesele); the altered state is written kia in older work and !aia by Katz and Biesele. This guide uses the client's own spelling and terms. [source: Katz & Biesele 2010; Platvoet 1999]

What it is. This is not a psychotherapy. It is a living communal healing tradition of the Ju/'hoansi, one of several San peoples of southern Africa. Ethnographers describe it as the central ritual of Ju/'hoan life: an all-night community event through which the community keeps harmony and consensus. In Ju/'hoan understanding, as these authors report it, n/om is a spiritual energy that, in an elderly healer's words, "helps keep us alive". During the dance it "boils" in the healers, who enter !aia, are understood to reach the spirit realm, and release n/om's healing for everyone present. [source: Katz & Biesele 2010]

How change happens, as the tradition holds it. Illness and misfortune are understood largely as the result of spiritual attack, including invisible arrows held to be shot by the spirits of the dead (//gauwasi), and of social disharmony. The dance is described as a way of keeping these forces out of the community, of releasing tension and of sharing, so that healing is a renewable good, freely available to all rather than held by a few. Katz and Biesele describe it as a way to repair rifts and "make the community whole". [source: Platvoet 1999; Katz & Biesele 2010] These are the tradition's concepts as scholars report them; this guide neither asserts nor dismisses them.

Who holds authority. Healing authority rests with the healers themselves (Platvoet gives the Ju/'hoan term n/um kxausi, "owners of n/um") and with the community that makes the dance. Becoming a healer is described as a long, painful and frightening process, and many people, not a small specialist class, become healers (one secondary source, citing Dowson, gives about half of men and a third of women [uncertain: not verified in a primary source]). For research and outside engagement in South Africa, the San Council manages the San research protocol; San leaders asked outsiders to "come through the door, not the window". [source: Platvoet 1999; Katz & Biesele 2010; San Code of Research Ethics 2017; Wikipedia, San healing practices] Authority over the dance in particular Namibian or Botswanan communities (conservancies, traditional authorities, healers' own networks) is not described in the sources used here [uncertain: not verified].

Whose account this is. Almost everything published is outsiders' ethnography, much of it describing the 1950s–1990s. Platvoet warns that his data describe the pre-settlement period and may not fit present-day beliefs. Katz and Biesele record change between 1968 and 1989: more intense !aia among healers, growing doubt among schooled young people, talk of paying healers, and pressure from alcohol, a permanent clinic and an all-day school. [source: Platvoet 1999; Katz & Biesele 2010]

The psychotherapist's place. A psychotherapist does not perform, teach, stage or simulate this dance, and this guide gives no procedure for it. What follows is the psychotherapist's own culturally responsive work with a San client (or a client whose life touches this tradition): cultural assessment with the DSM-5-TR Cultural Formulation Interview, the client's explanatory model, telling culturally normative experience from disorder, collaboration with community healers when the client wishes, integration, safeguarding and attention to dispossession and racism. [synthesis]

2. Framework

The tradition itself has no phases for a therapist to follow. The framework below is the psychotherapist's own course of work, built around the structure of the DSM-5-TR Cultural Formulation Interview (CFI). No source gives session counts for this population; the numbers are guidance only. [synthesis; CFI structure: source APA DSM-5-TR CFI]

Format. Individual sessions, often with a family member or other informant present with consent; a Ju/'hoan-speaking (or other San-language) interpreter where the client prefers; flexible scheduling and outreach where clients live far from services. [synthesis]

Phase 0. Preparation (before first contact).

  • Goal: examine your own assumptions (including romantic or "primitive" images of San people), learn the history of dispossession, find an interpreter, and learn what local San organisations exist.
  • Move on when: you can name the client's community and language, have an interpreter plan, and know where community advice could come from if the client wants it. [synthesis]

Phase 1. Engagement and cultural assessment (about sessions 1–3).

  • Goal: build trust; complete the core CFI (16 questions, four domains) and, if a relative joins, the Informant Version; add supplementary modules as needed. The CFI supports clinical understanding and is not meant as the only basis for a diagnosis. Its administration time is not given in APA forms, and the field trial reports only that later interviews took less time [uncertain: no figure in minutes]. [source: APA DSM-5-TR CFI; APA Supplementary Modules; Lewis-Fernández et al. 2017]
  • Move on when: you can state, in the client's words, what the problem is called, what caused it, who helps, and what they want from you.

Phase 2. Explanatory model and differential (about sessions 2–4, overlapping).

  • Goal: explore the explanatory model (Kleinman's eight questions); if trance, spirit or healer experiences are part of the picture, decide with cultural input whether they are normative, part of a disorder, or both.
  • Move on when: you have a working view of whether experiences fall within accepted collective practice, informed by the client, family and (with consent) a cultural broker, and any risk has been assessed. [source: Kleinman et al. 1978 via Tanenbaum handout; PMC9199574; Lewis 2023 study guide; findacode ICD-11 mirror; synthesis]

Phase 3. Shared formulation and plan (about sessions 3–5).

  • Goal: offer a formulation that makes sense in both the client's frame and yours; agree goals; agree whether, and how, community healers, elders or family are involved, and what is shared with them.
  • Move on when: the client agrees the plan in their own words and has given or refused specific consent for any collaboration. [synthesis]

Phase 4. Treatment, collaboration and integration (variable; often 6–20 sessions).

  • Goal: deliver the agreed psychological treatment, coordinate with the prescriber and with community healers where agreed, help integrate healing experiences, address trauma, discrimination and alcohol where relevant, and keep safeguarding in view. Repeat CFI modules as the picture changes; APA states modules can be used at intake, later in care or repeatedly. [source: APA Supplementary Modules; synthesis]
  • Move on when: goals are met or the client's community supports are carrying the work.

Phase 5. Ending and handover.

  • Goal: end in a way that leaves the client's community ties stronger, not dependent on you; agree how to return. [synthesis]

3. Guiding principles

  • Alongside, never in place of. You do not perform, demonstrate, teach or stage the healing dance or claim n/om or !aia. Practical meaning: your offer is psychotherapy; the dance belongs to San communities and their healers. [synthesis]
  • Authority sits with the community. Healers and the community make the dance; San bodies ask outsiders to use San processes and not bypass them ("come through the door, not the window"). Practical meaning: any contact with healers goes through the client and the community's own channels, never around them. [source: San Code of Research Ethics 2017; Katz & Biesele 2010]
  • Attribute, do not adjudicate. n/om, spirits of the dead and spirit journeys are described as Ju/'hoansi hold them. Practical meaning: say "in your understanding" or use the client's words; never argue for or against their reality. [synthesis]
  • Healing is communal. The tradition locates illness and healing in the whole community, and repairing rifts is part of healing. Practical meaning: ask about conflict, sharing and belonging, not only symptoms. [source: Katz & Biesele 2010; Platvoet 1999]
  • Normative experience is not pathology. DSM-5-TR and ICD-11 exclude trance and possession states that are part of broadly accepted collective cultural or religious practice from the trance and possession diagnoses. Practical meaning: a healer's !aia during a community dance is not by itself a symptom. [source: PMC9199574 review of DSM-5 and ICD-11 criteria; Lewis 2023 Pressbooks guide]
  • Do not miss illness either. Cultural explanations can sit alongside psychosis, depression, trauma, alcohol problems or physical disease. Practical meaning: complete a standard assessment, including risk, whatever the explanatory model. [synthesis]
  • Respect diversity and change. Not every San person is Ju/'hoan, and not every Ju/'hoan person takes part in or believes in the dance; schooled young people, in Katz and Biesele's account, increasingly doubted it. Practical meaning: never assume involvement; ask. [source: Katz & Biesele 2010; MRG 2008]
  • Name people as they name themselves. Minority Rights Group notes that both "San" and "Bushmen" are umbrella terms and that "San" is etymologically pejorative. Practical meaning: ask the client what they call themselves and their people, and use it. [source: MRG 2008]
  • Keep history in the room. San in Namibia are described as the country's most marginalised people, with dispossession of land, farm labour conditions likened to serfdom, discrimination and violence against women. Practical meaning: treat mistrust of services as understandable; ask about racism in care. [source: MRG 2008]
  • Do not extract. The San Code names theft of traditional knowledge and intrusive photography as past harms, and asks for consent, transparency, privacy and benefit to the community. Practical meaning: never record, photograph, write up or teach what a client tells you about healing without explicit consent, and never for your own curiosity. [source: San Code of Research Ethics 2017]
  • Client-led collaboration only. Practical meaning: involve healers or elders only when the client wishes, with specific consent about what is shared. [synthesis; collaboration evidence: COSIMPO, Ofori-Atta et al.]
  • No substances, no medicine advice, no touch. Practical meaning: do not discuss preparing or using any plant; route all medicine questions to the prescriber; you do not touch the client. [synthesis]
  • Safeguarding applies in every setting. Practical meaning: harm to a child or adult is acted on according to local law, whoever explains it and however. [synthesis]

4. Intervention inventory

All interventions below are the psychotherapist's own. None is a San healing practice, and none reproduces any part of the dance. Where a step is not taken from a named source it is marked [synthesis].

4.1 Cultural humility and self-examination

  • Purpose / when: before and throughout work with a San client; also when a non-San client brings ideas about "Bushman" or "trance dance" healing. Outsider images of San people have long been romantic or demeaning, and most writing about the dance is by outsiders. [source: Platvoet 1999; Katz & Biesele 2010; synthesis]
  • Steps: (1) Write down what you already believe about San people and the healing dance, and where those beliefs came from (films, tourism, popular books). (2) Mark which beliefs are about the 1950s–1990s and which you know to be current. (3) Learn the client's specific community history (country, area, language group, land and resettlement history). (4) In supervision, review how your own position (race, class, nationality, profession) may look to the client. (5) Repeat after any session where you felt fascination, pity or impatience. [synthesis]
  • Example language (illustrative): "I know only a little about your community, mostly from outsiders' books. I would rather learn from you what matters here."
  • Watch for: curiosity about the dance that is about your interest, not the client's need; treating the client as a representative of "the San"; surprise that a client is schooled, urban, Christian or sceptical. It is working when your questions follow the client's priorities and the client corrects you freely.

4.2 Working with interpreters and cultural brokers

  • Purpose / when: when the client prefers a San language, or when you need help understanding cultural norms. [source: APA DSM-5-TR CFI, Q16 on language barriers; synthesis]
  • Steps: (1) Ask the client which language and which interpreter they want; in small communities, check whether the interpreter is a relative, neighbour or rival. (2) Brief the interpreter on confidentiality and on interpreting first-person, without summarising. (3) Agree that the interpreter will flag terms that have no direct English equivalent (for example n/om, !aia) rather than translate them away. (4) A cultural broker (a trusted community member) gives context only with the client's consent, and is never asked to disclose sacred or restricted knowledge. (5) Debrief the interpreter after sessions that touch distressing or spiritual material. [synthesis]
  • Example language (illustrative): "Please tell me the word you use, and then explain it in your own way. I would rather keep your word than use one of mine."
  • Watch for: the client answering the interpreter rather than you, shortened answers, discomfort when community matters arise (possible relationship conflict). It is working when the client uses their own terms and expands on them.

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

  • Purpose / when: first assessment; APA states it is designed for any clinician with any person in any setting. It clarifies the problem from the client's and their network's perspective: meaning, sources of help and expectations of services. [source: APA DSM-5-TR CFI; APA DSM-5-TR Section III]
  • Steps: (1) Use the official APA form (16 questions; clinicians may reproduce it for use with their patients; adapting or translating needs APA permission). (2) Work through the four domains in order: cultural definition of the problem; cultural perceptions of cause, context and support (including cultural identity); cultural factors affecting self-coping and past help-seeking (including barriers); cultural factors affecting current help-seeking (preferences and the clinician–patient relationship, including perceived racism and language barriers). (3) Paraphrase each question in plain language through the interpreter, keeping its intent. (4) Note where the client's answers point to a supplementary module. (5) Write a short cultural formulation in the client's words. The CFI is not the only basis for diagnosis. [source: APA DSM-5-TR CFI] Time needed: not stated in APA forms [uncertain: about 15–20 minutes is often quoted but not verified].
  • Example language (illustrative): "How would you describe what has been happening, in your own words, as you would explain it to people at home?" / "Have you or your family looked for help from anyone, including healers or the dance? What happened?"
  • Watch for: short or polite answers that may reflect distrust of officials; whether the client expects you to be like clinic staff who discouraged the dance (Katz and Biesele note a mobile clinic from 1974 and teachers who discouraged all-night dances). It is working when the client describes cause and help in their own frame, not only in biomedical terms. [source: Katz & Biesele 2010; synthesis]

4.4 CFI Informant Version (family or community member)

  • Purpose / when: when a relative or friend accompanies the client, or when the community view of the problem matters to the plan, which it often will in a tradition that locates healing in the community. [source: APA CFI Informant Version; Katz & Biesele 2010]
  • Steps: (1) Get the client's consent for the informant's involvement and agree what may be discussed. (2) Use the Informant Version (17 questions; Q1 covers the informant's relationship to the client, then the same four domains). (3) Interview separately or jointly as the client prefers. (4) Compare accounts without treating either as the correct one. [source: APA CFI Informant Version; synthesis]
  • Example language (illustrative): "How do people in the family understand what is happening to her? Who do they think could help?"
  • Watch for: the informant speaking over the client; family pressure toward or away from healers; disagreement between generations about the dance (scholars report growing doubt among schooled youth). It is working when you can describe both views and where they meet. [source: Katz & Biesele 2010; synthesis]

4.5 CFI supplementary modules

  • Purpose / when: for in-depth assessment, as add-ons or standalone, at intake, later or repeatedly. Most relevant here: Explanatory Model; Spirituality, Religion, and Moral Traditions; Cultural Identity; Social Network; Coping and Help-Seeking; Patient–Clinician Relationship; Psychosocial Stressors; and, for a displaced or resettled client, Immigrants and Refugees (use with care, since internal displacement is not migration). School-Age Children and Adolescents, Older Adults and Caregivers apply when relevant. [source: APA Supplementary Modules; synthesis on fit]
  • Steps: (1) Pick modules from the core CFI's pointers. (2) Explain why you are asking. (3) In the spirituality module, ask about meaning, belonging and practice in general terms; do not ask the client to describe what healers do, what is sung, or what is restricted. (4) Record answers in the client's words. (5) Revisit modules when the picture changes. [source: APA Supplementary Modules; synthesis]
  • Example language (illustrative): "You don't need to tell me anything that is not for outsiders. I'd like to understand what gives you strength and who you turn to."
  • Watch for: the client feeling tested or studied (the San Code records long experience of extractive research). It is working when the client chooses what to share and returns to the topic willingly. [source: San Code of Research Ethics 2017; synthesis]

4.6 Exploring the explanatory model (Kleinman)

  • Purpose / when: whenever the client's understanding of the problem may differ from yours; useful when illness is understood as spiritual attack, spirits of the dead or social disharmony. [source: Kleinman et al. 1978, questions paraphrased in Tanenbaum handout; Platvoet 1999]
  • Steps: Ask, in your own words and over more than one session if needed, Kleinman's eight areas: (1) what the client calls the problem; (2) what caused it; (3) why it began when it did; (4) what it does to them and how it works; (5) how severe it is and whether it will be short or long; (6) what treatment they think they should receive; (7) the main problems it has caused; (8) what they fear most about it. Then (9) reflect back the model and ask what you missed; (10) ask how your treatment could fit with it. [source: Tanenbaum handout; synthesis for 9–10]
  • Example language (illustrative): "What do you think started this? Some people tell me it is about the body, some about spirits, some about trouble between people, some all of these. What is it for you?"
  • Watch for: answers that change when you seem to favour one model; a model of spiritual attack that comes with fear you can work with directly. It is working when you can explain the plan in the client's model and they agree it fits.

4.7 Asking about healers and the dance without judgement

  • Purpose / when: at assessment and whenever the client mentions healing; to understand help-seeking, not to evaluate the tradition. Clinics and schools in the area have historically discouraged the dance, so clients may expect disapproval. [source: Katz & Biesele 2010; APA DSM-5-TR CFI, past help-seeking]
  • Steps: (1) Normalise using many forms of help. (2) Ask whether they have taken part, sought healing or are themselves a healer, and how it helped. (3) Ask what the healers or community think about the current problem. (4) Ask whether they want the two kinds of help to stay separate or to be coordinated. (5) Record without evaluative words. [synthesis]
  • Example language (illustrative): "Many people use more than one kind of help. Has your community's healing been part of this for you? I'm not here to judge it."
  • Watch for: guardedness, laughter or changing the subject (possible fear of ridicule); a client who is a healer and feels their standing is at stake. It is working when the client speaks about both kinds of help openly.

4.8 Cultural concepts of distress

  • Purpose / when: when the client uses an idiom, explanation or syndrome that carries cultural meaning. DSM-5-TR defines cultural concepts of distress as including idioms, explanations or perceived causes, and syndromes, and revised its examples to avoid stigmatising or generalising language. [source: APA DSM-5-TR Section III]
  • Steps: (1) Note the client's own term and ask what it means, who else uses it, and what is usually done. (2) Decide whether it works as an idiom (a way of expressing distress), an explanation (a cause) or a syndrome (a recognised cluster). (3) Do not map it onto a DSM-5-TR glossary item unless it fits; no Ju/'hoan or other San concept appears in the lists available here (DSM-5-TR examples include ataque de nervios, susto, khyâl cap and kufungisisa per a secondary source [uncertain: the DSM-5-TR list is not verified from APA's own text]). (4) Assess for any disorder separately. One secondary source mentions a Ju/'hoan notion of "star sickness" linked to jealousy and quarrels [uncertain: not verified in primary ethnography]; do not introduce such terms yourself. [source: APA DSM-5-TR Section III; UNMC slides; Wikipedia, San healing practices]
  • Example language (illustrative): "You said it is like an arrow that came in at night. Can you tell me more about what that means for you?"
  • Watch for: your own urge to translate the term into a diagnosis too fast. It is working when the term helps you track change (for example, the client reports the feeling has lessened).

4.9 Distinguishing normative trance and healer experience from disorder

  • Purpose / when: when a client who is a healer, is becoming one, or attends dances reports altered states, out-of-body journeys, animal transformation, near-death or rebirth experiences, pain or burning, or contact with spirits of the dead. Ethnographers report all of these as part of the healer's path in Ju/'hoan understanding, so their presence alone is not evidence of illness. [source: Katz & Biesele 2010; Platvoet 1999]
  • Steps: (1) Ask whether the experience happens within the community dance and is recognised by others as healing. (2) Check the diagnostic exclusions: DSM-5-TR other specified dissociative disorder (dissociative trance) does not apply when the trance is a normal part of a broadly accepted collective cultural or religious practice; dissociative identity disorder requires that the disturbance is not a normal part of such practice; ICD-11 6B62 trance disorder and 6B63 possession trance disorder require that the state is involuntary and unwanted and not part of accepted cultural or religious practice, with significant distress or impairment. [source: PMC9199574 review; findacode ICD-11 mirror; Lewis 2023 Pressbooks guide] DSM-5-TR's exact wording is [uncertain: verified only through DSM-5 text and a paraphrasing study guide]. (3) Look for signs outside the normative frame: experiences occurring outside dances, unwanted and uncontrollable; persisting after the event; impaired self-care; command hallucinations; fixed persecutory beliefs the community does not share; mood elevation with reduced sleep; suicidal thinking; substance or alcohol involvement. (4) With the client's consent, ask a family member or trusted community member whether the experience is what they would expect. (5) Complete standard risk and mental-state assessment. (6) Agree a formulation that can hold both. [synthesis for 1, 3–6] Whether DSM-5-TR still carries a culture note excluding culturally sanctioned beliefs from psychotic symptoms is [uncertain: not verified].
  • Example language (illustrative): "When this happens at the dance, how do people around you see it? Has it happened at other times, when you didn't want it? How is that different?"
  • Watch for: both errors: labelling a healer's !aia as psychosis, and dismissing a new psychosis as "just culture". Also distress the community itself sees as unusual. It is working when the client, family and you agree on what is expected and what is a concern.

4.10 Collaboration and referral with community-sanctioned healers or elders

  • Purpose / when: only when the client wishes it, for clients whose recovery is bound up with community healing. Trials elsewhere in Africa support collaboration between biomedical and traditional or faith healing: in Nigeria and Ghana, collaborative shared care between healers and primary care for psychosis gave greater symptom reduction and fewer harmful practices than usual care (COSIMPO, Gureje et al. 2020, The Lancet); in a Ghanaian prayer camp, adding psychiatric medication reduced symptoms but did not significantly reduce days in chains (Ofori-Atta et al., British Journal of Psychiatry 212(1) [uncertain: year 2018 or 2019]). These trials are West African and did not involve San communities. [source: COSIMPO via pubannotation; Centre for Global Mental Health; Ofori-Atta repository page]
  • Steps: (1) Ask whether the client wants any link between you and healers or elders; accept no. (2) Ask who the right person is; it is the client and community who decide, not you. (3) Get specific written consent: who, what may be shared, for what purpose, for how long. (4) Make contact through the route the client names (the client themselves, a family member, a community organisation). (5) Keep the aim practical: shared understanding, coordinating timing, safety, and not undermining each other. Do not ask about procedure, songs or restricted knowledge, and do not ask to attend. (6) Coordinate with the prescriber on medical care; never advise on medicines. (7) Review the arrangement with the client regularly. [synthesis] Legal frameworks: South Africa regulates traditional health practitioners under the Traditional Health Practitioners Act 2007 and its Council [uncertain: not verified]; Namibia's Traditional Health Practitioners Bill, tabled in 2014, proposed a Traditional Health Practitioners Council of Namibia with registration [source: New Era 2015], but its current status is [uncertain: not verified]; Botswana's framework [uncertain: not verified]. Ju/'hoan healers working within their own communities may not fit any registration scheme [synthesis].
  • Example language (illustrative): "Would it help if I understood how the healers see this? You decide whether that happens, who it would be, and what I may say."
  • Watch for: pressure from you or family that overrides the client's wishes; confidentiality breaches in small communities; turning a community healer into an unpaid service extender (the San Code asks that engagement bring benefit to the community). It is working when the client reports the two kinds of help as complementary. [source: San Code of Research Ethics 2017; synthesis]

4.11 Integrating healing-dance experiences

  • Purpose / when: when a client brings experiences from the dance (as healer, singer or participant) into therapy, wishes to make sense of them, or is troubled by them. Ethnographers describe the healer's path as painful and frightening, involving near-death and rebirth experiences. [source: Katz & Biesele 2010]
  • Steps: (1) Let the client set the meaning; ask what the experience meant to them and to their community. (2) Ask what support their community offers for this (for example older healers), and whether they are using it. (3) Work on the parts the client brings to you: fear, sleep, relationships, the effect on daily life. (4) Do not interpret the experience into psychological terms unless the client invites it. (5) If the experience is distressing beyond what the community expects, return to 4.9. [synthesis]
  • Example language (illustrative): "You've said it was frightening and that the older healers say this is part of the path. What helps you carry it between dances?"
  • Watch for: your interpretation replacing theirs; the client feeling you have taken their experience away from its community. It is working when the client feels steadier and keeps their own frame.

4.12 Working with family and community

  • Purpose / when: when the problem is bound up with conflict, sharing or belonging; the tradition treats repairing rifts as part of healing. [source: Katz & Biesele 2010; Platvoet 1999]
  • Steps: (1) Map the client's social network with them (CFI Social Network module). (2) Ask about conflicts, obligations of sharing and who feels left out. (3) Offer family sessions only with consent. (4) Support the client's own ways of repairing relationships; do not run a substitute community ritual. [source: APA Supplementary Modules; synthesis]
  • Example language (illustrative): "Who is affected by this besides you? Is there any trouble between people that you think is part of it?"
  • Watch for: confidentiality pressure; power differences by age or gender. It is working when relationships the client named become less strained.

4.13 Dispossession, discrimination and historical trauma

  • Purpose / when: throughout; Minority Rights Group describes San in Namibia as the country's most marginalised people, with loss of land through colonial and later policies, eviction (the Hai//om from Etosha), farm labour conditions likened to serfdom, discrimination, and rape of San women linked to persistent stereotypes. [source: MRG 2008] Katz and Biesele link pressures on the dance to land, cattle, water, schooling and economic change. [source: Katz & Biesele 2010]
  • Steps: (1) Ask about land, relocation and the family's history when the client is ready. (2) Ask directly about racism in services (CFI clinician–patient relationship). (3) Name injustice as real when the client describes it. (4) Treat trauma with an evidence-based approach adapted to the client's frame. (5) Connect the client, if wanted, with community and advocacy organisations. [source: APA DSM-5-TR CFI; synthesis]
  • Example language (illustrative): "Have you been treated badly by clinics or officials because you are San? I'd like to know, so it doesn't happen here."
  • Watch for: the client protecting you from their anger; your own guilt steering the session. It is working when the client can disagree with you and say what does not help.

4.14 Alcohol in context

  • Purpose / when: when alcohol affects the client or family. MRG describes alcoholism as a social problem arising from degradation and dependency in townships; Katz and Biesele report that home brew became widely available in the mid-1970s, that drunkenness is seen as blocking !aia, and that drunk attendees disrupt dances. [source: MRG 2008; Katz & Biesele 2010]
  • Steps: (1) Assess use and risk with standard tools. (2) Ask how the client and their community see alcohol in relation to healing and community life. (3) If the client values the dance, explore whether that value supports change (a motivational frame the client owns). (4) Offer evidence-based treatment and, for withdrawal, medical referral. [synthesis]
  • Example language (illustrative): "You said drinking gets in the way of the dance. What would it mean to you to be able to take part fully again?"
  • Watch for: moralising; treating alcohol problems as a cultural trait. It is working when the client sets goals in their own terms.

4.15 Safeguarding

  • Purpose / when: whenever there is risk of harm to a child or adult, including violence, sexual violence, neglect or delay of urgent medical care. [synthesis]
  • Steps: (1) Assess risk with standard methods. (2) Follow local law and your service's procedures. (3) Do not treat a harmful act as protected because it is explained in cultural terms, and do not treat a legitimate community practice as harmful because it is unfamiliar; seek cultural consultation where unsure. (4) Never name minors in records shared outside the service. (5) Where violence against San women is involved, be alert to police and service responses that MRG reports as inadequate, and support the client's access to legal help. [source: MRG 2008 for 5; synthesis]
  • Example language (illustrative): "I respect your community's ways. I also have a duty to act when someone is being hurt, and I'll tell you what I need to do."
  • Watch for: your own hesitation to act out of cultural deference. It is working when safety improves and the client stays engaged.

4.16 Ethics of recording, writing and teaching

  • Purpose / when: before writing a case study, presenting, researching, photographing or recording anything about a San client or the dance. The San Code of Research Ethics asks for prior engagement, approval through San processes, transparency, privacy, respect for social norms, no misrepresentation, feedback before publication and benefit-sharing; it names photographing people in their homes, breastfeeding mothers and children as past harms. [source: San Code of Research Ethics 2017; !Khwa ttu page]
  • Steps: (1) Ask whether the work is necessary at all. (2) Get explicit, informed consent from the client. (3) For research, approach the relevant San body (in South Africa, the San Council) before starting, and do not assume approval. (4) Never publish restricted or sacred material. (5) Return what you produce to the community. [source: San Code of Research Ethics 2017]
  • Example language (illustrative): "I'd like to write about what we learned, without your name. You can say no, and nothing changes in your care."
  • Watch for: professional benefit flowing one way. It is working when the client and community see the work and agree with how they are shown.

4.17 Clients who joined commercial "San trance dance" events outside communities

  • Purpose / when: when a non-San client describes a workshop or retreat marketed as San or "Bushman" trance dance, with distress afterwards or wanting to pursue it. The sources here do not address such events; this is [synthesis].
  • Steps: (1) Assess what happened and current state (dissociation, sleep, panic, psychotic symptoms, risk). (2) Help the client make sense of the experience in their own terms. (3) Note, without lecturing, that San healing belongs to San communities and that San bodies ask outsiders to engage through their own processes. (4) Do not suggest seeking ceremonies elsewhere. [source: San Code of Research Ethics 2017 for 3; synthesis]
  • Example language (illustrative): "What did you hope it would give you? Let's look at how to meet that need in your own life."
  • Watch for: spiritual-emergency presentations needing urgent assessment; the client idealising San people. It is working when distress settles and the client's own supports grow.

5. Handling problems

The sources on the healing dance do not discuss psychotherapy problems. Everything in this section is [synthesis] unless a source is named.

  • Client is guarded or gives short, polite answers. Likely causes: distrust of officials, past discrimination, fear of ridicule about healing (clinics and schools historically discouraged the dance [source: Katz & Biesele 2010]). Response: slow down, explain what you will do with information, offer the client control over topics, ask directly whether they have been treated badly by services, and consider a different interpreter or a trusted companion.
  • Stuck: the problem won't fit your model. Response: return to the explanatory model (4.6); ask what the client's community would do next; agree goals in the client's language (sleep, peace at home, ability to take part in community life) rather than diagnostic labels.
  • "Resistance" that is really a different plan. A client who prefers the dance or healers to therapy is making a help-seeking choice, not resisting. Response: ask how you can be useful alongside it; keep the door open; ensure they know how to reach you and urgent care.
  • Overwhelm or distress after a dance or healing experience. Response: assess safety and mental state first (4.9); ask what the community and older healers advise and whether that support is available; use grounding and sleep-focused work in the client's terms; refer for urgent assessment if psychotic, manic or suicidal features appear. Do not offer to perform or substitute any part of the healing.
  • Non-attendance. Often practical (distance, transport, cost, seasonal movement, family duties) rather than motivational. Response: offer flexible times, outreach, phone contact, fewer but longer sessions, and agree in advance how to resume after gaps.
  • Rupture: the client feels judged, studied or misrepresented. Response: name it, apologise specifically, ask what you got wrong, and change course. If it involved notes, photos or writing, offer to remove or correct them. The San Code's concerns about misrepresentation and extraction make this an especially sensitive area. [source: San Code of Research Ethics 2017]
  • Family or community disagree about the dance or the problem. Generational differences in belief are documented. [source: Katz & Biesele 2010] Response: hold both views, keep the client's own wishes at the centre, and avoid taking sides between "tradition" and "modernity".
  • Healer or community member asks you to endorse, oppose or fund something. Response: stay within your role; say what you can and cannot do; do not pay for healing on the client's behalf or broker payment; consult your professional body if unsure.
  • You are unsure whether experiences are normative or illness. Response: do not decide alone; seek, with consent, a family or community view and a psychiatric consultation; monitor over time; plan for both possibilities (4.9).
  • Medication conflicts with the client's healing beliefs. Response: do not advise on starting, stopping or changing any medicine; explore the client's concerns; arrange a joint discussion with the prescriber; respect the client's decision within safety limits.
  • Plants or remedies come up. Response: ask only enough to inform the prescriber of possible interactions; do not discuss preparation, sourcing or use; route to the prescriber or pharmacist.
  • Safeguarding concern framed as tradition (or tradition misread as harm). Response: follow 4.15; consult culturally informed colleagues and act according to law.
  • Colleague proposes using "trance dance" as a therapy technique, or a workshop markets it. Response: decline and explain that San healing is held by San communities, and that San bodies ask outsiders to come through their processes. [source: San Code of Research Ethics 2017] Offer evidence-based alternatives within your own scope.
  • Your own fascination or guilt is steering sessions. Response: take it to supervision; re-do 4.1.

Sources

Web sources:

Books and articles cited:

  • Katz R (1982). Boiling Energy: Community Healing among the Kalahari Kung. Cambridge, MA: Harvard University Press. (Catalogue record only; content cited via Katz & Biesele.)
  • 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 NK, Lam PC, 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 trial. The Lancet. [uncertain: full title and pages 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]
  • Platvoet JG (1999). At War with God: Ju/'hoan Curing Dances. Journal of Religion in Africa 29(1):2–61.
  • Low C (2015). The role of the body in Kalahari San healing dances. Hunter Gatherer Research 1(1):29–60.
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