Esan and Igbo music healing

1. Introduction

Version followed: the ethnomusicological account of Esan music healing by Charles O. Aluede and colleagues (Ambrose Alli University, Ekpoma), centred on the Iyayi Society of Edo State, as summarised in Aluede, Ogisi and Okakah (2023), Aluede and Iyeh (2008) and Aluede and Omoera (2010), with Mereni's (1997) typology of healing music as cited there; for the Igbo, the scholarly record available here is thin (Okonkwo 2012 on Nsukka Igbo healing, as cited; Agbo 2024 on dibia practice) and no detailed published account of Igbo music healing is used [uncertain: not verified]. The clinician's own procedures follow the DSM-5-TR Cultural Formulation Interview (APA).

This is not a psychotherapy and not a single method. It is a group of living healing traditions in which music, song, drumming and dance are part of how illness is understood and addressed in some Esan and Igbo communities of southern Nigeria. Its practitioners are the communities' own healers, religious societies and musicians; a psychotherapist does not perform it. Aluede and colleagues report that most Nigerian cultures "firmly believe in the therapeutic potency of music", and that illness is understood as having several interacting causes, so healing addresses body, mind, social relations and the spiritual order together [source: Aluede, Ogisi & Okakah 2023]. In Esan thought as Aluede (2010) records it, sickness may be natural, "night sickness" attributed to witches and wizards, sickness from ancestors, gods and spirits, or sickness carried over from a past earth life [source: Aluede, Ogisi & Okakah 2023, p. 3]. These are the tradition's own causal categories, described here as held, not stated as fact or dismissed.

The Iyayi Society is described by Aluede as a religious movement that grew from the Urhobo Igbe religion as it spread into the former Benin Province (as Osenughegbe and Iyayi); Aluede reports that its music healing addresses "psycho-somatic and anxiety related disorders" [source: Aluede, academia.edu publication list; Aluede, Ogisi & Okakah 2023, p. 4]. Among the Igbo, dibia (rendered by Agbo as medicine man, priest, diviner or healer) are reported to be resurging in Nsukka-Igbo communities, including among young people [source: Agbo 2024, abstract]. How music features in contemporary dibia practice is [uncertain: not verified].

For the psychotherapist, the core idea of change is this: when the clinician understands the client's own account of the illness, including its spiritual, social and musical dimensions, and works alongside (not against) the community's sanctioned healers when the client wishes, engagement, safety and outcomes can improve. A cluster randomised trial in Nigeria and Ghana found collaborative shared care between traditional and faith healers and primary care workers reduced psychotic symptoms and harmful practices more than usual care [source: COSIMPO, Gureje et al. 2020, via pubannotation]. That trial did not study music healing specifically [synthesis].

2. Framework

The Esan and Igbo traditions do not publish a staged protocol for outside clinicians; the phases below are the psychotherapist's own culturally responsive work, built around the CFI [synthesis]. Aluede reports that some Iyayi healing rites run over "seven or fourteen days" [source: Aluede, Ogisi & Okakah 2023, p. 4]; their content is the Society's own and is not described here.

Phase 1: Engagement and cultural humility (session 1, often continuing into 2). Goal: a safe, respectful relationship in which the client can speak about healers, music, spirits and religion without fear of being judged or labelled. Format: individual, with a professional interpreter where Esan, Igbo, Nigerian Pidgin or another language is preferred. Move on when the client has described the problem in their own words and knows they may talk about healing consultations openly [synthesis].

Phase 2: Cultural assessment (sessions 1 to 3). Goal: understand the problem through the client's eyes and network. Use the core CFI (16 questions, four domains), the Explanatory Model and Spirituality, Religion and Moral Traditions modules as needed, and the Informant Version with a family member when the client agrees [source: APA CFI; APA Supplementary Modules]. APA gives no administration time; the field trial reports that later interviews took less time but the abstract gives no minutes [uncertain: not verified] [source: Lewis-Fernández et al. 2017]. Move on when you can state the client's explanatory model, help-seeking history, current preferences, and a differential that weighs culturally normative experience against disorder [synthesis].

Phase 3: Formulation and shared plan (sessions 2 to 4). Goal: a plan the client and, where appropriate, family accept, naming the clinician's role, any community healer's role, medical input and safety arrangements. Collaboration or referral happens only with the client's consent [synthesis; see COSIMPO]. Move on when the plan is agreed and any medical or safeguarding concerns are actioned.

Phase 4: Ongoing therapy alongside the tradition (variable; typically weekly). Goal: evidence-based psychological work for the presenting problem, adapted to the explanatory model, with space to integrate experiences from healing rites, church, temple or community music. Revisit CFI modules as needed; APA states the modules can be used at first evaluation, later, or repeatedly [source: APA Supplementary Modules]. Move on when goals are met or the client chooses to continue only with community healing.

Phase 5: Review and ending. Goal: consolidate gains, agree how the client will draw on both community and clinical supports, and how to return if needed [synthesis].

3. Guiding principles

The tradition belongs to its community. Healing music of the Iyayi Society, dibia and community ensembles is held by those bodies; never reproduce, teach or perform their songs or rites. [source: Aluede & Iyeh 2008, healing music is "primarily in the hands of the traditional healers"]
Name who holds authority. In the sources: Iyayi Society temples and their leaders [uncertain: titles not verified]; dibia among the Igbo [source: Agbo 2024]; for Esan community decisions, elders' councils (Ogua or Ogbakha) led by the Odionwele [source: Aluede & Omoera 2010]; traditional musicians whose standing rests on community acceptance rather than formal accreditation [source: Aluede & Omoera 2010]. Practical meaning: ask the client which healer, society or church they are connected with, and treat that as their authority, not yours.
Multi-causal illness is the client's frame, not an error to correct. Esan and wider Nigerian views hold that natural, social, ancestral and spiritual causes can co-act [source: Aluede, Ogisi & Okakah 2023; Nzewi 2002]. Practical meaning: explore all the causes the client names before offering a psychological model, and present yours as one more lens.
Neither affirm nor dismiss spiritual explanations. Practical meaning: use the client's words (for example "night sickness", spirits, ancestors) and ask what they mean to them, without stating them as true or false [synthesis].
Healing is communal. Nzewi describes group participation as supporting the sick person's life energy; Aluede reports music used to ease tension, support the bereaved and "cleanse the land" [source: Nzewi 2002; Aluede, Ogisi & Okakah 2023, p. 4]. Practical meaning: ask about family, lineage, church or society members, and invite them into the work when the client wishes.
Familiar music matters. Aluede and Omoera write that "the elderly needs the musical genre he is used to" [source: Aluede & Omoera 2010]. Practical meaning: if music features in your own work (for example, a client choosing songs that comfort them), let the client choose music from their own life, not yours.
Avoid both pathologising and missing illness. DSM-5-TR and ICD-11 exclude trance or possession that is part of broadly accepted cultural or religious practice from disorder [source: PMC9199574; findacode ICD-11 6B62; umsystem pressbooks]. Practical meaning: assess distress, impairment, involuntariness and fit with community norms, with informants, before diagnosing.
Consent and confidentiality govern collaboration. Practical meaning: no contact with a healer, temple or church without the client's explicit consent about what is shared [synthesis].
Safety overrides deference. Practical meaning: chaining, beating, starvation, coerced confession, withholding of urgent medical care and abuse of children are safeguarding matters whatever their framing [synthesis; COSIMPO measured harmful practices].
Never advise on medicines or herbs. Practical meaning: questions about herbal remedies or stopping medication go to the prescriber [synthesis].
Music therapy is a distinct discipline. Aluede and colleagues call for music therapy training in Nigerian universities and for music therapists to learn indigenous cultural realities [source: Aluede, Ogisi & Okakah 2023, pp. 9-10]. Practical meaning: refer to a qualified music therapist for structured music interventions rather than improvising one yourself [synthesis].

4. Intervention inventory

All interventions below are the psychotherapist's own. None involves performing, teaching or reproducing Esan or Igbo healing music, rites, songs, divination or sacred objects. Example language is illustrative.

4.1 Cultural humility and self-examination

Purpose / when: before and throughout work with any Esan, Igbo or other Nigerian client, especially when spirits, witchcraft, ancestors or healing songs come up. [source: APA CFI; synthesis]
Steps: (1) Before the first session, note your own assumptions about African healing, possession and music as therapy, including any colonial or missionary framings you have absorbed. (2) Note what you do not know (for example the difference between an Iyayi temple, a Pentecostal or Aladura church and a dibia). (3) In session, say plainly that the client is the expert on their culture. (4) After sessions, review moments where you felt sceptical, fascinated or alarmed, and check whether that shaped your questions. (5) Use supervision or consultation with a clinician from the community when available. [synthesis]
Example language (illustrative): "I know a little about Esan culture but you know far more. Please correct me whenever I get something wrong."
Watch for: exoticising (treating the music healing as fascinating material rather than the client's life), or quiet dismissal. It is working when the client corrects you freely and volunteers spiritual or healing material without prompting.

4.2 Core Cultural Formulation Interview

Purpose / when: early assessment of any client for whom culture shapes the problem; APA says it can be used "by any clinician providing services to any individual in any care setting" [source: APA DSM-5-TR Section III].
Steps: (1) Explain that you will ask how the client and the people around them see the problem. (2) Work through the four domains in your own order of conversation: cultural definition of the problem (Q1-3); cultural perceptions of cause, context and support (causes Q4-5, stressors and supports Q6-7, cultural identity Q8-10); self-coping and past help seeking (Q11-13, including barriers); current help seeking (preferences Q14-15, clinician-patient relationship Q16, for example perceived racism or language barriers) [source: APA CFI]. (3) Use the official APA form; clinicians may reproduce it for their patients without permission, but modifying or translating it needs APA permission [source: APA CFI]. (4) Record answers in the client's words. (5) Treat it as support for clinical understanding, not the sole basis of diagnosis [source: APA CFI].
Example language (illustrative): "How would you describe what is happening to someone in your family or your village?" "Have you seen anyone else for help, such as a healer, a church, a temple or a hospital?"
Watch for: guarded answers about healers (common where clients expect disapproval). Time per CFI is not given by APA [uncertain: not verified]. It is working when the client names local terms, causes and helpers you had not anticipated.

4.3 Supplementary modules and Informant Version

Purpose / when: deeper assessment where a domain matters. APA's 12 modules include Explanatory Model; Spirituality, Religion and Moral Traditions; Cultural Identity; Coping and Help-Seeking; Social Network; Psychosocial Stressors; Patient-Clinician Relationship; School-Age Children and Adolescents; Older Adults; Immigrants and Refugees; Level of Functioning; Caregivers [source: APA Supplementary Modules].
Steps: (1) Choose modules from what the core CFI raised: for example Spirituality, Religion and Moral Traditions when the client is an Iyayi member or attends a healing church; Older Adults when an elder's wellbeing is tied to community music and dance; Immigrants and Refugees for diaspora clients. (2) Use them as add-ons or standalone, at first evaluation, later or repeatedly [source: APA Supplementary Modules]. (3) With consent, use the Informant Version (17 questions) with a relative, since Esan and Igbo views of illness are often held collectively [source: APA Informant Version; Nzewi 2002 on communal healing]. (4) Feed findings into the formulation.
Example language (illustrative): "Does your faith or your society have its own way of understanding this illness?" To a relative: "What does the family think has caused this?"
Watch for: the informant's view overriding the client's; note differences rather than resolving them. Working when the formulation includes both voices.

4.4 Explanatory model exploration (Kleinman)

Purpose / when: to learn the client's own model of the illness, especially where causes span the natural and spiritual.
Steps: (1) Ask, in your own words, Kleinman's eight areas: what the client calls the problem; what caused it; why it started when it did; what it does and how it works; how severe it is and how long it will last; what treatment they think they should receive; the chief problems it has caused; what they fear most [source: Tanenbaum handout of Kleinman, Eisenberg & Good 1978]. (2) Listen for the Esan causal classes Aluede records (natural sickness, "night sickness" attributed to witches and wizards, sickness from ancestors, gods or spirits, sickness carried from a past life) and others such as sorcery, breach of taboo or curses [source: Aluede, Ogisi & Okakah 2023, p. 3; Aluede & Iyeh 2008]. (3) Ask what has already been done within each frame (hospital, herbs, church, temple, healer), without asking for details of rites. (4) Reflect the model back and ask whether you have it right. (5) Place your own psychological explanation beside it, never in place of it.
Example language (illustrative): "Some people I work with say an illness can have more than one cause at once. Does that fit for you?" "What do you fear most about this?"
Watch for: fear of curses or witchcraft accusation within the family, which raises safeguarding questions (see 4.11). It is working when the client can hold more than one explanation and agree on shared goals.

4.5 Asking about healing and music consultations without judgement

Purpose / when: at intake and whenever symptoms change; Aluede and colleagues found places of worship and village meetings were the main sources of information about music healing among respondents [source: Aluede, Ogisi & Okakah 2023, Table 3].
Steps: (1) Normalise: many people use several kinds of help. (2) Ask which healers, societies, churches or temples the client has used or plans to use, and whether music, singing or dance played a part. (3) Ask what helped, what did not, and how they felt during and after. (4) Ask about any remedies taken, only so you can tell the prescriber; do not advise on them. (5) Ask whether the healer has views about hospital or psychological care, so you can anticipate conflicts. (6) Do not ask for songs, procedures, sacred words or divination findings.
Example language (illustrative): "Many people go to a healer or a church as well as coming here. Has music or a healing gathering been part of your care?"
Watch for: the client trying to protect you or the healer from disapproval; shame about attending; healer instructions to stop medication. It is working when the client tells you about consultations as they happen.

4.6 Exploring the meaning of music in the client's life

Purpose / when: when the client says music helps or harms, or describes healing music experiences. Aluede's survey found 87.75% of respondents believed music has power over emotions and 65.25% reported personally experiencing a therapeutic effect [source: Aluede, Ogisi & Okakah 2023, p. 9].
Steps: (1) Ask what music the client grew up with, which music comforts them, which they associate with healing or with fear. (2) For elders, ask about community music and dance they took part in; Aluede and Omoera describe elders being drummed for, singing, clapping and dancing, often with masquerades of their own lineage, and stress using music the person already knows [source: Aluede & Omoera 2010]. (3) Use this to understand identity, losses (for example losing community music after migration) and coping. (4) If the client wants to use music for self-soothing between sessions, let them choose their own everyday music; do not use or adapt sacred or healing songs [synthesis]. (5) For structured music interventions, refer to a qualified music therapist [synthesis].
Example language (illustrative): "What music do you turn to when things are hard?" "Is there music from home you miss?"
Watch for: music that is tied to frightening ritual experiences; grief over lost community music. Working when music becomes a resource the client uses by choice.

4.7 Cultural concepts of distress and differential assessment (possession, trance, normative experience)

Purpose / when: when a client or family describes spirit possession, trance, spirit-caused illness or experiences during healing music and dance, and you must decide whether a disorder is present. Aluede and Iyeh, citing Nigerian sources, report that curses or broken taboos are believed to show as madness, depression or spirit possession, and Mereni's typology (as cited) includes "psycholytic" music aimed at freeing a person from evil spirits [source: Aluede & Iyeh 2008].
Steps: (1) Use DSM-5-TR's cultural concepts of distress framework (idioms, explanations or perceived causes, and syndromes) to record the client's terms, without forcing them into a named syndrome; none of the DSM-5-TR glossary examples is specific to Esan or Igbo [source: APA DSM-5-TR Section III; UNMC slides]. (2) For possession-type experiences, note that DSM-5-TR dissociative identity disorder allows identity disruption described as possession, but excludes experiences that are part of broadly accepted cultural or religious practice; dissociative trance (other specified dissociative disorder) carries the same exclusion [source: PMC9199574; umsystem pressbooks; exact DSM-5-TR wording uncertain]. (3) ICD-11 6B62 trance disorder and 6B63 possession trance disorder require the state to be involuntary, unwanted and outside accepted cultural or religious practice, with significant distress or impairment [source: findacode ICD-11; PMC9199574]. (4) Ask: does the experience happen in the expected setting (for example a healing gathering) and end as expected? Does the community regard it as normal? Is it wanted? Is there distress or impairment outside that setting? (5) Screen for psychosis, mood disorder, PTSD, substance use and medical causes in the usual way. (6) Consult a cultural broker or, with consent, a relative or community member about what is normative. (7) The DSM-5-TR note on not counting culturally sanctioned beliefs as delusions is [uncertain: not verified]; apply the principle cautiously with informant input.
Example language (illustrative): "When this happens at the gathering, is that something your community expects? Does it also happen at other times, when you don't want it?"
Watch for: labelling expected ritual experience as psychosis; equally, attributing new hallucinations, mania or confusion entirely to spirits and delaying medical care. Working when the differential is shared with the client and family in terms they accept.

4.8 Collaboration and referral with community-sanctioned healers

Purpose / when: when the client wishes to continue with, or return to, an Iyayi temple, dibia, church healer or community elder alongside your work. The COSIMPO trial in Nigeria and Ghana (307 patients, 51 clusters) found collaborative shared care between traditional and faith healers and primary care workers reduced PANSS scores more than usual care (adjusted mean difference -15.01) and reduced harmful practices from 57% to 9% [source: pubannotation PubMed 32861306]. In a Ghanaian prayer camp, adding psychiatric medication to usual care lowered symptoms but did not significantly reduce days in chains [source: Ofori-Atta et al., mentalhealthdataprizeafrica]. Aluede and colleagues call for collaboration between ethno-medical practitioners, music therapists, psychologists and medical staff [source: Aluede & Iyeh 2008].
Steps: (1) Ask whether the client wants contact between you and their healer; respect a no. (2) If yes, agree in writing what may be shared and what may not (for example diagnosis, medication, risk). (3) Make contact through the client or family's own channel, showing respect for the healer's standing. (4) Explain your role and limits; ask about the healer's view of the problem and what they recommend, without asking for ritual detail. (5) Agree on shared safety commitments: medical care continues, no restraint or deprivation, urgent symptoms are referred. (6) Review the arrangement with the client regularly. (7) Regulation: in 2020 Nigeria's Federal Executive Council approved a bill for a Council for Traditional, Alternative and Complementary Medicine Practice; whether it has become law is [uncertain: not verified] [source: BusinessDay 2020]. Diaspora clients should be supported to find healers through their own community's legitimate channels, not through you [synthesis].
Example language (illustrative): "Would it help if I spoke with the elder at your temple, so we're working together? You decide what I can share."
Watch for: the healer advising the client to stop medicines or avoid hospital; coercion of the client by family to attend; your own pressure on the client to involve or avoid a healer. Working when the client experiences the two forms of care as complementary.

4.9 Interpreters and cultural brokers

Purpose / when: when the client prefers Esan, Igbo, Pidgin or another language, or when terms for illness and healing do not translate. [synthesis]
Steps: (1) Use a professional interpreter, not a family member, for assessment and risk. (2) Brief the interpreter on confidentiality and on translating spiritual terms literally, then explaining them. (3) Check that the interpreter is not connected to the client's healer, church or family. (4) Where available, consult a cultural broker (for example a clinician or community worker from the same background) about local meanings, with the client's consent. (5) Debrief the interpreter after emotionally heavy sessions. [synthesis]
Example language (illustrative): to the interpreter: "Please give me the client's exact word for the illness first, then what it means."
Watch for: interpreter softening references to witchcraft or spirits, or adding their own views. Working when local terms appear in your notes accurately.

4.10 Integrating healing experiences

Purpose / when: after the client has attended healing gatherings, music and dance rites, or church deliverance, and wants to make sense of the experience. [synthesis]
Steps: (1) Invite the client to describe what they experienced and what it meant, at the level they choose; do not ask for songs or procedures. (2) Ask what changed afterwards (mood, relationships, symptoms, sense of belonging). (3) Link positive changes to goals in therapy. (4) Where the experience was frightening or shaming (for example a public confession), process it as you would any distressing event, and assess for trauma symptoms. (5) Ask whether the client wants to continue that form of care, and support their choice within safety limits. [synthesis]
Example language (illustrative): "What was it like for you, and what has been different since?"
Watch for: retraumatisation, shame, or the client feeling they must choose between you and the healer. Working when the client can bring the experience into therapy without hesitation.

4.11 Safeguarding when a practice harms

Purpose / when: when a client, child or vulnerable adult is at risk of harm linked to healing. The COSIMPO trial measured harmful practices in healing settings, and the prayer-camp trial measured days in chains [source: pubannotation; mentalhealthdataprizeafrica]. Aluede reports that in Esan an adulterous woman may be "purged" through confessions expressed in music and dance [source: Aluede, Ogisi & Okakah 2023, p. 4]; a client coerced into such confession, or blamed for family illness, may need protection and trauma-informed support [synthesis].
Steps: (1) Ask directly, and routinely, whether anyone has restrained, beaten, starved, isolated or sexually touched the client during healing, or kept them from medical care. (2) Ask whether any child in the family has been accused of witchcraft or of causing illness. (3) Follow your jurisdiction's adult and child protection procedures; harm framed as tradition is still harm, and genuine tradition should not be misread as abuse without assessment. (4) Where coercive confession or blame occurred, assess for domestic abuse and honour-based abuse risks. (5) Document carefully and consult. [synthesis]
Example language (illustrative): "Some healing places use restraint or keep people from food. Has anything like that happened to you?"
Watch for: fear of community reprisal; family pressure to withdraw from therapy. Working when the client is safe and remains engaged.

4.12 Working with family and community

Purpose / when: when illness is understood collectively or when family steer help seeking; Nzewi describes the community sharing responsibility for managing illness [source: Nzewi 2002].
Steps: (1) With consent, invite relatives or elders the client trusts. (2) Use the Informant Version or family discussion to map shared and differing explanations. (3) Agree roles: who supports attendance, who liaises with healers, who notices warning signs. (4) Keep the client's own wishes central, especially for younger adults or women whose views may be overruled. [source: APA Informant Version; synthesis]
Example language (illustrative): "Everyone here wants him to get well. Can each of you say what you think will help?"
Watch for: blame (for example accusations of witchcraft against a relative); confidentiality breaches. Working when the family supports the agreed plan.

4.13 Migration, colonial history and racism

Purpose / when: for diaspora clients and anyone whose healing traditions were dismissed by missionaries, colonial authorities or health services; CFI Q16 asks about the clinician-patient relationship, including perceived racism [source: APA CFI]. Aluede and colleagues note how little indigenous healing knowledge has been recorded, and that it remains largely oral [source: Aluede, Ogisi & Okakah 2023].
Steps: (1) Ask about experiences of being judged by services for using healers or church. (2) Acknowledge that such dismissal has happened. (3) Use the Immigrants and Refugees module where relevant. (4) Explore loss of community music, festivals and elders after migration. [synthesis]
Example language (illustrative): "Have doctors or therapists ever made you feel your beliefs were wrong?"
Watch for: the client testing whether you will also dismiss them. Working when trust grows and disclosures widen.

4.14 Medical liaison

Purpose / when: whenever the client takes herbal or other remedies, has new physical or psychotic symptoms, or is being advised to stop medication. [synthesis]
Steps: (1) Record what the client reports taking, without advising. (2) Pass the information, with consent, to the prescriber or GP. (3) Refer urgently for any signs of medical emergency. (4) Never advise starting, stopping or changing a medicine. [synthesis]
Example language (illustrative): "Your doctor needs to know about everything you're taking so they can keep you safe. Can I let them know?"
Watch for: concealment of remedies; abrupt stopping of psychiatric medication. Working when the prescriber has a full picture.

5. Handling problems

The Esan and Igbo sources describe the healing traditions, not problems in psychotherapy alongside them; all guidance below is [synthesis] unless a source is named.

Client will not talk about healers or music rites. Likely fear of judgement or a duty of secrecy. Respond: state that you will not ask for anything that is private to the society or healer, only how the client is and what helps; return to it later. Never press for songs, rites or divination results.
Client asks you to take part in, or attend, a healing gathering, or to use healing songs in session. Decline warmly: explain that the healing belongs to the healer and community, and that your part is separate. Offer to coordinate with the healer instead (4.8).
Client or family insist the problem is purely spiritual and refuse medical assessment. Respect the explanatory model while naming specific medical concerns plainly; ask whether the healer would support a medical check alongside spiritual care (in COSIMPO, healers worked with primary care [source: pubannotation]); escalate if risk is high.
Healer advises stopping medication. Do not argue about the healer's authority; tell the client this is a matter for the prescriber, and with consent inform the prescriber. Offer a joint conversation.
Stuck therapy: the client sees therapy as irrelevant because the cause is spiritual. Revisit the explanatory model (4.4); agree goals the client values whatever the cause (sleep, relationships, work), and frame therapy as one support among several.
Overwhelm after a healing gathering, deliverance or public confession. Ground, assess safety and dissociation, process the event at the client's pace (4.10); screen for PTSD; check for coercion (4.11).
Possession or trance experiences outside the expected setting. Reassess using 4.7; seek informant and cultural-broker input; arrange psychiatric review if experiences are involuntary, unwanted, persistent or impairing [source: findacode ICD-11 6B62].
Witchcraft accusation inside the family (especially against a child or older woman). Treat as a safeguarding matter; follow protection procedures; work with the family on the fear behind the accusation without endorsing or ridiculing the belief.
Non-adherence (missed sessions during rites or festivals). Ask in advance about the community calendar; reschedule rather than treat absence as resistance. Aluede reports some Iyayi healing rites run for seven or fourteen days [source: Aluede, Ogisi & Okakah 2023, p. 4].
Rupture: client feels you dismissed their beliefs. Name it, apologise for the specific moment, ask what it meant to them, and invite correction; CFI Q16 can help open this [source: APA CFI].
Conflicting authorities (for example a Pentecostal family and an Iyayi or dibia-affiliated relative). Map who holds authority for whom; support the client's own choice; avoid siding with either religious view.
You are unsure whether a practice is normative or harmful. Consult a cultural broker and your safeguarding lead; document your reasoning.
Limited published guidance. Detailed Igbo music healing practice and Iyayi leadership structures are [uncertain: not verified]; ask the client and, with consent, their community rather than filling gaps with assumptions.

Sources

Online sources:

Books and papers referenced in the sources above [uncertain: not verified]:

Aluede, C. O. (2010). Music as therapy by the Iyayi Society of Edo State, Nigeria. VDM Verlag.
Aluede, C. O. (2014). Healing the adulterous woman through music in Esan, Nigeria. In C. Aluede, K. Samuel & S. O. Adedeji (Eds.), African musicology: Past, present and future (pp. 235-250). Association of Nigerian Musicologists.
Aluede, C. O. & Omoera, O. S. (2009). The concept of illness and music therapy among members of Iyayi Society of the Esan, Edo State of Nigeria. African Journal for Physical, Health Education, Recreation & Dance, 15(3), 392-408. A similarly titled 2009 paper is listed in Lwati; whether these are the same work is [uncertain].
Mereni, A. E. (1997), typology of healing music, as cited in Aluede & Iyeh 2008 [uncertain: full details not verified].
Okonkwo, E. E. (2012). Traditional healing systems among Nsukka Igbo. Journal of Tourism and Heritage Studies, 1(1), 69-81.
Kleinman, A., Eisenberg, L. & Good, B. (1978). Culture, illness, and care. Annals of Internal Medicine, 88, 251-258.
Gureje, O., Appiah-Poku, J., et al. (2020). COSIMPO trial. The Lancet.

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