Maya daykeepers (aj q'ij) and h-men

1. Introduction

Version followed: the roles as Guatemalan state and Peace Accord texts, Maya authors and Maya organisations describe them (Guatemala, mainly K'iche' and Kaqchikel usage of ajq'ij), plus attributed ethnography for the Yucatec Maya h-men (Mexico); the therapist's own work follows the DSM-5-TR Cultural Formulation Interview (core version, DSM-5-TR; supplementary modules and informant version as published for DSM-5).

What this is. These are not therapies and not something a psychotherapist does. They are living Maya spiritual and healing roles, held and recognised within Maya communities:

Ajq'ij (plural ajq'ijab'; spellings vary, e.g. aj q'ij, aj'qi'j; Spanish guía espiritual, contador de los días, "daykeeper" in English ethnography). Guatemala's Ministry of Culture describes the ajq'ij as the person in charge of spirituality who applies the 260-day Cholq'ij calendar to help individuals and the community overcome problems, and states that women and men both hold the role. [source: https://mcd.gob.gt/wp-content/uploads/2017/02/El-Rostro-y-el-Ser-de-los-Cuatro-Pueblos.pdf] A K'iche' Maya writer describes an ajq'ij as a guide, counsellor and "contador del tiempo" who cared for the community. [source: https://www.culturalsurvival.org/node/13041] Maya health practitioners writing for Cultural Survival describe "Guardians of Time" working alongside curanderos and comadronas (iyom), combining knowledge in severe cases. [source: https://www.culturalsurvival.org/es/news/guardianes-de-la-salud-medicina-tradicional-y-el-legado-de-vida-digna]
H-men (also j-men, jmeen; female x-men), Yucatec Maya healers in the Yucatán Peninsula. An ethnographer with four decades of fieldwork reports that the term h-men became common only from the late 19th to 20th century, that the role absorbed functions of priests and outside doctors, and that female healers have been overlooked in research; he distinguishes h-menes from urban espiritistas and from newer "traditional doctors" who use plants without ritual (outsider's account). [source: https://revistas.unla.edu.ar/saludcolectiva/article/download/1077/1984/14037] A Quintana Roo state Indigenous development institute lists J'Meenes alongside herbalists, sobadores, hueseros and parteras as specialists of Maya traditional medicine. [source: https://inmaya.qroo.gob.mx/wp-content/uploads/2025/04/LA-MEDICINA-TRADICIONAL-INDIGENApt1.pdf]

How change happens, in the tradition's own terms (attributed). Guatemala's Ministry of Culture describes Maya health care as restoring balance of several kinds: mechanical, emotional (e.g. susto, sadness), hot–cold, and energetic (e.g. mal de ojo), within a cosmovision of harmony between cosmos, people and nature. [source: https://mcd.gob.gt/wp-content/uploads/2017/02/El-Rostro-y-el-Ser-de-los-Cuatro-Pueblos.pdf] In Yucatán, the ethnographer reports illness attributed to ik' (wind, linked to ancestors) or to pulyah (spell), with family fates seen as connected and trust as central (he quotes a view that without belief the treatment does not work). [source: https://revistas.unla.edu.ar/saludcolectiva/article/download/1077/1984/14037] These are the tradition's explanations, stated here neither as fact nor dismissed.

The psychotherapist's role. Your work runs alongside: understanding the client's explanatory model and help seeking with the Cultural Formulation Interview (CFI), distinguishing culturally normative experience from disorder, coordinating with community-recognised ajq'ijab' or h-menes when the client wishes, addressing collective and historical trauma, and safeguarding. You do not read the calendar, diagnose in Maya terms, perform or direct ceremonies, or decide who is a legitimate ajq'ij or h-men. [synthesis]

2. Framework

No source sets phases or session counts for psychotherapy alongside ajq'ij or h-men care; the structure below is the therapist's own culturally responsive process. [synthesis] The CFI and its modules can be used at first evaluation, later in care or repeatedly. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]

Phase 0. Preparation (before and between clients). Goal: know the landscape without appropriating it. Learn which Maya people and language the client belongs to (e.g. K'iche', Kaqchikel, Q'eqchi', Mam, Ixil, Yucatec), the legal and institutional context (below), and your own assumptions. Move on: when you can name what you do not know. [synthesis]

Phase 1. Engagement and cultural assessment (usually sessions 1–2, can extend). Goal: the client's definition of the problem, causes, supports, identity, coping and help seeking, including any consultation with an ajq'ij, h-men, comadrona or other Maya specialist. Format: core CFI, adding the Explanatory Model; Spirituality, Religion and Moral Traditions; Cultural Identity; Coping and Help-Seeking; and, where relevant, Immigrants and Refugees modules; informant version with family if the client agrees. Field-trial clinicians found later CFIs took less time than the first [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]; a time per CFI is [uncertain: not verified]. Move on: when you can restate the problem in the client's own terms and they agree with your restatement. [synthesis]

Phase 2. Formulation and differential (1–2 sessions, alongside standard assessment). Goal: separate culturally normative experience and idioms from conditions needing clinical care; screen risk; check medicines, remedies and physical practices. Move on: when you have a shared formulation, a risk plan, and the client knows which concerns you will treat and which belong to their own healers. [synthesis]

Phase 3. Collaborative plan (1 session, revisited). Goal: decide with the client whether to keep care parallel, coordinate with a named community practitioner (with written consent), or neither. Move on: when consent, information sharing and boundaries are documented. [synthesis]

Phase 4. Treatment and integration (length set by the presenting problem, e.g. 8–20 sessions of an evidence-based therapy). Goal: deliver the indicated psychological treatment in a culturally adapted form, help the client integrate meaning from their own healers' care, and work with family, community and collective history. Move on: when goals are met or reassessment shows a change in the problem or in help seeking. [synthesis]

Phase 5. Review and ending. Goal: repeat relevant CFI questions, consolidate supports (community, family, healers, services), relapse and crisis plan. [synthesis]

Context the therapist needs.

Guatemala. The 1995 Agreement on Identity and Rights of Indigenous Peoples (Government of Guatemala and URNG) recognises "la importancia y la especificidad de la espiritualidad maya", commits the Government to respect its practice in public and private and the respect due to Indigenous spiritual guides, and provides for access to ceremonial centres to be regulated with Indigenous spiritual organisations and for a commission including spiritual guides to define other sacred places. [source: https://defensores.org.gt/wp-content/uploads/1.01-Acuerdo_Sobre_Identidad.pdf] The Constitution (art. 66) recognises, respects and promotes Indigenous forms of life, customs and traditions; a 2012 reform to recognise the Maya, Garífuna and Xinka peoples was not approved as a whole. [source: https://mcd.gob.gt/wp-content/uploads/2017/02/El-Rostro-y-el-Ser-de-los-Cuatro-Pueblos.pdf] The Ministry of Health (MSPAS) created a Traditional and Alternative Medicine Programme in 2002 and an Indigenous Peoples Unit in 2009, issues norms for culturally relevant care (latest 2023) and supports a national policy on comadronas; the presentation names comadronas but not ajq'ijab', and does not address mental health. [source: https://tcim-globalsummit.bvsalud.org/wp-content/uploads/2023/08/p3_Guatemala_Enrique-Molina.pdf] No state licensing or register of ajq'ijab' was found [uncertain: not verified].
Mexico. The Quintana Roo institute cites Constitution art. 2 (recognition of Indigenous traditional medical practices) and Ley General de Salud arts. 6 and 93 (promoting traditional medicine where health is not put at risk; respecting Indigenous health practices), and notes continuing difficulty integrating traditional and allopathic medicine. [source: https://inmaya.qroo.gob.mx/wp-content/uploads/2025/04/LA-MEDICINA-TRADICIONAL-INDIGENApt1.pdf]
Who holds authority. Recognition of an ajq'ij or h-men comes from Maya communities, lineages and their organisations, not from outside credentials; the Peace Accord names spiritual guides and Indigenous spiritual organisations as interlocutors for the state. [source: https://defensores.org.gt/wp-content/uploads/1.01-Acuerdo_Sobre_Identidad.pdf] Women ajq'ijab' may be discredited or have their authority diminished in front of male specialists, according to a doctoral study in a Kaqchikel town. [source: https://ecosur.repositorioinstitucional.mx/jspui/bitstream/1017/2531/1/36369_Documento.pdf] Whether national councils of spiritual guides speak for all ajq'ijab' is [uncertain: not verified].

3. Guiding principles

Alongside, never instead. You treat what is within your competence; ajq'ij and h-men work belongs to them. Practical meaning: never offer, imitate, interpret or schedule ceremonies or calendar readings. [synthesis]
Community authority decides legitimacy. Practical meaning: ask the client and their community who they trust; do not vet practitioners by your own criteria or by online marketing. [source: https://defensores.org.gt/wp-content/uploads/1.01-Acuerdo_Sobre_Identidad.pdf] [synthesis]
Attribute, do not adjudicate. Practical meaning: write "the client understands the problem as susto / wind / a spell", never "the client has" or "the client believes, falsely". [synthesis]
The client's definition first. Practical meaning: open with the CFI's cultural definition of the problem before your diagnostic questions. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Medical pluralism is normal. Guatemala's Ministry of Culture states that Maya people today combine the Maya and Western health systems. Practical meaning: expect parallel care and ask about it routinely, without implying a choice. [source: https://mcd.gob.gt/wp-content/uploads/2017/02/El-Rostro-y-el-Ser-de-los-Cuatro-Pueblos.pdf]
Collective and land-related wellbeing. Maya authors writing on psychotherapy with Maya migrants describe K'iche' and Ixil cosmovision as oriented to community and Mother Earth, and warn that individual-pathology models can be minimally helpful or harmful. Practical meaning: include family, community, land and structural oppression in the formulation. [source: https://digitalcommons.kennesaw.edu/mayaamerica/vol7/iss1/3]
Shared power. The same authors call for dialogue and shared power rather than clinician-led hierarchy. Practical meaning: co-write goals and check your formulation with the client. [source: https://digitalcommons.kennesaw.edu/mayaamerica/vol7/iss1/3]
History is present in the room. During Guatemala's armed conflict, elders and ajq'ijab' were among the most persecuted people, according to a Kaqchikel-area study; ethnomedical knowledge has been disqualified by biomedicine. Practical meaning: expect mistrust of services and of questions about spirituality; earn trust before probing. [source: https://ecosur.repositorioinstitucional.mx/jspui/bitstream/1017/2531/1/36369_Documento.pdf]
Cultural humility over expertise. Practical meaning: you are a learner about this client's tradition; the client and their community are the authority. [synthesis]
Normative experience is not pathology, and pathology is not excused as culture. Practical meaning: use DSM-5-TR and ICD-11 cultural exclusions both ways. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]
Consent and confidentiality govern collaboration. Practical meaning: no contact with a healer, family or community member without the client's explicit, specific, revocable consent. [synthesis]
Safety overrides. Practical meaning: witchcraft accusations, violence, coercion or delayed urgent medical care trigger your usual safeguarding duties, whoever is involved. [source: https://www.culturalsurvival.org/node/13041] [synthesis]
No advice on remedies or medicines. Practical meaning: ask about herbal and other remedies and route questions to the prescriber; never recommend starting or stopping anything. [synthesis]
Language justice. Practical meaning: many Maya clients' first language is a Mayan language, not Spanish or English; offer an interpreter in that language. [synthesis]

4. Intervention inventory

All interventions below are the psychotherapist's own. None involves performing, imitating or directing Maya ceremony, calendar work or healing. Example language is illustrative wording, not quoted from any source.

4.1 Cultural humility and self-examination

Purpose / when: before first contact and whenever you notice certainty, fascination or dismissal about Maya spirituality. [synthesis]
Steps: (1) Write down what you assume about "shamans", "Maya calendar" and "witchcraft", and where those assumptions came from (tourism, media, New Age marketing, religion). (2) Note your own religious and scientific commitments and how they might colour your notes. (3) Learn the client's specific people, language and region rather than a generic "Maya" picture; Maya institutions themselves distinguish many specialists (e.g. iyom midwife, ajq'ayis herbalist, ajb'aq bone specialist, ajtuj sauna healer). [source: https://mcd.gob.gt/wp-content/uploads/2017/02/El-Rostro-y-el-Ser-de-los-Cuatro-Pueblos.pdf] (4) Read Maya-authored sources first and treat outsider ethnography as attributed context. (5) Bring reactions to supervision. [synthesis]
Example language (illustrative): "I know a little about Maya traditions in general, but I don't know how things are understood in your family and community. I'd like you to teach me what matters for your care."
Watch for: romanticising (treating the client as a guide to exotic wisdom), or the opposite reflex of reducing everything to symptoms. Working: the client corrects you freely and your notes use their words. [synthesis]

4.2 Core Cultural Formulation Interview

Purpose / when: first assessment of every client from a Maya background, and again when care stalls. The core CFI has 16 questions in four domains: cultural definition of the problem; cultural perceptions of cause, context and support; cultural factors in self-coping and past help seeking; and cultural factors in current help seeking. It supports, but is not the sole basis for, diagnosis. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] APA describes it as for any clinician in any setting. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]
Steps: (1) Download the official form (clinicians may reproduce it for use with their patients; translating or modifying it requires APA permission). [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] (2) Explain why you ask. (3) Work through the four domains in order, in your own conversational wording, using the client's terms for the problem in later questions. (4) Note where the form points to a supplementary module and add it (4.3–4.6). (5) Summarise back and ask for correction. [synthesis for steps 2, 3, 5]
Example language (illustrative): "People describe problems in their own way. How would you describe what brings you here, in your own words, or in K'iche' if that fits better?"
Watch for: short, polite answers that may reflect mistrust of institutions; Spanish-only wording that misses Mayan-language concepts. Working: the client starts to use their own illness terms and names who else they have consulted. [synthesis]

4.3 Spirituality, Religion and Moral Traditions module

Purpose / when: when the client mentions Maya spirituality, an ajq'ij or h-men, the calendar, ancestors, a church, or moral conflict; also when families are religiously mixed (Maya spirituality, Catholic, evangelical). The module is one of 12 supplementary modules. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
Steps: (1) Ask what spiritual or religious traditions matter to the client and family. (2) Ask how those traditions understand the current problem and what they ask of the client. (3) Ask about conflicts (e.g. family members who reject Maya spirituality, or community pressure). (4) Ask how comfortable they are discussing this with you. (5) Record meanings, not ritual details; do not ask for ceremony content, prayers or calendar specifics. [synthesis]
Example language (illustrative): "Is Maya spirituality, a church, or both part of your life? How do they see what is happening to you? You don't need to tell me anything private about ceremonies; I'm interested in what it means for you."
Watch for: disclosure of conflict between Maya spirituality and evangelical or Catholic family members; fear of being judged; past persecution (4.13). Working: the client names spiritual resources without fear of ridicule. [synthesis]

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

Purpose / when: whenever the client attributes the problem to susto, wind/ik', mal de ojo, a spell, the ancestors, their day-sign, or envy. Kleinman, Eisenberg and Good (1978) set out eight questions, paraphrased: what do you call it; what caused it; why then; what does it do to you and how; how severe and how long; what treatment should you get; what are the chief problems it has caused; what do you fear most. [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf] [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader]
Steps: (1) Ask the eight questions over one or two sessions in conversational form. (2) Ask what different people say (family, ajq'ij or h-men, doctor). (3) Map where the client's model and the clinical model overlap (e.g. sadness, fear, loss of sleep) and where they differ. (4) Negotiate a shared description that both can use (e.g. "the fright and what has followed it"). [synthesis for steps 2–4]
Example language (illustrative): "What do you call this? What do you think started it, and why now? What does your family think it is? What are you most afraid it will lead to?"
Watch for: explanatory models that carry social danger (e.g. a named person suspected of a spell; see 4.16). Working: you can describe the problem in words the client accepts, and plans address both sets of concerns. [synthesis]

4.5 Cultural Identity module

Purpose / when: early, to locate the client among Maya peoples and languages, generations and migration, and to see how identity bears on the problem. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
Steps: (1) Ask which people, community and language(s) the client identifies with. (2) Ask about ladino/mestizo, Mexican, US or other identities and how they sit together. (3) Ask about experiences of racism, including in health services (CFI question 16 area). [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] (4) Note gender: women may hold spiritual roles yet face discrediting. [source: https://ecosur.repositorioinstitucional.mx/jspui/bitstream/1017/2531/1/36369_Documento.pdf]
Example language (illustrative): "How do you describe yourself, for example as Maya, as Q'eqchi', as Guatemalan, or something else? Which language do you feel most yourself in?"
Watch for: internalised shame about Indigenous identity; tension between generations. Working: the client volunteers identity material and links it to the problem. [synthesis]

4.6 Coping and Help-Seeking module: asking about ajq'ij, h-men and other healers

Purpose / when: at intake and at every review, because parallel use of Maya and Western care is common. [source: https://mcd.gob.gt/wp-content/uploads/2017/02/El-Rostro-y-el-Ser-de-los-Cuatro-Pueblos.pdf] People often try several healers and remedies in turn, the Yucatán ethnography reports. [source: https://revistas.unla.edu.ar/saludcolectiva/article/download/1077/1984/14037]
Steps: (1) Ask in a normalising way who the client has consulted, including ajq'ij, h-men, curandero, comadrona, huesero/sobador, espiritista, pastor or priest. (2) Ask what each said and advised, how it helped and what it cost (cost and family debt are a reported burden). [source: https://revistas.unla.edu.ar/saludcolectiva/article/download/1077/1984/14037] (3) Ask about remedies and physical treatments for safety screening (4.12). (4) Ask whether they want you to know more or to be in contact (4.11). [synthesis]
Example language (illustrative): "Many people see a spiritual guide, a h-men or a curandero as well as coming here. Have you, or has your family, seen anyone like that about this? What did they say?"
Watch for: concealment if the client expects disapproval; consulting only commercial or unknown practitioners (4.16). Working: the client tells you about other care without prompting at later sessions. [synthesis]

4.7 Involving family: CFI informant version

Purpose / when: when a family member is central to help seeking, interpretation of the problem or care, and the client consents. The informant version has 17 questions, starting with the informant's relationship to the patient. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf] In Yucatán, patients are reported to attend healers with family because family fates are seen as linked. [source: https://revistas.unla.edu.ar/saludcolectiva/article/download/1077/1984/14037]
Steps: (1) Get the client's consent and agree what may and may not be discussed. (2) Interview the family member separately or jointly as the client prefers. (3) Compare the family's model with the client's. (4) Use family strengths in the plan. [synthesis]
Example language (illustrative): "Your mother has known you all your life. Would it help if I asked her how she understands what is happening, with you present?"
Watch for: family pressure on the client to follow or abandon a specific healer; disclosure risks in small communities. Working: family and client describe a common plan. [synthesis]

4.8 Working with cultural concepts of distress

Purpose / when: when the client uses idioms such as susto (fright), sadness/pena, mal de ojo, wind (ik'), nervios. Guatemala's Ministry of Culture classifies susto and sadness under restoring emotional balance and mal de ojo under restoring energy. [source: https://mcd.gob.gt/wp-content/uploads/2017/02/El-Rostro-y-el-Ser-de-los-Cuatro-Pueblos.pdf] DSM-5-TR treats cultural concepts of distress as idioms, explanations or syndromes; secondary sources list susto and nervios among its examples. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf] [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf] A Q'eqchi' healers' association in Belize recognises 17 mental illnesses grouped into four narrative genres (ethnography). [source: https://harvest.usask.ca/items/af0d88c4-a25f-4188-becc-c332e40e82c1]
Steps: (1) Record the idiom in the client's language and words. (2) Ask what happened at onset (e.g. the frightening event), what symptoms belong to it, and what usually helps. (3) Screen separately for depression, PTSD, anxiety, psychosis and medical causes; an idiom can co-occur with a disorder, explain it, or stand alone. (4) Do not translate the idiom into a diagnosis in the client's presence; describe both. [synthesis]
Example language (illustrative): "You said this began with a susto after the accident. Tell me what has been happening since then, in your body, your sleep, your thoughts."
Watch for: missed trauma behind a susto narrative; missed physical illness behind an energy or wind narrative. Working: the client experiences you as taking the idiom seriously and also accepts screening. [synthesis]

4.9 Differentiating normative experience from disorder

Purpose / when: when the client reports dreams, signs, ancestral presence, calling to a spiritual role, spirit or wind affliction, trance, or messages linked to their day-sign (nawal, which the Ministry of Culture says shapes character and abilities). [source: https://mcd.gob.gt/wp-content/uploads/2017/02/El-Rostro-y-el-Ser-de-los-Cuatro-Pueblos.pdf]
Steps: (1) Ask whether people in the client's community would see this experience as expected, meaningful or worrying. (2) Ask whether it is wanted or unwanted, voluntary or not, and its effect on functioning. (3) Apply the cultural exclusions: DSM-5 dissociative trance does not apply when it is part of broadly accepted collective cultural or religious practice; DID criterion D excludes normal parts of such practice; ICD-11 6B62 trance disorder and 6B63 possession trance disorder require involuntary, unwanted states outside accepted practice with distress or impairment. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://www.findacode.com/icd-11/code-1807490186.html] Whether DSM-5-TR keeps the exact DSM-5 wording is [uncertain: not verified]; a study guide citing DSM-5-TR paraphrases the same exclusions. [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299] (4) With consent, consult a cultural broker or a community member the client trusts about whether the experience is typical. (5) Screen for psychosis, mania, substance use and organic causes in parallel. [synthesis for 1, 2, 4, 5]
Example language (illustrative): "In your community, would people see this as something that happens and has a meaning, or as a sign that something is wrong? How does it affect your days?"
Watch for: both errors, pathologising a culturally expected calling and missing a psychotic illness described in spiritual terms. Working: the client's community view and your clinical assessment are both recorded and reconciled in the plan. [synthesis]

4.10 Language access: interpreters and cultural brokers

Purpose / when: whenever the client's strongest language is a Mayan language, or when cultural meanings need explaining. The CFI asks about language barriers and the clinician–patient relationship (question 16 area). [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Steps: (1) Ask the client's preferred language; do not assume Spanish. (2) Book a trained interpreter for that language (e.g. K'iche', Mam, Q'eqchi', Kaqchikel, Ixil, Yucatec Maya); avoid using children or family as interpreters. (3) Brief the interpreter on confidentiality and on rendering illness terms as said, not "correcting" them. (4) Check with the client that they are comfortable with the interpreter, who may belong to the same small community. (5) Separately, and only with consent, use a cultural broker (e.g. a Maya community organisation worker) to explain context, not to assess the client. [synthesis]
Example language (illustrative): "Would you prefer to speak in Mam with an interpreter? You can tell me if you would rather the interpreter not be from your own town."
Watch for: interpreter softening spiritual content, or the client withholding because of community ties. Working: longer, richer answers and use of Mayan-language terms. [synthesis]

4.11 Collaboration and referral with community-recognised ajq'ijab' or h-menes

Purpose / when: only when the client asks for it or welcomes it; to coordinate parallel care, reduce conflicting advice and improve safety. No Maya-specific collaboration protocol is published in the cited sources [uncertain: not verified]. Evidence from West Africa shows such collaboration is possible: in COSIMPO (Gureje et al., The Lancet 2020), collaborative shared care between traditional and faith healers and primary care in Nigeria and Ghana gave greater reductions in psychotic symptoms and fewer harmful practices than controls [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839]; in a Ghanaian prayer-camp trial (Ofori-Atta et al., Br J Psychiatry 212(1)) adding psychiatric care reduced symptoms but did not significantly reduce days in chains. [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial] WHO's 2014–2023 strategy promotes safe integration of traditional medicine, including practitioners, into health systems. [source: https://www.who.int/activities/implementation-of-the-WHO-traditional-medicine-strategy-2014-2023]
Steps: (1) Ask whether the client wants you to know about, or be in contact with, their ajq'ij or h-men. (2) The client chooses the practitioner through their own community pathway; do not refer to practitioners you found yourself, especially commercial "Maya shaman" services. (3) Get specific written consent: who, what information, for what purpose, how long, revocable. (4) Keep contact to coordination: shared understanding of the problem, warning signs needing medical care, how to reach you, and respect for each other's roles. (5) Do not attend, observe or comment on ceremonies or calendar work, and do not ask the practitioner to change their practice except on safety. (6) Document consent and contacts. [synthesis]
Example language (illustrative, to client): "If it would help, and only if you want, I could speak with the ajq'ij you trust so we're not pulling you in different directions. What would you want me to share, and what not?" (illustrative, to practitioner): "I work with [client] on the worries and sleep problems. I respect the work you do with them. If you ever see signs that they are unsafe, here is how to reach me."
Watch for: confidentiality breaches in small communities; the client feeling pushed to choose; any practice involving coercion or delayed medical care (4.16). Working: the client reports consistent messages from both sides. [synthesis]

4.12 Safety screening of remedies, medicines and physical practices

Purpose / when: at intake and at review, because Maya medicine draws on medicinal plants, minerals and animal products and includes sauna (ajtuj) and bone specialists (ajb'aq). [source: https://mcd.gob.gt/wp-content/uploads/2017/02/El-Rostro-y-el-Ser-de-los-Cuatro-Pueblos.pdf] Mexican law promotes traditional medicine where health is not put at risk, and the federal health regulator COFEPRIS oversees herbal products. [source: https://inmaya.qroo.gob.mx/wp-content/uploads/2025/04/LA-MEDICINA-TRADICIONAL-INDIGENApt1.pdf]
Steps: (1) Ask neutrally which remedies, plant preparations, sweat-bath or massage/bone-setting treatments the client uses. (2) Pass the list to the prescriber or GP with consent; do not advise on doses, combinations, starting or stopping anything, medicines or remedies. (3) For physical practices, ask about injuries, burns, fainting or heat intolerance and any medical conditions; refer for medical review if concerned. (4) Ask whether any treatment involves being touched without consent or in intimate ways; any sexual contact by a practitioner is abuse and a safeguarding matter. [synthesis]
Example language (illustrative): "Are you taking any plants or remedies, or having sweat baths or massage, for this? I'm not here to judge them; your doctor just needs to know so nothing clashes with your medicines."
Watch for: stopping prescribed medication on others' advice; heat or physical exertion in people with heart disease, pregnancy or on certain medicines (route to doctor). Working: the prescriber has the full list and the client keeps both. [synthesis]

4.13 Working with collective, historical and persecution trauma

Purpose / when: for clients affected by Guatemala's armed conflict and genocide, displacement, or historical suppression of Maya spirituality. Elders and ajq'ijab' were among the most persecuted during the conflict, a doctoral study reports. [source: https://ecosur.repositorioinstitucional.mx/jspui/bitstream/1017/2531/1/36369_Documento.pdf] A K'iche' writer describes centuries of colonial suppression of Maya spiritual practice. [source: https://www.culturalsurvival.org/node/13041] Oxlajuj Ajpop, formed after the 1996 peace agreement, offers psychological counselling drawn from Maya cosmovision and legal support to families seeking exhumation of relatives killed in the war. [source: https://www.peaceinsight.org/ar/organisations/oxlajuj-ajpop/]
Steps: (1) Ask about family and community history when the client is ready, not at first contact. (2) Assess PTSD, complicated grief (including disappeared relatives) and depression with standard measures, explained in the client's language. (3) Place symptoms in their collective context in the formulation. (4) Offer an indicated trauma-focused therapy, adapted for collective meaning, and, with consent, links to Maya-led psychosocial or exhumation-support organisations. (5) Recognise ceremonies and community commemorations as the community's own, not as therapy you prescribe. [synthesis]
Example language (illustrative): "Some of what you carry may come from what happened to your family and community during the war. We can look at that together at your pace, and you can decide what other support you want from your community."
Watch for: re-traumatisation through rushed history taking; distrust of state-linked services. Working: the client links personal symptoms to shared history without being overwhelmed. [synthesis]

4.14 Community-, family- and land-oriented framing; migration (Immigrants and Refugees module)

Purpose / when: for Maya migrants and for clients whose distress centres on separation from land, community or family. Maya authors advise acknowledging structural oppression, centring K'iche' and Ixil cosmovision oriented to community and Mother Earth, and working through dialogue and shared power toward what they call cosmic wellness. [source: https://digitalcommons.kennesaw.edu/mayaamerica/vol7/iss1/3] The CFI includes an Immigrants and Refugees module. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
Steps: (1) Use the module to explore migration history, separation, legal and work stressors. (2) Include obligations to family at home, community ties and relationship to land in goals. (3) Link the client with Maya community organisations they choose. (4) Address immigration and labour stressors practically (referrals to legal aid, social work). (5) Where an individual-focused protocol is indicated, adapt its framing to collective goals. [synthesis]
Example language (illustrative): "When you think about being well again, who else is part of that picture, here and back home? And how does being far from your land affect you?"
Watch for: framing systemic harm (deportation fear, exploitation) as personal cognitive error. Working: goals the client recognises as theirs and their community's. [synthesis]

4.15 Integrating experiences from Maya healing

Purpose / when: after a client has consulted an ajq'ij, h-men or other specialist and wants to make sense of it within therapy. [synthesis]
Steps: (1) Invite the client to share only what they wish; do not ask for ceremony content. (2) Ask what changed, what it meant, and what it asks of them. (3) Connect meanings and commitments to therapy goals (e.g. reconciliation in the family, restoring balance, honouring ancestors). (4) Explore any distress or conflict the experience raised. (5) Never reinterpret the healer's diagnosis or contradict it on spiritual grounds. [synthesis]
Example language (illustrative): "You said you felt lighter after seeing the h-men. What do you make of that, and how could we build on it here?"
Watch for: new fears (e.g. of a named person after a spell attribution); financial strain from repeated consultations, which ethnography reports can push families into debt. [source: https://revistas.unla.edu.ar/saludcolectiva/article/download/1077/1984/14037] Working: the client draws on both forms of care coherently. [synthesis]

4.16 Safeguarding

Purpose / when: whenever accusations of witchcraft or spells, violence, coercion, exploitation, abuse of children, or delay of urgent medical care appear. In 2020 an ajq'ij from a community in Petén was beaten and burned to death by people accusing him of witchcraft, as Cultural Survival reports. [source: https://www.culturalsurvival.org/node/13041] Explanations involving spells (pulyah) are reported in Yucatán. [source: https://revistas.unla.edu.ar/saludcolectiva/article/download/1077/1984/14037]
Steps: (1) When a spell or envy is blamed, ask whether anyone is suspected and whether anyone is at risk of harm, including the client, the suspected person or a child. (2) Assess risk to self and others using standard procedures. (3) Follow your jurisdiction's adult and child safeguarding and reporting duties for violence, sexual abuse, coercion or neglect, regardless of who is involved. (4) Where urgent medical care is being delayed, explain the medical risk plainly and support access to care without attacking the client's spirituality. (5) Remember that ajq'ijab' themselves can be targets of violence; a client who is a spiritual guide may need protection. [synthesis]
Example language (illustrative): "When people think someone has sent harm, it can lead to fear or to conflict. Is anyone at risk right now, you, your children, or the person who is suspected?"
Watch for: escalation toward collective violence; exploitation by people selling "Maya ceremonies" outside community pathways [synthesis]. Working: risks are named and plans protect everyone involved. [synthesis]

4.17 Documentation and re-formulation

Purpose / when: throughout; the CFI and modules can be repeated during treatment. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
Steps: (1) Write a cultural formulation section in the record using the client's terms, attributed. (2) Record consents for any contact with healers or family. (3) Do not record ceremony content or the identity of practitioners beyond what is needed. (4) Revisit help seeking and explanatory model at reviews and at any deterioration. [synthesis]
Example language (illustrative): "I'd like to write how you understand this in your own words, so that other staff understand it too. Is this how you would put it?"
Watch for: language that frames the client's beliefs as symptoms when they are not. Working: the client agrees with what you wrote. [synthesis]

5. Handling problems

Sources on ajq'ij and h-men roles do not address psychotherapy problems; all guidance in this section is [synthesis] unless a source is tagged.

Client is guarded or gives minimal answers about spirituality. Likely reasons: persecution history, fear of ridicule, or past racism in services. [source: https://ecosur.repositorioinstitucional.mx/jspui/bitstream/1017/2531/1/36369_Documento.pdf] Response: say why you ask, that nothing about ceremonies needs to be shared, and return to the topic later; offer a Mayan-language interpreter; ask about experiences of discrimination in care (CFI question 16 area). [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] [synthesis]
Client asks you to perform, join, recommend or interpret a ceremony or calendar reading. Response: decline warmly, explain that this belongs to their own spiritual guides and community, and offer to coordinate with a guide they trust (4.11). (Illustrative: "That isn't my place; it belongs to the people your community recognises. What I can do is work alongside them.") [synthesis]
Client asks whether the spell, wind or susto is "real". Response: do not rule on spiritual questions; describe what you can help with (fear, sleep, grief, conflict) and how that fits with what their guide is doing. [synthesis]
Stuck: symptoms persist despite therapy and Maya healing. Response: repeat the explanatory-model and help-seeking questions; check for missed diagnoses (depression, PTSD, psychosis, substance use, medical illness), medication adherence and remedy interactions (via prescriber); ask whether the client's own healers see a different problem; consider family or community stressors and debt from treatment. [source: https://revistas.unla.edu.ar/saludcolectiva/article/download/1077/1984/14037] [synthesis]
Non-adherence to medication because a healer or family advises against it, or because the client thinks it conflicts with Maya care. Response: explore the reasons without blame, involve the prescriber, and, with consent, coordinate with the healer on shared warning signs; never advise stopping or changing medicine yourself. [synthesis]
Rupture: client feels judged after you named a diagnosis. Response: acknowledge it, restate the client's own description, explain that a diagnosis is a tool for accessing care and does not replace their understanding, and check the formulation together. [synthesis]
Overwhelm when trauma history surfaces (war, disappearance, persecution). Response: slow down, ground in the present, return control to the client over pace and content, and offer Maya-led psychosocial supports they choose. [source: https://www.peaceinsight.org/ar/organisations/oxlajuj-ajpop/] [synthesis]
Family conflict over Maya spirituality versus church affiliation. Response: use the Spirituality, Religion and Moral Traditions module with each party (with consent); work on the relationship conflict, not on which belief is right. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] [synthesis]
Client is consulting a commercial or unknown "Maya shaman" (e.g. tourist-market ceremonies) and is being harmed or exploited. Response: ask how the person is recognised in the client's own community; discuss costs, pressure and any abuse; follow safeguarding duties; support the client to return to community pathways if they wish. Whether Maya organisations have issued formal statements about outsiders selling ceremonies is [uncertain: not verified]. [synthesis]
Spell accusation against a named person, or community threat of violence. Response: assess and act on risk to all parties (4.16); recall that guides themselves have been killed after witchcraft accusations. [source: https://www.culturalsurvival.org/node/13041] [synthesis]
Unusual experiences: calling, dreams, ancestral contact, trance. Response: apply 4.9; consult a cultural broker with consent; avoid both pathologising and missing psychosis; if unsure and risk is low, watch over time while keeping a crisis plan. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [synthesis]
Client is themselves an ajq'ij or h-men (or in training) and seeks therapy. Response: treat them as any client with the right to confidentiality; do not ask them to teach you their practice; recognise possible role strain, community expectations and, for women, discrediting. [source: https://ecosur.repositorioinstitucional.mx/jspui/bitstream/1017/2531/1/36369_Documento.pdf] [synthesis]
Confidentiality in small communities (interpreter, broker or healer knows the family). Response: ask the client's preferences each time, use interpreters from outside the community when requested, and share only the minimum needed with written consent. [synthesis]
Your own discomfort (scepticism, fascination, religious objection). Response: take it to supervision; if it impairs care, refer to a colleague with relevant cultural competence. [synthesis]

Sources

Maya roles, institutions and law:

Scholarship (attributed context; outsider accounts except where noted):

Cultural assessment, diagnosis and collaboration:

Books and articles cited by reference:

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.
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).

← Previous · XI-103Mexican curanderismo Next · XI-105 →Mazatec mushroom velada