Brujería and counter-magic

1. Introduction

Version followed: the psychotherapist's culturally responsive work as framed by the DSM-5-TR Cultural Formulation Interview (CFI) and its supplementary modules (APA); brujería and its counter-magic described only as published ethnography and clinical studies report them (Viladrich 2018 on botánicas; Hoskins and Platt 2022 on therapists and curanderxs); harm account framed by UN Human Rights Council resolution 47/8 (2021) and documented cases.

What it is. Brujería (Spanish: witchcraft or sorcery) is not a therapy and has no manual. It is a belief framework, found in many Latin American and Latinx communities, in which illness, distress, bad luck, relationship breakdown or money trouble may be attributed to harm deliberately sent by another person through spiritual means; "counter-magic" is the protective and remedial help people seek in response, such as limpias (cleansings), consultations with curanderos or curanderxs, spiritual counsellors and botánica providers, and protection practices [synthesis]. These beliefs are described here as the people who hold them describe them, neither stated as fact nor dismissed.

What published research shows. An ethnographic study of botánicas (shops offering spiritual, healing and religious services, mainly to Latino and Caribbean customers in US cities, chiefly New York City) found that providers offer natural remedies such as herbs, informal counselling and religious ceremonies including prayer and ritual cleansing; providers mainly identified depression and nervios as what they treat, and linked them to undocumented status, family conflict and financial worries, within a holistic model that joins social stressors with divine causes [source: https://journals.athmsi.org/index.php/ajtcam/article/view/4966]. A qualitative study of eight bilingual licensed therapists found that collaboration between psychotherapists and curanderxs is rare, few training programmes teach anything about curanderismo, and mistrust between the two groups hinders collaboration [source: https://www.emerald.com/insight/content/doi/10.1108/JMHTEP-05-2021-0043/full/html]. A small qualitative social-work study set out to explore how therapists can work with Latino clients who explain distress through supernatural events such as brujería; interviewed clinicians stressed asking for the client's own view and not denying or negating it [source: https://sophia.stkate.edu/msw_papers/780].

Who holds authority. Whether any regulator, licensing body or official register exists for curanderismo or for brujería-related healing is [uncertain]. Recognition of a healer comes from clients, families and the healer's own religious or community networks [synthesis]. Some practitioners belong to religious traditions with their own houses, lineages or clergy (for example Afro-Caribbean religions or the Catholic Church), and each of those holds its own authority over who may practise [uncertain]. In Bolivia, a 2010 EFE report noted that a law recognising Indigenous justice had just been signed, that a further law was needed to define its limits, and that the government and some Indigenous organisations reject calling lynchings "community justice" [source: https://www.elmostrador.cl/noticias/mundo/2010/10/26/campesinos-del-sureste-de-bolivia-linchan-a-pareja-acusada-de-brujeria/]. Resolution 47/8 asks states to distinguish harmful practices from the lawful exercise of religion or belief, and distinguishes traditional, complementary or integrative medicine from these practices [source: https://digitallibrary.un.org/record/3936009/files/A_HRC_RES_47_8-EN.pdf].

Core idea of how change happens. Within the tradition, people describe relief as coming when the sent harm is removed or blocked by someone they recognise as able to do so (as believers hold it) [uncertain]. For the psychotherapist, change comes through understanding the client's explanatory model, treating any disorder present, easing the real stressors and conflicts that the brujería account often carries, supporting safe help-seeking of the client's choosing, and protecting clients from accusation violence and exploitation [synthesis]. The psychotherapist does not perform limpias, protection or counter-magic, does not confirm or rule out that sorcery has been done, and does not direct clients to practitioners outside pathways the client and their community recognise [synthesis].

2. Framework

No phased protocol exists for working with brujería beliefs. The structure below is a clinical framework built around the CFI [synthesis]; the CFI itself has no fixed sessions.

The CFI as the backbone. The core CFI has 16 questions in four domains: cultural definition of the problem; cultural perceptions of cause, context and support; cultural factors affecting self-coping and past help seeking; and cultural factors affecting current help seeking [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]. APA describes it as designed for any clinician, with any individual, in any care setting [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]. It supports clinical understanding and is not meant to be the only basis for a diagnosis [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]. The 12 supplementary modules can be used as add-ons or standalone, at first evaluation, later, or repeatedly during treatment [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]. In the DSM-5 field trial (318 patients, 75 clinicians) the CFI was found feasible, acceptable and useful, and later interviews took less time; no time in minutes is given [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]. A typical duration is [uncertain].

Phase A: Engagement, cultural assessment and safety (sessions 1–2) [synthesis]. Goals: build trust; complete the core CFI (Informant Version with a relative if the client agrees); screen for immediate risk: suicide, violence, an accusation made against the client or a family member, threats, children at risk, large payments to a spiritual provider, and delayed medical care. Move on when the client's own name for the problem, its perceived cause and their help-seeking so far are recorded, and immediate risks have a plan.

Phase B: Formulation and shared plan (sessions 2–4) [synthesis]. Goals: write a cultural formulation; work through the differential (culturally shared belief, cultural concept of distress, or a mental disorder, or several at once); use supplementary modules where needed; agree goals in the client's terms; decide with the client whether to involve family, an interpreter, a cultural broker or a community-recognised healer. Move on when the client and therapist agree what therapy is for and what it is not for.

Phase C: Treatment alongside the client's own help-seeking (length set by the presenting disorder) [synthesis]. Goals: deliver the evidence-based treatment indicated for any disorder present; work on the stressors and relationships that the brujería account points to; coordinate with healers or clergy when the client wishes; keep reviewing safety and spending. Repeat CFI modules when the picture changes.

Phase D: Integration and ending [synthesis]. Goals: help the client weave therapy and any spiritual help into one account they can live with; plan for relapse, new accusations or new pressure to pay; agree how the client will seek help in future.

Safety track (throughout) [synthesis]. Safeguarding of children, protection of anyone accused, and response to fraud take priority over phase order.

Format. Individual sessions; family sessions with consent (the CFI Informant Version has 17 questions and is used with a relative or friend [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]); professional interpreters where needed [synthesis].

3. Guiding principles

Cultural humility first. Assume you do not know what brujería means to this client; ask. [synthesis; consistent with CFI purpose, source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Attribute, do not adjudicate. Record the belief as the client's; never say sorcery did or did not happen. Interviewed clinicians stressed not denying or negating the client's view [source: https://sophia.stkate.edu/msw_papers/780].
The client's model leads the conversation. Use their words for the problem and its cause in notes and sessions [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf].
Stay in your lane. You do not perform, prescribe or recommend counter-magic; you do your own work alongside it [synthesis].
Belief is not a symptom; distress and impairment may be. Shared cultural beliefs are assessed against culture, not counted as psychosis by default; illness is not missed either [synthesis; see DSM and ICD-11 criteria in Section 4].
Stressors behind the story. Envy, conflict, migration, money and family strain often travel with the brujería account; they are workable targets [source: https://journals.athmsi.org/index.php/ajtcam/article/view/4966; synthesis].
Client chooses help-seeking. Ask about healers without judgement; support collaboration only when the client wishes and with consent [source: https://www.emerald.com/insight/content/doi/10.1108/JMHTEP-05-2021-0043/full/html; synthesis].
Tradition is not exploitation. Respect lawful religion and traditional medicine, and separately act on fraud, threats and violence, as resolution 47/8 distinguishes them [source: https://digitallibrary.un.org/record/3936009/files/A_HRC_RES_47_8-EN.pdf].
Local context matters. Resolution 47/8 says attention to local context is critical; learn the client's country, region and community history [source: https://digitallibrary.un.org/record/3936009/files/A_HRC_RES_47_8-EN.pdf].
Safety overrides rapport. Accusations against children, threats against an accused person, and medical neglect trigger safeguarding regardless of belief [source: https://www.nelincs.gov.uk/assets/uploads/2025/08/Child-Abuse-linked-to-Faith-or-Belief.pdf].
Never advise on medicines or remedies. Botánicas may supply herbs [source: https://journals.athmsi.org/index.php/ajtcam/article/view/4966]; questions about combining them with prescribed medicines go to the prescriber or pharmacist [synthesis].
Confidentiality travels with the client. Share nothing with a healer, priest or family member without explicit consent [synthesis].
Name your own position. Notice your reactions (scepticism, fascination, fear, faith) and keep them out of the client's decisions [synthesis].

4. Intervention inventory

All interventions below are the psychotherapist's own work. None of them is a counter-magic, cleansing or protection procedure, and none should be presented to the client as one. Steps are [synthesis] unless a source is given.

4.1 Cultural humility and self-examination

Purpose / when: Before and throughout work with any client who raises brujería, envy-sent harm or counter-magic; especially when you notice strong reactions of your own.
Steps: (1) Before the session, write down what you believe about witchcraft, sorcery and healers, and where those beliefs came from (faith, training, family). (2) List what you do not know about this client's country, region, religion and migration history. (3) In session, signal openness early and ask the client to teach you their terms. (4) After the session, check your notes for evaluative words ("superstitious", "bizarre", "magical thinking") and replace them with the client's own words in quotation marks. (5) Take cases where you feel lost or reactive to supervision or cultural consultation.
Example language (illustrative): "Different families and communities understand these things in different ways. I'd like to understand how you and your family see it, in your own words."
Watch for: Over-agreeing to seem respectful (which can feel like you are confirming a curse), or quiet disbelief that leaks into tone. Working signs: the client corrects you, uses their own terms freely and brings in details they had held back.

4.2 Core Cultural Formulation Interview

Purpose / when: Standard opening assessment; whenever brujería, a curse, envy or spiritual harm is mentioned as a cause, or when you suspect the client is holding back such an explanation. The CFI clarifies the problem from the perspective of the person and their social network, its meaning, possible sources of help and what they expect from services [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].
Steps: (1) Use the official APA form; it may be reproduced by clinicians for use with their patients, but modification or translation needs APA permission [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]. (2) Work through the four domains in order: how the client defines the problem; what they think caused it, current stressors and supports, and the role of their cultural identity; how they have coped and whom they have consulted, and what got in the way; what help they want now, and how they feel about you as a clinician (including any experience of racism or language barriers) [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]. (3) Write down the client's words for the problem and its cause verbatim. (4) Note every helper they name (doctor, priest, pastor, curandero, botánica, family elder, online "brujo") and what each did or asked for. (5) Mark which subtopics need a supplementary module.
Example language (illustrative): "Sometimes people describe what is happening with words from their family or community. What do you call this problem?" / "Who else have you gone to for help with this, here or back home?"
Watch for: The client giving the "medical" answer they think you want, then revealing the brujería explanation later; ask again gently in later sessions. The field trial found the CFI feasible and acceptable, and later administrations quicker [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]. Working signs: you can state the client's model in a sentence they agree with.

4.3 CFI Informant Version and family perspective

Purpose / when: When family members hold, dispute or drive the brujería explanation; when the client is a child or adolescent; when someone in the family is suspected as the sender of harm. The Informant Version (17 questions) is for a relative or friend of the person seeking care [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf].
Steps: (1) Get the client's consent for who is interviewed and what may be shared. (2) Interview the informant separately first if there is any hint of conflict, accusation or coercion. (3) Ask about the informant's relationship with the client, then follow the four domains. (4) Compare accounts: who believes what, who is blamed, who is paying for help, who decides. (5) Do not reveal one person's suspicions about another without consent.
Example language (illustrative): "I'd like to hear how you see what is happening to your sister, and what you think would help her."
Watch for: A relative naming a specific person, especially a child, an older woman or a person with a disability, as the cause; this is a safety flag (see 4.13 and 4.14). Working signs: shared goals emerge even where beliefs differ.

4.4 Supplementary modules: Explanatory Model; Spirituality, Religion and Moral Traditions; Coping and Help-Seeking; Immigrants and Refugees; and others

Purpose / when: In-depth assessment when the core CFI shows a strong spiritual explanation, heavy reliance on healers, a migration story or a child client. The 12 modules include Explanatory Model; Level of Functioning; Social Network; Psychosocial Stressors; Spirituality, Religion and Moral Traditions; Cultural Identity; Coping and Help-Seeking; Patient-Clinician Relationship; School-Age Children and Adolescents; Older Adults; Immigrants and Refugees; and Caregivers [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
Steps: (1) Choose modules from the gaps flagged on the core form. (2) For brujería presentations, start with Explanatory Model, Spirituality, Religion and Moral Traditions, and Coping and Help-Seeking. (3) Add Immigrants and Refugees where migration stress is present (botánica providers themselves link distress to undocumented status, family conflict and money worries [source: https://journals.athmsi.org/index.php/ajtcam/article/view/4966]). (4) Add School-Age Children and Adolescents for young clients, and Caregivers for the carer. (5) Repeat modules later in care as the picture changes [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
Example language (illustrative): "Is faith or spirituality part of how you are getting through this? Is anyone in your faith community helping, or making things harder?"
Watch for: Religious conflict inside the family (for example, one member consulting a healer another considers forbidden) [uncertain: how typical this is]. Working signs: a clearer map of who helps, who harms and what the client values.

4.5 Exploring the explanatory model (Kleinman)

Purpose / when: To understand the client's own account of a sent harm in enough detail to plan care. Kleinman, Eisenberg and Good (1978) set out questions on what the client calls the problem, its cause, why it started when it did, what it does and how it works, its severity and course, what treatment the client wants, what problems it has caused, and what the client fears most (paraphrased) [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 questions conversationally over one or two sessions, not as a checklist. (2) For brujería accounts, listen especially for "why now" (a recent conflict, success, separation, inheritance or migration) and "who" (whether a specific person is suspected). (3) Ask what the client fears most; fears often include harm to children, death, madness or losing a partner [synthesis]. (4) Ask what kind of help the client thinks is needed, and whether they see therapy as covering part of it. (5) Summarise the model back and ask for correction. (6) Write a two-column formulation: the client's model and your clinical understanding, side by side, without one cancelling the other.
Example language (illustrative): "Why do you think this started when it did?" / "What worries you most about what could happen?" / "If this were fully resolved, what would be different?"
Watch for: A named suspect plus anger or plans to confront them (risk of violence; see 4.13); a model in which only payment can stop harm (risk of exploitation; see 4.12). Working signs: the client feels understood and agrees to work on some part of the problem with you.

4.6 Recognising DSM-5-TR cultural concepts of distress

Purpose / when: When the client uses a named idiom of distress or a cultural explanation. DSM-5-TR describes cultural concepts of distress as including idioms, explanations or perceived causes, and syndromes, and says the examples were revised to avoid stigmatizing or generalizing language [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]. Concepts relevant to Latin American and Caribbean clients in the DSM-5-TR list include ataque de nervios, nervios and susto; Haitian clients may relate to maladi dyab [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf]. DSM-5 (2013) listed maladi moun ("humanly caused illness") [source: https://revistapsiquiatria.pt/index.php/sppsm/article/download/139/69]; whether DSM-5-TR replaced it with maladi dyab is [uncertain]. Brujería itself functions as a perceived cause (an explanation) [synthesis].
Steps: (1) Read the DSM-5-TR text for each concept before using it; do not rely on summaries. (2) Use the concept to understand, not to diagnose: it is not a disorder label. (3) Ask the client whether the term fits and what it means in their family. (4) Assess separately for any DSM disorder that may co-occur. (5) Record both: the cultural concept in the client's words, and any diagnosis with your reasoning.
Example language (illustrative): "You said your mother calls this nervios. What does that mean in your family? How is it different from just feeling stressed?"
Watch for: Using the term as a stereotype ("all Latinos have nervios"); treating a cultural explanation as ruling out depression, PTSD or psychosis. Working signs: the client hears their language in your summary and accepts the treatment plan.

4.7 Distinguishing culturally shared experience from disorder

Purpose / when: When beliefs about being bewitched, possessed, watched or harmed raise the question of psychosis or dissociation.
Criteria to know: DSM-5 dissociative identity disorder allows that identity disruption may be described in some cultures as possession, and excludes disturbance that is a normal part of broadly accepted cultural or religious practice; DSM-5-TR retains this in substance, exact wording [uncertain] [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299]. Dissociative trance (other specified dissociative disorder) does not apply when the trance is a normal part of broadly accepted collective cultural or religious practice [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]. ICD-11 6B62 trance disorder and 6B63 possession trance disorder both require the state to be involuntary and unwanted and not part of accepted cultural or religious practice [source: https://www.findacode.com/icd-11/code-1807490186.html] [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]. A DSM-5-TR note on not counting culturally sanctioned beliefs as psychotic symptoms is [uncertain].
Steps: (1) Ask whether others in the client's family or community share the belief and in the same form. (2) Ask how the belief arose (told by a healer, family, own conviction) and how fixed it is. (3) Look for features beyond the shared belief: hallucinations, formal thought disorder, bizarre elaborations no one else in the community would recognise, marked decline in functioning, mood episodes, substance use. (4) With consent, consult a cultural broker or a member of the client's community about whether the presentation is typical. (5) Repeat the assessment over time; do not decide in one session. (6) If psychosis or severe mood disorder is likely, refer for psychiatric assessment while respecting the client's spiritual help-seeking.
Example language (illustrative): "In your family, do others also think this could be brujería? Does it seem to them the way it seems to you, or is it different?"
Watch for: Both errors: pathologising a shared belief, and missing an illness because "it's cultural". Escalating fear, sleeplessness, command experiences, plans to harm the suspected sender. Working signs: a formulation that both the client's community informant and a psychiatric colleague would find plausible.

4.8 Asking about healers, botánicas and counter-magic without judgement

Purpose / when: At assessment and at regular reviews; many clients will not volunteer this. Botánicas offer herbs, informal counselling and religious ceremonies including prayer and ritual cleansing [source: https://journals.athmsi.org/index.php/ajtcam/article/view/4966].
Steps: (1) Normalise the question. (2) Ask whom they have seen, what was recommended, whether they found it helpful, and how they felt afterwards. (3) Ask, without asking for any ritual details, whether anything ingested, applied or done to the body was involved, so you can pass health questions to the medical team. (4) Ask what it has cost so far and whether more payments have been requested (see 4.12). (5) Ask whether the helper said anything about other people, especially family members or children, being responsible. (6) Record facts, not ritual content. Do not ask the client to describe prayers, ceremonies or objects.
Example language (illustrative): "Many people I work with also see a curandero, a pastor or someone at a botánica. There is no right or wrong answer; it just helps me to know. Have you seen anyone like that?"
Watch for: Shame or fear of being judged; herbal products taken alongside prescribed medication (route to prescriber or pharmacist; never advise on them yourself); a helper who discourages medical care. Working signs: the client starts mentioning healer visits spontaneously.

4.9 Interpreters and cultural brokers

Purpose / when: When the client is more at ease in Spanish, Portuguese, an Indigenous language or Haitian Creole, or when you need help judging whether a presentation is typical in the client's community.
Steps: (1) Use a professional interpreter, not a family member, especially where family conflict or accusation is involved. (2) Brief the interpreter beforehand: spiritual terms are to be rendered faithfully, without softening or ridicule. (3) Check the interpreter is not from the client's small local community, or ask the client whether that matters to them. (4) A cultural broker (a person from the client's background with clinical or community standing) may be consulted with consent, with identifying details removed where possible. (5) Debrief after the session.
Example language (illustrative): "Please translate exactly what she says, including any words about brujería or spirits; I want to hear it as she means it."
Watch for: Interpreters who editorialise or show disbelief; brokers who hold strong views on who is to blame. Working signs: the client speaks more freely and uses their own terms. [synthesis throughout]

4.10 Collaboration and referral with community-recognised healers or clergy (only when the client wishes)

Purpose / when: When the client values a curandero, spiritual counsellor, priest, pastor or other helper and wants care to be coordinated. Collaboration between psychotherapists and curanderxs is rare and hindered by mistrust; Hoskins and Platt offer an integrative model with educational, clinical and policy recommendations (details [uncertain]) [source: https://www.emerald.com/insight/content/doi/10.1108/JMHTEP-05-2021-0043/full/html]. Evidence from West Africa shows such collaboration can help: in the COSIMPO cluster trial in Nigeria and Ghana (Gureje et al., The Lancet 2020), collaborative shared care between traditional and faith healers and primary care workers gave a greater fall in psychosis symptoms, and harmful practices fell from 57% to 9% with the intervention against 42% to 10% in 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]. Neither trial was done with Latin American healers; transfer is [synthesis].
Steps: (1) Ask the client whether they want any contact between you and the healer, and what for. (2) Get written, specific consent: who, what may be shared, for how long. (3) Make contact respectfully: introduce your role, ask how they understand the client's situation, and agree what each of you will and will not do. (4) Agree red lines that protect the client: no discouraging prescribed medical or psychiatric care; no naming of a family member or child as the sender of harm; no restraint, beating or deprivation; transparent fees. (5) Agree how you will communicate if the client's mental state worsens. (6) Never refer the client to a specific spiritual provider yourself; support only the client's own choice within pathways their community recognises. (7) If the helper refuses the red lines, tell the client your concern plainly and continue to offer your care.
Example language (illustrative): To the client: "Would it help if I spoke with the curandero you trust, so we are not pulling in different directions? You decide what I can share." To the healer: "I'm her therapist. I'm not here to judge your work. I'd like us to agree how we both keep her safe."
Watch for: The helper using the contact to legitimise demands for more money, or to confirm a named suspect; the client feeling caught between two authorities. Working signs: the client reports less conflict between helpers and stays in medical care.

4.11 Working on the stressors and relationships behind the account

Purpose / when: Once the explanatory model is understood. Botánica providers themselves link depression and nervios to undocumented status, family conflict and financial worries, combining social and divine causes [source: https://journals.athmsi.org/index.php/ajtcam/article/view/4966]. Interviewed clinicians in one small study named CBT and trauma-focused CBT as effective, alongside family involvement and building on resilience [source: https://sophia.stkate.edu/msw_papers/780].
Steps: (1) Without challenging the spiritual explanation, list with the client the concrete pressures present when the trouble began (conflict, envy, separation, debts, legal status, losses). (2) Choose the evidence-based treatment indicated for any disorder present (for example, for depression, anxiety or PTSD) and adapt its language to the client's model. (3) Use problem-solving for practical stressors and link to legal, housing and financial help. (4) For conflict with the suspected sender, work on safety, boundaries and communication rather than proof of guilt. (5) Frame therapy as working on "the part we can work on together", leaving the spiritual part to the client and their chosen helpers.
Example language (illustrative): "Whatever else is going on, this has come at a time of a lot of pressure: the separation, the money, the papers. Shall we work on what's in our hands?"
Watch for: The client hearing this as "it's all in your head"; check after reframes. Working signs: reduced symptoms, more activity, fewer crises, the client attributing less power to the suspected sender. [synthesis except where sourced]

4.12 Screening for exploitation and fraud by people presenting as spiritual healers

Purpose / when: At every review where the client is paying a spiritual provider. Documented fraud follows a pattern of telling a person they or their family are cursed and escalating payments: in Riverside, California (reported November 2021), a man working from a botánica allegedly persuaded a client that she had parasites and then that her family and children were cursed, taking over $50,000; police brought felony theft charges, and the article reports a prior similar conviction in Chicago [source: https://www.univision.com/local/los-angeles-kmex/andres-pena-limpias-parasitos-riverside-california].
Steps: (1) Ask what the client has paid, to whom, and whether further payment has been demanded. (2) Ask whether they were told harm would come to them or their children unless they paid, or told to keep it secret. (3) Ask whether they were told to stop medical treatment. (4) Distinguish the client's chosen, long-trusted helper from a recent, escalating, fear-driven demand, without attacking the client's faith. (5) If fraud seems likely, give information about reporting to police and consumer-protection or victim services; in the US, adult protective services may apply for older or dependent adults [uncertain: local procedures vary]. (6) Address shame: fraud victims often blame themselves.
Example language (illustrative): "Some people who say they can remove curses ask for more and more money and frighten people about their children. I'm not saying that's your healer, but has anything like that happened?"
Watch for: Secrecy, loans, sold possessions, threats, and urgent deadlines. Working signs: the client feels free to pause payments and to seek a second opinion from someone their community trusts.

4.13 Responding when the client accuses someone, or is accused

Purpose / when: When a client names a person as the source of brujería, or when the client or a relative has been accused. Accusations have preceded killings, burials alive, torture and expulsion in Latin America (see Harm account).
Steps: (1) If the client names a suspect: assess anger, intent and plans to confront, expose or harm them; ask about others (family, neighbours, community bodies) who may act. (2) Do not endorse the accusation; reflect the fear and the conflict. (3) Follow your usual duty-to-protect procedures if there is a credible threat to an identifiable person. (4) If the client has been accused: assess immediate danger (threats, ultimatums, community meetings, expulsion), help with a safety plan, link with police, legal aid, human-rights or women's services as relevant; in Peru, a ministry response to one case alerted women's emergency centres [source: https://grupoclarin-la-voz-prod.cdn.arcpublishing.com/sucesos/peru-campesinos-torturaron-y-desterraron-a-ocho-mujeres-acusadas-de-brujeria]. (5) Treat the trauma and social loss of accusation as clinical targets.
Example language (illustrative): "I can hear how frightened you are of her. Before we go further, I need to ask: have you or anyone in the family thought about doing something to her?" / to an accused client: "Being accused like this is dangerous and deeply hurtful. Let's look first at whether you are safe tonight."
Watch for: Accusations aimed at older women, children, people with disabilities or people who live alone; resolution 47/8 names women, children, persons with disabilities, older persons and persons with albinism as at risk [source: https://digitallibrary.un.org/record/3936009/files/A_HRC_RES_47_8-EN.pdf]. Working signs: no escalation, a safety plan in place, the accused client re-connecting with support. [synthesis except where sourced]

4.14 Safeguarding children linked to witchcraft or spirit beliefs

Purpose / when: Whenever a child is said to be bewitched, possessed or a source of witchcraft, or is undergoing spiritual treatment. UK local safeguarding guidance on child abuse linked to faith or belief lists beliefs including spirit possession, witchcraft, black magic, the evil eye and child sorcerers, and indicators such as neglect or fasting, scapegoating of a child seen as "different" because of illness, disability or disobedience, withdrawal, scars or restraint marks, and unexplained drinks [source: https://www.nelincs.gov.uk/assets/uploads/2025/08/Child-Abuse-linked-to-Faith-or-Belief.pdf]. It refers to the 2012 national action plan [source: https://www.nelincs.gov.uk/assets/uploads/2025/08/Child-Abuse-linked-to-Faith-or-Belief.pdf]. Treat any accusation of witchcraft against a child as a safeguarding matter. Latin American-specific data on child witchcraft accusations is [uncertain].
Steps: (1) Follow your jurisdiction's child-protection procedures; the guidance above directs referral to children's social care, investigation under section 47 of the Children Act 1989 where relevant (England and Wales), seeing the child alone, checking sleeping and living arrangements, assessing siblings, a full health assessment, and treating any plan to take the child abroad seriously [source: https://www.nelincs.gov.uk/assets/uploads/2025/08/Child-Abuse-linked-to-Faith-or-Belief.pdf]. (2) Seek assent from the child and consent from those with parental responsibility for therapy, except where safeguarding law allows or requires action without it. (3) Understand the family's beliefs, using independent advisers and community members where possible [source: https://www.nelincs.gov.uk/assets/uploads/2025/08/Child-Abuse-linked-to-Faith-or-Belief.pdf]. (4) Never name the child in any communication outside the protection process.
Example language (illustrative): To a parent: "I understand you are frightened something spiritual is affecting him. My job is to make sure he is safe while you look for help. Can you tell me what has been done so far?"
Watch for: A carer who is not the parent, complex family structures [source: https://www.nelincs.gov.uk/assets/uploads/2025/08/Child-Abuse-linked-to-Faith-or-Belief.pdf]; a child blamed for family misfortune. Working signs: child safe, scapegoating stopped, family engaged with services.

4.15 Supporting people accused, expelled or exploited

Purpose / when: Clients who survived accusation, violence or expulsion, including in diaspora where the event happened back home, and clients defrauded by false healers.
Steps: (1) Establish safety and practical needs (housing, documents, legal status, income). (2) Assess for PTSD, depression, complicated grief and suicide risk using standard practice. (3) Offer trauma-focused treatment when stable. (4) Work on stigma and community loss: who still stands with them, which ties can be restored. (5) Respect the client's spiritual frame: they may want protection from their own tradition as well as therapy; support safe options of their choosing. (6) Help with documentation for legal or asylum processes when asked, within your role.
Example language (illustrative): "What was done to you was wrong, whatever anyone believed. We can go at your pace."
Watch for: Self-blame, fear of further sorcery, hypervigilance about the accusers; retraumatisation if pressed for details too early. Working signs: sleep, safety and social contact improving. [synthesis throughout]

4.16 Integrating spiritual help and therapy

Purpose / when: When the client has had or is having limpias or other spiritual help and wants to make sense of it alongside therapy.
Steps: (1) Ask what the experience meant and what changed afterwards, without asking for ritual content. (2) Note what helped (relief, hope, feeling protected, a sense of action) and build on those gains in therapy. (3) Explore any fears it raised (for example, being told a relative is responsible). (4) Help the client hold both: "I've done what my tradition offers" and "I'm working on my sleep, mood and relationships here". (5) Record the experience in the client's words.
Example language (illustrative): "After you went, what felt different? What would you like to keep from that?"
Watch for: Disappointment when spiritual help "didn't work", which can bring hopelessness or a search for a stronger (and costlier) helper. Working signs: the client describes a coherent plan that includes both. [synthesis throughout]

4.17 Working with families and communities

Purpose / when: When the family shares, disputes or acts on the brujería explanation, or when community leaders could protect an accused person.
Steps: (1) With consent, hold family sessions focused on support and safety, not on proving or disproving sorcery. (2) Identify allies (relatives, clergy, community leaders) who reject violence and exploitation. (3) Offer psychoeducation on the client's disorder using their words alongside clinical ones. (4) Where communities hold their own justice processes, refer concerns about violence to the state authorities; resolution 47/8 calls for accountability and protection of persons in vulnerable situations [source: https://digitallibrary.un.org/record/3936009/files/A_HRC_RES_47_8-EN.pdf].
Example language (illustrative): "Everyone here wants him to get better. Can we agree on how we keep everyone safe while he does?"
Watch for: A family member using the session to accuse another; collusion with a harmful helper. Working signs: shared safety agreements, less blame. [synthesis except where sourced]

5. Handling problems

The sources cited do not address most of these problems directly. Unless a source is given, the guidance below is [synthesis].

"Do you believe me? Do you believe in brujería?" Answer honestly and briefly, then return to the client's experience: "I don't have the answer to that, and I won't pretend to. What I do know is that you are suffering, and I believe that completely." Avoid both confirming and debunking.
Client asks you to recommend a healer, do a cleansing or say a prayer. Decline kindly and explain your role: "That isn't something I'm trained or recognised to do. If you want spiritual help, the people you and your family trust are the right ones to ask. I can help with the rest." Do not give names of providers.
Client believes only counter-magic can help and wants to stop therapy. Respect the choice; agree a door-open plan and safety contacts; offer a review session. Ask what would make therapy worth continuing alongside spiritual help (often sleep, mood, family conflict).
Stuck: symptoms improve but fear of the sender persists. Do not argue about the sender's power. Work on safety behaviours that shrink the client's life (avoidance, checking, hypervigilance) as anxiety targets, in the client's terms; use the client's own spiritual resources if they wish.
Overwhelm when talking about the suspected sender or the accusation. Slow down; ground; shift to safety and present-day stability; return later. With accusation survivors, do not push for details of violence (see 4.15).
Non-adherence: client stops prescribed medicine on a helper's advice. Do not advise on medicines yourself. Explore what the client was told and fears; with consent, inform the prescriber promptly; if the helper is open to contact, raise the red line in 4.10. If there is acute risk (psychosis, suicidality), follow emergency procedures.
Herbal products from a botánica alongside prescribed medicine. Record what the client says they take and route questions to the prescriber or pharmacist; give no advice on combining, stopping or doses. Botánicas may supply herbs [source: https://journals.athmsi.org/index.php/ajtcam/article/view/4966].
Rupture after differential-diagnosis questions ("you think I'm crazy"). Name it and repair: "I asked those questions because I ask everyone; it's my job to make sure nothing is missed. It doesn't mean I think your experience isn't real."
Rupture after a safeguarding referral. Explain in advance where possible, be transparent about what you shared and why, stay engaged, and separate the referral from any judgement of the family's faith.
The client is the accuser and wants to confront or expose someone. Assess risk (4.13); explore the cost of confrontation for the client (legal, family, community); work on fear and conflict, and on other routes (distance, mediation, legal protection).
News of an accusation back home (diaspora). The client may feel guilt, helplessness or fear for relatives; help them contact human-rights, legal or consular support; treat the distress; avoid advising on actions in another country beyond your knowledge.
Paying a likely fraudster and unwilling to stop. Do not shame; use 4.12; set a small step (pause, second opinion from a trusted community member, talk to a relative); provide reporting information; review at each session.
Religious conflict in the family (for example, a church forbidding healers). Avoid taking sides; help the family find a shared goal; the client decides their own spiritual path.
Therapist's discomfort, fascination or disbelief. Take it to supervision; check notes for evaluative language (4.1).
You share the client's community. Discuss dual-relationship and confidentiality risks openly; consider referral if gossip or accusation could follow the client.
Colleagues dismiss or pathologise the beliefs. Share the CFI-based formulation; point out that the CFI is designed for any clinician in any setting [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf].

Harm account

What was actually done

UN Human Rights Council resolution 47/8 (adopted without a vote on 12 July 2021) describes attacks and other human rights violations based on witchcraft or ritual accusations as harmful practices, and names women, children, persons with disabilities, older persons and persons with albinism as at risk of killings, mutilation, burning, trafficking, torture and stigmatisation [source: https://digitallibrary.un.org/record/3936009/files/A_HRC_RES_47_8-EN.pdf]. It asked the High Commissioner for a study, issued as A/HRC/52/47 (1 February 2023) [source: https://digitallibrary.un.org/record/4004272]; its content is [uncertain]. Documented Latin American examples (Spanish-language press reports, summarised in English):

Bolivia, 2010. In the community of Ichupampa (municipality of Tomina, Chuquisaca), campesinos lynched a couple aged 48 and 46 accused of brujería. Police linked the killing to prosecutors having declined a hearing because Bolivia's Penal Code has no offence of witchcraft. The same EFE report describes a second witchcraft lynching that year: in August, in Cochabamba, a man accused of bewitching and killing another farmer was buried alive. The Church, the Ombudsman and the UN expressed concern at rising lynchings [source: https://www.elmostrador.cl/noticias/mundo/2010/10/26/campesinos-del-sureste-de-bolivia-linchan-a-pareja-acusada-de-brujeria/].
Guatemala, June 2020. In the community of Chimay (San Luis, Petén), residents accused a man of about 36, reportedly a practitioner of natural medicine, of harming people through witchcraft; local media reported that he was set on fire. Residents then blocked police and prosecutors from entering until negotiations with community leaders [source: https://emisorasunidas.com/2020/06/06/linchan-a-un-hombre-acusado-de-brujeria/].
Peru (La Libertad, Pataz province). After a communal assembly decision prompted by families who said they were victims of witchcraft, rondas campesinas captured eight women accused of witchcraft against residents of Carhuacocha and held them in Chillia; a relative reported severe beatings; release was to be conditional on leaving the community. The Ministry of Women and Vulnerable Populations announced an investigation with the Ministry of the Interior and the Ombudsman, and put women's emergency centres on alert [source: https://grupoclarin-la-voz-prod.cdn.arcpublishing.com/sucesos/peru-campesinos-torturaron-y-desterraron-a-ocho-mujeres-acusadas-de-brujeria]. Date [uncertain].
Fraud by people presenting as brujos or healers. Riverside, California (reported 2021): a man working from a botánica allegedly told clients they were cursed and must pay to cure ailments such as diabetes, headaches, insomnia and "parasites"; one client, told her children were also in danger, paid over $50,000; felony theft charges followed [source: https://www.univision.com/local/los-angeles-kmex/andres-pena-limpias-parasitos-riverside-california]. Tolima, Colombia (March 2026): army, prosecutors and US Homeland Security Investigations raided 12 sites linked to a group called "Los Brujos" that offered esoteric services and fake migration paperwork; authorities allege the "spiritual help" business laundered money [source: https://www.publimetro.co/noticias/2026/03/19/red-de-falsos-brujos-que-estafa-con-servicios-esotericos-recibe-duro-golpe-en-operativo-de-las-autoridades/].
Children. UK safeguarding guidance documents abuse of children linked to witchcraft and spirit-possession beliefs (neglect, fasting, restraint, scapegoating) [source: https://www.nelincs.gov.uk/assets/uploads/2025/08/Child-Abuse-linked-to-Faith-or-Belief.pdf]. Child witchcraft accusations are handled as safeguarding matters (4.14). Published data on child witchcraft accusations specifically in Latin American or Latinx communities is [uncertain].
Restraint in spiritual healing settings (outside Latin America). In Ghanaian prayer camps, residents were held in chains; adding psychiatric care 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].

How it caused harm

Death and injury. Lynching, burning and burial alive (Bolivia, Guatemala) and beatings (Peru), as reported above.
Expulsion and loss. Conditional release on leaving the community (Peru) means loss of home, land, livelihood and social ties [source: https://grupoclarin-la-voz-prod.cdn.arcpublishing.com/sucesos/peru-campesinos-torturaron-y-desterraron-a-ocho-mujeres-acusadas-de-brujeria; consequences synthesis].
Mechanism [synthesis]. An accusation turns diffuse misfortune (illness, death, bad luck) into a person who can be blamed; where people see no legal remedy (Bolivia's prosecutors had no offence to charge) or distrust the state, collective punishment can follow; people already marginal (older women, people living alone, healers, people with disabilities) are easiest to blame.
Fraud. Financial ruin, debt, shame and fear for one's children; risk of delayed medical care when illnesses such as diabetes are attributed to a curse [source: https://www.univision.com/local/los-angeles-kmex/andres-pena-limpias-parasitos-riverside-california; delay risk synthesis].
Psychological sequelae [synthesis]. Trauma symptoms, chronic fear of sorcery, stigma, isolation, grief and, among accusers, guilt; children who are scapegoated may suffer neglect and abuse with lasting effects.
Most at risk. Women, children, persons with disabilities, older persons and persons with albinism (resolution 47/8 preamble) [source: https://digitallibrary.un.org/record/3936009/files/A_HRC_RES_47_8-EN.pdf]; healers and herbalists themselves (Guatemala case); migrants under financial and legal pressure (fraud cases) [synthesis].

Recognising it today

In a client's account: a named person (especially a relative, neighbour, older woman or child) blamed for illness or misfortune; talk of community meetings, ultimatums or "making them leave"; fear of being accused oneself.
In a helper's practice (red flags): telling the client a family member or child is the cause; demanding escalating payments, secrecy or loans; warning of harm to children unless paid; telling the client to stop medical or psychiatric treatment; claiming to cure physical diseases; restraint, beating, starvation or isolation; bundling spiritual services with immigration paperwork or other legal "help" [source: https://www.univision.com/local/los-angeles-kmex/andres-pena-limpias-parasitos-riverside-california] [source: https://www.publimetro.co/noticias/2026/03/19/red-de-falsos-brujos-que-estafa-con-servicios-esotericos-recibe-duro-golpe-en-operativo-de-las-autoridades/] [source: https://www.nelincs.gov.uk/assets/uploads/2025/08/Child-Abuse-linked-to-Faith-or-Belief.pdf].
In children: the indicators in 4.14.
How legitimate help differs [synthesis]. Trusted community helpers who offer prayer, counsel and comfort, charge transparently, do not blame named individuals, support medical care and accept the client's freedom to stop. Resolution 47/8 separates traditional medicine and lawful religion from harmful practices [source: https://digitallibrary.un.org/record/3936009/files/A_HRC_RES_47_8-EN.pdf].
In colleagues or services [synthesis]: dismissing accusation threats as "cultural"; failing to refer a child; recommending specific spiritual providers; colluding with a helper who discourages treatment.

What to do instead and how to help those harmed

Instead: the CFI-based assessment, explanatory-model work, evidence-based treatment of any disorder, and collaboration only with consent and agreed red lines (Section 4). Collaborative care with healers has reduced harmful practices in a West African trial [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306].
Assessment of affected clients: safety now; trauma, depression, grief and suicide risk; losses (home, land, documents, money); ongoing threats; children in the household; current helpers and payments (4.12–4.15).
Treatment: stabilisation and practical help first, trauma-focused therapy when stable, work on stigma and reconnection, respect for the client's spiritual frame [synthesis].
Duties: child-protection referral where a child is at risk (4.14); duty-to-protect procedures for credible threats to an identifiable person; information on reporting fraud to police; documentation for legal or asylum processes when the client asks; confidentiality otherwise. Specific legal duties vary by jurisdiction [uncertain: local law varies].
Policy context: resolution 47/8 urges states to eliminate these practices, ensure accountability and protect persons in vulnerable situations, while respecting freedom of religion or belief [source: https://digitallibrary.un.org/record/3936009/files/A_HRC_RES_47_8-EN.pdf].

Sources

Brujería, counter-magic and clinical practice

Harm account

Cultural assessment, diagnosis and collaboration

Cited by author, year, title

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).

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