Māori rongoā, mirimiri and tohunga

1. Introduction

Version followed: rongoā Māori as described by the Ministry of Health's voluntary standard Tikanga ā-Rongoā (2014) and Te Aka Whai Ora's Rongoā Māori Action Plan (2023), with ACC's Rongoā Māori service as a current funded pathway; Mason Durie's Te Whare Tapa Whā (1984) as described by Pitama et al. (2007) and Healthify; the Meihana Model in its 2014 form with the Hui Process, as set out for psychologists by Pitama et al. (2017), noting the earlier six-dimension version (Pitama et al., 2007); DSM-5-TR Cultural Formulation Interview (CFI).

What it is. Rongoā Māori is the traditional healing system of Māori. The Action Plan calls it "a complete and complex, uniquely Māori system of healing", a taonga tuku iho (treasure handed down) by tohunga, mātanga rongoā, whānau, hapū and iwi, derived from mātauranga Māori and connecting people with the natural environment [source: Te Aka Whai Ora Rongoā Action Plan]. Its named forms include mirimiri and romiromi (body therapies), mahi wairua (spiritual work), wai rākau and rongoā rākau (plant-based remedies), and, in the Action Plan's list, whakairo, tā moko and moko kauae [source: Te Aka Whai Ora Rongoā Action Plan]. Karakia (prayer) is part of treatment in published accounts [source: bpac 2008; ACC]. A secondary source describes mirimiri as lighter massage and romiromi as deep-tissue work [source: Wikipedia, Rongoā] [uncertain: secondary source; practitioners describe these differently by rohe].

Tohunga. "Tohunga" names both the expert and the discipline. Tohunga are "recognised experts in their field by their communities". There is no single training institution, and knowledge passes through elders and apprenticeship. Practice varies by tribe, area, local plants and the person's needs [source: bpac 2008]. The Tohunga Suppression Act 1907 penalised people who claimed supernatural powers to treat disease or foretell events among Māori. It pushed rongoā underground and was repealed in 1962 [source: bpac 2008; Wikipedia, Tohunga Suppression Act 1907]. The repealing statute is named the Maori Welfare Act 1962 in some sources and listed under its later title, the Maori Community Development Act 1962, in others [uncertain].

How change happens (as the tradition describes it). Health is holistic: spiritual, psychological, physical and whānau dimensions. Illness is understood as disharmony or imbalance, which the healer identifies before treating spiritually and physically [source: bpac 2008]. Toolkit 4 of the standard centres on protecting mauri, which it describes as "an essential essence of being, and an energy that permeates through all things" [source: Tikanga ā-Rongoā Toolkit 1]. These are the tradition's own concepts. This guide reports them as held and does not judge them.

The psychotherapist's role. A psychotherapist does not practise rongoā, mirimiri, karakia or the work of tohunga unless trained and recognised within it by Māori authorities. This guide covers your own work alongside it: culturally safe engagement, assessment with Māori models and the CFI, asking about rongoā without judgement, collaborating with and referring to kairongoā (rongoā practitioners) when the client wishes, integrating what clients bring from rongoā into therapy, and safeguarding [synthesis]. Te Whare Tapa Whā and the Meihana Model are assessment and practice frameworks, not therapies. They organise how you engage, assess and plan.

2. Framework

There is no session count for the therapist's work alongside rongoā. The phases below organise your own work around the Hui Process stages and the Meihana Model's Whakatere step [source: Pitama et al. 2017]. The way these are combined with the CFI and with rongoā collaboration is [synthesis].

3. Guiding principles

• Tohunga, mātanga rongoā and whānau hold authority on rongoā. The Action Plan names them "the experts and authority on rongoā Māori" [source: Te Aka Whai Ora Rongoā Action Plan]. In practice: never assess, approve or adapt a rongoā practice yourself; ask the client, and with consent the kairongoā.
• Practice follows rohe tikanga. Toolkit 5 helps practitioners work out rongoā principles and practices within local tikanga [source: Tikanga ā-Rongoā]. In practice: don't generalise from one iwi or practitioner to another.
• Self-identification is enough. The Meihana authors assume that any client or whānau who self-identifies as Māori is Māori, and say clinicians should not judge how Māori someone is. There is "no 'checklist'" for Māori beliefs, values and experiences [source: Pitama et al. 2007]. In practice: don't assume a client uses or rejects rongoā; ask.
• Whānau at the centre. Whānau is "the centre of the assessment and intervention processes" and includes kaupapa whānau such as peers or supporters [source: Pitama et al. 2007]. In practice: invite whānau, but let the client choose who comes.
• Tūroro tino rangatiratanga (the person's self-determination). The rongoā standard puts the person's total wellbeing first and protects informed choice, the right to refuse treatment, and the right to a support person [source: Tikanga ā-Rongoā Toolkit 1]. In practice: the client decides whether rongoā and therapy are linked at all.
• Holism. In Te Whare Tapa Whā, taha tinana, taha wairua, taha whānau and taha hinengaro interlock like the walls of a whare; damage to one leaves the person "unbalanced" [source: Healthify; Pitama et al. 2007]. In practice: assess and plan across all four, not only hinengaro.
• Name the four winds. Colonisation, racism, migration and marginalisation shape Māori experience historically and now [source: Pitama et al. 2017]. In practice: ask about them directly, including racism within health services.
• Acknowledge and reduce bias. Whakatere asks clinicians to "acknowledge and mitigate personal and institutional biases" [source: Pitama et al. 2017]. In practice: check your formulation for deficit framing and for over- or under-reading of wairua experiences.
• Seek Māori expertise throughout. Clinicians should seek Māori cultural advice through assessment, formulation and intervention, and use cultural peer supervision [source: Pitama et al. 2007]. In practice: set up access to a Māori clinician, kaumātua or cultural advisor before you need one.
• Don't reproduce sacred knowledge. Karakia and the work of tohunga belong to their holders. The Tohunga Suppression Act's main effect was to drive tohunga underground [source: Te Ara, Rongoā – the impact of colonisation], and rongoā mātauranga is to be protected [source: Te Aka Whai Ora Rongoā Action Plan]. In practice: don't ask clients to teach you karakia or rongoā recipes, record them, or use them in your sessions [synthesis].
• The client chooses both, either or neither. Māori users want the option of healers and doctors and support collaboration, but many don't disclose healer visits for fear of "criticism or ridicule" [source: Te Ao Māori News, Mark study]. In practice: make asking routine and neutral.
• Collaborate according to the person's wishes. Earlier Ministry standards required rongoā practitioners to co-operate with other health professionals "according to the wishes or needs of the patient", and to refer onward for acute needs [source: bpac 2008]. In practice: the same consent rule binds you.
• Spiritual concepts are reported as held. Mauri, wairua, tapu and imbalance are the tradition's concepts [synthesis]. In practice: use the client's words; neither endorse nor dismiss them.
• No advice on remedies or medicines. In practice: rongoā rākau and prescribed medicines are questions for the kairongoā and the prescriber, never for you [synthesis; source: bpac 2008 on interactions].

4. Intervention inventory

All interventions below are the psychotherapist's own. None involves performing rongoā, mirimiri, karakia or the work of tohunga. Example language is illustrative and should be adapted to the client and rohe.

4.1 Cultural self-examination and bias check

• Purpose / when: before and throughout work with Māori clients; the Whakatere step requires clinicians to "acknowledge and mitigate personal and institutional biases" [source: Pitama et al. 2017].
• Steps: (1) Note your own assumptions about rongoā, tohunga and spiritual experience, including inherited views from the suppression era ("charlatans", "unsafe") [source: Wikipedia, Tohunga Suppression Act 1907; bpac 2008]. (2) Note what your service does that may repeat racism, such as no whānau space, no te reo pronunciation, or Mental Health Act use [source: Pitama et al. 2007 on Iwi Katoa]. (3) Before formulating, ask: would I read this differently if the client were Pākehā? (4) Take one case a month to cultural supervision or a Māori colleague [synthesis].
• Example language (illustrative, to supervisor): "I'd like to check whether I'm reading his account of his tupuna as a symptom when it may not be one."
• Watch for: defensiveness, tokenism (a mihi with no change to assessment), over-correction (treating every unusual experience as cultural and missing illness). It is working when your formulations name strengths and systemic factors, not only deficits [synthesis].

4.2 Hui Process engagement (mihimihi, whakawhanaungatanga, kaupapa, poroaki)

• Purpose / when: every first meeting and, in brief form, every session. Pitama et al. (2017) present the Hui Process as the engagement frame for psychologists: mihimihi (initial greeting and engagement), whakawhanaungatanga (making a connection and building relationships), kaupapa (attending to the purpose of the encounter) and poroaki/whakamutunga (closing) [source: Pitama et al. 2017].
• Steps: (1) Greet the client and whānau by name, pronounced correctly; introduce yourself with where you are from and your role. (2) Make a connection before the task: places, people, shared links, without demanding whakapapa. (3) State the kaupapa: why you are meeting, what will happen, how long, confidentiality and its limits. (4) Do the work. (5) Close: summarise, agree next steps, check who needs to know what, and thank the client and whānau. Whether karakia opens or closes a meeting is for the client, whānau or a kaumātua to lead, never something you perform unless you are recognised to do so [synthesis; detailed steps beyond the stage names are not set out in the source].
• Example language (illustrative): "Kia ora, I'm [name]. I grew up in [place] and I work here as a psychologist. Before we get into why you're here, I'd like to know a bit about you and who's come with you." Closing: "Is there anyone else who should hear what we've agreed today?"
• Watch for: rushing to the kaupapa; reading quietness as "engaged" or "withdrawn" too early. It is working when whānau speak, questions come back to you, and the client returns [synthesis].

4.3 Te Whare Tapa Whā holistic assessment

• Purpose / when: a shared map of health that most Māori clients and many services already know. Durie documented it in 1984: four cornerstones like the four walls of a whare [source: Pitama et al. 2007; Mental Health Foundation, Te Whare Tapa Whā]. Taha tinana is physical health and capacity to grow; taha wairua is spiritual health, including faith and wider communication; taha whānau is the capacity to belong, care and share; taha hinengaro is mental health, with mind and body inseparable [source: Healthify]. The Mental Health Foundation adds connection with whenua as the foundation the walls stand on [source: Mental Health Foundation, Te Whare Tapa Whā].
• Steps: (1) Draw or describe the whare and invite the client to say how each wall is standing. (2) Ask about each wall in turn, starting where the client wants. (3) Ask which wall is weakest and which is strongest. (4) Ask what already strengthens each wall, including rongoā, church, marae, kapa haka, mahi or whenua. (5) Set goals on more than one wall. (6) Revisit at review [synthesis: the structured step order is the clinician's application].
• Example language (illustrative): "Some people think of health as a house with four walls: body, spirit, family, and mind. How is each of yours standing at the moment?" "What keeps your wairua strong?"
• Watch for: using the model as a tick-box; avoiding taha wairua because it feels outside your scope. It is working when the client adds to the picture and goals span more than symptoms [synthesis].

4.4 Meihana Model assessment

• Purpose / when: a fuller clinical assessment built on Te Whare Tapa Whā, "from first contact" and ongoing, using several informants with consent [source: Pitama et al. 2007].
• Versions: The 2007 version has six dimensions: whānau, tinana, hinengaro, wairua, taiao (physical environment) and iwi katoa (societal context, including racism, low income and legal structures such as the Mental Health Act). Māori beliefs, values and experiences overlay all six [source: Pitama et al. 2007]. The 2014 version, used in the 2017 psychologists' guide, has four parts. The Waka Hourua (client and whānau) covers tinana, hinengaro, wairua, taiao, and ratonga hauora (access to quality health services, previously iwi katoa). Ngā Hau e Whā (four winds) are colonisation, racism, migration and marginalisation. Ngā Roma Moana (ocean currents) are āhua (personal indicators), tikanga, whānau, and whenua (genealogical or spiritual connection to land). Whakatere (navigation) integrates the information into formulation [source: Pitama et al. 2017]. This guide follows the 2014 version.
• Steps: (1) With consent, name a lead facilitator to coordinate information across dimensions [source: Pitama et al. 2007]. (2) Waka Hourua: tinana (health history, how whānau have coped with illness, negative healthcare experiences); hinengaro (within cultural context, with cultural supervision guiding tool choice); wairua (attachment to people, places and things that sustain, and spiritual frameworks; the authors note higher attachment reduces non-attendance); taiao (housing, poverty, suitability of your facility); ratonga hauora (access to and quality of services) [source: Pitama et al. 2007; 2017]. (3) Ngā Hau e Whā: ask about the effects of colonisation, racism, migration (including urban migration away from iwi) and marginalisation. (4) Ngā Roma Moana: ask what matters to this person in tikanga, whānau roles and responsibilities, and connection to whenua; don't assume [source: Pitama et al. 2017]. (5) Carry everything to Whakatere (4.6).
• Example language (illustrative): "Where do you feel connected to: a place, a marae, a river or maunga?" "Have you been treated differently in health services because you're Māori?" "Who in your whānau has had to deal with something like this before, and what helped?"
• Watch for: the 2007 case example of a young man who declined a Māori caseworker because he did not want "to be treated any differently" [source: Pitama et al. 2007]. Self-identification and preference both apply; offer, don't impose. It is working when the assessment explains engagement problems through systemic factors as well as individual ones [synthesis].

4.5 Cultural Formulation Interview (core and modules)

• Purpose / when: a standardised way to hear the problem in the client's terms. 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: APA CFI]. APA says it is "designed to be used by any clinician providing services to any individual in any care setting" [source: APA DSM-5-TR Section III]. It supports understanding and decisions and is not meant to be the sole basis for diagnosis [source: APA CFI].
• Steps: (1) Use it in phase 2, after whakawhanaungatanga, not as the opening. (2) Ask the core questions in your own words, following the four domains. (3) Add supplementary modules as needed. There are 12. The most relevant here are Spirituality, Religion and Moral Traditions; Explanatory Model; Cultural Identity; Coping and Help-Seeking; Social Network; Patient–Clinician Relationship [source: APA CFI Supplementary Modules]. (4) Use the Informant Version (17 questions) with whānau, with the client's consent [source: APA CFI Informant Version]. (5) Clinicians may reproduce it for use with their patients; modifying or translating it needs APA permission [source: APA CFI]. (6) Map answers onto the Meihana dimensions [synthesis].
• Time: the DSM-5 field trial found the CFI "feasible, acceptable and useful", and later interviews "required less time" [source: Lewis-Fernández et al. 2017, U Minnesota Experts]. A figure of 15–20 minutes for the core is [uncertain].
• Example language (illustrative): "In your own words, what's been happening?" "What do your whānau think is going on?" "Have you seen anyone else about this: a kairongoā, a minister, a kaumātua?" "Is there anything about me or this service that might make it harder to get help here?"
• Watch for: reading the questions like a form; skipping the clinician–patient relationship question. It is working when the client corrects or extends your summary [synthesis].

4.6 Explanatory model and Whakatere formulation

• Purpose / when: after assessment, to agree a shared understanding. Kleinman, Eisenberg and Good (1978) proposed eliciting the person's explanatory model: what they call the problem, its cause, why it started when it did, what it does, how severe it is and how long it will last, what treatment they should receive, the chief problems it has caused, and what they fear most (paraphrased) [source: Tanenbaum handout]. Whakatere integrates the Meihana information into formulation, diagnosis and treatment [source: Pitama et al. 2017].
• Steps: (1) Elicit the client's (and whānau's) model in their words, including any account in terms of wairua, tapu, mauri or imbalance. (2) Lay your clinical understanding beside theirs, not over it. (3) Name the four winds and the service factors in the formulation. (4) Run the bias check (4.1). (5) Write a formulation that the client recognises, noting where explanations differ and how both can guide the plan. (6) Review it longitudinally; it is "dynamic" [source: Pitama et al. 2017] [steps 2–5 synthesis].
• Example language (illustrative): "You've said this feels like something to do with your wairua being unsettled since your nan passed. From my side, I'm also seeing very broken sleep and grief. Could we work on both, with your kairongoā looking after the wairua side if you'd like that?"
• Watch for: forcing agreement; silently translating the client's model into yours. It is working when the client uses parts of the shared language and plans include both [synthesis].

4.7 Asking about rongoā and other help without judgement

• Purpose / when: at assessment and at every review. Some Māori patients may be unwilling to disclose rongoā use, but clinicians "should feel comfortable asking", and a good relationship helps [source: bpac 2008]. Māori users report fearing "criticism or ridicule" from doctors [source: Te Ao Māori News, Mark study].
• Steps: (1) Ask routinely, as you would about any other support. (2) Ask what form (mirimiri or romiromi, rongoā rākau, mahi wairua, whitiwhiti kōrero), who provides it, and what the client hopes for. (3) Record it neutrally, with the client's agreement on wording. (4) If the client takes any plant remedy and any prescribed medicine, encourage them to tell both the kairongoā and the prescriber or pharmacist, because remedies may interact with medicines [source: bpac 2008]. Do not advise on either [synthesis]. (5) Do not ask for karakia, plant names or preparation details [synthesis].
• Example language (illustrative): "Lots of people I work with also see a rongoā practitioner, a tohunga or their church. Is anyone like that helping you? It's useful for me to know, and I won't judge it." "Does your doctor know about the rongoā? Would you like to let them know, so they can check it fits with your medication?"
• Watch for: hesitation or a quick "no" (come back later); signs of past ridicule. It is working when disclosure grows over time [synthesis].

4.8 Distinguishing wairua experiences from illness

• Purpose / when: when a client reports seeing or hearing tupuna, or experiences that look like hallucinations. The Meihana authors ask clinicians to consider the cultural meaning of hallucinations and to identify what lies outside accepted Māori norms while checking their own bias [source: Pitama et al. 2007]. In DSM, dissociative identity disorder and other specified dissociative disorder (dissociative trance) exclude experiences that are a normal part of a broadly accepted cultural or religious practice [source: PMC9199574; UM System Pressbooks] (exact DSM-5-TR wording [uncertain]). ICD-11 6B62 trance disorder and 6B63 possession trance disorder apply only when the state is involuntary, unwanted and not part of accepted cultural or religious practice [source: findacode ICD-11 6B62; PMC9199574]. The DSM-5-TR culture note on culturally sanctioned beliefs and psychotic symptoms is [uncertain: not verified].
• Steps: (1) Ask what the experience means to the client and whānau, and whether others in their whānau or iwi would see it as expected. (2) Ask about distress, functioning, duration, and whether the experience is wanted or welcome. (3) Screen for features that point to illness regardless of culture: marked decline in self-care, disorganisation, sustained loss of sleep, risk to self or others, substance use, medical causes. (4) With consent, seek Māori cultural advice (a Māori clinician, kaumātua, or the client's kairongoā) before deciding [source: Pitama et al. 2007, on seeking cultural advice]. (5) Hold both possibilities if unclear, and review [steps 1–3 and 5 synthesis].
• Example language (illustrative): "When your koro comes to you at night, what's that like for you? Is it comforting, frightening, or something else?" "Would your aunties see this as something that happens in your whānau?"
• Watch for: two errors: labelling expected wairua experience as psychosis, and calling a first-episode psychosis "just cultural" and missing it. Escalate to psychiatric assessment for risk or rapid decline whatever the explanation [synthesis].

4.9 Working with whānau

• Purpose / when: throughout; whānau is the centre of assessment and intervention, broadly defined to include kaupapa whānau [source: Pitama et al. 2007].
• Steps: (1) Ask the client who their whānau are and who should be involved. (2) Get explicit consent for what may be shared with whom. (3) Use the CFI Informant Version with consenting whānau [source: APA CFI Informant]. (4) Ask how whānau have coped with illness before and what support they need [source: Pitama et al. 2007]. (5) Hold whānau hui at a time and place that suits them [synthesis].
• Example language (illustrative): "Who are the people you'd want with you for this? Is there anyone you'd rather didn't know the details?"
• Watch for: whānau pressure on the client about rongoā or church in either direction; family violence. Respect the client's choices [synthesis].

4.10 Collaboration and referral with rongoā services

• Purpose / when: when the client wants rongoā alongside therapy or wants you and their kairongoā to communicate.
• Pathways (as published): (a) ACC Rongoā Māori service, a kaupapa Māori service funding rongoā "to support social rehabilitation after an injury" and available "to all New Zealanders with a covered injury". It names whitiwhiti kōrero, mirimiri, romiromi and karakia, and excludes non-Māori techniques such as reiki. ACC-registered kairongoā are listed on Healthpoint. Over 15,000 people used it in its first five years (June 2020 to June 2025): 57% Māori and 43% non-Māori; about a third after sexual harm and a third for soft-tissue injury [source: ACC, About our Rongoā Māori Service]. Access: the client needs a covered ACC claim (someone without one is directed to a GP or physiotherapist to lodge it), and ACC must approve rongoā before funded sessions start; sessions before approval are paid by the client. ACC funds up to a set number of sessions, and the kairongoā applies for more with a Rongoā Hauora report (ACC7426). Herbal preparations and equipment for home use are not funded [source: ACC, Rongoā Māori practitioner quick guide]. Listed practitioners tell ACC clients they can ask their case manager or ACC's claims line about rongoā [source: Healthpoint, Hei Toki Healing listing]. The maximum number of sessions is [uncertain]. (b) Health New Zealand / Te Whatu Ora (formerly Te Aka Whai Ora) funded rongoā providers, in clinical settings or as standalone hauora services. The Action Plan aims for Māori to reach rongoā "without needing a referral" and includes health-practitioner awareness training [source: Te Aka Whai Ora Rongoā Action Plan]. (c) Community and iwi practitioners recognised by their communities, some working in clinics called Whare Oranga [source: bpac 2008]. Ngā Ringa Whakahaere o te Iwi Māori was set up in 1993 as the national organisation of Māori traditional practitioners [source: bpac 2008]. The current role of Te Paepae Motuhake as a national rongoā body is [uncertain].
• Steps: (1) Ask whether the client wants rongoā, already has a kairongoā, or wants help finding one; the choice of practitioner is theirs and their whānau's. (2) If they want a link, get written consent specifying what is shared, with whom, and for what purpose. (3) Contact the kairongoā as a colleague: introduce yourself, the client's goals, and what you can offer; ask how they prefer to communicate. Don't ask about their methods. (4) Agree who does what: for example, the kairongoā attends to wairua and tinana in their way and you provide therapy; both encourage GP contact for physical symptoms. (5) Agree how acute risk is handled; rongoā standards expect onward referral for emergency or acute needs [source: bpac 2008]. (6) Review the arrangement with the client [steps synthesis; consent principles: Tikanga ā-Rongoā Toolkit 1].
• Evidence context (outside Aotearoa): in Nigeria and Ghana, collaborative shared care between traditional and faith healers and primary care (COSIMPO; Gureje et al., The Lancet 2020) gave greater reduction in psychosis symptoms, and harmful practices fell from 57% to 9% with the intervention [source: PubAnnotation PubMed 32861306; Centre for Global Mental Health]. In a Ghana prayer-camp trial (Ofori-Atta et al., Br J Psychiatry 212(1)), adding psychiatric medication reduced symptoms, but days in chains were not significantly reduced [source: APHRC repository]. These are different traditions; they show collaboration is feasible, not that rongoā works the same way [synthesis].
• Example language (illustrative, to client): "Would it help if your rongoā practitioner and I were in touch? You decide what I share. We can write it down together." (To kairongoā): "Kia ora, I'm working with [client] on [goal] with their permission. I'm not asking about your mahi; I'd just like us to know how to support them together."
• Watch for: the client feeling caught between practitioners; boundary drift, such as you advising on rongoā or the kairongoā being asked to manage clinical risk. It is working when the client experiences one coordinated plan [synthesis].

4.11 Mirimiri and romiromi: consent and physical safety

• Purpose / when: when a client receives or plans to receive mirimiri or romiromi, especially after sexual harm, where about a third of ACC rongoā use occurs [source: ACC].
• Steps: (1) Tell the client their rights under the Code of Health and Disability Services Consumers' Rights apply: informed choice and consent, information in a form they understand, the right to refuse, and the right to a support person present [source: Tikanga ā-Rongoā Toolkit 1]. (2) Help the client prepare to say what touch is and is not okay, to ask before each part, and to stop at any time. Touch is never sexual or genital [synthesis]. (3) For trauma survivors, plan grounding and a stop signal in advance; consider whether body work should wait until they feel ready [synthesis]. (4) Encourage the client to tell the kairongoā about injuries, pregnancy, blood-thinning medicines, recent surgery, osteoporosis or other conditions, and to see their GP for physical clearance where unsure [synthesis]. Published complications of mirimiri or romiromi are [uncertain: not verified]. (5) Do not describe or rate techniques; that is the practitioner's domain.
• Example language (illustrative): "You're allowed to say 'stop' or 'not there' at any time, and a good practitioner will expect that. Would you like to bring someone with you?"
• Watch for: dissociation or flashbacks after sessions (explore in therapy); any touch that felt sexual, coercive or painful beyond what was agreed, which is a safeguarding matter (4.14).

4.12 Integrating rongoā experiences into therapy

• Purpose / when: after rongoā sessions, when the client wants to make sense of them [synthesis].
• Steps: (1) Invite the client to share only what they wish; sacred content may not be shareable. (2) Explore the meaning in their own terms (for example, feeling lighter, reconnected, or that something was lifted). (3) Link it to their Te Whare Tapa Whā goals. (4) Support follow-through on changes they took from it (whānau reconnection, time on whenua). (5) Watch for distress and attend to it clinically [synthesis].
• Example language (illustrative): "You don't need to tell me what happened there. What do you notice in yourself since?"
• Watch for: pressure to disclose; the client feeling rongoā "failed" or that they failed it. It is working when the experience strengthens the client's sense of identity and agency [synthesis].

4.13 Addressing suppression, colonisation and racism

• Purpose / when: when distrust of services, hidden help-seeking or shame about rongoā appears. The Tohunga Suppression Act (1907, repealed 1962) pushed rongoā underground and tohunga identities into secrecy [source: bpac 2008; Te Ara, Rongoā – the impact of colonisation]. It was seen as a breach of the Treaty of Waitangi because it challenged traditional Māori knowledge, a taonga [source: Te Ara].
• Steps: (1) Name colonisation, racism, migration and marginalisation in the formulation [source: Pitama et al. 2017]. (2) Ask about experiences of racism in health care. (3) Acknowledge the history plainly when relevant, without lecturing. (4) Support reconnection the client chooses: te reo, marae, iwi, whenua. (5) Address service-level barriers (Iwi Katoa / ratonga hauora) through your team [synthesis on steps 2–5].
• Example language (illustrative): "For a long time, rongoā was pushed out of sight by law. It makes sense that people might not talk about it in a place like this."
• Watch for: guilt-led over-apology that centres you; the client being asked to educate you. It is working when the client feels safer to speak openly [synthesis].

4.14 Safeguarding and rights

• Purpose / when: whenever any provider (including you) may be causing harm. The rongoā standard requires that clients be free from discrimination, coercion, harassment, exploitation, abuse and neglect, that incidents be reported promptly to the relevant authorities, and that complaint processes follow Right 10 of the Code, with advocacy available [source: Tikanga ā-Rongoā Toolkit 1].
• Steps: (1) If a client reports sexual or coercive touch, threats, exploitation, financial pressure, or being told to stop medical care, take it seriously; assess safety. (2) Explain options: the provider's complaints process, a Health and Disability advocate, ACC if ACC-funded, police for crimes [synthesis; advocacy and Right 10: Toolkit 1]. (3) Follow your own mandatory reporting and child-protection duties. (4) Never frame rongoā itself as the problem; the problem is a specific harmful act [synthesis].
• Example language (illustrative): "What you've told me isn't okay, whoever did it. You have rights here, and I can help you decide what to do."
• Watch for: delay of urgent medical care. Plant remedies can be toxic if misidentified or wrongly prepared (tutu has caused death) [source: bpac 2008]. Route physical concerns to a GP or emergency care at once.

4.15 Cultural supervision and Māori expertise

• Purpose / when: throughout. The Meihana authors call for cultural peer supervision, Māori cultural advice at all stages, and access to Māori peers, kaumātua and support roles [source: Pitama et al. 2007]. The 2017 guide is intended for supervision, training and continuing competence [source: Pitama et al. 2017].
• Steps: (1) Arrange regular cultural supervision. (2) Know who your service's kaumātua or Māori clinical leads are. (3) Offer clients a Māori clinician or health worker, and respect a decline. (4) Bring formulations, not only crises [synthesis].
• Example language (illustrative): "We have a kaumātua and a Māori health team here. Would you like either of them involved?"
• Watch for: using Māori colleagues as unpaid consultants; cultural supervision that never changes practice [synthesis].

5. Handling problems

The sources used here do not address most of these problems. Responses are [synthesis] unless a source is given.

• Client won't say whether they use rongoā. Don't press. Disclosure is often withheld for fear of ridicule [source: Te Ao Māori News, Mark study]. Say once that you are open to it and return at review. (illustrative) "The door's open if you ever want me to know about other help you get." [synthesis]
• Client wants you to choose or endorse a kairongoā or tohunga. Explain that authority rests with tohunga, mātanga rongoā and whānau [source: Te Aka Whai Ora Rongoā Action Plan]. Point to published routes (ACC-registered kairongoā on Healthpoint; Te Whatu Ora-funded providers; iwi health providers; their own whānau and marae) and let them decide. [synthesis]
• Client asks you to perform karakia or "do" mirimiri. Decline warmly: it isn't your role unless you are recognised to do so. Offer to make space for the client or a whānau member or kaumātua to lead karakia if they want. [synthesis]
• Client asks whether a plant remedy is safe with their medication, or wants to stop medication for rongoā. Don't advise. Route the question to the prescriber or pharmacist and the kairongoā together, and support the client to raise it [source: bpac 2008 on interactions]. If stopping medication raises risk (for example in psychosis or bipolar disorder), tell the prescriber with consent and review the risk plan. [synthesis]
• Conflict between rongoā and psychiatric advice. Treat it as a difference of explanatory models (4.6). Seek a joint conversation with consent; involve Māori clinical leadership. Keep acute safety non-negotiable. [synthesis]
• Uncertainty whether an experience is wairua or illness. Use 4.8: cultural advice, longitudinal review, and clear escalation thresholds for risk or rapid decline. [synthesis]
• Client declines Māori-specific services or models. Respect it; the 2007 Meihana case shows this happens [source: Pitama et al. 2007]. Keep using holistic assessment without labelling it, and leave the offer open. [synthesis]
• Whānau disagree with the client about rongoā or therapy. Return to the client's tino rangatiratanga and consent [source: Tikanga ā-Rongoā Toolkit 1]. Hold a whānau hui if the client wants one, with clear limits on what is shared. [synthesis]
• Rupture after a culturally unsafe moment (mispronounced name, dismissive comment, unwanted touch to the head, a rushed start). Name it, apologise briefly, ask what would make it right, change practice, and take it to cultural supervision. (illustrative) "I got that wrong, and I'm sorry. What would help us get back on track?" [synthesis]
• Overwhelm after mirimiri, romiromi or other rongoā (especially after sexual harm). Stabilise first (grounding, sleep, safety). Encourage the client to tell the kairongoā about pacing. Consider pausing body work while trauma processing is under way, if the client agrees. [synthesis]
• Non-attendance. Check taiao and ratonga hauora barriers (transport, cost, venue, racism) before reading it as low motivation [source: Pitama et al. 2007, 2017]. Strengthen wairua attachments, which the Meihana authors link to lower non-attendance [source: Pitama et al. 2007].
• A reported harm by a practitioner. Follow 4.14: safety, rights, complaints, advocacy, police where criminal, and mandatory reporting for children [source: Tikanga ā-Rongoā Toolkit 1]. Don't generalise from one practitioner to rongoā as a whole. [synthesis]
• Requests to record, write up or share rongoā knowledge. Decline to record karakia or remedies. The Action Plan calls for protection of rongoā mātauranga and resolution of intellectual property issues [source: Te Aka Whai Ora Rongoā Action Plan]. [synthesis]
• Non-Māori client seeking rongoā. ACC reports 43% of its rongoā users are non-Māori [source: ACC]. Treat it like any other referral wish: route to legitimate providers, with the same consent and safety steps. [synthesis]
• Your own discomfort or doubt about rongoā. Take it to supervision; keep it out of the client's care. [synthesis]

Sources

• Tikanga ā-Rongoā (Ministry of Health, 2014)
• Tikanga ā-Rongoā Toolkit 1: Tūroro Tino Rangatiratanga (Ministry of Health, 2014)
• Rongoā Māori Action Plan (Te Aka Whai Ora, 2023)
• About our Rongoā Māori Service (ACC)
• Demystifying Rongoā Māori: Traditional Māori healing (bpacnz, Best Practice Journal 13, 2008)
• Study shows Māori keen for doctors and healers to collaborate (Te Ao Māori News)
• Tohunga Suppression Act 1907 (Wikipedia)
• Rongoā (Wikipedia)
• Māori health for healthcare providers (Healthify)
• Jones R (2012). Rongoā – medicinal use of plants: The impact of colonisation. Te Ara – the Encyclopedia of New Zealand
• Rongoā Māori practitioner quick guide (ACC)
• Hei Toki Healing, ACC-registered rongoā Māori (Healthpoint)
• Te Whare Tapa Whā (Mental Health Foundation of New Zealand)
• Mason Harold Durie, bibliography (Kōmako)
• Pitama S, Robertson P, Cram F, Gillies M, Huria T, Dallas-Katoa W (2007). Meihana Model: A Clinical Assessment Framework. NZ Journal of Psychology 36(3), 118–125
• Pitama SG, Bennett ST, Waitoki W, et al. (2017). A proposed hauora Māori clinical guide for psychologists: using the hui process and Meihana model in clinical assessment and formulation. NZ Journal of Psychology 46(3)
• APA DSM-5-TR Cultural Formulation Interview
• APA DSM-5-TR Section III
• APA CFI Supplementary Modules
• APA CFI Informant Version
• Lewis-Fernández R, et al. (2017). Feasibility, acceptability and clinical utility of the CFI. Br J Psychiatry 210(4):290–297
• Explanatory Models of Illness handout (Tanenbaum)
• 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.
• PubMed Central article PMC9199574 (DSM-5 and ICD-11 possession and trance criteria)
• ASWB prep study guide, dissociative disorders (UM System Pressbooks)
• ICD-11 6B62 Trance disorder (findacode)
• COSIMPO results, PubMed 32861306 (PubAnnotation); Gureje O, et al. (2020), The Lancet
• COSIMPO (Centre for Global Mental Health)
• Ofori-Atta A, et al. Joining psychiatric care and faith healing in a prayer camp in Ghana: randomised trial. Br J Psychiatry 212(1) (APHRC repository)
• Durie M (1984). Te taha hinengaro: an integrated approach to mental health. Community Mental Health in New Zealand 1(1): 4–11 (as listed by Kōmako); the model is described here from Pitama et al. (2007) and the Mental Health Foundation. [uncertain: original article not seen]