Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 128
Guide XI-128

Charming and Besprechen

A 34 · L 55 · M 1115 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: charming and Besprechen as folklorists, ethnologists and clinicians describe them. The British and Irish tradition follows Davies (1998) and Hillers, Carey, Ó Gealbháin and Tuomi (2019). The German-language tradition (Besprechen, Gesundbeten, and in French-speaking Switzerland "le secret") follows a DFG ethnography of spiritual healing in the Eifel (2012–2015), Swiss public reporting (2012) and a Lausanne burn-centre study (Kasser et al. 2019). The psychotherapist's own work follows the DSM-5-TR Cultural Formulation Interview (CFI) and Kleinman's explanatory-model approach.

What it is. Charming is a European folk-healing tradition. A recognised person, the charmer, is believed to relieve a specific ailment with a spoken or silent formula, a touch, or an inherited gift. Folklorists treat charmers as a distinct group within folk medicine. They have often been confused with cunning-folk, who offered wider services such as countering witchcraft. Davies describes charmers as diverse but sharing features that set them apart, with strong popular faith in them and some traditional forms continuing into recent times [source: https://uhra.herts.ac.uk/handle/2299/10170]. A secondary summary reports three sources of a charmer's power: an inborn gift passed on by touch, an object believed to heal, or a verse charm. Verse charms were the most common and usually drew on Biblical or apocryphal material. The same summary says charmers usually refused fees, accepted gifts in kind, and did not take on cases attributed to witchcraft or possession [source: https://en.wikipedia.org/wiki/Charmer_(folklore)] [uncertain: secondary source with citation warnings]. Irish charm scholarship covers medieval to modern evidence, with case studies of charms against headache, nightmare and bleeding, and fieldwork with a contemporary healer [source: https://folklore.indiana.edu/research/publications/2019-charms-ireland.html].

Besprechen ("speaking over" or "talking away" an illness) is the German name for healing with spoken formulae. Related terms are Gesundbeten ("praying well") and, in Switzerland, Gebetsheilen. A DFG-funded ethnography in the Eifel (2012–2015) treats orally transmitted faith healing as a living part of everyday health practice alongside academic medicine, not a relic. It interviewed healers, their patients, licensed doctors and psychotherapists [source: https://gepris.dfg.de/gepris/projekt/213337922]. In the canton of Fribourg, healing by prayer ("le secret", Gesundbeten) is mainly used for burns and cuts. Practitioners describe it as a gift, take no payment, and present it as a complement to medicine. Many hospital emergency departments in French-speaking Switzerland keep lists of such healers [source: https://www.srf.ch/news/bern-freiburg-wallis-geistiges-heilen-ist-in-freiburg-weit-verbreitet]. In Styrian (Austrian) folk medicine, Grabner describes Besprechen, also called Abbeten, as one of the oldest healing methods: usually a spoken blessing combined with touching, stroking or pressing the affected part [source: https://www.historischerverein-stmk.at/wp-content/uploads/Z_Jg91_92_Elfriede-GRABNER-Von-der-Volksmedizin-zu-den-Wunderheilern.pdf].

How change is understood. Within the tradition, relief comes through the charmer's gift or the efficacy of the words, which are often prayers or blessings: the German names Gesundbeten and Abbeten mean praying an illness well or away, and Grabner describes Besprechen as a spoken blessing [source: https://www.srf.ch/news/bern-freiburg-wallis-geistiges-heilen-ist-in-freiburg-weit-verbreitet] [source: https://www.historischerverein-stmk.at/wp-content/uploads/Z_Jg91_92_Elfriede-GRABNER-Von-der-Volksmedizin-zu-den-Wunderheilern.pdf]. Conventional medicine attributes reported effects to placebo, according to the Fribourg report [source: https://www.srf.ch/news/bern-freiburg-wallis-geistiges-heilen-ist-in-freiburg-weit-verbreitet]. Controlled evidence that charming treats any physical disease is [uncertain], so it is not presented here as a treatment for physical illness. For the psychotherapist, the relevant change processes belong to the therapist's own work: understanding what charming means to the client, protecting medical safety, and supporting the client's chosen combination of help [synthesis].

Who holds authority. No regulator, college or licence governs charmers. Authority rests on community recognition of a person's gift and on person-to-person transmission [source: https://www.srf.ch/news/bern-freiburg-wallis-geistiges-heilen-ist-in-freiburg-weit-verbreitet]. Some Swiss hospitals informally recognise healers through emergency-department lists [same source]. The Swiss Federal Office of Culture, working with the cantons, placed "le secret" on Switzerland's list of living traditions for Fribourg, Jura and Valais [same source]. One clinical paper describes this as a UNESCO intangible-heritage listing since 2012 [source: https://serval.unil.ch/notice/serval:BIB_6F1E388420AF]. Whether this is the national inventory or UNESCO's international list is [uncertain: not verified]. A psychotherapist does not practise charming, does not learn or use charms, and does not reproduce charm texts.

2. Framework

Charming is a folk tradition, not a psychotherapy, and it has no phases or session structure that a therapist delivers. The framework below organises the psychotherapist's own culturally responsive work with a client who uses, has used, practises or is affected by charming or Besprechen [synthesis]. The assessment tools in it are those the APA publishes [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].

Phase A: Engagement and cultural assessment (sessions 1–2).

  • Goal: learn whether and how charming figures in the client's help-seeking, without judgement.
  • Format: the core CFI (16 questions across four domains) inside the intake, plus the Informant Version (17 questions) when a family member arranged the charming. The APA does not specify a duration for the CFI, and the field trial found later interviews took less time [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]. A figure of 15–20 minutes is [uncertain].
  • Move on when: the client's own name for the problem, perceived cause, coping and help-seeking (including charmers) are documented in the client's words [synthesis].

Phase B: Explanatory model and differential thinking (sessions 2–3).

  • Goal: understand the meaning of charming for the client. Separate culturally normative belief and practice from symptoms that need clinical attention, such as health anxiety, obsessional magical thinking, psychosis or delay of medical care.
  • Format: Kleinman's explanatory-model questions and the CFI supplementary modules on Explanatory Model; Spirituality, Religion and Moral Traditions; and Coping and Help-Seeking [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
  • Move on when: a shared formulation exists that the client recognises, and medical safety for any physical complaint is confirmed [synthesis].

Phase C: Coordination (as needed, at any point).

  • Goal: when the client wishes, align psychotherapy, medical care and the client's chosen charmer. Responsibility for each stays with the person who holds it.
  • Format: consent-based information sharing, liaison with the GP or treating team, and, only on the client's request, a respectful note of the charmer's role in the care plan. Some Swiss emergency departments already treat charming as a complement to medical burn care [source: https://www.srf.ch/news/bern-freiburg-wallis-geistiges-heilen-ist-in-freiburg-weit-verbreitet] [source: https://serval.unil.ch/notice/serval:BIB_6F1E388420AF].
  • Move on when: roles are clear and nothing delays urgent medical care [synthesis].

Phase D: Integration and review (ongoing, then at intervals).

  • Goal: help the client make sense of the experience of being charmed, or of carrying a gift. Address family, heritage and identity themes. Review whether the plan still fits.
  • Format: ordinary psychotherapy sessions. The APA notes that the supplementary modules can be repeated during treatment [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
  • End when: the cultural material is integrated into the main treatment goals [synthesis].

3. Guiding principles

  • Alongside, not within. The therapist works beside the tradition and never charms, prays over or "speaks away" a complaint. Practically: do not offer, imitate or request charm formulae [synthesis].
  • Attribute, do not adjudicate. Describe the gift and the power of the words as the client and tradition hold them, neither as fact nor as superstition. Practically: say "you experienced relief after the charmer" rather than "the charm worked" or "that was placebo" [synthesis].
  • Respect secrecy and transmission norms. Charms pass from person to person, and healers describe them as a gift [source: https://www.srf.ch/news/bern-freiburg-wallis-geistiges-heilen-ist-in-freiburg-weit-verbreitet]. Practically: never ask a client to recite or write out a charm. Ask about meaning and experience instead [synthesis].
  • Medical care comes first for physical injury. Patients in the Lausanne study saw charming as a complement, not a replacement [source: https://serval.unil.ch/notice/serval:BIB_6F1E388420AF]. Practically: for burns, bleeding, wounds or skin disease, confirm medical assessment. Never advise on medicines; route to the prescriber [synthesis].
  • Client choice. Coordination with a charmer happens only if the client wants it. Practically: ask, document consent, and accept a "no" in either direction [synthesis].
  • Cultural humility. The CFI is "designed to be used by any clinician" in any setting [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]. Practically: treat yourself as the learner about the client's world, including rural, regional and religious backgrounds close to your own [synthesis].
  • Do not pathologise normative practice, and do not miss illness. The CFI 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]. Practically: a shared family belief in a charmer is not a symptom. Rigid, distressing or escalating rituals may be [synthesis].
  • Confidentiality with healers. People seeking help may give a healer identifying details and a description of the ailment [source: https://www.srf.ch/news/bern-freiburg-wallis-geistiges-heilen-ist-in-freiburg-weit-verbreitet]. Practically: share nothing with a healer without explicit consent, and remind the client that a healer is not bound by professional confidentiality rules [synthesis] [uncertain: legal position varies by country].
  • Watch for exploitation. In the tradition as reported, charmers take no fee [source: https://www.srf.ch/news/bern-freiburg-wallis-geistiges-heilen-ist-in-freiburg-weit-verbreitet]. Practically: large fees, pressure to stop medical treatment or promises to cure serious disease depart from the tradition as described and are red flags [synthesis].
  • Name modern reconstructions. Commercial courses or books that teach "healing words" are modern products, not community transmission. Practically: label them as such when clients raise them [synthesis].

4. Intervention inventory

Every item below is the psychotherapist's own work. None of it performs, teaches or imitates charming. Example language is illustrative unless quoted.

4.1 Cultural self-examination before and during the work

  • Purpose / when: Before working with clients from regions where charming or Besprechen is common (rural Ireland and Britain, German-speaking areas, French-speaking Switzerland) and whenever you notice a strong reaction such as amusement, scepticism or fascination [synthesis].
  • Steps: (1) Note your own family's and training's attitude to folk healing, and whether you reach for "placebo" or "superstition" as an explanation. (2) Note whether a tradition close to home feels less "cultural" to you than a distant one; it is equally cultural. (3) Decide in advance that you will ask about meaning, not efficacy. (4) Bring strong reactions to supervision [synthesis].
  • Example language (illustrative, to yourself or in supervision): "Am I treating this client's charmer as a curiosity rather than as part of their care network?"
  • Watch for: smiling or using diminishing words ("old wives' tale") in session; over-enthusiasm that encourages a client towards practices outside their own community. It is working when you can describe the client's use of charming in their own terms in your notes [synthesis].

4.2 Asking about charmers and healers without judgement

  • Purpose / when: At intake and when physical complaints come up (burns, warts, shingles, bleeding, skin conditions), since these are typical areas where people consult charmers [source: https://www.srf.ch/news/bern-freiburg-wallis-geistiges-heilen-ist-in-freiburg-weit-verbreitet] [source: https://folklore.indiana.edu/research/publications/2019-charms-ireland.html]. Wart charming and blood stopping continue in Newfoundland [source: https://ojs.folklore.ee/incantatio/article/view/17]; Irish material includes charms against bleeding, headache and toothache [source: https://www.uwp.co.uk/book/charms-charmers-and-charming-in-ireland]. Shingles as a typical target is [uncertain].
  • Steps: (1) Normalise: many people combine several sources of help. (2) Ask openly about "anyone else who helps", then name the local terms if the client hesitates (charmer, someone with a gift or a cure, Besprecher, Gebetsheiler, someone who "has the secret"). (3) Ask what it was like, not whether it worked. (4) Record it as help-seeking in the CFI help-seeking domain [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] [synthesis for steps 1–3].
  • Example language (illustrative): "Some people see a doctor and also someone in the family or village who has a gift for burns or warts. Is anything like that part of how you look after yourself?" / "What was it like to go to her?"
  • Watch for: hesitancy or embarrassment, which suggests expected disapproval; a client checking your face. It is working when the client offers details spontaneously in later sessions [synthesis].

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

  • Purpose / when: The structured way to gather the client's view of the problem, its causes, supports, coping and help-seeking, including charmers. It is usable by any clinician in any setting [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]. Use it at the first evaluation.
  • Steps: Work through the four APA domains in order. (1) Cultural definition of the problem (Q1–3): the client's own words for it. (2) Cultural perceptions of cause, context and support (Q4–10): causes, stressors, supports, and the role of cultural identity, including regional, religious and rural belonging. (3) Cultural factors affecting self-coping and past help seeking (Q11–13): include charmers, prayer and family remedies, and barriers. (4) Cultural factors affecting current help seeking (Q14–16): preferences, and the clinician–patient relationship, including fear of being judged [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]. Clinicians may reproduce the form for use with their own patients; modifying or translating it needs APA permission [same source]. Paraphrase in session; do not improvise new items.
  • Example language (illustrative): "Sometimes people describe their problem in their own way, which may differ from how doctors describe it. How would you describe it?" / "Who else have you turned to for this?"
  • Watch for: clients withholding the charmer at domain 3 and mentioning them only later. Note discrepancies with the referral letter. The CFI is not meant to be the sole basis of a diagnosis [same source]. It is working when you can write a cultural formulation paragraph that the client agrees with [synthesis].

4.4 CFI Informant Version with family members

  • Purpose / when: When a parent, partner or grandparent arranged the charming, for example for a child's burn, or when a relative is the charmer.
  • Steps: (1) Obtain the client's consent. (2) Use the Informant Version: Q1 covers the informant's relationship to the client, then the same four domains follow (17 questions) [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]. (3) Compare family and client accounts. (4) With minors, ask the parent about medical care alongside the charmer [synthesis].
  • Example language (illustrative): "When your son was burned, what did the family do first, and who decided?"
  • Watch for: intergenerational disagreement, where a young adult may be embarrassed by a grandparent's practice, and family pressure. It is working when family members feel their practice was taken seriously and medical steps are confirmed [synthesis].

4.5 CFI supplementary modules relevant to charming

  • Purpose / when: For depth after the core CFI, at any point in care, or repeatedly [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
  • Steps: Choose from the 12 APA modules [same source].
    • Spirituality, Religion and Moral Traditions: when charming is framed as a God-given gift or prayer.
    • Explanatory Model: when the client attributes cause or cure to the charmer.
    • Coping and Help-Seeking: to map the sequence of doctor, charmer, pharmacy and family.
    • Cultural Identity: for regional, rural, linguistic (dialect) and confessional identity.
    • Older Adults: for older clients who grew up with charmers.
    • Caregivers: for parents arranging care for children.
    • Immigrants and Refugees: for clients who left a region where charming was available.
    • Patient–Clinician Relationship: for fear of ridicule.
  • Example language (illustrative): "You said she has a gift from God. How does your faith fit with going to her and also seeing your doctor?"
  • Watch for: module overload. Choose one or two. It is working when the module answers a specific formulation question [synthesis].

4.6 Kleinman explanatory-model questions

  • Purpose / when: To understand the client's model of a complaint for which they consulted a charmer, especially when anxiety, pain or skin conditions overlap with psychological distress. Source: Kleinman, Eisenberg and Good (1978), Annals of Internal Medicine [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader].
  • Steps: Ask in paraphrase, over one or more sessions: what the client calls the problem; what caused it; why it started when it did; what it does and how it works; how severe it is and whether it will last; what treatment they should receive; the chief problems it has caused; and what they fear most about it [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf]. Place the charmer within the client's answers on treatment and cause.
  • Example language (illustrative): "What do you think the charmer does for this that the doctor doesn't?" / "What worries you most if it doesn't clear?"
  • Watch for: fears hidden behind the folk remedy, such as fear of cancer, scarring or disfigurement, which need medical answers. It is working when fears are named and routed [synthesis].

4.7 Distinguishing normative belief from clinical concern

  • Purpose / when: When charm-related belief or behaviour appears alongside possible symptoms.
  • Steps: (1) Establish whether the belief is shared within the client's community or family. Consulting a charmer or holding a family gift is, as reported, a recognised and widespread practice in some regions [source: https://www.srf.ch/news/bern-freiburg-wallis-geistiges-heilen-ist-in-freiburg-weit-verbreitet] [source: https://uhra.herts.ac.uk/handle/2299/10170]. (2) Look for departures from the community norm: compulsive repetition of self-made formulae to prevent harm (obsessional magical thinking); escalating doctor–healer shopping driven by fear (health anxiety); a belief in having unique healing powers that the community does not recognise, with other signs of mania or psychosis. (3) If dissociative phenomena appear, note that DSM-5-TR excludes trance that is a normal part of a broadly accepted collective cultural or religious practice from dissociative trance [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299] [uncertain: exact DSM-5-TR wording]. ICD-11 trance disorder (6B62) and possession trance disorder (6B63) require the state to be involuntary and unwanted, and trance disorder also requires that it is 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]. Charming as folklorists describe it is not a trance practice, so these codes will rarely apply [synthesis]. (4) Consult someone from the client's community or a colleague familiar with the region (with consent) when unsure [synthesis].
  • Example language (illustrative): "In your family, how do people usually talk about your grandmother's gift? Does what you're experiencing feel like that, or different?"
  • Watch for: both errors: treating a common regional practice as a symptom, and accepting escalating private rituals as "tradition". It is working when the client and, where relevant, family agree on what is ordinary and what is distressing [synthesis].

4.8 Using the cultural-concepts-of-distress lens

  • Purpose / when: DSM-5-TR describes cultural concepts of distress as idioms, explanations or perceived causes, and syndromes [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]. Its named examples (such as ataque de nervios, susto, khyâl cap, kufungisisa) do not include a European folk-healing concept [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf] [uncertain: secondary, unverified]. Use the lens for the client's own idioms and causal explanations around a complaint, not to treat charming itself as a syndrome [synthesis].
  • Steps: (1) Note regional or dialect words the client uses for the complaint or for its cause. (2) Ask what the word means in their family. (3) Record it as an idiom or explanation in the cultural formulation. (4) Avoid translating it straight into a diagnosis [synthesis].
  • Example language (illustrative): "You called it something your grandmother would 'speak away'. What kind of trouble is that, in your family's way of seeing it?"
  • Watch for: imposing exotic framing on a familiar regional practice. It is working when the formulation uses the client's words [synthesis].

4.9 Medical-safety check and routing

  • Purpose / when: Whenever the complaint taken to a charmer is physical: burns, bleeding, wounds, skin lesions, pain. No practice is presented here as treatment for physical disease. In the Lausanne burn-centre study, patients saw charming as a complement, not a replacement, for medical care [source: https://serval.unil.ch/notice/serval:BIB_6F1E388420AF]. Fribourg healers reportedly advise seeing a doctor depending on the case [source: https://www.srf.ch/news/bern-freiburg-wallis-geistiges-heilen-ist-in-freiburg-weit-verbreitet].
  • Steps: (1) Ask whether a doctor has seen the problem. (2) If not, and especially for burns, heavy bleeding, wounds or changing skin lesions, encourage prompt medical assessment, with urgency matched to severity. (3) Never advise starting, stopping or changing a medicine or ointment; refer to the prescriber or GP. (4) Document the advice [synthesis].
  • Example language (illustrative): "It sounds like the charmer helped you feel calmer about the burn. Has a doctor or nurse looked at it too? Burns can need medical care even when the pain eases."
  • Watch for: pain relief from charming leading a client to skip wound care; reluctance to see a doctor out of shame. It is working when the client holds both sources of help without conflict [synthesis].

4.10 Coordination with a charmer when the client wishes

  • Purpose / when: When the client wants their charmer acknowledged in their care, or when a medical team already uses healer lists. Many emergency departments in French-speaking Switzerland keep lists of healers and suggest calling one alongside treatment, particularly for burns [source: https://www.srf.ch/news/bern-freiburg-wallis-geistiges-heilen-ist-in-freiburg-weit-verbreitet]. In the Lausanne burn centre, most of the 36 professionals surveyed thought "le secret" might be useful and reduce pain, and only one considered it dangerous [source: https://serval.unil.ch/notice/serval:BIB_6F1E388420AF]. Structured collaboration with community healers has been tested elsewhere for psychosis. In Nigeria and Ghana (COSIMPO; Gureje et al., The Lancet 2020), collaborative shared care reduced symptoms more than control [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)), symptoms fell but days in chains were not significantly reduced [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial]. These trials come from different traditions and settings and are cited only as examples of collaborative models [synthesis].
  • Steps: (1) Ask whether the client wants any coordination; most will not need any. (2) If yes, agree exactly what may be shared, usually nothing clinical. (3) Do not refer clients to a charmer yourself or keep your own list unless your service has a policy [synthesis]. (4) Do not contact the charmer without written consent. (5) Do not give the charmer clinical information; a healer is not bound by professional confidentiality [synthesis] [uncertain: legal position varies]. (6) Record the client's chosen help in the care plan.
  • Example language (illustrative): "Would you like your visits to her noted in your plan, so the team knows it matters to you? I won't contact her unless you ask me to."
  • Watch for: the therapist being drawn into endorsing a particular healer; pressure from family; any suggestion to stop medical care. It is working when the client feels free to mention the charmer and the medical plan is intact [synthesis].

4.11 Children, minors and safeguarding

  • Purpose / when: When charming is arranged for a child, often by phone for burns [source: https://www.srf.ch/news/bern-freiburg-wallis-geistiges-heilen-ist-in-freiburg-weit-verbreitet]. The Lausanne study included parents of minors [source: https://serval.unil.ch/notice/serval:BIB_6F1E388420AF]. The tradition as reported is non-invasive. Safeguarding concern arises only if urgent medical care is delayed or if a practice described as charming involves harm [synthesis].
  • Steps: (1) Treat a parent's use of a charmer alongside medical care as ordinary. (2) Ask about medical care for the injury. (3) If urgent care was or is being withheld, follow local child-protection procedures. (4) Seek the child's assent and the parent's consent for any discussion. Never name minors in records shared outside the team [synthesis].
  • Example language (illustrative): "Lots of families here call someone for a burn. What did the hospital or doctor say about it?"
  • Watch for: over-reporting of a benign custom, and under-reporting of real neglect. It is working when the family stays engaged and the child is medically safe [synthesis].

4.12 Integrating the experience of being charmed

  • Purpose / when: When a client describes relief, comfort, unease or doubt after charming, or connects it to family memory or faith.
  • Steps: (1) Invite a narrative of the experience. (2) Explore what it meant: care from the community, a link to grandparents, faith, or a sense of control. (3) Link these meanings to therapy goals, such as coping with pain, anxiety or grief. (4) Avoid telling the client what "really" happened [synthesis].
  • Example language (illustrative): "When she spoke over your hand, what did you feel? What does it mean to you that someone in the village still does this?"
  • Watch for: clients who feel caught between a sceptical partner and a believing family; grief when a charmer dies and the gift has passed on. It is working when the experience becomes a resource rather than a secret [synthesis].

4.13 Working with a client who holds or is offered the gift

  • Purpose / when: When the client is a charmer, has been chosen to receive a gift, or feels burdened by being asked for help. Charming is commonly passed from person to person and described as a gift [source: https://www.srf.ch/news/bern-freiburg-wallis-geistiges-heilen-ist-in-freiburg-weit-verbreitet]. In Newfoundland the ability to charm is often passed cross-sex, and some people are held to have it by circumstance of birth, such as posthumous children [source: https://ojs.folklore.ee/incantatio/article/view/17]. In Styria, Grabner describes family healing knowledge passing from father to son and mother to daughter [source: https://www.historischerverein-stmk.at/wp-content/uploads/Z_Jg91_92_Elfriede-GRABNER-Von-der-Volksmedizin-zu-den-Wunderheilern.pdf]. Rules differ by place; other details are [uncertain].
  • Steps: (1) Explore the client's own understanding of the gift, using the Spirituality, Religion and Moral Traditions module [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]. (2) Address workload, boundaries, responsibility and guilt when relief does not come. (3) Respect secrecy; do not ask for the formula. (4) Treat any associated distress (for example perfectionism or burnout) with your usual methods [synthesis].
  • Example language (illustrative): "People call you at night for burns. How do you look after yourself with that responsibility?"
  • Watch for: distress framed as spiritual failure; family conflict over who inherits the gift. It is working when the client sets boundaries they feel are consistent with their tradition [synthesis].

4.14 Language, dialect and documentation

  • Purpose / when: When charming is discussed in Irish, Welsh, regional German, Swiss German or French terms [synthesis].
  • Steps: (1) Ask the client to explain local terms rather than assuming meaning. (2) Use an interpreter where needed, and brief them that the topic is a respected local practice. (3) In notes, record the practice in neutral, attributed language ("client reports consulting a charmer for burn pain"), never as superstition. (4) Do not record any charm text [synthesis].
  • Example language (illustrative): "You used a word for it I'm not sure I understand. Can you tell me what it means where you grew up?"
  • Watch for: notes that would embarrass the client if they read them. It is working when the client would recognise themselves in your record [synthesis].

4.15 Recognising commercialisation and modern reconstruction

  • Purpose / when: When a client reports paid "healing-word" courses, books, online healers or high fees. The tradition as reported involves a gift, person-to-person transmission and no payment [source: https://www.srf.ch/news/bern-freiburg-wallis-geistiges-heilen-ist-in-freiburg-weit-verbreitet].
  • Steps: (1) Ask neutrally about cost, claims and any advice to stop medical care. (2) Help the client compare these with their own community's understanding of the tradition. (3) Where claims to cure serious disease or pressure to abandon treatment appear, discuss risk and support medical follow-up [synthesis].
  • Example language (illustrative): "How does this compare with how people at home did it?"
  • Watch for: financial exploitation, isolation from medical care, and dependency. It is working when the client makes an informed choice [synthesis].

5. Handling problems

The sources above do not address psychotherapy problems with charming. Everything in this section is [synthesis] unless a source is tagged.

  • Client hides use of a charmer. This may reflect expected ridicule; the CFI includes the clinician–patient relationship as a domain [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]. Response: normalise combined help-seeking, revisit later, and do not press. Illustrative: "Whatever else you use is welcome here. I'm interested, not judging."
  • Client asks whether you "believe in it". Response: be honest that your role is not to judge it, and return to what it means for them. Illustrative: "I can't speak for how it works, but I can see it mattered to you. Tell me more about that." Avoid both endorsement and debunking.
  • Client asks you to recommend a charmer. Response: decline. This is outside your role, and authority in the tradition rests on community recognition [source: https://www.srf.ch/news/bern-freiburg-wallis-geistiges-heilen-ist-in-freiburg-weit-verbreitet]. Suggest they ask within their own family or community. Some hospital units keep lists under their own policies [same source].
  • Client uses charming instead of medical care. Response: Do not attack the practice. Point out that, as reported, healers themselves advise seeing a doctor when needed [same source], and that patients in the Lausanne burn-centre study saw it as a complement [source: https://serval.unil.ch/notice/serval:BIB_6F1E388420AF]. Escalate urgently if the injury is serious, and follow safeguarding procedures for a child.
  • Rupture after a dismissive remark (yours or a colleague's). Response: name it, apologise specifically, and repair. Illustrative: "Last week I called it an old custom in a way that sounded dismissive. I'm sorry. It clearly matters to you."
  • Family conflict between believers and sceptics. Response: use the Informant Version or a family session to give each view space [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]. Focus on shared goals, such as the child's recovery, rather than on who is right.
  • Charm-related ritual becomes compulsive or anxious. Response: explore whether it fits the community norm (see 4.7). If it is a private, escalating ritual driven by fear, treat it as you would other compulsions, with respect for the underlying tradition. Consult a cultural broker if unsure.
  • Overwhelm or grief around a dying charmer or a lost gift. Response: treat it as grief and loss of a community role. Explore what the client wants to keep of the tradition and from whom they would learn it within their own community.
  • Client is a charmer and struggling. Response: support boundaries and self-care (see 4.13). Do not question the gift. Watch for burnout and guilt.
  • Non-adherence to medical treatment because charming relieved pain. Response: explore the meaning of the relief, encourage completing medical care, and never advise on medicines; refer to the prescriber.
  • Pressure from a commercial healer to stop treatment or pay large sums. Response: discuss risk directly and contrast it with the no-fee tradition as reported [source: https://www.srf.ch/news/bern-freiburg-wallis-geistiges-heilen-ist-in-freiburg-weit-verbreitet]. Involve the GP. Consider consumer-protection or adult-safeguarding routes where exploitation is clear.
  • Therapist unsure about legal or ethical position. Response: check your professional code and local regulation, and seek supervision. The legal status of non-medical healers varies by country. In Germany, a local court (Gießen, reported 2014), relying on a 2004 Federal Constitutional Court decision, held that a spiritual healer who claims no scientific proof and does not discourage medical care is not practising Heilkunde and needs no Heilpraktiker licence [source: https://www.aerztezeitung.de/Wirtschaft/Gericht-schuetzt-Wunderheiler-242410.html]. Other countries' rules are [uncertain].
  • Colleague mocks or prohibits the practice. Response: advocate for the client's right to combine help. Cite hospital examples where professionals considered it safe and helpful [source: https://serval.unil.ch/notice/serval:BIB_6F1E388420AF].

Sources

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