East Slavic zagovory

1. Introduction

Version followed: the East Slavic (Russian, Ukrainian, Belarusian) and Podlasie (Polish-Belarusian borderland) charm traditions as folklorists and ethnographers document them (Agapkina 2022; Mazalova 2008; Forrester 2013 and 2020; Sadanowicz 2018), with Russian Federal Law 323-FZ Article 50 for current legal status. The therapist's own work follows the DSM-5-TR Cultural Formulation Interview (APA). This is a folk healing tradition, not a psychotherapy. The guide describes it for the clinician who works alongside it and does not reproduce any charm.

What it is. A zagovor (plural zagovory; Polish zamawianie, "ordering" an illness away) is a spoken healing or protective formula. Folklorists treat it as a verbal folk genre. Forrester calls it a genre of "spells, charms, or hexes" that "is at the heart of Russian folk healing, though it was suppressed in the Soviet period" [source: https://works.swarthmore.edu/fac-russian/29]. The Great Russian Encyclopedia describes the wider practice, znakharstvo, as healing, protective and prognostic magic. Its main tool was the charm, together with prayers to God, the saints and natural forces. Practitioners named the causes of illness as sorcery ("spoiling", porcha, and the evil eye, sglaz), evil spirits, or sudden fright [source: https://bigenc.ru/c/znakharstvo-50b2c8]. Many charms call on God, the Mother of God and the saints, and blend Christian figures with older folk belief, which is why they are often framed as prayer [source: https://www.kunstkamera.ru/files/lib/978-5-02-025233-2/978-5-02-025233-2_04.pdf]. Recorded uses include bleeding and wounds, fright in children, the evil eye, "spoiling", toska (longing or anguish), skin conditions, chills, and protection at work [source: https://journals.ku.edu/folklorica/article/download/14971/13618] [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf]. Charms against bleeding and wounds are a recognised East Slavic sub-genre [uncertain: not verified].

How change is understood within the tradition. The spoken word carries the healing power, and practitioners attribute that power to God, the Mother of God or the saints. The ritual "orders" the illness or spell to leave the person [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf]. Patients take part actively. Their trust rests on the belief that illness has an external cause (forest, wind, people) that can be sent away [source: https://www.kunstkamera.ru/files/lib/978-5-02-025233-2/978-5-02-025233-2_04.pdf]. These are the tradition's own explanations, stated here neither as fact nor dismissed. No source treats charms as a treatment for physical disease, and none should be presented as one.

The psychotherapist's role. The psychotherapist does not cast or teach charms. The clinical work is the therapist's own culturally responsive practice: understanding what a client's visit to a babka, znakharka or szeptucha means, assessing distress described in these terms, keeping medical care safe, and respecting the client's faith and community [synthesis].

2. Framework

There is no staged clinical protocol, because this is a folk tradition and not a therapy. Below is (a) the tradition as documented and (b) a framework for the therapist's own work.

(a) The tradition as documented

Who practises. The practitioners are mainly older women, and in many accounts women past menopause. Older men also practise, and in Podlasie there are male szeptuni [source: https://ojs.folklore.ee/incantatio/article/download/143/14/461] [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf]. Russian folk medicine had no separate healer profession. Terms such as znakhar' and znayushchiy ("one who knows") also covered people who practised love or herding magic [source: https://www.kunstkamera.ru/files/lib/978-5-02-025233-2/978-5-02-025233-2_04.pdf]. Midwives were closely associated with healing [source: https://bigenc.ru/c/znakharstvo-50b2c8].
Where it continues. In Podlasie (around Bielsk Podlaski and Hajnówka) szeptuchy are mostly Orthodox elderly women. Clients still travel long distances to see them, although rural depopulation is shrinking the tradition [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf]. Ukrainian Polissia fieldwork from 2008 to 2015 describes residents who use phones and the internet but still consult healers, while believing that fewer remain [source: https://nz.lviv.ua/archiv/2022-6/6.pdf]. Northern Russian collections run from the 1970s to the 2010s. Informants kept practices they found useful, and adapted them in towns [source: https://journals.ku.edu/folklorica/article/download/14971/13618].
Authority and transmission. No council or licensing body exists for charmers. Authority rests on lineage, a chosen successor, and community reputation. Charms pass from older to younger, usually within the family but sometimes to unrelated pupils. They are often handed on only near the end of life, and key closing parts (the "lock") are kept back for a chosen successor. Healers are graded, from those who treat one ailment to stronger healers who see serious cases [source: https://ojs.folklore.ee/incantatio/article/download/143/14/461] [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf]. Written charm texts carried more authority than memorised ones. A taboo against passing charms from a younger to an older person still persists [source: https://www.kunstkamera.ru/files/lib/978-5-02-025233-2/978-5-02-025233-2_04.pdf].
Payment. Sources differ. Many healers held that charging money is sinful and weakens the charm [source: https://ojs.folklore.ee/incantatio/article/download/143/14/461]. The encyclopedia describes znakhari as charging fees [source: https://bigenc.ru/c/znakharstvo-50b2c8]. [uncertain]
Churches. Attitudes inside the tradition are ambivalent: healing is seen as either a God-given gift or a sin [source: https://bigenc.ru/c/znakharstvo-50b2c8]. Both the Catholic and Orthodox Churches have long opposed the healers. Clergy have issued bans and threats of excommunication, and a bishop's sermon in Podlasie called visits to healers a serious sin [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf]. The Russian Orthodox Church's 2022 draft on exorcism warned against treating church rites as magic and called for possession to be distinguished from mental illness [source: https://azbyka.ru/news/?p=6187].
State. In Russia, "folk medicine" may be practised only with a permit from the regional health authority, and the permit must be supported by a submission from a medical professional organisation. The law expressly excludes "оказание услуг оккультно-магического характера" (occult-magical services) and religious rites. Unlicensed practice, or harm caused through folk medicine, carries liability [source: https://www.consultant.ru/document/cons_doc_LAW_121895/1498a4ebc56ba8cb777c0e0c416523b6b84e7719/]. Whether charming falls under the permit regime or the exclusion is a legal question the cited sources do not settle [uncertain]. Regulation in Poland, Ukraine and Belarus [uncertain: not verified].
Soviet history. The practice was suppressed in the Soviet period [source: https://works.swarthmore.edu/fac-russian/29]. Soviet ideology stigmatised these beliefs, and some former collective-farm officials still distance themselves from them [source: https://nz.lviv.ua/archiv/2022-6/6.pdf].

(b) The therapist's framework [synthesis, built on the APA CFI]

Phase	Goal	Typical format	Move on when
1. Engagement and cultural assessment	Understand the problem in the client's terms, including any healer visits	Core CFI within the first 1–2 sessions; supplementary modules as needed	Client has named the problem, its causes and the help they have used, and feels safe saying so
2. Safety and differential	Screen for urgent medical need, psychosis, risk and safeguarding issues	Same sessions; medical liaison if needed	Medical and risk issues addressed; normative belief separated from disorder
3. Shared formulation	Combine the client's explanatory model with the clinical picture	1 session, revisited later	Client recognises their view in the formulation
4. Treatment alongside the tradition	Evidence-based therapy for the diagnosed condition, with the tradition acknowledged; liaison only if the client wishes	Usual course for the condition	Goals met; tensions (church, family, healer) workable
5. Integration and ending	Make sense of healing experiences; relapse plan that includes the client's help-seeking preferences	1–2 sessions	Client can say how they will use both kinds of help

The APA describes the CFI as having 16 questions in four domains, for "any clinician" in "any care setting". It supports clinical decisions and is not the sole basis for diagnosis [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]. How long the CFI takes in minutes [uncertain]. In the field trial, later interviews "required less time" [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/].

3. Guiding principles

Alongside, never instead of. The therapist does not perform, teach, recommend or imitate charms. In practice: if asked to "say something" over the client, decline warmly and redirect to your own role. [synthesis; consistent with the tradition's own lineage rules, source: https://ojs.folklore.ee/incantatio/article/download/143/14/461]
Describe, don't reproduce. Charm texts are secret, lineage-held knowledge, and their closing parts are deliberately withheld [source: https://ojs.folklore.ee/incantatio/article/view/143]. In practice: do not ask clients to recite charms or record them; ask what the visit meant instead.
Attribute, neither endorse nor dismiss. Porcha, sglaz, fright and the divine power of the word are the tradition's own concepts. In practice: use phrases like "in your family's understanding…" and record the client's own words. [synthesis]
Authority lies with lineage, community and church, not with outsiders. In practice: there is no credential to verify. Do not "vet" healers, and do not refer clients to one. Respect the client's own pathways. [synthesis; source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf]
Faith tension is real. Clients may be Orthodox or Catholic and see healer visits as a gift, or as a sin their priest condemns [source: https://bigenc.ru/c/znakharstvo-50b2c8]. In practice: explore both sides without taking either side. Offer the client the option of involving their own priest.
Medical safety first. No charm is presented as a treatment for bleeding, wounds or other physical disease. In practice: any current bleeding, injury, sick infant or serious symptom goes to medical care now; the client can still see the healer as well. [synthesis]
Cultural concepts of distress are not diagnoses. Fright, toska, "nerves" and spoiling are idioms and explanations. DSM-5-TR uses cultural concepts of distress to cover idioms, explanations and syndromes [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]. In practice: assess the underlying condition as well; do not translate "fright" straight into PTSD.
Normative belief versus illness. Shared belief in spoiling is not delusion. A belief that is fixed, idiosyncratic, escalating or impairing needs assessment. In practice: compare the belief with family and community norms, using informants. [synthesis; source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]
History and stigma. The practice was suppressed in the Soviet period and is still condemned by churches, so clients may hide it [source: https://works.swarthmore.edu/fac-russian/29]. In practice: normalise the question; expect disclosure to come late.
Consent and confidentiality. Contact with a healer, priest or family member happens only with explicit, specific consent. In practice: document what may be shared and with whom. [synthesis]
Safeguarding over tradition. Fraud, coercion, delay of urgent care, child neglect and accusations against a named person override cultural deference. In practice: follow local safeguarding and consumer-protection routes. [synthesis]
Do no harm with touch. The psychotherapist uses no touch in this work. In practice: ask whether a healer's ritual involved touch, and whether the client was comfortable with it; never sexual touch. [synthesis]

4. Intervention inventory

All interventions below are the psychotherapist's own. None of them involves performing, prescribing or imitating a charm. Example language is illustrative. Where the APA forms are named, the questions are paraphrased and not reproduced. APA permits clinicians to reproduce the CFI for their own patients, but modifying or translating it needs APA permission [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].

4.1 Cultural humility and self-examination

Purpose / when: Before and throughout work with clients from Russian, Ukrainian, Belarusian or Podlasie backgrounds, to check your assumptions ("superstition", "post-Soviet backwardness", or a romantic view of folk healing) [synthesis].
Steps: (1) Note your own reactions to magic, prayer healing and church authority. (2) Learn the local terms (babka, znakharka, szeptucha, zagovor, zamawianie, porcha, sglaz, toska) and what they mean. (3) Notice the political sensitivities of Russian-Ukrainian-Belarusian-Polish identity, and do not assume one nationality from one language. (4) Take these questions to supervision or consultation.
Example language (illustrative): "I'm not from your background, so I'll ask about things that may be obvious to you. Please correct me."
Watch for: Smirking or diagnostic labels applied to belief alone. Over-identifying with the tradition, or asking for charm texts out of curiosity. Working when: the client offers the vernacular terms unprompted.

4.2 Core Cultural Formulation Interview

Purpose / when: At intake, or when the client's account mentions spoiling, the evil eye, fright, a babka or a szeptucha. The CFI clarifies the problem from the client's and their network's perspective, its meaning, sources of help, and what the client expects from services [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].
Steps: Work through the four APA domains in your own words: (1) cultural definition of the problem (Q1–3); (2) perceived causes, context and supports, including cultural identity (Q4–10); (3) self-coping and past help-seeking, with barriers (Q11–13); (4) current help-seeking preferences and the clinician-patient relationship (Q14–16). Record the client's own words, for example "they put porcha on me" or "it's toska". Use the core form's pointers to open supplementary modules [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
Example language (illustrative): "How would you describe this problem to someone in your family or village?" / "Have you already looked for help anywhere, from doctors, the church, or someone who 'knows' how to help?"
Watch for: Clients from former Soviet countries may answer "correctly" in medical language and keep folk attributions private. Leave room and come back to it. Working when: help-seeking answers include non-medical sources.

4.3 Explanatory model (Kleinman questions and CFI Explanatory Model module)

Purpose / when: When the client attributes symptoms to spoiling, the evil eye, fright, wind or chill, or to a person. The aim is to understand the client's model before negotiating a shared one [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf].
Steps: Cover Kleinman's eight areas in your own words: what the problem is called; its cause; why it started when it did; what it does and how it works; how severe it is and how long it will last; what treatment it needs; the main problems it causes; what the client fears most [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf] (Kleinman, Eisenberg and Good 1978 [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader]). Add questions about who in the family shares the model, and whether the client holds more than one model at once (a medical one and a spoiling one).
Example language (illustrative): "When your grandmother says it's sglaz, what does she mean has happened? And what do you think yourself?"
Watch for: Several models existing together is common and not a contradiction. A fear of who caused the harm may point to conflict (see 4.8). Working when: the client can say how the different explanations fit together for them.

4.4 Spirituality, religion and moral traditions module

Purpose / when: When the client is Orthodox, Catholic, Protestant or non-religious and the healer visit raises questions of sin, gift or guilt. Sources describe church condemnation and the tradition's own sense that healing is a God-given gift [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf] [source: https://bigenc.ru/c/znakharstvo-50b2c8].
Steps: (1) Ask about the client's religious identity and practice. (2) Ask how their church and their family view healers. (3) Explore any guilt, fear of sin, or conflict with a priest. (4) Offer the option of involving their own clergy. Do not judge the theology. Use the APA module in your own words [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
Example language (illustrative): "Some people find comfort in going to a szeptucha, and some feel their priest wouldn't approve. How is it for you?"
Watch for: Scrupulosity or religious OCD presenting as guilt about healer visits. Shame that stops disclosure. Protestant converts who reject folk tradition, as reported in Polissia [source: https://nz.lviv.ua/archiv/2022-6/6.pdf]. Working when: the client names their own position rather than repeating an authority's.

4.5 Asking about healer consultation without judgement (Coping and Help-Seeking module)

Purpose / when: At every assessment, because visits are often hidden. They have been stigmatised in the Soviet period, condemned by clergy, and they are secret by tradition [source: https://works.swarthmore.edu/fac-russian/29] [source: https://ojs.folklore.ee/incantatio/article/view/143].
Steps: (1) Normalise: many families use both doctors and "those who know". (2) Ask what was done in general terms (prayer, whispering, water). Do not ask for words or texts. (3) Ask how it felt and what changed. (4) Ask about any advice given about medicines, food, contact with people, or doctors. (5) Ask whether the client paid, and whether it felt fair.
Example language (illustrative): "You don't need to tell me any words. I'd just like to know whether it helped and how you felt afterwards."
Watch for: Advice to stop medicines or avoid doctors goes to the prescriber or GP (see 4.9). Large or escalating payments to commercial "magicians" (see 4.13). Working when: the client describes healer use openly and keeps doing so over time.

4.6 Working with cultural concepts of distress (fright, evil eye, spoiling, toska, nerves)

Purpose / when: When a client or parent describes fright (Russian ispug, Polish przestrach, Ukrainian perelyak), the evil eye, spoiling, toska or "nerves". In Podlasie, fright is among the most common complaints that bring people to healers, typically a child crying without obvious cause. "Nerves" is linked with kołtun and long-term bodily pain [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf]. Northern Russian records name sglaz, porcha and toska [source: https://journals.ku.edu/folklorica/article/download/14971/13618].
Steps: (1) Record the idiom and its local meaning. (2) DSM-5-TR treats cultural concepts as idioms, explanations or syndromes. Decide which applies here [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]. (3) Assess for underlying conditions: anxiety, depression or grief behind toska; trauma after a frightening event; somatic symptom presentations behind "nerves"; and medical causes, especially in infants. (4) Use the idiom in the shared formulation. Fright has a family resemblance to DSM-5-TR's susto, but do not equate the two [synthesis; the DSM-5-TR concept list is from a secondary source, source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf].
Example language (illustrative): "You said this began as toska after your mother died. Can we look at what that longing is like day to day?"
Watch for: Missing major depression, PTSD or a medical illness because the idiom seems explanatory. The opposite error is pathologising a normal idiom of grief. Working when: the client feels the idiom has been heard and accepts assessment of the underlying condition.

4.7 Distinguishing normative belief from psychopathology

Purpose / when: When beliefs about spoiling, the evil eye or sorcery are intense, or when a client reports possession-like states.
Steps: (1) Establish whether the belief is shared by the client's family and community, using informants (4.8). Belief in spoiling is documented as widespread in these communities [source: https://nz.lviv.ua/archiv/2022-6/6.pdf]. (2) Look for features that point beyond the cultural norm: fixity despite the community's own reassurance, bizarre elaboration, spread to new persecutors, hallucinations, functional decline, and other psychotic, mood or OCD features. (3) For possession or trance states, use the DSM criteria. Possession-form identity disruption and dissociative trance are excluded when they are part of a broadly accepted cultural or religious practice [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299]. The ICD-11 codes are 6B62 trance disorder and 6B63 possession trance disorder, in which the state is involuntary and unwanted, outside accepted practice, and causes distress or impairment [source: https://www.findacode.com/icd-11/code-1807490186.html]. (4) The Russian Orthodox Church's own 2022 draft calls for possession to be distinguished from mental illness, which can support a joint approach with a client's priest [source: https://azbyka.ru/news/?p=6187]. The DSM-5-TR note on culturally sanctioned beliefs not counting as psychotic symptoms [uncertain: not verified].
Example language (illustrative): "Do others in your family see it the same way? Has anyone said they're worried about how much this is on your mind?"
Watch for: Two opposite errors: diagnosing psychosis from culturally shared belief, and missing early psychosis because it is "just village belief". Working when: the formulation explains why this person's belief is or is not within the norm, with informant evidence.

4.8 Family and informant interviews

Purpose / when: When the client is a child, an older adult or a person with possible psychosis, or when the family drives healer use. Grandmothers are often the bearers of the tradition [source: https://ojs.folklore.ee/incantatio/article/download/143/14/461].
Steps: (1) With consent, use the CFI Informant Version (17 questions, beginning with the informant's relationship to the patient) [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]. (2) Map who holds which explanation. (3) If spoiling is attributed to a named relative or neighbour, explore what that attribution does in the family (grievances, inheritance, in-law conflict) [synthesis]. (4) Use the Caregivers, Older Adults or School-Age modules as needed [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
Example language (illustrative): "Your mother took him to the babka for fright. I'd like to understand what she noticed that worried her."
Watch for: Accusations that escalate into harassment or threats against the person blamed. Generational conflict, where younger members feel ashamed of the elders' practices. Working when: family members can hold the different explanations without fighting over them.

4.9 Medical safety and medicines

Purpose / when: Always, and especially where charms are used for bleeding, wounds, children's fright or crying, fever, or long-term pain. Charms are not treatment for physical disease.
Steps: (1) Ask whether any current physical symptom has been seen by a doctor. (2) For active bleeding, injury, a sick infant or red-flag symptoms, arrange urgent medical care now. (3) If a healer or family has advised stopping or changing a medicine, do not advise on medicines yourself. Route the question to the prescriber and support the client to raise it. (4) Ask the client's consent to share relevant information with their GP or psychiatrist [synthesis].
Example language (illustrative): "It's fine to see the szeptucha as well. I'd also like a doctor to look at this today, because it involves bleeding."
Watch for: Delay of care for children. A client stopping medication quietly. Working when: the client uses medical and folk help in parallel and tells both.

4.10 Collaboration and liaison with healers or clergy (only if the client wishes)

Purpose / when: When the client wants their healer, priest or both to know about or support their care. There is no formal referral programme for charmers, and healers keep their knowledge secret and some refuse to talk to outsiders [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf]. Collaboration will therefore usually be indirect.
Steps: (1) Clarify what the client wants: just your acknowledgement, a letter, a call, or the involvement of clergy. (2) Get written consent that states who may receive what. (3) Keep any contact to the shared goal (safety, medication adherence, reducing fear), and do not request or discuss ritual content. (4) Never seek out, recommend or rate a healer for a client. The evidence that collaboration helps comes from other contexts: in Nigeria and Ghana (COSIMPO, Gureje et al., The Lancet 2020), shared care between traditional and faith healers and primary care reduced psychosis symptoms more than usual care, and harmful practices fell [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839]. In a Ghana prayer-camp trial (Ofori-Atta et al., Br J Psychiatry 212(1)), adding psychiatric care reduced symptoms, 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]. How far these findings apply to East Slavic charming [synthesis; uncertain].
Example language (illustrative): "Would it help if your priest knew you were seeing me? You decide what, if anything, I share."
Watch for: Clergy who condemn the healer visits and increase the client's guilt. Healers who are unwilling to engage, which should be respected. Working when: the people the client trusts are not pulling in opposite directions.

4.11 Integrating healing experiences

Purpose / when: When a client reports relief, comfort or a sense of being cared for after a visit, or disappointment that it did not work.
Steps: (1) Invite the client to describe the experience (not the words used) and what felt helpful: attention, an elder's care, faith, the sense that the cause had been sent away [source: https://www.kunstkamera.ru/files/lib/978-5-02-025233-2/978-5-02-025233-2_04.pdf]. (2) Link these to resources the client can keep using in therapy, such as family support, prayer as they choose, and continuity with their roots. (3) If the visit disappointed them, explore the meaning ("even that didn't help") and screen for hopelessness [synthesis].
Example language (illustrative): "What was it like to have your grandmother's healer take your fear seriously? How can we bring some of that steadiness into what we do here?"
Watch for: Hopelessness after a "failed" visit, which requires a suicide risk assessment by standard practice. Working when: the client describes the experience as part of their own story rather than a secret.

4.12 Identity, migration and history (Cultural Identity and Immigrants and Refugees modules)

Purpose / when: For migrants, refugees (including people displaced from Ukraine), and clients who grew up under Soviet stigma or with village-city splits.
Steps: (1) Use the modules in your own words to cover language, nationality, religion, region, rural or urban roots, and migration history [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]. (2) Explore what the tradition means after migration: loss of the village healer, grief, a link to a grandmother. (3) Acknowledge that the practice was suppressed historically [source: https://works.swarthmore.edu/fac-russian/29]. (4) Be careful with national-political assumptions [synthesis].
Example language (illustrative): "Back home there was someone to go to for this. What is it like not to have that here?"
Watch for: War trauma, in which "fright" may be the family's word for traumatic stress. Identity tensions across nationalities. Working when: the client can connect the tradition with their current life without shame.

4.13 Safeguarding and consumer protection

Purpose / when: When there are signs of financial exploitation, coercion, a delay of urgent care, harm to a child, or threats to a person accused of causing spoiling.
Steps: (1) Assess the risk, including the amounts paid and any pressure to continue. Commercial "magic" offers that promise to remove spoiling are a separate market from village charmers and should not be confused with them [synthesis]. (2) In Russia, occult-magical services are excluded from legal folk medicine, and unlicensed practice or harm caused through folk medicine carries liability [source: https://www.consultant.ru/document/cons_doc_LAW_121895/1498a4ebc56ba8cb777c0e0c416523b6b84e7719/]. Elsewhere, use local fraud and consumer routes [synthesis]. (3) For children, follow local child-protection procedures if medical care is being withheld. (4) Support the person accused of spoiling if they are at risk.
Example language (illustrative): "You've paid a lot and been told the curse is getting stronger. I'm worried someone is taking advantage of your fear. Can we look at that together?"
Watch for: Shame, and the client defending the provider. Isolation from family. Working when: the client sets limits and spending stops.

4.14 Interpreters and language

Purpose / when: When the client's first language is Russian, Ukrainian, Belarusian, Polish, or a local dialect (Podlasie healers speak a local dialect with Ukrainian and Belarusian roots [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf]).
Steps: (1) Use a trained interpreter, not a family member. Choose one acceptable to the client on nationality and religion. (2) Brief the interpreter to keep idioms (porcha, toska) as spoken and not to "medicalise" them. (3) Debrief afterwards on cultural meanings, and use the interpreter as a cultural broker only with the client's consent [synthesis].
Example language (illustrative): "Please keep the client's exact word for the illness, and then explain what it means."
Watch for: Interpreter embarrassment or judgement about folk belief. Political tension between interpreter and client. Working when: the idioms reach you intact.

4.15 Documentation

Purpose / when: Throughout care.
Steps: Record the client's own idioms and explanatory model, their healer and church use, what they consented to share, the differential reasoning for any diagnosis, and safeguarding actions. Avoid pejorative terms. Do not record any charm content [synthesis].
Example language (illustrative): "I'll note that you see a szeptucha and find it calming. Is that how you'd want it written?"
Watch for: Records that later stigmatise the client, for example with a "magical thinking" label applied without assessment. Working when: the client would recognise themselves in the record.

5. Handling problems

The folklore sources do not address clinical problems, so all guidance in this section is [synthesis] unless a source is cited.

Client hides healer use, then discloses late. The practice was suppressed in the Soviet period and is condemned by clergy, so concealment is expected [source: https://works.swarthmore.edu/fac-russian/29] [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf]. Response: thank the client and do not comment on the delay. Update the formulation, and ask what made it safe to say now.
Client asks you to "say a charm", or to endorse the charm as treatment. Response: decline warmly, because this is not your role and the tradition holds charms within lineages [source: https://ojs.folklore.ee/incantatio/article/view/143]. Say what you can offer, and do not argue about efficacy.
Client asks you to recommend a healer. Response: do not recommend, rate or locate healers. Explore the client's own community pathways (family, neighbours, parish) and their reasons for seeking one.
Client wants to stop prescribed medication because a healer or relative advised it. Response: do not advise on medicines. Validate the dilemma, involve the prescriber promptly with consent, and explore fears about side effects or stigma.
Spoiling attributed to a named person (relative, neighbour, ex-partner). Response: explore the relationship and the conflict. Assess any risk to or from the accused person, and do not validate or dispute the accusation as fact. If threats appear, follow risk and safeguarding procedures.
Belief appears to be escalating towards a delusion. Response: use informants to compare the belief with community norms. Assess for psychosis, mood disorder or OCD, and arrange psychiatric review. Treat the illness while still respecting the client's faith (4.7).
Faith conflict ("my priest says it's a sin"). Response: do not take sides. Explore the client's values. Offer, if the client wishes, to involve their priest, and remember that the Orthodox Church's own 2022 draft calls for possession to be distinguished from mental illness [source: https://azbyka.ru/news/?p=6187].
Rupture: the client feels you think they are "backward" or "superstitious". Response: name the possible rupture, apologise for any dismissiveness, return to the explanatory model, and use their terms.
Overwhelm or fear ("the curse is too strong", "the fright is back"). Response: attend to the present: grounding, sleep, and contact with safe people. Assess risk and the underlying anxiety or trauma, using the client's idiom as a bridge.
Stuck: the client attributes everything to spoiling and sees no point in therapy. Response: agree on goals that fit both models (sleep, fear, family conflict). Let the client hold their own explanation while working on what they want to change.
Non-adherence: missed sessions around healer visits or religious seasons. Response: plan around the calendar, check whether a healer advised stopping therapy, and discuss openly.
Commercial "magician" exploitation (online offers, escalating fees). Response: see 4.13. Help the client distinguish their family's tradition from commercial services, without dismissing either.
Child brought for "fright" with medical red flags (fever, persistent crying, poor feeding). Response: arrange urgent medical assessment, involve the parents respectfully, and follow child-protection procedures only if care is being withheld.
Historical exclusionary beliefs. Some historical sources record rules excluding certain groups from treatment, for example Jews in some accounts [source: https://ojs.folklore.ee/incantatio/article/download/143/14/461]. Response: if a client from an affected group encounters such attitudes, acknowledge the hurt and do not minimise it.
Therapist curiosity or appropriation. Response: do not collect charm texts, record rituals, or adopt the practice. Notice and manage your own fascination in supervision.

Sources

Folklore, ethnography and law:

Cultural assessment and collaboration:

Books and articles cited by reference:

Adonyeva S.B., Stepanov A.V. (eds) (2020). Магические практики севернорусских деревень: заговоры, обереги, лечебные ритуалы. 2 vols. St Petersburg: Propp Centre. (Described from the Forrester review.)
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.
Gureje O. et al. (2020). COSIMPO collaborative shared care trial. The Lancet.

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