Polish szeptuchy

1. Introduction

Version followed: szeptuchy as Polish ethnological and sociological research describes them (mainly Sadanowicz 2018 and 2025, with Weber 2014, Kuzyka 2024 and Hozyasz 2025). The psychotherapist's own work follows the DSM-5-TR Cultural Formulation Interview (CFI) and its supplementary modules (APA).

What it is. Szeptuchy ("whisperers"; locally often babki, "grandmothers") are folk healers of Podlasie in north-eastern Poland. Male healers are called szeptuni. They are not a therapy, a school or a regulated profession. They are a living folk-religious healing tradition. Researchers describe them as mostly older rural women, mainly Orthodox, with little formal education. They are concentrated in Hajnówka and Bielsk Podlaski counties, and some now live in towns such as Hajnówka, Bielsk Podlaski and Białystok. Sadanowicz cites estimates of 50–100 practitioners (Charyton 2008, as cited) and about 50 today, including some who work mainly within their own families. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/19642/1/Stud_Podl_33_2_E_Sadanowicz_Podlasie_Whisperers.pdf] Their core practice is zamawianie, healing through spoken prayer and charm-formulas. The PWN dictionary defines a szeptucha as a woman who heals or drives away evil forces by zamawianie. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/17220/1/BSL_24_2024_J_Kuzyka_Szeptucha_i_Natura_Od_analizy_leksykograficznej.pdf]

What people bring to them. People bring:

• folk illnesses: urok (a harmful look or charm), róża (skin conditions), kołtun, przewianie (chills or "wind");
• nerw ("nerves") with pain or paralysis;
• przestrach (fright), especially in children who cry for no clear cause;
• family, neighbour, money and property troubles;
• mental-health concerns and illnesses that conventional medicine has not helped.

[source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/19642/1/Stud_Podl_33_2_E_Sadanowicz_Podlasie_Whisperers.pdf] [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf] Clients include local people and visitors from across Poland and abroad. [source: https://pressto.amu.edu.pl/index.php/kwod/article/download/14747/14469/29711]

How change happens, as the tradition holds it. Practitioners and clients hold that the healing power comes from God, the Mother of God or the saints, who give it to the healer as a gift. Treating the sick is regarded as a sacred duty. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf] [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/17220/1/BSL_24_2024_J_Kuzyka_Szeptucha_i_Natura_Od_analizy_leksykograficznej.pdf] Scholars offer outside interpretations. Sadanowicz (drawing on Engelking) stresses the power of the spoken word: naming an illness lets it be controlled. She describes the healer as a mediator between the sacred and the everyday, within Orthodox "dual faith" (dwuwiara). [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf] These are the tradition's beliefs and scholars' readings. They are not presented here as fact, and they are not dismissed. Verified health outcomes are [uncertain: not verified]. Clients' stories of cures for serious physical illness, including cancer, are testimonies. The tradition is not a treatment for cancer or any other physical disease. [source: https://pressto.amu.edu.pl/index.php/kwod/article/download/14747/14469/29711]

The psychotherapist's role. You do not practise zamawianie, and you do not perform, imitate or arrange it. The prayers and formulas are secret and are passed on selectively. Researchers report that many healers decline to speak with outsiders. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf] Your work runs alongside the tradition:

• understand what a visit to a szeptucha means for the client;
• assess culturally, without pathologising and without missing illness;
• keep medical care on track;
• hold any conflict between folk practice and the client's church;
• safeguard.

In your work, change comes from feeling understood in the client's own terms and from a shared formulation that fits both the client's explanatory model and clinical care. [synthesis]

2. Framework

Who holds authority. The tradition has no licensing body, register or professional college. Authority rests on:

• the gift, believed to come from God or the saints;
• how it is passed on: orally, often to a willing, mature family member such as a youngest or eldest daughter. Some hold that it passes by touch or can be inborn, and many believe a healer must pass it on before death;
• local reputation: healers who reach their limits refer people on to "stronger" healers.

[source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/19642/1/Stud_Podl_33_2_E_Sadanowicz_Podlasie_Whisperers.pdf] [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf]

The Orthodox Church does not sanction the practice. The Orthodox and Catholic churches have long condemned it as pagan, including with threats of excommunication. Clergy commonly call visits sinful and harmful. In 2009 a bishop publicly warned at a funeral that visiting szeptuchy is a grave sin. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf] [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/19642/1/Stud_Podl_33_2_E_Sadanowicz_Podlasie_Whisperers.pdf] Individual priests vary. One researcher met a priest who was on good terms with a healer active in parish life. [source: https://pressto.amu.edu.pl/index.php/kwod/article/download/14747/14469/29711] Sadanowicz's doctoral thesis compares the official Orthodox teaching on health and healing with the szeptuchy's practice. [source: https://old.soc.uwb.edu.pl/images/doktoraty/esadanowicz/wojakowski.pdf] No formal collaboration or referral programme exists between Polish health services and szeptuchy. [uncertain: not verified] The legal status of folk healing in Poland is also [uncertain: not verified].

Phases of the psychotherapist's work [synthesis, built around the CFI's four domains] [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]

Safeguarding runs through every phase (see 4.12). [synthesis]

3. Guiding principles

• Describe, do not practise. Never reproduce, perform or coach the prayers, charms or ritual steps. In practice, if a client asks you to "do what the babka does", decline warmly and stay in your own role. [synthesis] [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf]
• Attribute, neither endorse nor dismiss. Say "in your family, urok is understood as…", not "urok is real" or "urok is superstition". In practice, use the client's terms and frame causes as their beliefs. [synthesis]
• Expect shame and secrecy. Healer use can be treated as a sign of "backwardness", or as a "shameful secret" among some local elites. In practice, ask routinely and normalise the question so disclosure costs little. [source: https://mfuir.mfu.ac.th/jspui/bitstream/123456789/1115/1/2025-v07-no02-p.28-33.pdf]
• Use is common and crosses groups. In one 2022 survey of 58 nursing students in southern Podlasie, 12.1% had seen a whisperer as children, 31% had parents who had, and 46.6% had friends who had. Denomination or non-belief does not limit use. In practice, do not assume a young, educated or Catholic client has no contact. [source: https://mfuir.mfu.ac.th/jspui/bitstream/123456789/1115/1/2025-v07-no02-p.28-33.pdf]
• Hold the religious tension. Many clients are Orthodox, and their church calls these visits sinful. In practice, explore any guilt or conflict without taking the church's side or the healer's. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/19642/1/Stud_Podl_33_2_E_Sadanowicz_Podlasie_Whisperers.pdf] [synthesis]
• Protect medical care. People often come to szeptuchy as a last resort. A belief connected with nerw holds that sufferers should avoid injections, surgery and biopsies, which can delay care. In practice, check for postponed medical treatment every time a folk illness is named. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/19642/1/Stud_Podl_33_2_E_Sadanowicz_Podlasie_Whisperers.pdf]
• Never advise on medicines or remedies. In practice, route any questions about medication or about natural products a healer gave to the prescriber or GP. [synthesis]
• Normative is not diagnostic. The CFI informs clinical judgement and is not the sole basis for diagnosis. In practice, a shared belief in urok is not a delusion. Assess form, distress, impairment and context. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
• Client-led collaboration. No sanctioned referral pathway exists, and the church opposes the practice. In practice, you do not refer clients to szeptuchy. If the client chooses to consult one, you coordinate around that choice, with consent. [synthesis]
• Protect privacy. Healers often refuse outsiders, and clients may fear gossip in small villages. In practice, never contact or name a healer without the client's explicit consent, and record no identifying details of healers. [synthesis] [source: https://pressto.amu.edu.pl/index.php/kwod/article/download/14747/14469/29711]
• Cultural humility. Podlasie is a borderland of religions, languages and East–West traditions. In practice, examine your own Catholic, secular or urban assumptions before judging. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf] [synthesis]

4. Intervention inventory

Every item below is the psychotherapist's own work. None of it is the szeptuchy's practice. Where an item is general clinical practice applied to this tradition, it is marked [synthesis].

4.1 Cultural humility and self-examination

• Purpose: to reduce your own bias before assessment. Use it before the first session and whenever you feel dismissive or fascinated. [synthesis]
• Steps:
  1. Note your stance toward folk healing, Orthodoxy and rural Podlasie.
  2. Recognise the cultural pull to treat healer use as "backwardness". [source: https://mfuir.mfu.ac.th/jspui/bitstream/123456789/1115/1/2025-v07-no02-p.28-33.pdf]
  3. Separate curiosity that serves the client from curiosity about an exotic tradition.
  4. Plan to ask what the client wants you to know, not what you want to learn.
  5. Take this to supervision if strong reactions persist. [synthesis]
• Example language (illustrative): "I don't know your village's ways from the inside. Please correct me when I get something wrong."
• Watch for:
  • asking for details of the prayers or ritual (this serves your interest, not the client);
  • smiling or hurrying past the topic;
  • assuming that Catholic, urban or young clients have no contact.
  It is working when the client brings up the healer without being asked. [synthesis]

4.2 Core Cultural Formulation Interview (CFI)

• Purpose: to clarify the problem from the client's and their network's view. It covers what the problem means, possible sources of help and what the client expects from services. Use it at intake with any client from Podlasie folk-religious backgrounds, or when folk illness terms appear. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
• Steps:
  1. Work through the CFI's four domains in order:
     • cultural definition of the problem;
     • perceived causes, context and supports, including cultural identity;
     • self-coping and past help seeking, and barriers to help;
     • current help-seeking preferences and the clinician–patient relationship.
  2. Use the official APA form. Clinicians may reproduce it for use with their own patients. Do not modify or translate it without APA permission. An official Polish version is [uncertain: not verified].
  3. Record the client's exact words (e.g. przestrach, urok, nerw).
  4. Write a brief cultural formulation that informs, but does not replace, 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]
• Example language (illustrative): "People describe troubles in different ways. How would you describe yours to someone back home?" Later: "Have you already looked for help anywhere, from doctors, the church, or someone in the village?"
• Watch for:
  • a client who answers in biomedical terms only, then mentions a babka at the door (the disclosure was being tested);
  • perceived judgement or language barriers in the relationship.
  It is working when the client's own label and cause appear in your formulation. In the DSM-5 field trial, clinicians found the CFI feasible and useful, and later interviews took less time. [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]

4.3 Explanatory-model inquiry (CFI Explanatory Model module; Kleinman's questions)

• Purpose: to map how the client names, explains and expects to treat the problem. Use it when a folk illness (przestrach, urok, nerw, róża, kołtun, przewianie) or a healer visit is mentioned. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/19642/1/Stud_Podl_33_2_E_Sadanowicz_Podlasie_Whisperers.pdf]
• Steps: cover Kleinman's eight areas in your own words: [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf]
  1. what the client calls it;
  2. what caused it;
  3. why it started when it did;
  4. what it does and how it works;
  5. how severe it is and how long it will last;
  6. what treatment the client should receive;
  7. the main problems it has caused;
  8. what the client fears most about it.
  Then ask whether the client sees doctors, church and healer as dealing with different parts of the problem. Summarise the model back to the client before offering your own. [synthesis]
• Example language (illustrative): "You called it przestrach. What does that mean in your family? What do you think brought it on?" "What are you most afraid will happen if it isn't treated?"
• Watch for:
  • a model in which a neighbour's ill will or a harmful charm caused the problem (explore the social conflict; see 4.9);
  • nerw models that forbid injections or surgery (see 4.10).
  It is working when the client says "yes, that's it" to your summary. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/19642/1/Stud_Podl_33_2_E_Sadanowicz_Podlasie_Whisperers.pdf] [synthesis]

4.4 Spirituality, Religion and Moral Traditions module

• Purpose: to understand Orthodox (or Catholic) affiliation, the role of faith in coping, and any conflict over healer visits. Use it when religion is central or when guilt about seeing a szeptucha appears. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
• Steps:
  1. Ask about the client's religious identity and practice.
  2. Ask whether the church supports or forbids anything relevant.
  3. Ask how the client reconciles healer visits with church teaching.
  4. Ask whether a priest or confessor matters in their recovery.
  Do not argue theology. Note that the church's opposition is a known source of tension. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf] [synthesis]
• Example language (illustrative): "Some people feel torn between what the priest says and what helped their grandmother. Is anything like that true for you?"
• Watch for:
  • scrupulosity or intense guilt (distinguish religious conscience from obsessional doubt);
  • fear of sin blocking disclosure.
  It is working when the client can talk about both church and healer in the same session. [synthesis]

4.5 Cultural concepts of distress: mapping local idioms

• Purpose: to treat local terms as idioms, explanations or syndromes in the DSM-5-TR sense. DSM-5-TR defines cultural concepts of distress as including idioms, explanations or perceived causes, and syndromes. Use the mapping to improve communication, not to diagnose. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]
• Steps:
  1. Note that Podlasie terms such as przestrach, urok and nerw are not among DSM-5-TR's named examples. A secondary list of those examples includes susto, nervios and ataque de nervios. [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf]
  2. Use the DSM-5-TR approach anyway: decide whether each term works for this client as an idiom of distress, a causal explanation, or a recognised syndrome.
  3. Map each term to symptoms (sleep, fear, pain, low mood, somatic complaints) without translating it into a diagnosis.
  4. Any likeness between przestrach and susto (both fright-illnesses) is your own comparison. Do not present it as established. [synthesis] [uncertain]
• Example language (illustrative): "When you say your nerw is bad, what do you notice in your body, your sleep, your mood?"
• Watch for:
  • reducing a rich idiom to "anxiety" too fast;
  • missing depression or a somatic illness behind a folk label.
  It is working when symptoms and idiom are both documented. [synthesis]

4.6 Asking about szeptucha consultation without judgement (Coping and Help-Seeking module)

• Purpose: to learn about all past and current help-seeking, including healers, church, spring water, homeopathy and doctors. Use it routinely at intake. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] Local surveys show these overlap: families who used whisperers also used other complementary medicine. [source: https://mfuir.mfu.ac.th/jspui/bitstream/123456789/1115/1/2025-v07-no02-p.28-33.pdf]
• Steps:
  1. Normalise the question: many people in the region have seen a babka.
  2. Ask what the client sought, what happened in general terms, and what they took away. Do not ask for the prayers or ritual.
  3. Ask whether anything was given to take home and whether it is being used. Pass any medical questions to the GP. [synthesis]
  4. Ask whether the client plans further visits and whether they would like you to know.
• Example language (illustrative): "Many families round here have taken a child to a babka. Have you or your family ever gone to one about this? I'm asking so I understand, not to judge."
• Watch for:
  • embarrassment or denial followed by later disclosure;
  • visits made instead of urgent medical care.
  It is working when help-seeking is no longer kept secret from you. [synthesis]

4.7 Distinguishing shared belief from disorder

• Purpose: to avoid both pathologising and missing illness. Use it when a client attributes symptoms to urok, to a harmful charm, or to a healer's or neighbour's ill will, or describes unusual experiences. [synthesis]
• Steps:
  1. Establish whether the belief is shared in the client's family and community. Researchers report a local belief that healers who can cure can also cause illness. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/19642/1/Stud_Podl_33_2_E_Sadanowicz_Podlasie_Whisperers.pdf]
  2. Assess form and course: fixity beyond what peers hold, idiosyncratic elaboration, other psychotic features, functional decline.
  3. For trance-like or identity-altering episodes, consider the diagnostic exclusions:
     • ICD-11 6B62 (trance disorder) and 6B63 (possession trance disorder) require the state to be involuntary, unwanted and not part of accepted cultural or religious practice; [source: https://www.findacode.com/icd-11/code-1807490186.html] [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]
     • DSM-5-TR keeps, in substance, the rule that dissociative identity disorder is not diagnosed when the disturbance is part of broadly accepted cultural or religious practice. Its exact wording is [uncertain]. [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299]
  4. If unsure, interview a family member (CFI Informant Version) or consult a cultural broker, with consent. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
  5. The DSM-5-TR culture note on not counting culturally sanctioned beliefs as psychotic symptoms is [uncertain: not verified].
• Example language (illustrative): "Do other people in your family see it the same way? Has anything about how you're thinking changed recently that worries them?"
• Watch for:
  • escalating, private or bizarre elaborations;
  • persecutory beliefs spreading beyond one person;
  • sleep loss, agitation or self-neglect.
  It is working when family and client agree on what is "our way" and what is "not like him/her". [synthesis]

4.8 Working with families: Informant Version and children brought for przestrach

• Purpose: to bring in the family's view. Parents and grandparents often decide on healer visits, and children's fright and unexplained crying are a traditional reason to go. Use it with children, older adults and family-centred clients. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf] [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
• Steps:
  1. With consent, run the CFI Informant Version (17 questions) with a relative.
  2. For children, use the School-Age Children and Adolescents module. For older clients, use the Older Adults module. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
  3. Ask what the family has tried, including any visit to a babka.
  4. Check the child's medical review (persistent crying, fever, pain), sleep, development and stressors in the home. [synthesis]
  5. Respect the family's view while keeping paediatric care in place. [synthesis]
• Example language (illustrative): "Grandma thinks it's przestrach. Tell me what you've noticed, and let's also make sure the doctor has checked her."
• Watch for:
  • generational disagreement (a parent who is embarrassed, a grandparent who insists);
  • a child's symptoms that need medical assessment;
  • signs of trauma or neglect behind "fright".
  It is working when the family speaks with one plan. [synthesis]

4.9 Addressing fear of harm and social conflict

• Purpose: to work with fears that someone, such as a neighbour, a rival or a healer asked to do harm, has caused the illness or misfortune. Use it when the explanatory model is interpersonal. Researchers record local beliefs that some healers will carry out harmful requests, and that disputes between people are among the problems brought to szeptuchy. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/19642/1/Stud_Podl_33_2_E_Sadanowicz_Podlasie_Whisperers.pdf] [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf]
• Steps:
  1. Take the fear seriously as the client's experience.
  2. Map the real relationships and conflicts involved: land, inheritance, family feuds.
  3. Work on the conflict itself with problem-solving, communication and boundary-setting, and treat the anxiety with your usual methods.
  4. Assess any risk of retaliation or violence in either direction.
  5. Do not confirm or refute the supernatural cause. [synthesis]
• Example language (illustrative): "Whatever is behind it, this quarrel with your neighbour is weighing on you. Let's look at what is in your hands to change."
• Watch for:
  • accusations against a named person and threats of revenge (safeguarding, see 4.12);
  • hypervigilance amounting to persecutory ideation (see 4.7).
  It is working when worry falls and the client takes practical steps. [synthesis]

4.10 Screening for medical delay and coordinating with physicians

• Purpose: to make sure healer visits run alongside medical care, not instead of it. People often come to szeptuchy as a last resort. One local belief holds that people with nerw should avoid injections, surgery and tumour biopsies. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/19642/1/Stud_Podl_33_2_E_Sadanowicz_Podlasie_Whisperers.pdf] Clients' stories of cures where doctors failed are told locally. [source: https://pressto.amu.edu.pl/index.php/kwod/article/download/14747/14469/29711]
• Steps:
  1. Each time a folk illness or healer visit comes up, ask whether any medical test, treatment or operation has been postponed or refused.
  2. If so, explore the reason in the client's terms.
  3. With consent, contact the GP or treating physician.
  4. Never advise starting, stopping or changing any medicine, and refer questions about remedies or natural products a healer gave to the prescriber.
  5. Frame both forms of help as able to sit together, where the client wishes. Some patients report a doctor suggesting a whisperer for a skin complaint. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/19642/1/Stud_Podl_33_2_E_Sadanowicz_Podlasie_Whisperers.pdf] [synthesis]
• Example language (illustrative): "You can keep going to the babka if it helps you. I'd like your doctor to know what's happening with the operation too. Could I call her with you?"
• Watch for:
  • a cancelled biopsy or surgery, or abandoned medication, especially antipsychotics or antidepressants;
  • a worsening physical condition.
  It is working when medical appointments are kept. [synthesis]

4.11 Consultation with cultural brokers, clergy and (client-led) healers

• Purpose: to get contextual knowledge from people the client trusts, such as an Orthodox priest, a relative, or a local health worker who knows the area. Use it when the formulation is unclear, or when the client wants their spiritual adviser involved. [synthesis]
• Steps:
  1. Ask whom the client trusts and gain written consent for exactly what you will share.
  2. Remember that clergy commonly oppose szeptuchy, so a priest may not be a neutral broker on this issue. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/19642/1/Stud_Podl_33_2_E_Sadanowicz_Podlasie_Whisperers.pdf]
  3. Do not seek out, contact or name a healer unless the client explicitly asks and the healer agrees. Many healers decline contact with outsiders, and no collaborative programme is documented. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf] [uncertain: not verified]
  4. For context only: trials in West Africa found benefits from structured collaboration with traditional and faith healers for psychosis. In the COSIMPO trial (Gureje et al., The Lancet 2020), symptoms fell more with collaborative shared care. In a Ghana prayer-camp trial (Ofori-Atta et al., Br J Psychiatry 212(1)), symptoms fell but days in chains were not significantly reduced. These settings and practices differ from Podlasie's. [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial]
• Example language (illustrative): "Is there anyone, from church or family, whose view on this you'd want me to hear? I'd only share what you agree to."
• Watch for:
  • the client feeling exposed in a small community;
  • a broker taking sides on whether visits are sinful.
  It is working when added information changes or confirms the formulation. [synthesis]

4.12 Safeguarding

• Purpose: to act where any practice or belief causes harm. Use it throughout. [synthesis]
• Steps:
  1. Screen for:
     • delay of urgent medical care (4.10);
     • children whose medical needs go unmet;
     • financial exploitation (the tradition is described as usually having no fixed fee, so large or escalating demands for money are a red flag); [source: https://pressto.amu.edu.pl/index.php/kwod/article/download/14747/14469/29711]
     • threats or violence arising from accusations of causing harm (4.9);
     • any sexual or coercive conduct by anyone presenting as a healer.
  2. Follow your national and professional reporting duties. Polish child-protection procedures are [uncertain: not verified].
  3. Document facts, not beliefs. [synthesis]
• Example language (illustrative): "I respect that this matters to you. I also have to make sure nobody is being hurt or pressured. Has anyone asked you for money or done anything that felt wrong?"
• Watch for:
  • secrecy around a child's care;
  • escalating payments;
  • fear of a named person.
  It is working when risks are named and acted on without damaging the alliance. [synthesis]

4.13 Integrating the client's experience of a healer visit

• Purpose: to help the client make sense of what a visit meant to them (comfort, hope, being cared for by an elder, or disappointment) and fold it into therapy. Use it after a client reports a visit. [synthesis]
• Steps:
  1. Ask about the client's experience and what changed, not about the ritual.
  2. Reflect what the client valued: being listened to, family continuity, faith.
  3. Link those values to therapy goals.
  4. If the visit disappointed or frightened the client, process that.
  5. Do not evaluate whether the healing "worked". Verified outcomes are [uncertain: not verified]. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/19642/1/Stud_Podl_33_2_E_Sadanowicz_Podlasie_Whisperers.pdf]
• Example language (illustrative): "What was it like to sit with her? What did you take home with you, in yourself?"
• Watch for:
  • magical expectations that therapy will work just as fast;
  • guilt after the visit (4.4).
  It is working when the client's account becomes coherent and less secret. [synthesis]

4.14 Language, identity and the borderland context

• Purpose: to account for Podlasie's mix of Orthodox and Catholic, Polish and Eastern Slavic identities, and for clients who have migrated to cities. Use it with the CFI Cultural Identity module and the Patient–Clinician Relationship module. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf] [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
• Steps:
  1. Ask about identity, home language or dialect, and any experience of being looked down on as "from the village" or as Orthodox.
  2. Offer an interpreter or culturally familiar colleague if the client prefers another language or dialect. Local dialect needs are [uncertain: not verified].
  3. Name any power difference between you and the client. [synthesis]
• Example language (illustrative): "Which language do you feel most yourself in when talking about this?"
• Watch for:
  • code-switching around folk topics;
  • deference that hides disagreement.
  It is working when the client corrects you freely. [synthesis]

5. Handling problems

The sources describe the tradition but give no clinical guidance on these problems. Everything below is [synthesis] unless a source is cited.

• Client denies any healer contact, then it emerges later.
  • Why it happens: shame and the label of "backwardness" are documented. [source: https://mfuir.mfu.ac.th/jspui/bitstream/123456789/1115/1/2025-v07-no02-p.28-33.pdf]
  • Response: thank the client, do not point out the earlier denial, and restate that you ask everyone.
  • Example (illustrative): "I'm glad you told me. It helps me understand the whole picture."
• Client asks you to say whether the babka is right, or whether it is a sin.
  • Response: decline to rule on either. Reflect the client's own values. Offer to include a trusted spiritual adviser if wanted (4.11).
  • Example (illustrative): "That's a question for your faith and your conscience. I can help you think it through, but I won't decide it for you."
• "Resistance" that is really a clash of models, for example a client who sees therapy as irrelevant to urok.
  • Response: return to the explanatory model (4.3). Negotiate goals that fit both views, such as sleep, conflict with the neighbour, or mood. Avoid persuading the client.
• Stuck: symptoms persist while the client cycles through healers.
  • Response: review the formulation for missed depression, psychosis or physical illness (4.5, 4.7, 4.10). Bring in family (4.8). Agree a time-limited plan with review points.
• Overwhelm or fear after a visit, for example being told a serious harm has been cast.
  • Response: stabilise first with grounding, sleep and safety. Then treat it as acute stress. Do not interpret the healer's statement. Process it in the client's terms (4.9, 4.13).
• Non-adherence to medication "because the babka will heal it", or a refused biopsy or surgery because of nerw. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/19642/1/Stud_Podl_33_2_E_Sadanowicz_Podlasie_Whisperers.pdf]
  • Response: do not give medication advice. With consent, involve the prescriber or surgeon promptly. Explore the client's fears. Present the two forms of help as compatible if the client accepts that. Escalate when there is risk to life (4.10, 4.12).
• Rupture when the client feels judged, for example after a dismissive remark by you or another service.
  • Response: name it and apologise specifically. Use the Patient–Clinician Relationship module to explore past experiences of being looked down on. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
• Client asks you to perform, learn or recommend a specific healer or ritual.
  • Response: decline. You are not part of the tradition, healers keep their knowledge within selected people, and the church opposes it. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/7484/1/Pogranicze_32_2018_E_Sadanowicz_Szeptuchy.pdf] Help the client decide for themselves whom to consult and how to stay safe.
• Family conflict over visits (a believer grandparent and a sceptical or devout-Orthodox parent).
  • Response: hold a family meeting focused on the shared aim of the person's health. Agree that medical care continues whatever else is chosen (4.8).
• Belief that the healer, or someone through a healer, is causing harm, with anger at a named person.
  • Response: assess risk of violence and of harassment, and safeguard (4.12). Work on the underlying conflict (4.9). Assess for psychosis if the belief is idiosyncratic or spreading (4.7).
• Healing tourism and online "szeptuchy". Researchers note media interest, healing tourism and help sought online. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/19642/1/Stud_Podl_33_2_E_Sadanowicz_Podlasie_Whisperers.pdf]
  • Response: for clients from outside the region, explore expectations and costs. Watch for exploitation, such as large fees or remote "services" sold online. These are signs of commercialisation, not of the village tradition as described. [uncertain]
• Therapist over-identification or romanticising.
  • Response: take it to supervision. Remember that researchers record mixed local views: the szeptucha as wise or holy, and also as a fraud or a witch. [source: https://repozytorium.uwb.edu.pl/jspui/bitstream/11320/17220/1/BSL_24_2024_J_Kuzyka_Szeptucha_i_Natura_Od_analizy_leksykograficznej.pdf]

Sources

Tradition (Polish scholarship)

• Sadanowicz E. (2025) Podlasie Whisperers (szeptuchy) as Folk and Religious Healers, Studia Podlaskie 33(2):176–195, doi 10.15290/sp.2025.33.02.09. The journal name is inferred from the repository file name and DOI [uncertain].
• Sadanowicz E. (2018) Szeptuchy jako specyficzne zjawisko znachorskie pogranicza na Podlasiu, Pogranicze. Studia Społeczne 32:191–207, doi 10.15290/pss.2018.32.13
• Weber E. (2014) Podlasie – gdzie religia spotyka magię, Kultury wschodniosłowiańskie – Oblicza i dialog 4. The page range is [uncertain].
• Kuzyka J. (2024) Szeptucha i Natura. Od analizy leksykograficznej do opowieści…, doi 10.15290/bsl.2024.24.07. The journal is likely Białostockie Studia Literaturoznawcze [uncertain].
• Hozyasz K.K. (2025) Exploration of the Use of Traditional Healers Among Nursing Students in Podlasie, Poland, J Health Sci Altern Med 7(2):28–33 (abstract page) and full text
• Wojakowski D. (2022) Review of the doctoral thesis by E. Sadanowicz, Szeptuchy jako element specyfiki ludowej religijności prawosławia na Podlasiu, University of Białystok
• Wilk S. (2015) Szeptuchy – kobiety z Podlasia, które uzdrawiają modlitwą, BA thesis, Jagiellonian University (record only)
• Charyton M.A. (2008) is cited only as reported by Sadanowicz (2025) and Weber (2014). Its full details are [uncertain: not verified].

Cultural assessment and collaboration

• APA, DSM-5-TR Cultural Formulation Interview
• APA, DSM-5-TR Section III (Culture and Psychiatric Diagnosis)
• APA, CFI Supplementary Modules
• APA, CFI Informant Version
• Lewis-Fernández R. et al. (2017) CFI field trial, Br J Psychiatry 210(4):290–297
• DSM-5-TR webinar slides, cultural concepts of distress (UNMC BHECN)
• Dissociative and possession presentations, DSM-5 and ICD-11 (PMC9199574)
• ICD-11 6B62 Trance disorder (third-party mirror of WHO text)
• Dissociative disorders, DSM-5-TR study guide (University of Missouri System Pressbooks)
• Tanenbaum, Explanatory Models of Illness handout (Kleinman's questions)
• 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 trial, The Lancet (PubMed 32861306 abstract)
• Ofori-Atta A. et al. Joining psychiatric care and faith healing in a prayer camp in Ghana: randomised trial, Br J Psychiatry 212(1)