Italian segnature and benedicaria

1. Introduction

Version followed: segnature as Italian ethnographers have documented them in fieldwork in Emilia-Romagna, Campania and other regions (Riccò 2013; Bartolucci 2016, as reviewed by Azzaroni 2019; Magliocco's 2005–06 fieldwork; Puca 2019). Benedicaria is treated as a later label for Southern Italian and Italian-American household folk-Catholic healing, not as a governed system. The psychotherapist's own work follows the DSM-5-TR Cultural Formulation Interview (CFI) and Kleinman's explanatory-model questions.

What segnature are. In Italian, a segnatura is a healing act in which a local healer (segnatore or segnatrice) marks the affected body area with signs of the cross, together with gestures and spoken words. In the Parma district, the conditions most often brought to healers were fuoco di Sant'Antonio (herpes zoster, shingles), storte (sprains), scottature (burns) and erysipelas (locally rosipola). Healers also treated stomach and eye complaints, vermi (worms) and malocchio (the evil eye) [source: Riccò 2013, AM 35–36]. A study of Emilian practice lists fuoco di Sant'Antonio, storte, verminosi and colpo della strega (acute low-back pain) [source: Azzaroni 2019 review of Bartolucci 2016]. Healers have many regional names and are mostly women. Many describe their ability as an inborn sign or power, or as a gift handed on to them (Magliocco). Puca, writing from 2016–18 fieldwork, groups segnatori with local folk figures named janare in Campania and masche in Piedmont. She describes the tradition as alive, especially in rural areas, but secretive, and open mainly to family and community members [source: Puca 2019 abstract]. Earlier folklorists also recorded signing among a wider set of religious remedies: saints invoked for particular illnesses, holy water, blessed oil, blessings, pilgrimages and spoken formulas [source: Romeo, Gallo & Tagarelli 2015].

What benedicaria is. The word comes from the Italian root for 'blessing'. Today it names Southern Italian and Sicilian household devotion and healing (saints, the Madonna, blessings, cures for malocchio) as carried into Italian-American families. A practitioner-oriented online essay says the term spread in print and online in the later twentieth century, and that families did not historically use it for their own practice. It also says there is no founder, governing body or fixed curriculum [source: Mystic Journal essay; uncertain: not a scholarly source, origin of the term not verified]. Contemporary books present benedicaria as a living ancestral tradition, often passed between women, that mixes Catholic devotion with plant lore (e.g. Edwards, Benedicaria: The Blessing Way of Southern Italian Folk Medicine) [source: italoamericano.org listing]. Scholars note that Italian immigrants brought a magico-religious worldview to North America. Belief in the evil eye, witchcraft and magic persisted in Italian-American communities into the 1970s [source: Vecoli 1977, eHRAF abstract; Magliocco, Calandra Institute abstract]. Modern Italian-American Stregheria, shaped by Leland, Martello and Grimassi, is a Neo-Pagan reconstruction. Magliocco stresses that the cunning craft it draws on is "emphatically not a pagan religion" [source: Magliocco, Italian Cunning Craft].

What this guide is. Neither segnature nor benedicaria is a psychotherapy. A psychotherapist does not sign, bless or remove malocchio. The tradition's ways of passing on the gift, its words and its diagnostic methods are not described here, because practitioners guard them as secret [source: Puca 2019; Riccò 2013; Azzaroni 2019]. The intervention inventory below is the therapist's own culturally responsive work with clients who use, practise, inherited or fear these traditions.

How change happens. As the tradition holds it (attributed): the healer's received gift, together with the cross, the saints and the spoken words, acts on the illness. Riccò found that most patients judged the results subjectively and "non si pone troppe domande" (do not ask themselves too many questions). She treats the possible mechanisms she discusses (pharmacological, psychosomatic, parapsychological) as open questions for research [source: Riccò 2013, p. 417]. For the therapist [synthesis]: change comes from understanding the client's explanatory model (what malocchio, a burn being 'signed', or an inherited gift means to them). That understanding builds trust, lets you assess risk accurately and fit evidence-based treatment of any disorder to the client's own meanings. It also keeps folk healing in a safe place next to medical care.

2. Framework

This is not a phased therapy, and no manual exists for psychotherapy alongside segnature. The structure below is a [synthesis] built on the CFI's intended use: to support clinical understanding and decision-making, at the first evaluation, later in care or repeatedly [source: APA CFI; APA Supplementary Modules].

Who holds authority (orientation for the therapist).

Within the tradition: authority lies with the individual healer and the family or local line through which the gift passed. Traditional criteria included being a seventh child, having borne twins or being born with the caul. Riccò reports these criteria now seem to have faded. Today the gift passes at birth or baptism, through teaching on the night of 24 December from an established healer, or informally from a relative [source: Riccò 2013, pp. 405–408]. Others describe a lascito (bequest), usually between women: historically from mother-in-law to daughter-in-law, now often from grandmother to grandchild [source: Azzaroni 2019]. Magliocco names midnight Mass on Christmas Eve as a common moment for passing it on [source: Magliocco, Italian Cunning Craft]. There is no college, register or licensing body.
Payment: in Parma, none of the healers asked for money, and many described healing as voluntary service [source: Riccò 2013, p. 396]. In Emilia, small offerings in money or in kind, which Azzaroni calls symbolic, were reported [source: Azzaroni 2019]. Paid 'maghi' or occultists who sell cures are a different thing from community segnatori [synthesis].
Catholic Church: the Catechism rejects all forms of divination. It calls magic and sorcery gravely contrary to religion "even if this were for the sake of restoring their health". It states that recourse to "so-called traditional cures" does not justify invoking evil powers or exploiting others' credulity (CCC 2116–2117) [source: Catechism, vatican.va]. Many segnature use canonical prayers and the sign of the cross. Some healers use formulas with no Christian content, and Riccò places the practice between Christianity and an older substratum [source: Riccò 2013, p. 414]. Individual clergy may take different pastoral attitudes [uncertain: not verified].
Italian State: practising, without authorisation, a profession that requires a state licence is an offence (art. 348 codice penale, amended by Law 3/2018). Courts have applied this to unlicensed people who diagnosed or prescribed, including a pranotherapist whose talks with clients about psychological problems amounted to diagnosis and therapy [source: Brocardi, art. 348 c.p.].

Therapist's workflow [synthesis].

Phase A, Engagement and cultural assessment (sessions 1–2, 50–60 min, individual; family or informant optional). Goals: hear the problem in the client's own terms, using the core CFI (16 questions in four domains). Ask about healers and the Church without judgement. Screen for urgent medical needs (active shingles, burns, infection) and for risk. The DSM-5 field trial found the CFI feasible and acceptable, and later interviews took less time. The time a first CFI takes is [uncertain: not verified]. Move on when you can state the client's explanatory model in words they accept, and urgent medical issues are routed to a doctor.
Phase B, Formulation and shared plan (sessions 2–4). Goals: write a cultural formulation. Decide whether malocchio or a related belief is a normative cultural explanation, an idiom of distress, or part of a disorder. Agree on how folk healing, medical care and therapy will sit side by side. Add supplementary modules as needed. Move on when the client agrees to the plan and any liaison they want (with a GP, a priest or the family) has been consented to.
Phase C, Treatment of the presenting problem (length set by the disorder and the evidence-based treatment chosen). Goals: deliver standard treatment adapted to the client's meanings, integrate healing experiences, and work with family and inheritance themes. Revisit the CFI when new cultural material appears or progress stalls [source: APA Supplementary Modules, for repeated use].
Phase D, Consolidation and ending. Goals: relapse prevention that includes the client's own resources (faith, family, healer) where safe, and a plan for when to see a doctor versus a healer. End when treatment goals are met.

3. Guiding principles

Alongside, not inside. You work next to the tradition and never perform it. Practically, never sign, bless, 'test' for malocchio or offer to remove it, even if asked [synthesis].
Attribute, don't adjudicate. Describe malocchio, the gift and the saints' agency as the client and tradition hold them. Practically, say "in your family's understanding…", neither affirming nor debunking [synthesis].
Respect secrecy. Healers guard their words and methods, and the tradition is entered through family and community [source: Puca 2019; Azzaroni 2019]. Practically, never ask a client to recite or demonstrate a charm. Ask about meaning and effects, not wording.
Medical care first for physical illness. Segnature are often used alongside medicines, and sometimes only after medicine has failed [source: Riccò 2013, p. 397]. Practically, check that shingles, burns, sprains and infections have been seen by a doctor. Never present signing as a treatment for physical disease, and never advise on medicines; route to the prescriber [synthesis].
Avoid the 'southern superstition' stereotype. Magliocco found cunning craft more common in Emilia-Romagna than in Campania, contrary to regional stereotypes [source: Magliocco, Italian Cunning Craft]. Practically, do not assume belief from region, class or age; ask.
Avoid both pathologising and missing illness. Practically, a shared family belief in malocchio is not a delusion. Fixed, idiosyncratic, escalating fears that others in the client's community do not share need a full assessment [source: DSM-5-TR and ICD-11 cultural exclusion criteria; synthesis].
Respect the client's religious frame, which may conflict with the Church's. Practically, a devout client may feel guilt about visiting a segnatrice given CCC 2117. Explore the conflict; do not take sides [source: Catechism; synthesis].
Distinguish community healers from paid occultists. Practically, ask whether money, escalating fees or secrecy demands are involved [source: Riccò 2013; Brocardi art. 348; synthesis].
Consent for everything, including liaison. Practically, contact healers, clergy or family only with explicit, specific consent, and respect the healer's right to decline [synthesis].
Name the version. Distinguish community segnature, family benedicaria and Neo-Pagan Stregheria reconstructions, and use the client's own term [source: Magliocco].
Know your own position. Your own Catholic, secular, Italian or Italian-American background shapes your reactions. Practically, monitor amusement, nostalgia or contempt [synthesis].

4. Intervention inventory

All interventions below are the psychotherapist's own. Example language is illustrative and not taken from any source.

4.1 Cultural humility and self-examination

Purpose / when: before and during work with any client who uses segnature, benedicaria, malocchio cures or Stregheria. Your reactions (e.g. memories of a grandmother who 'signed', secular scepticism, Catholic disapproval) can leak into the work as amusement, romanticising or correction [synthesis].
Steps: (1) Before the first session, note your own family and religious relation to Italian folk Catholicism. (2) Note any stereotypes, such as 'southern', 'peasant' or 'superstitious'. Magliocco found the practice more common in Emilia-Romagna than in Campania, contrary to regional stereotypes [source: Magliocco, Italian Cunning Craft]. (3) Use supervision when you notice strong reactions. (4) In session, ask before assuming what a term means to this client.
Example language (illustrative): "Different families mean different things by malocchio. I'd rather learn what it means in yours than assume."
Watch for: the client testing whether you will laugh. Signs it's working: the client volunteers details of healer visits without hedging ("you'll think this is silly, but…").

4.2 Core Cultural Formulation Interview

Purpose / when: at intake, or whenever folk healing, malocchio or religious conflict comes up. The CFI helps clarify the problem from the perspective of the person and their social network: what it means, sources of help, and what they expect from services. It supports clinical understanding and decision-making, and is not the only basis for diagnosis [source: APA CFI].
Steps: Use APA's form; clinicians may reproduce it for their own patients [source: APA CFI]. Work through the four domains in your own words: (1) cultural definition of the problem; (2) perceived causes, stressors, supports and the role of cultural identity; (3) self-coping, past help-seeking and barriers; (4) current help-seeking preferences and the clinician–patient relationship. In domain 3, ask specifically about family remedies, saints, priests and healers. In domain 4, ask about language and dialect, and how the client feels about consulting someone outside the community.
Example language (illustrative): "Some people, when they have shingles or bad headaches, go to someone in the family or the village who 'signs' it. Has anything like that been part of how you've coped?"
Watch for: answers about healers that are short or deflecting, which may reflect the secrecy the tradition expects [source: Puca 2019] rather than dishonesty. Signs it's working: the client names their own term for the problem and their own expectations of you.

4.3 Explanatory model (Kleinman)

Purpose / when: whenever the client attributes symptoms to malocchio, envy, a curse or a spiritual cause, or explains why signing worked or failed. Kleinman, Eisenberg and Good (1978) set out eight questions, paraphrased here: 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 how long it will last; what treatment the client should receive; what problems it has caused; what the client fears most [source: Tanenbaum handout; Dinos et al. 2017]. The CFI Explanatory Model module expands this [source: APA Supplementary Modules].
Steps: (1) Use the client's word (malocchio, occhio, fattura, invidia, or a dialect term). (2) Ask who, if anyone, they think sent it, and how sure they are. (3) Ask what a healer said and did in general terms, without asking for words or methods. (4) Ask what the client thinks medicine, therapy and the healer can each do. (5) Ask what they fear most, for example harm to a child, or that the illness is a punishment (Romeo et al. note illness was historically seen as punishment for sin [source: Romeo et al. 2015]). (6) Reflect the model back and check you have it right.
Example language (illustrative): "So when the headaches started after your sister-in-law's visit, your mother felt it was the eye, and the signing helped for a while. What do you make of it yourself?"
Watch for: differences between the client's own model and their family's. A client may hold both a biomedical and a malocchio explanation; this is common and not a contradiction to resolve [synthesis]. Signs it's working: the plan uses the client's words, and the client agrees with your summary.

4.4 CFI supplementary modules

Purpose / when: for in-depth assessment, at any point in care [source: APA Supplementary Modules]. Most relevant: Spirituality, Religion, and Moral Traditions (Catholic identity, devotion to saints and Madonnas, guilt about folk practice); Cultural Identity (Italian, regional, Italian-American generation, Neo-Pagan identity); Coping and Help-Seeking; Older Adults (older relatives are often the keepers of the gift); Immigrants and Refugees (first-generation migrants); Caregivers; the Informant Version for a family member [source: APA Informant Version].
Steps: (1) Pick one or two modules matched to the gap in your formulation. (2) Tell the client why you are asking. (3) Use your own words and follow the module's structure. (4) Record the answers in the formulation, not as a separate checklist.
Example language (illustrative): "You mentioned feeling bad going to the healer because of what the priest says. Could we spend some time on what your faith means to you and where that tension sits?"
Watch for: fatigue from too many questions. Signs it's working: new information changes the plan, for example a grandmother's planned lascito turns out to be a source of stress.

4.5 Asking about healer consultation without judgement

Purpose / when: at intake and at each review. Segnature are used alongside medicine, and sometimes only after medicine has failed. Most clients treat the practice as part of their heritage [source: Riccò 2013, p. 397, p. 417]. Clients rarely mention it unless asked [synthesis].
Steps: (1) Normalise the question. (2) Ask what they used, when, how often, and whether money was involved. (3) Ask what changed afterwards. (4) Ask whether they plan to continue. (5) Record the answers neutrally. (6) Do not ask for the words or method.
Example language (illustrative): "Lots of families have someone they go to for the evil eye or for a burn. I ask everyone, because it helps me understand what's already helping you."
Watch for: a client who has delayed seeing a doctor because of the healer's reassurance (see 4.7). Signs it's working: the client tells you about later healer visits on their own.

4.6 Cultural concepts of distress: malocchio and normative belief versus disorder

Purpose / when: when malocchio, envy, curses, witch figures (janare, masche, streghe) or spirits of the dead appear in symptom accounts. DSM-5-TR cultural concepts of distress include idioms, explanations or perceived causes, and syndromes [source: APA DSM-5-TR Section III]. Malocchio does not appear in the DSM-5-TR list as given in one secondary source (ataque de nervios, dhat syndrome, hikikomori, khyâl cap, kufungisisa, maladi dyab, nervios, shenjing shuairuo, susto, taijin kyofusho) [source: UNMC slides; uncertain: not verified against APA's text]. It is best treated as a cultural explanation or perceived cause [synthesis]. Magliocco reports that spirits of the dead are believed to cause and cure illness, and that witch accusations can arise when misfortune strikes a community [source: Magliocco, Italian Cunning Craft].
Steps: (1) Establish whether the belief is shared in the client's family or community (use the Informant Version where useful). (2) Assess the form of the belief: whether it is fixed, idiosyncratic, systematised or escalating, and how far it impairs functioning. (3) Screen for anxiety, OCD (repetitive protective rituals beyond community norms), depression, somatic symptom disorder, psychosis and trauma. (4) Where trance or possession is reported (rare in this tradition) [uncertain: prevalence not verified], apply the cultural exclusions: DSM-5-TR dissociative identity disorder excludes disturbance that is a normal part of a broadly accepted cultural or religious practice [source: PMC9199574; Pressbooks study guide; exact DSM-5-TR wording uncertain]. ICD-11 6B62 trance disorder and 6B63 possession trance disorder require the state to be involuntary, unwanted and outside accepted cultural or religious practice [source: findacode ICD-11 6B62; PMC9199574]. (5) Consult a cultural broker (e.g. an Italian-speaking colleague from the same region) if unsure. (6) Document the reasoning.
Example language (illustrative): "Your aunt and your mother also see this as the eye, so I don't see the belief itself as a symptom. What worries me more is that you've stopped leaving the house because of it. Can we look at that part together?"
Watch for: missing psychosis because 'it's cultural', or diagnosing psychosis because the belief is unfamiliar to you. Look for paranoid themes aimed at a specific neighbour or relative that go beyond what the family endorses. Signs it's working: the family and the client both find your formulation fair.

4.7 Medical safety check and routing to physicians

Purpose / when: whenever the client reports signing for a physical condition (shingles, burns, sprains, erysipelas, worms, back pain) [source: Riccò 2013; Azzaroni 2019]. Healers in Parma did not oppose medicine, and patients used both [source: Riccò 2013, p. 397]. The risk is delay, not conflict [synthesis].
Steps: (1) Ask whether a doctor has seen the condition. (2) If not, encourage prompt medical review, especially for shingles near the eye, spreading redness, fever, deep or large burns, suspected fractures, or any symptom in a baby, an older adult or an immunocompromised person [synthesis; general medical prudence, not from the folk sources]. (3) Never comment on medicines; route questions to the prescriber. (4) Frame medicine and signing as compatible if that matches the client's view.
Example language (illustrative): "It's fine with me that your grandmother is signing it. Shingles can sometimes need treatment that works best early, so could you also let your GP see it this week?"
Watch for: the client hearing your advice as an attack on the healer. Signs it's working: the client gets medical review without giving up the family practice.

4.8 Collaboration and liaison with healers, clergy and family (only when the client wishes)

Purpose / when: when the client wants their healer, priest or family involved, or when the plan depends on shared understanding. In Italy there is no formal programme linking segnatori with health services [uncertain: not verified]. Healers are reluctant to discuss their practice, and some refuse to talk about malocchio at all [source: Puca 2019; Riccò 2013, p. 405]. Evidence for collaboration comes from other settings. In COSIMPO (Gureje et al., The Lancet 2020), a cluster trial in Nigeria and Ghana, collaborative shared care between traditional and faith healers and primary-care workers gave a greater reduction in psychosis symptoms and fewer harmful practices than usual care [source: PubAnnotation PubMed 32861306; Centre for Global Mental Health]. In a prayer-camp trial in Ghana (Ofori-Atta et al., Br J Psychiatry 212(1)), adding psychiatric care to faith healing reduced symptoms, but days in chains were not significantly reduced [source: APHRC repository]. These findings come from different traditions and only support the general principle of respectful collaboration [synthesis].
Steps: (1) Get specific written consent: who, what may be shared, and for what purpose. (2) Let the client make the first contact. (3) Keep the aim narrow, e.g. agreeing that the client will also see a doctor, or that a family ritual will not replace therapy for depression. (4) Do not ask the healer to explain or demonstrate the method. (5) Accept a refusal. (6) With clergy, keep to pastoral support and the client's stated wishes. (7) Document the contact.
Example language (illustrative): "If it would help, you could tell your aunt that you're also seeing me for the panic attacks. You don't have to, and I won't contact her unless you want me to."
Watch for: pressure from family to choose one system, or a healer who discourages medical care (rare in the documented community practice [source: Riccò 2013]; more likely with paid occultists [synthesis]). Signs it's working: care stays coordinated and the client feels no split loyalty.

4.9 Integrating healing experiences and using the tradition as a coping resource

Purpose / when: when a segnatura, a blessing or devotion to a saint brought relief, meaning or connection to family. Romeo et al. suggest these remedies may support coping and symbolic meaning today, while noting that evidence of direct health benefit is limited [source: Romeo et al. 2015].
Steps: (1) Invite the client to describe the experience and what it meant: being cared for, connection to a grandmother, hope. (2) Link these meanings to therapy goals. (3) Where the client wishes, include faith and family practices as coping strategies in the plan, without prescribing them. (4) If the healing 'didn't work', explore what that meant for the client, for example fear of a stronger curse or loss of faith.
Example language (illustrative): "When your nonna signed the burn, what did that feel like, being looked after like that? Where else in your life do you get that feeling now?"
Watch for: relying on the ritual to manage anxiety in a way that keeps avoidance going (synthesis). Signs it's working: the client draws on family and faith resources flexibly.

4.10 Working with the client who is, or is expected to become, a healer

Purpose / when: when a client has received or is due to receive the gift (lascito, teaching on 24 December, or a gift recognised at birth or baptism) [source: Riccò 2013, pp. 405–408; Azzaroni 2019]. Azzaroni reads women's healing role partly as a way of overcoming hard past circumstances and claiming a gift [source: Azzaroni 2019]. Inheritance can bring pride, obligation, secrecy or conflict with Church or partner [synthesis].
Steps: (1) Ask what the role means to the client and their family. (2) Explore any ambivalence (wanting the bond with the grandmother but not the role, or fear of 'losing' the gift). (3) Explore confidentiality burdens, since secrecy is expected [source: Puca 2019]. (4) Help the client keep boundaries if neighbours seek them out at night (sessions are often held after dinner [source: Azzaroni 2019]). (5) Support grief when the person who passed on the gift dies.
Example language (illustrative): "It sounds like taking this on from your grandmother would keep her close, and also feels heavy. Can we make room for both?"
Watch for: burnout or guilt about refusing people. Signs it's working: the client makes their own choice about the role.

4.11 Families, migration and intergenerational transmission (benedicaria context)

Purpose / when: with Italian-American or other diaspora clients whose families keep household blessings, saints' devotions or malocchio practices. Italian immigrants brought these practices to North America, and evil-eye and witchcraft beliefs persisted into the 1970s [source: Vecoli 1977; Calandra Institute abstract]. By the 1960s the practices were largely detached from their original context, and later generations sometimes reinterpreted them as witchcraft or Stregheria [source: Magliocco, Italian Cunning Craft].
Steps: (1) Map who in the family practises or believes, across generations. (2) Explore intergenerational conflict (a parent dismissing it, a grandparent insisting on it, a young adult reclaiming it as heritage or as Neo-Pagan identity). (3) Explore experiences of anti-Italian prejudice or shame about 'old country' ways, if the client raises them. (4) Use the CFI Cultural Identity and Older Adults modules.
Example language (illustrative): "Your grandmother calls it the eye, your father calls it nonsense, and you've been reading about Stregheria. Where do you feel you fit in that?"
Watch for: treating Neo-Pagan reconstruction and family practice as the same thing. Name the difference respectfully [source: Magliocco]. Signs it's working: the client can hold their own version without needing the family to agree.

4.12 Language, dialect and cultural brokers

Purpose / when: when the client's terms come from a regional dialect, or when older family members speak mainly Italian or dialect. Ethnographers record many regional names for healers and illnesses [source: Magliocco; Azzaroni 2019].
Steps: (1) Ask the client to teach you their terms and write them down. (2) Use professional interpreters, not grandchildren, for older relatives. (3) Brief the interpreter not to translate disparagingly. (4) Where helpful, consult a colleague who knows the region, with the client's consent.
Example language (illustrative): "What's the word your family uses for it? I'd like to use the same one."
Watch for: the interpreter's own religious or class attitudes. Signs it's working: the client corrects you freely.

4.13 Safeguarding, exploitation and physical contact

Purpose / when: when there are signs of financial exploitation, coercion, delayed medical care, involvement of children, or unwanted touch. Documented community segnatori in Parma did not ask for money [source: Riccò 2013, p. 396]. Practitioners who charge for cures, diagnose or prescribe without a licence may commit an offence in Italy (art. 348 c.p.), and courts have included advice on psychological problems [source: Brocardi, art. 348 c.p.]. Signing involves close physical contact [source: Magliocco, Italian Cunning Craft].
Steps: (1) Ask about money, escalating fees, threats ('the curse will get worse'), secrecy demands, and isolation from family or doctors. (2) Ask whether any touch was unwanted, intimate or sexual; touch in any healing practice needs explicit consent before and during, the right to stop, and is never sexual [synthesis]. (3) For children, check that medical care is not being delayed and that no frightening or harmful practices are used; follow local child-protection procedures [synthesis]. (4) For older or cognitively impaired clients, consider financial abuse procedures. (5) Help the client report fraud or abuse to the police or relevant authority where they wish or where the law requires; get legal advice for your jurisdiction [synthesis].
Example language (illustrative): "Some people who sell cures for the evil eye ask for more and more money and say things will get worse if you stop. Has anything like that happened?"
Watch for: shame that silences disclosure. Signs it's working: the client can separate a trusted family healer from someone exploiting them.

5. Handling problems

The folk sources do not address psychotherapy, so all guidance in this section is [synthesis] unless a source is tagged.

The client won't talk about the healer. Secrecy is part of the tradition [source: Puca 2019; Riccò 2013, p. 405]. Say clearly that you will never ask for words or methods, only what it means and whether it helped. "You don't have to tell me anything that's meant to stay in the family. I'm only interested in how it's affected you."
The client asks you to confirm or deny malocchio. Don't do either. Reflect the question back and explore why it matters now (e.g. it would mean someone envies them). "I can't tell you whether it's the eye. I can help with the fear and the sleeplessness, whatever the cause."
The client asks you to refer them to a healer, or asks whether to go. Do not refer to individual healers or recommend going. The tradition is reached through family and community [source: Puca 2019]. Explore the client's reasons and help them decide within their own family and faith. If they decide to go, check for medical cover and any exploitation risk (4.13).
Conflict between Church teaching and folk practice. A devout client may feel guilt given CCC 2117 [source: Catechism]. Explore the conflict without taking sides, and suggest the client speak with a priest they trust if they wish. Do not quote doctrine at them.
Delayed medical care. If signing is used instead of medical review for shingles near the eye, spreading infection, serious burns or symptoms in a child, be direct about the risk and keep the alliance: "I'm not asking you to stop; I'm asking you to add the doctor." Escalate under safeguarding duties for children or adults at risk.
Belief intensifying into suspected psychosis or OCD. Signs include new, idiosyncratic or escalating beliefs the family does not share, hostility toward a specific neighbour, or hours of protective rituals. Do a full assessment, seek psychiatric consultation, and use the Informant Version with family [source: APA Informant Version]. Keep the cultural explanation in the formulation; don't strip it out.
Overwhelm or fear of a curse after a 'failed' signing. Ground the client, assess risk (including suicide risk, using standard practice), and treat anxiety in the usual way. Explore the meaning of failure, such as fear of a stronger curse or loss of the protective figure.
Rupture from a perceived sneer. If the client reads amusement or disbelief in you, name it and repair: "I think I came across as dismissive just now. That's not how I see your family's ways. Can we go back?"
Family pressure to choose. Help the client define what each source of help is for (doctor for the body, therapist for anxiety, family healer for protection and belonging, priest for faith) without ranking them, unless there is a safety issue.
Paid occultists or online 'healers'. Healers and patients now also connect online [source: Azzaroni 2019]. Watch for escalating payments, threats and isolation. Use 4.13, and support reporting where the client wishes or the law requires (art. 348 c.p. in Italy; local fraud and consumer law elsewhere [uncertain: jurisdiction-specific]).
Neo-Pagan versus family-tradition disputes. A client reclaiming Stregheria may meet ridicule from Catholic relatives, or a client may feel their family practice has been taken over by others. Name the versions neutrally [source: Magliocco] and work on the relationships, not on which version is authentic.
The therapist's own heritage overlaps with the client's. Watch for over-identification, nostalgia or shared contempt. Use supervision.
Non-adherence to evidence-based treatment because 'the healer is handling it'. Explore the client's explanatory model again (4.3) and agree complementary roles. Do not frame it as a choice between the two.

Sources

Web sources:

Books and articles cited:

Bartolucci A. (2016) Le streghe buone. I simboli, i gesti, le parole. Come muta la medicina tradizionale nell'era di Internet. Correggio: Alibert (cited through Azzaroni's 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.
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