Talismans and exorcism (Zhengyi)

1. Introduction

Version followed: the Zhengyi (正一, "Orthodox Unity") talisman-and-register (符籙 fulu) tradition as described in the Daoinfo reference entry on registers, Lee Fong-mao and Chang Chih-hsiung's study of Zhengyi talisman methods (Tsing Hua Journal of Chinese Studies, 2010), Zhang Guangbao's history of Longhushan authority (2022), and Chang Hsun's ethnography of the jijie (祭解) rite at Baoan Temple, Taipei (2010). The therapist's work alongside it follows the DSM-5 Cultural Formulation Interview (CFI) and its supplementary modules, UK local safeguarding procedures on child abuse linked to faith or belief, IOCDF guidance on religious OCD, and two clinical case reports on talisman-related lead poisoning.

This is a religious observance, not a therapy. It is not a technique for the therapist to perform, and this guide gives no ritual procedure.

• What the tradition holds. In Zhengyi Daoism, a register (籙 lu) is a book of talismans. It lists the names of spirit officers, generals and soldiers together with their talismans, diagrams and images. The tradition holds that registers are condensations of the vital breath of nature, transmitted by divine persons. A register lets its holder call on and command the spirit officers listed in it, to protect the body or to carry out ritual skills. It also binds the holder to the school's commandments. Registers are conferred in a grand ritual, after which recipients hold the qualification of a ritual master, under the authority of the Celestial Master (天師 Tianshi) lineage of Longhushan (龍虎山, Dragon and Tiger Mountain) in Jiangxi. [source: Daoinfo, Registers]
• Talismans. Talismans (符 fu) are written in black or red ink on coloured paper. They carry figurative signs and formal symbols such as constellations, the five phases and the eight trigrams. The tradition describes them as manifestations of cosmic energies, representations of a deity, or orders issued by a deity: in effect contracts that give the priest authority over spirits. Lee and Chang group their functions into summoning, hearing (petition), exorcism and subduing. Before summoning deities, the adept observes precepts and prohibitions and meditates with concentration. [source: Lee & Chang 2010, abstract]
• Exorcism and healing rites. At Baoan Temple in Taipei, a Daoist master performs the jijie rite, described as an exorcistic, luck-repairing healing ritual. It is often sought for illness that has not responded to biomedical treatment. Its account of illness rests on three ideas: the person's horoscope, malign "spirit killers" (煞 sha), and death pollution. Chang identifies two ways it works for participants: it evokes repentance, and it transfers the illness to a paper substitute body. He frames the rite as complementary or alternative to biomedicine, not a replacement for it. [source: Chang 2010]

Core idea of change. In the tradition's own terms, an authorised priest, acting through the register and its spirit officers, expels or subdues malign influences and restores protection and fortune. These are the tradition's concepts, described here without endorsement or dismissal. Psychotherapy does not use the rite as a technique. The therapist's job is to understand what the rite means in the client's life, keep the client and any child safe, route health questions to the doctor, and work with the fear, guilt, grief or compulsive help-seeking that may surround it. [synthesis]

No practice described here is a treatment for physical disease. The tradition's healing claims are attributed to it. Clinical evidence that the rites treat disease is absent, and two published case reports document harm (lead poisoning) from swallowing preparations made from talismans (see 4.5). [source: Ye et al. 2013; Chan et al. 2014]

2. Framework

Who leads or authorises the rite.

• Historically. From the Southern Song onward, the Longhushan Celestial Master held the right to issue talismans and registers. In 1391 the Ming founder's edict banned private issuing of talismans. Talismans had to carry the seal of the Zhengyi altar at Longhushan, and an earlier Song court case penalised a relative of the Celestial Master for issuing talismans without authority. The edict was aimed at sellers "惑民取财" (deceiving the people to take their money). [source: Zhang 2022]
• Today, mainland China. Daoist clergy are required to register with the state-supervised Chinese Taoist Association, which launched a searchable database of official practitioners in February 2023. [uncertain: secondary, unverified] Current Zhengyi ordination rules and how they are applied are [uncertain: not verified].
• Today, Taiwan and the diaspora. A Taiwan-based lineage claims the Celestial Master title. [uncertain: secondary, unverified] Temple-based Daoist masters perform rites such as jijie. [source: Chang 2010]
• Other figures. Spirit mediums (童乩 tâng-ki), fortune-telling shops and other folk practitioners also issue talismans or rites. They are not Zhengyi priests. Clients may not draw the distinction, so ask who the practitioner was. [source: Tseng 1972, via citing summaries; Ye et al. 2013] [synthesis]

The therapist's work alongside the rite. The sources give no session counts or formats for this work. The phases below are a working structure. [synthesis]

Safety concerns that emerge at any phase take priority and return the work to phase B. [synthesis]

3. Guiding principles

• Attribute; do not endorse or dismiss. In practice: "In your tradition, the talisman protects you by…", never "it works" or "that's superstition". [synthesis]
• Client-led integration. Religious material enters therapy only as far as the client wants. In practice: ask before discussing the rite, and follow the client's language (fu, jijie, sha). [synthesis]
• The therapist is not a priest. Ritual authority belongs to authorised clergy [source: Daoinfo; Zhang 2022]. In practice: never write, interpret, prescribe, remove or bless talismans, and never advise on the ritual.
• Children's safety comes first. Beliefs are genuine and must be taken into account, but they must not be used to explain away risk to a child. In practice: follow the local safeguarding procedure, regardless of how sincere the family is. [source: Oxfordshire procedure; West Midlands procedure]
• Health questions go to the doctor. Swallowed talisman preparations have caused lead poisoning. In practice: ask about anything taken by mouth or applied to the skin, and pass it to the doctor. Give no advice on remedies or medicines. [source: Ye et al. 2013; Chan et al. 2014]
• Complementary, not instead. Participants often seek rites when biomedicine has not helped [source: Chang 2010]. In practice: support continued medical care alongside religious help.
• Separate values-based practice from fear-driven compulsion. Healthy religious practice grows from values. OCD is ego-dystonic and driven by fear. [source: IOCDF] In practice: notice repeated rites, talismans or reassurance that never settle the fear.
• Watch for exploitation without suspecting faith itself. Historical regulation targeted sellers who deceived people for money [source: Zhang 2022]. In practice: ask about fees, pressure and threats while respecting legitimate clergy.
• Cultural humility. In practice: ask the client to teach you, and check your understanding with the CFI. [source: CFI modules] [synthesis]
• Clear roles and limits on self-disclosure. In practice: keep your own beliefs out of the room unless disclosure clearly serves the client, and avoid dual relationships with the client's temple. [synthesis]

4. Intervention inventory

Every item below is the psychotherapist's own work alongside the observance. None of it is ritual. Example language is illustrative unless quoted and cited.

4.1 Understanding the meaning of the talisman or rite in the client's life

• Purpose: to learn what the talisman, the register or the exorcism means to this client and their family. It may be protection, repair of fortune, an explanation for illness, family duty, or a source of fear. Use it whenever a client mentions fu, temple rites, being "hit by sha", death pollution or possession. [synthesis, drawing on Chang 2010 for the concepts]
• Steps:
  1. Ask permission to talk about it.
  2. Ask what happened, who performed or issued it (priest, temple, medium, fortune-teller), and why.
  3. Ask what the client believes caused the problem. Chang reports three common explanations: the person's horoscope, malign sha, and death pollution.
  4. Ask what the rite was meant to change, and what the client felt during and after it.
  5. Ask how family members see it, and whether anyone disagrees.
  6. Reflect back in the client's own words, then check your summary with them.
  7. Note any strengths (hope, community, a sense of being cared for) and any burdens (fear, cost, conflict).
• Example language (illustrative): "You mentioned the talisman from the temple. Would it help to tell me what it means for you?" / "When the master said sha was involved, what did that mean to you and your family?"
• Watch for: the client relaxing and adding detail is a good sign. Guarded, brief answers may mean the client expects ridicule. Slow down and affirm that you are asking in order to understand. Fear that rises while talking may be a sign of scrupulosity or a curse-related anxiety (see 4.8).

4.2 Cultural Formulation Interview, with its spirituality, religion and moral traditions module

• Purpose: to structure the cultural assessment. Use it at intake, or when religious explanations shape symptoms, help-seeking or adherence. [source: APA CFI supplementary modules]
• Steps:
  1. Use the CFI core interview, which is freely reproducible for clinical use.
  2. Add the Spirituality, Religion, and Moral Traditions module (16 questions). Its four areas are the client's spiritual identity and affiliations, the role of the tradition in daily and family life, how it relates to the problem (coping, contact with leaders, texts, practices), and the stresses it brings (distress, discrimination, conflict).
  3. Add the Explanatory Model module (14 questions): how the client understands the problem, its causes, its likely course and what treatment they expect.
  4. Add the Coping and Help-Seeking module (13 questions), which covers self-directed spiritual practices, religious communities and other healers. Ask here about temples, mediums and fortune-tellers, and about anything swallowed or applied.
  5. Record the client's own terms.
  6. Write a cultural formulation and share it with the client.
• Example language (illustrative): "Some people find help in their religion or at a temple, and some find stress there too. How has it been for you?" / "What do you think caused this, and what do your family think?"
• Watch for: differences between the client's view and the family's. They matter, especially when a child or a vulnerable adult is the focus of the rite. Paraphrase the module's questions; do not read them out mechanically. [source: APA CFI supplementary modules] [synthesis]

4.3 Mapping the practitioner, authority and cost

• Purpose: to understand who is providing the rite, what authority they hold, and what it costs the client, without judging legitimate clergy. Use it when rites are repeated, costly or frightening. [synthesis; historical background in Zhang 2022]
• Steps:
  1. Ask whether the provider is a Daoist priest at a temple, a household priest, a spirit medium or a fortune-telling shop. Registers and talisman authority have historically been tied to the Celestial Master lineage and its seal [source: Daoinfo; Zhang 2022]. Do not try to decide whether a priest is legitimate. That is a question for the tradition.
  2. Ask about fees, repeat visits, and any warnings of harm if the client stops.
  3. Ask whether anything was given to take by mouth, burn at home or apply to the skin. If so, go to 4.5.
  4. Ask whether children are involved. If so, go to 4.6.
• Example language (illustrative): "Who did the rite, and how did you come to them?" / "Has anyone told you something bad will happen if you stop?"
• Watch for: escalating fees, threats, secrecy, isolation from family or doctors, and pressure to stop medical treatment. These suggest exploitation or coercion (see 4.12).

4.4 Accommodation in scheduling and treatment

• Purpose: to fit therapy around the client's religious life. Use it when festival dates, rites, auspicious days or temple visits clash with appointments, or when the client wants to keep a talisman with them. [synthesis]
• Steps:
  1. Ask which dates and rites matter to the client.
  2. Offer flexible scheduling around them.
  3. Let the client wear or carry a talisman in session. Do not handle it, comment on its contents or ask to see it unless the client offers.
  4. If an exposure task (see 4.8) would involve the talisman, plan it only with the client's consent and, where the client wishes, with their religious authority.
  5. Document the accommodations you agree.
• Example language (illustrative): "Are there dates in the coming months when you'll be at the temple, so we can plan around them?"
• Watch for: accommodation that the client experiences as respectful is a good sign. If talismans or rites start to replace the agreed treatment because of fear, rather than sitting alongside it, review this with the client.

4.5 Health issues: swallowed talisman preparations, delayed care and coordination with the doctor

• Purpose: to identify physical risks linked to the practice and route them to the doctor. Use it whenever a client or family member has swallowed or applied talisman-derived material, or has delayed medical care in favour of rites.
• What the clinical literature reports:
  • Ye et al. (2013): an adolescent developed lead poisoning with acute hepatitis and anaemia after swallowing a preparation made from talismans, given by a parent on a fortune-telling shop's advice. The red ink on the talismans contained lead, mercury and cadmium. The diagnosis was delayed because exposure was not explored at first. The authors call for thorough exposure histories. [source: Ye et al. 2013]
  • Chan et al. (2014): a woman's markedly raised blood lead was traced to talismans from a religious practitioner. The authors suspected red lead had been substituted for cinnabar. They advise clinicians to take a detailed history of religious and home remedies when blood lead is unexplained. [source: Chan et al. 2014]
• Steps:
  1. Ask neutrally whether anything from a rite has been taken by mouth, put in drinks or put on the skin, by the client or by anyone in the household.
  2. If yes, do not advise on continuing or stopping. Encourage the client to tell their doctor, and with consent contact the doctor yourself.
  3. If a child has been given such material, treat it as a safeguarding and health concern (see 4.6).
  4. Ask whether rites have replaced medical treatment. Support continued medical care alongside religious help, which is how Chang frames the rite [source: Chang 2010].
  5. Document what you were told and the referral you made.
• Example language (illustrative): "Sometimes rites include something to drink or put on the skin. Has anything like that been part of yours? I ask because doctors like to know about everything people take."
• Watch for: vague answers, concealment for fear of disapproval, or physical symptoms such as abdominal pain, weakness or fatigue. Do not interpret symptoms yourself; route them to the doctor. This guide gives no information on how such preparations are made or taken. [synthesis]

4.6 Child safeguarding where children are involved in exorcism or talisman rites

• Purpose: to protect children, following safeguarding bodies' guidance. Use it whenever a child is the subject of an exorcism, is seen as possessed or as bringing bad fortune, or is given talisman-derived material. [source: Oxfordshire procedure; West Midlands procedure]
• What the safeguarding procedures say (UK local safeguarding children procedures, which refer to the 2012 National Action Plan to Tackle Child Abuse Linked to Faith or Belief):
  • Abuse can arise in attempts to exorcise or "deliver" a child believed to be possessed or to be harming others through evil forces. The beliefs may be sincerely held and occur across cultures and religions. The procedures name no Daoist cases. Their principles apply across traditions. [source: West Midlands procedure; Oxfordshire procedure]
  • Forms of abuse listed: beating, burning, cutting; starvation or "fasting"; neglect relative to siblings; isolation; restraint; and forced ingestion of unchecked drinks or substances. [source: West Midlands procedure]
  • Children at higher risk are those seen as "different": through disability, illness, bed-wetting, nightmares or disobedience; children blamed for family misfortune; and children in families under stress or with complex structures. Concerns usually involve children aged roughly 2 to 14. [source: Oxfordshire procedure]
  • Indicators: distress or withdrawal, scapegoating, unexplained injuries or restraint marks, poorer care than siblings. [source: West Midlands procedure; Oxfordshire procedure]
  • Professional actions: refer to children's social care. A full health assessment of the child is needed. Statutory agencies see and speak to the child alone and assess siblings. Any talk of taking the child abroad must be taken seriously, with legal advice. Do not let a parent's mental health problems explain away the risk. The family's faith community may be considered in the assessment. [source: West Midlands procedure; Oxfordshire procedure]
• Steps for the therapist:
  1. If a child's safety is in question, follow your local safeguarding procedure and consult your safeguarding lead.
  2. Do not investigate yourself, confront the family in ways that could raise the risk, or promise confidentiality.
  3. Record exactly what you were told, and when.
  4. Explain the limits of confidentiality to adult clients at the start of therapy.
  5. Consent and assent: a child's agreement to a rite, or the parents' consent, does not make harmful practices acceptable. In therapy, seek the child's assent in age-appropriate language alongside parental consent, and hear the child's view separately where that is appropriate. [synthesis]
  6. Where no harm is present (for example, a protective talisman worn by a child), respect the family's practice and do not over-refer. [synthesis]
• Example language (illustrative): to a parent: "I can see how worried you are about your son and how much you want to protect him. When a child is given something to swallow, or is restrained or kept from food during a rite, I have to involve the people whose job is children's safety. I'd like to do that with you."
• Watch for: a child described as the cause of the family's misfortune, a child kept from school or doctors, and hints at a planned trip abroad for a rite. Any one of these should prompt consultation.

4.7 Possession and affliction explanations: assessing without pathologising or missing illness

• Purpose: to respect the client's account of spirit affliction while recognising mental or physical illness that needs treatment. Use it when the client or family describes possession, sha, ghosts or curses. [synthesis]
• Background: in Taiwanese folk religion, spirit mediums enter trance and serve clients, often families of sick children. Folk frameworks may see mental illness as fate set by higher powers, which can shape how families accept and care for an ill relative. [source: Tseng 1972, as summarised in citing works] [uncertain: full text not verified]
• Steps:
  1. Take the religious account seriously as the client's meaning (4.1).
  2. Separately, assess for psychosis, mania, depression, dissociation, substance effects and medical causes (including the exposures in 4.5), using your usual methods.
  3. Ask whether the experiences fit what the community regards as normal, for example trance in a culturally sanctioned ritual, or whether family and community also see them as unusual or harmful.
  4. Note the DSM-5-TR category Religious or Spiritual Problem (Z65.8) when distress concerns faith rather than a disorder. [source: ICD-10-CM Z65.8]
  5. Where a disorder is present, discuss treatment within the client's framework ("both the temple and the doctor").
• Example language (illustrative): "Your family see this as sha, and I want to respect that. I also want to make sure nothing medical is being missed, so I'd like to ask some health questions too."
• Watch for: command voices, loss of contact with reality, dangerous behaviour, or harm to self or others. Follow standard risk procedures. Distress that eases once the person feels understood points more towards a religious or cultural problem than a disorder, but keep reviewing.

4.8 Scrupulosity and fear-driven ritual seeking (curse- or sha-focused OCD)

• Purpose: to identify and treat OCD in which talismans, rites or repeated reassurance become compulsions. Use it when the client repeatedly seeks rites, checks talismans or fears contamination by death pollution in a way that never settles. [source: IOCDF, general principles] [synthesis for the Daoist application]
• What IOCDF states: OCD can target what matters most, including faith. Compulsions may mimic religious behaviour. Healthy practice is ego-syntonic and values-led, whereas OCD is ego-dystonic and fear-driven. ERP is first-line for all OCD subtypes, including scrupulosity. Accepting uncertainty is presented as compatible with faith. Some clinicians work with clergy to understand the tradition. IOCDF's page does not address Chinese or Daoist traditions. [source: IOCDF]
• Steps:
  1. Assess OCD with your usual standardised tools.
  2. With the client, sort the practices into those their tradition expects and those driven by fear (extra rites, repeated checking, reassurance-seeking from priests or family).
  3. With consent, ask the client's priest or temple what ordinary practice looks like, so that exposures never ask the client to break genuine religious obligations.
  4. Build a graded ERP hierarchy that targets the compulsions, not the faith. Agree each step, explain the rationale, and allow the client to stop. Any exposure involving religious objects needs explicit consent and, if the client wishes, their religious authority's view.
  5. Include response prevention for reassurance-seeking.
• Example language (illustrative): "Your faith is yours, and we won't touch it. What we'll work on is the fear that makes you go back again and again, even when your tradition wouldn't ask that of you."
• Watch for: working signs are a falling frequency of extra rites, tolerance of uncertainty and a return to valued practice. Contraindications and cautions: acute psychosis, severe depression with suicide risk, and situations where exposure would cause serious conflict with family or community without the client's agreement. [synthesis]

4.9 Repentance, guilt and moral injury

• Purpose: to work with guilt. Chang identifies repentance as one way the jijie rite works for participants, so guilt may already be in play. Use it when the client believes their own or their family's wrongdoing caused illness or misfortune. [source: Chang 2010] [synthesis]
• Steps:
  1. Explore what the client feels responsible for.
  2. Separate realistic responsibility from inflated self-blame.
  3. Explore repair the client values, which may be religious, relational or practical.
  4. Where guilt concerns harm the client did or failed to prevent, consider moral injury approaches.
  5. Respect the rite's role in repentance and work with it, without competing.
• Example language (illustrative): "It sounds like part of you believes this happened because of something you did. Can we look at that together?"
• Watch for: guilt that persists despite rites and repair suggests depression or scrupulosity (4.8). Risk assessment is needed where guilt is severe.

4.10 Grief, death pollution and community support

• Purpose: to support bereavement where beliefs about death pollution, ancestors or spirits shape grieving. Use it after a death, especially when the client fears pollution or troubled spirits. [source: Chang 2010 for the death-pollution concept] [synthesis]
• Steps:
  1. Ask which rites the family has held or plans to hold, and what they mean.
  2. Support participation in them.
  3. Explore the client's own grief, including fear and anger, separately from ritual duties.
  4. Identify community and temple supports.
  5. Watch for prolonged grief or fear-driven ritual that does not bring relief.
• Example language (illustrative): "The rites are for your father and your family. I'd also like to make room here for how you are doing."
• Watch for: community support that comforts is a good sign. Isolation, blame or financial strain from repeated rites are warning signs.

4.11 Collaboration with priests, temples and chaplains when the client wishes

• Purpose: to coordinate care with religious authorities. Use it when the client asks for it, or when ERP or treatment planning needs clarity on religious norms. [source: IOCDF on working with clergy] [synthesis]
• Steps:
  1. Get explicit, written consent, with a clear scope for what may be shared.
  2. Agree the questions in advance, for example what normal practice looks like and whether any obligations clash with treatment.
  3. Share only what is needed.
  4. Respect the priest's authority over ritual. The therapist keeps authority over clinical decisions.
  5. Feed the outcome back to the client.
  6. If the client prefers no contact, respect that.
• Example language (illustrative): "Would it help if I spoke with the master at your temple about what ordinary practice looks like, so our plan fits with your faith? You'd decide what I can share."
• Watch for: a priest who supports medical care is an ally. If any religious provider discourages medical or mental health care for a child, return to 4.6.

4.12 Recognising exploitation and coercion

• Purpose: to notice financial exploitation, threats or coercive control by any provider, without casting suspicion on legitimate clergy. The historical ban on unauthorised talisman sellers targeted those who deceived people for money [source: Zhang 2022]. The present-day guidance below is [synthesis].
• Steps:
  1. Ask about costs, debts and the frequency of rites.
  2. Ask about threats of supernatural harm for stopping, demands for secrecy, isolation from family or doctors, and sexual or other boundary violations.
  3. Help the client weigh options at their own pace.
  4. Where crimes or risks to others are disclosed, follow legal and safeguarding duties.
  5. Support the client if they decide to leave a provider. Fear of curses may then rise, so work on it (4.8).
• Example language (illustrative): "You've spent a lot and still feel afraid. Is there anyone who could help you think about whether this provider is right for you, perhaps someone else in your tradition?"
• Watch for: escalating dependence and secrecy are warning signs. Choices made freely, including staying with a trusted temple, are a good outcome.

4.13 Role clarity, self-disclosure and dual relationships

• Purpose: to keep the therapist's role distinct from religious roles. [synthesis]
• Steps:
  1. State your role: you are not a priest, medium or fortune-teller.
  2. Decline requests to judge whether a rite "worked" or whether a priest is genuine.
  3. Avoid social or business ties with the client's temple.
  4. Disclose your own beliefs only when it clearly serves the client.
  5. Seek supervision or cultural consultation when unsure.
• Example language (illustrative): "I can't tell you whether the rite worked in a religious sense. That's for your tradition. What I can help with is how you are coping."
• Watch for: a client who keeps pressing you for a religious verdict may be seeking reassurance (4.8).

5. Handling problems

The sources cited do not address most of these difficulties directly. Guidance is [synthesis] unless a source is tagged.

• The client expects ridicule and minimises the rite. Normalise it: many people use both temple and clinic, and Chang describes rites sought alongside biomedicine [source: Chang 2010]. Use CFI wording (4.2). Do not push. Return to the topic later.
• The client asks you to judge whether the talisman or exorcism is real or worked. Decline kindly and point to the priest's authority. Then explore what the answer would mean to them; it may be a reassurance-seeking loop (4.8, 4.13).
• The family insists the problem is spiritual and refuses medical assessment for a child. Acknowledge their beliefs. Explain that you have a duty to ensure the child's health is checked. Consult your safeguarding lead and follow the procedure. Safeguarding procedures state that beliefs must not override the child's welfare [source: Oxfordshire procedure; West Midlands procedure].
• A client discloses that talisman material is being swallowed. Make no comment on the practice's religious value. Make a prompt, consented link with the doctor, citing the lead-poisoning reports where helpful [source: Ye et al. 2013; Chan et al. 2014]. If a child is involved, go to 4.6.
• Overwhelm or panic about curses or sha during sessions. Slow down, ground the client in the present, and reduce the intensity of the topic. Agree a pace the client controls. Assess whether this is OCD (4.8), trauma, or an acute risk.
• Non-adherence to ERP because exposures feel sacrilegious. Re-check that every exposure targets compulsions, not core practice. With consent, seek the religious authority's view. Revise the hierarchy; drop a step rather than override the client's conscience [source: IOCDF on collaboration with clergy, general].
• Rupture after you raise safeguarding or exploitation. Name it, and acknowledge the client's anger or fear. Restate your concern for them and their family. Be transparent about next steps. Keep offering the relationship.
• The client stops rites, then fears retribution. Validate the fear and treat it as anxiety, using exposure to uncertainty if OCD is present. Support access to a trusted religious figure if the client wishes.
• The client is stuck: repeated rites and repeated therapy, with no change. Review the formulation. Consider a missed medical cause (4.5, 4.7), depression, trauma or untreated OCD. Ask what the client most hopes for, and whether family pressure keeps the cycle going.
• Interpreters and community dynamics. Where needed, use a professional interpreter rather than relatives, and check that they are comfortable with religious terms. Respect the client's wish for confidentiality from their community.
• The therapist's own reactions (discomfort, fascination, scepticism). Take them to supervision. Do not let curiosity about the rite drive the session.
• The client is a ritual practitioner themself (priest, medium) seeking therapy. Respect their role. Address their distress, burnout or conflicts within their tradition. Do not use them as a cultural informant for your own learning.

Sources

• Registers – Daoinfo (English Daoist encyclopedia)
• Talismans and Symbols (書符與符號：正一符法的圖像及其象徵) – Lee Fong-mao & Chang Chih-hsiung, Tsing Hua Journal of Chinese Studies, n.s. 40(3), 2010, abstract page
• 正一真人统领下的龙虎山道教与明代官道 – Zhang Guangbao, Chinese Social Sciences Net, 2022 (originally in 《世界宗教文化》)
• Taoist Healing Ritual in Contemporary Taiwan: An Exorcism in Baoan Temple, Taipei – Chang Hsun, Journal of Sinological Studies 1(1), 2010
• Psychiatric Study of Shamanism in Taiwan – Tseng, 1972 (citation summary page) [uncertain: full text not verified]
• DSM-5 Cultural Formulation Interview Supplementary Modules – American Psychiatric Association
• Child Abuse linked to Faith or Belief – West Midlands (Coventry) safeguarding children procedures
• Child Abuse Linked to Spiritual and Religious Beliefs – Oxfordshire safeguarding children procedures manual
• A Case of Lead Poisoning due to a Mixture of Talisman Ash – Ye et al., Annals of Occupational and Environmental Medicine 25:37, 2013
• Chinese talismans as a source of lead exposure – Chan, Ching, Lau & Lee, Hong Kong Medical Journal, 2014
• Living with OCD & Religious Traditions – International OCD Foundation
• Zhengyi Dao – Wikipedia [uncertain: secondary, unverified]
• Chinese Taoist Association – Wikipedia [uncertain: secondary, unverified]
• HM Government (2012), National Action Plan to Tackle Child Abuse Linked to Faith or Belief, as referenced in the procedures above. [uncertain: not verified]
• ICD-10-CM Z65.8, Other specified problems related to psychosocial circumstances (includes 'Religious or spiritual problem'), https://www.unboundmedicine.com/icd/view/ICD-10-CM/945432/all/Z65_8___Other_specified_problems_related_to_psychosocial_circumstances