What We Can Learn From Shamanic Healing:
Brief Psychotherapy With Latino Immigrant Clients
The author, a medical an-
thropologist and licensed psy-
chotherapist, draws on a
database of 700 Latino irn
migrant tamihes whom she
has treated to demonstrate
concepts and techniques of
psychotherapeutic interven-
tion that are derived from
shamanic roots in the Immi-
grant's original culture.
Congruences may exist be-
tween The shamanic tech-
niques of the coastal and
Amazonian regions of Peru
an6 3 Western psychotherapy
techniques—hypnosis, behav-
ior modification, and cogr^itive
restructuring.
By using historic links with
Hispanic culture and the tech-
niques discussed in the com-
meniary, psychotherapists can
acquire cultural competence
that win eriahle them to ef-
fectively reduce mental lilness
symptoms presented by US
Latino immigrants in clinical
practice, {Am J Public Health.
2002:92:1576-1578)
1576 ; Views on Complemenraiy and Alierridfive Medicine '. PIHT Reviewed ! Dotikm ae
Marlene Dobkin de Rios. Ph[)
AS A MEDICAL AtmiROPOLOGiST,
I spenl UH' (irst pail i>{ my career
as a field researcher, [•iinded by
the Foiiiiiialions Fund lor Re-
search in I'sychiaiiT, I spent a
yeiir(19(S8 U) ]9M) in the Peru-
visn AniazoTi city iif iqiiitos,
studying the usr uf the plant hal
lucmogen ayahuasiia (vani)us
Baniblerwpsis spp ) as ihey were
iiicorjtoraied inlo cuixmckrismi).
or traditional loik healing, to
treat clIetiLs' [jsychiikigiral ami
eiridtiona! disoniers TIILS re-
si'iircli [liaced me m ronla'i with
21 shamans. While (here. I h\eii
CHHI worked on a flodting house-
boat in .\ harriada {hi\wdiU'Y stA-
tleinent) oi' II ()(lil |)e()ji!i!, A
THiitibcr (if publicatiOiis I'csullcd
from this researrh,' ''' \\\ tlie
early 19811s, my irilci-csLs ha(i
shifted and I retLirned to the
I'niled States to obtain a second
master's degree, u! clinical psy-
clioio^L^'. and to he licensed as a
psychotherapisl,
in addition to \uy work as a
[iroTcssor of anthfoj)ologv at Caii-
Tornia State I'niversify, Fnlleruin.
I hecami; afllliatcd with the Burn
Center ai the Univei"sity of Caii-
i'ornia, In'inc Medicai Center,
using my acquired second km
jfuage, Spanish, and experience
with the urban poor in sqiiattcr
slunis ill I'rrii lo pRnide psy-
rhothera|)y to Spaiiish-s|)eak"in^
burn victims. O\er time, inv
|")rartire expanded to other hus|.i)-
tal services such as ortliopedics.
iK'uroIoi;}'-, surgery, and on<:ol-
(igy Over Ihe last 17 yc^ars. I
\\i\\v. also provided psychother-
apy to cliciiLs n^teiTed by man
aged care nisur-ers as well as
local couiil}' social ,serviccs
BRIDGES TO
PSYCHOTHERAPY
'I his ailicle examim^^ some ol'
lh<' iessons Iroin shaiiianic heal-
ing that lienvcd IVoni m\ stiiiiies
in the l''ci"ii\"iaii Ania/on mv.\
co<isuil regions in the lale I9{i()s
and iSiTOs It suggests bridt;es io
psychotherapy with l.atmo inmii-
grant clieiiLs in Ihe 1,'niled ,Slates
The <latii presrnled here are
liased on ni\ work svit.h more
than 7(10 Latino iniiTiigrants and
tfioir families ovc?- the last 17
years
Over the years, the mimbcr ot
S|ianisii-s|)eaking iramlgi•aiit,^ in
southern Ca!iiorma—as well as
in other areas of ihe Liiiiled
States—has increased drainati-
laily Mariv of these liiimigrants
iiave entered psychotherapy as a
result of their insurance coviir-
agi*. Since passage of the US lin-
tnigration lii^lorin and Control
Act of 1986.' about haii'of all
3niiiugrant5 siatioiiwjde have
been covered by major iiisurcr,s
such as Facifif~are Bi'ha\ioi*a]
II(;aUl!, Managed Health Net-
work, the F'flF Program, and
lihii'Criws More and more,
these ininiigmnts ha\e lieen ^^
lerred to privalc [tractitioners. in
my own [)i*actici^ the over-
whelming niajoiitj of (lieiii,'^
have had i(\ss Ihaii a [)iiblic
school sixlh-grade education
Many have been koni rural en
virontnents or have livc'd in
large squitltcr setllcinents
can Jouf»-ia! ot Piiiiiic Health
throughout Latin America, simi-
lar to ihe one in Iquilo.s where I
conducted research.
I ibifiid niyselt turning in-
creasingly to Ihe I'mnian
.shanumic techniques that I had
suidicd and written about, as
well as the unix'CLSiEy courses in
shamanism that 1 had taught I
rccogui/ed that these shamanic
approaches to healing I'ould be
reconciled wiih iiiethods of in-
tciTcntion I had Icarneii in my
master's counseling trairang. In
my b(K.>k liiief I'.\tfcht)lher(ipif
With ihe I alini) hrnnigrant
Cnoil.'" I detail the asscssmi^nt
and inteiTentions tiiat have
becii found to be efficacious
with this population. .-Uidihon-
ally, the non-Latmo therapist
can dcvelo[) ciiltural conipe-
[piicv hi U'ca! clients who wei'e
hoi'ii and raised in Latin Ameri-
can societies through an aware-
ness of these shamanii; roots
and derivative psychotherapy in~
There are a number o!' sirale-
SH's and themes connected to the
treatnK^nt of Latino ininiigrant
clients that den\'e Irom an un-
derstanding (jf shamanism, I'hese
strategies have deep roots m
Latin .\merican ciiltiiie. In parti<'-
ulai", it IS mipoiiaiit to focns on
hvpriosLs, beha\i(ir modification,
and cogiiitive restnicturiiig and
Iheir shamanic equivalents.
SHAMANISM:
A DISCUSSION
Mistorically, shamanism has
bocn x'lcwcd as the hrsi religion
October ?007, Vol 92, No 10

of huniankiHci," ha\'ing been iti
existence lor tnnn; ihaii 99"/(i of
our iL'xistcnrc a.s a s|)eci(',s. In
piirlicular, Ihi; term lias been
ap))lici.i to hunlc!-,s mid gaiher-
ei\s from !bc i'li'istocene pfinxi
(iiivvanl. Mi>s( shamans have
been iiu^ii. vviili thr veiy accn-
,sional woMiiiJi brconiing a ,sha-
ttian al'U'r mciioptUisc, With the
jiassin^ ol' linie, other typ<"S of
s|)!ritual pnidici's and beliefs
(.U'velopdi, associated with the
advent til'horliciilture and then
iigriaillttre. Dates \ai"y, but
15 000 years ago is a workable
{"•stimate ior ihe r)rigi!i ol agri-
rtiltttre
While shatnaiiisin oi'len gave
\vay t(! more bureaiieratie reli-
jiiotis techniques over the millen-
nia, tiie religion itself never artu-
ally (li,sapfiearecl; lallii'r, it look
on ne^^ loims over time. The key
elemeiil in shaniatttsni is the in-
dividual practitioner and his
dienl, iiol a eongregation. Tlie
airs key behavior is lo
into an altered state of con-
sei()tisnes,s. whii'h he mdures by
dnirntniiig. Oecasioiiallv, he may
do this by psvchological practices
stich as sensory overload or ,sen-
soty (lepnvatiiiTi. hi some cases,
not tinustial ui Laiin ,\menca. he
may himself itigest plant hailu-
einogcns or give Ihem to his
elieiiLs.
Mtich inis iM'en "^vrilten about
the altered s(ale of conseiousness
sj)ontaiie<)usly et3t(Ted itilo by
Ihe shaman,'" [ie controls the
iran( e slale and cari readily eiiUM-
into i! HI will. Tile allercd stati; i,s
used bv the shaman io |)redicl
[lie ftitttre, io lixpeneni'e inela-
plioriciiily a change in his shape,
anil k) I'onJaet spiritual (Mitities.
These latter entities are called
upon h\ the healer to eonquer
e\'il, negate hexes, neuti'ati7i'
vvitchi ral'i, and reslon' Lhe client
lo good health.
Outube- 2002, Vol 9'J. No. 10 • Aniencan
PSYCHOTHERAPEUTtC
DERIVATIVES FROM
SHAMANIC HEALING
11'we turn to contemporaiy
psychotherapy, the lesson is
clear, |-iypnosi,s is a very power-
Fui too! that can he used with La-
tino immigrants, either in linglisli
or SpfuiLsli, to create an altered
state of'consciousne,ss. in psy-
chotherapy, patients often pres-
ent with agitation, pain, anxiety,
and other symptoms of distress.
The psychotherapist can prepare
and present as an inexpensive
gift (generally costing less than
$1) a relaxation cassette tape
Relaxation therapy, which can
often be a gloss for hypnosis or
the light trance state that allevi-
ates symptoms, eart tone the
client s parasyntpathetic nen.'ous
system In addition, gifl-giving
enhances the therapetitic al-
liance, ensuring that the client re-
turns for luture sessions. The l.a-
tino nnmigrant populalion is
well-knowTi tbr iLs iaek of psycho-
logical sophistication. The
dro[iotit rate in psychotin'rapy
can l.!e vi'iy high, inhibiting the
t;/ of the thera[)ist to make
inter\'entions.
Basically, the therapist enables
the ciient to enter into an altered
state (ff consciotisness that is con-
dtici\e to healing, thus providing
the client with personal control
over his or lier body chemistry,
Morco\'er. a special state is estab-
lished whereby the therapist's
stigg(^stions are more readily I'ol-
lowei 1, In this way, the therapisi
ean l)reak down resistance and
enhance therapeutic goals.
Personal enipowennent is an
impoilant concept in hypnosis.
Calling on the presence of a pow-
erful animal--sueh as an eagle,
king of it-s dominion—caji be
metaj>boncaily linked to the
sliaman who perceives himself as
ol Public Heaith Dobkin de Rios \ Peer Reviewed | View-i on Coniplen^entEJi-y and Ailemalive MoiJicin(- \ 1577
Mil) MMMMlM MBltM
an eagle. The tlierapist tells the
client that he or she can relax at
will, anywhere ajid any time Hie
client is all-powerful, like the bird
or animal, {The eagle is an im-
portant ,symboi in Mexican cul-
ture, found on the Hag; it evokes
the Toltec prophecy of a sacred
homeland to be found where an
eagle was seen perched on a cac-
ttis with a snake m its iieak,) The
client is insttiicted to listen to the
tape during the wi'ek, often n -
porting back with positive relax-
ation elVecLs, At the Univei'sily of
California Burn Center, stndii's
were conducted to ,sht)w the effi-
cacy ol such altered states in
controlling pain, treating depres-
sion, an(i helping !n|unK"l workers
stifferitig Irom posttraumatic
stress disorder lo rettirn lo
Turning to the second psy-
chotherapy teclimque--behaMor
modification—we note that sha-
manie studies an^ niled with de-
scriptions and analyses of magic
and theatncalit)'. The Eslctmo
shaman plunges a knife into his
parka. Under it, he has hidden an
animal bladder full of blood,
which spurts everywhen,'. The
shaman falls down, appareiilly
dead, and is then resurrected in a
feat of stage magi(. "Hiis attests
to his man,'eiotis powers.
As a therapist, 1 build on inis
theatrical concept to explain be-
havior modification techuiques
to parents who have (iilficuit
children lo manage They are
shown a photograph of a kilJer
whale at Sea World juinpmg
straight up into the air This
image is used lo niotivale [)ar-
ent.s to learn the techniques of
behavior modification. If thi'
young trainers seen in the plioto-
g!"aph can train an 8t)0(}-pound
whal(^ to lio Iricks, then getting
one's children to behave ean (Eas-
ily be dotiel Whining, antisonal
acts, and dismptive behavior all
respond quickly to positive rein-
forcement and Ignoring the
child's minor behaviors.
Wilhiii I hour, the iherapist
and parents together ean teach a
3- to 7-year-old chiid lo say "ex-
cuse me" in,stead of constantly
interrupting the parent. The im-
])ro\'ed behavior ean be mam-
ttiined over time if the parents
leani lo properly reinforce it. To
the parents, these results appear
magisai; often, they have been
tiymg to ehange ihinr children's
behavior for years. Their suc-
cess, in tuni, leads them to have
faith in and admiration for the
therapist. This is similar to the
way that shamans create trust in
their clients,
Wheti 1 was conducting field
work with .shamans m Peru in the
late ]96()s," one healer came to
the outdoor healuig area wearing
a fine alpaca poncho that evety-
one admired. He boasted about
how h{' was given this fine gar-
ment heeause of his sticeess m
curing a client. Shortly after-
wards. I visited a well-knowti
psyehiatnst in New York—an es-
tabii,shed auihor and an adminis-
trator in that state's mental health
establLshment—to discuss my re-
search findings. He had a fine
townboLLse on Park Avenue with
a Japanese garden at tlie en-
trance; original Picassos adomed
ihe walls. It was hard lo see any
difference between the fine pon-
eho in rtiral Peru and the trap-
pings (if wealth and sticeess m
the New York townhouse. Of
course, each example niade .sen.se
within its own cultural matrix.
The third lesson from shaman-
ism—cognitive restruetuting-ib-
cuses on tlie shaman's rationality,
De,spite his tlu^atrieality and al-
tered slates of eonsciou.sne,ss, the
shaman is a rational and empin-
cal pcrs<")ii. He combines talents
in botiuiy, phamiac<'u(irals, and
psychology', lie is quick to giw
advice in his healing ca|)acity
Oru; folk hcalcf with whom I
worked, l)(iTi Hildt', lived in Ilie
central Amazonian cit\' ofi'u-
railpa. Pern.''"' lie diagnosed ill-
ness as natural or su[)ernatiirai in
origin (e.g.. caitsnii by witchcraft).
He also had an impressive list of
healing [)lant,s thai he grew oi'
(iiitsitie himself coming Trom the
spirits that he conti'ols or mas-
ters. By rontrast, the therapist's
knowledge is r<presented by the
(jiiickness with which he or she
can associate cultnrally base(i
pi-overbs and meiaphoi s with Ihe
clinical issue at hand, thus de-
scribing a rational and etTective
way for the client ii) behave.''''
bodies stretched out or their legs
sawed oiT. 'Fherapisi.s must not
insist ihai iheir Latino inirnigrani
clients fit into a Froerustcan bed,
Hathc!-, ibey musi make an effort
to find techniques and use them
wisely io provide p,sycho]ogiral
help for ihe problems they are
called upon to advise. •
1 i>n•,^lou^nl•^'^ / Pyi/iimactw Dnifi^
n , Dobiiin :\v Rios M, Friwiiiian jK.
Pain rontntl and systcniMlic desensJLua-
iKin iniluciiiins in Spariisb i'or symptoms
of tin- |iiisi-imumali(: >itnss disorder In.
ilnTnnioiiil DC, ed. flandbnok of Hyp-
imhc Su)i):i:s!i('m.M.ind ^Uilaphof^. Kcvi
York, \ \ \ \ W Xoiion. 1M>10,
\2 t)oi)kih dr Ki(i.s M, Arhaui'i- B.
I'aiii relief for ibe ihspftnic burn |iatienl
iisin;> (uitiiral nit-laphoi-s Plwit Refon^tr
.Siuy, lVl9O:18'^3-:i2.

gathered. Indeed, rational and
empirical techniques are th<'
,shaniaii!c liealcr's sirciigth.
I once told a liolistic health
physician how. as treatment lor
arthritis. Don 1 lildc k<^pl nxi ants
in a hotilc ol cane rum (Clients
suffering from arthritis wlsn
drank this iiqiuil offcn rcpoiicd
COMMENTS
It i.s ini|K)rtant for the therapist
not to lose control nl the liicrapy
hour, jnst as the shaman healer
lioasted oC his line poncho, the
psychoihi:rapis('s siiplomas
shonld be con.spiciiously dis-
j)!a)'ed on the wall. The therapist
About the Autiior
'Ih' aidliiir is iiith !lie l)iytuiiiii;iil i>! l\i)-
rhiulrt) iindIhiman Hi'h/ivior ['nircr'ntii
n'Culilhr/iiii Irvine
/I'wy(((•.•.(s- lor n-pruii'- ••.honld he \i'ni
i<i MarU-ne Duhkir, tU: Ri/r. /'hi). _>55.'>
I; ChapiiMH \vi- Siutf 107. I-'ulli:rttm
C \ 92831 'i:-nii.ul. scplriomiuolcom)
Tin-' roriimnilan/ ira^ urirj/tcil.\hiij
2!. ?(HI2
Ti Dolikin (ic Hios \l, inedmaii JK
Ih"]iiio!bci'apy wilh I lisjianic burn pa-
lu.'nis III! I Chit I:xp lh/p>t !987::i5:
87-94.
[4 Holikiii (Ir Kios M IricliocereLi!;
pacbanoi—a nsi•.'praline caclus used in
folk ht;alii!s; 111 i'cni. Fam Botiuu) 1968;
?.?. 191-19.i
I") DiibkLti de Kios .\1. -hnazon Ik-akr:
I III- I.iff am! riiiu'^ oJ iin L'rbuu Shiunim
l!nd[)ort, hnj;!an<.l: I'risni Pre^i. !i!i!2.

impi-m'einent. 'ilic holistic physi-
cian noted thai beekeepers had
a very low rate iif arlliritis com-
[)arcd with other populations,
owing to th<' enhancement of
their iinnume systc^ni from llie
toxin.s in t!ie bee stings ihal they
e.\pcrienee<i—similar to Don
I fildi^'s red aiit ti-eatmcnt .\
number of the plants that Don
Hiide used were elficacious;
sonic lowered blood sujjar lor di-
abetics. \vhile others all(!\iate<i
ciepression and anxiety. lA(;n
should refer io peojile he or she
ha.s cured (no ?iames or identifv-
ing charai'teristics, ol rotii^se).
Preferahly, they shonld ha\'e sui'-
f(M"ed Irom complaints similar to
those ol'the client, and the thera-
]>ist sboiild reiterate his or her
(ibiiity to siicce.ssfully treaf this
client as well, in brief psycho-
dicrapy. the psychotherapist luis
little linu' lo dcriv(! the elienl's
own meiaphoric workh'ie\\', as ss
{lone in psy(hoanaiysis; ihe La-
liiio immigrant client gcriercilly
References
! Diibkii] tic i-iios \i \ i^'ioiMiy r.'iic
!liilhiciuiiL'yiiif lh\itin^ in ihi' I'unman
.•\iiiuziiii Pn)spi'i'i Iicii:lii-s. nt W'avi'lunil
l'fC',s [9S4.
2 t)(ibkii^ lie liuw M A noli' m! ihii'
u>f ul'ayobujiM':! a n m i i g N!I'SII/,(J j^opu-
hifjoiis m l l u ' I V n i v i a n \nia/,o)i . 1 " '
.\iilln<>iii)l 147(1:7'^ 1 4 l ' - ) - M 2 2 .
3 Dohiuii dc liio^^ M. A\iihii:isra Ilir
ficalnii; \itU'. ID! / >"(« !\!iihtalni
I'tTI ,l7.:;i)li--2i>9
\ Dniikiii d(] Ki(!,^ M. ('ui'iiti4 vs itli
ayaiiu;iica t(i a IVruMoii Anui/on slum.
\i\- lianici" \ 1 | , cii. llalhianofien:: and
Shii>iuiiii~,»i \ c w \()ik. \ Y , Oxford V,m-
vrisKy Pix'ss; l'-i72'ii7--,S4
H) l)oi)kin de Hio>. M. Tlie ^'uifiilc
pbenonieitoii in ibiixl Wuriil tradLlioiuil
hfaliny: an Amazon cx;ini[)[e .Med .Aii-
ihmpol 1984:B:6O-7{I.
17 Riidnjauv ii Cavin |C. Tlie role oi
\nui/onNin psy^hoa(•!i^•e pianl.s in lite
(•beniothem[iy nf jiara'^nic woniis
/ l-'tliimpluinmicol 1982:6:3O"i-;iO9
IS. n r l l a \ b j | i a A, Dobkin de Hids ,Ni.
MoIapliDf and niiseiy enhancing pj^y-
rb(ilheni|iciior fonHnnnicaiion wilh
Spanish-spfaking clienis In: Mi'lliy AK,
Lonini.-! AK t-dv I..A.CUS Ivrtim XKVL
I'ulicrtijn. C'alil: i.inguislic .Associaiion of
Canaiia and Ihc tinited States, 2 0 0 0 ;

hallucinogens like ayahuasca
ha\e been shown to diniinisli
helniintliic disease (intestinal
wornis), '
Like the shamanic hcaier, (he
psychotherapist must help the
client to think ii! the niosl ra-
tional way possihie. finding meth-
ods to alter or restmcturc irra-
tional beliefs and negative
se]f-U3!k. WTiile the shaman uses
his s|)iril entities to give direc-
tives regarding liis client's behav-
ior, the psychotliera|iisl mstrucLs
sei^ks quick relielOr symptoms
Till' jisychnthera[)ist must not ex-
p('et to I'ngage in long-term psy-
(•hothi'rapy, t]or io undf^rstand
transl'ereiic)^ or io lieKe into in-
lra[)sychic issues, but rather io
stick to the here and now.
Those mosi likely to bciu^lit
from these techniques are imnu-
giaiiLs lo (he I'nited Siates whose
eulture of origin is (loses! io
shamanic roots, hi ii'ving to be
cnlturaliy compc^tcnt, therapists
must not insist that clients be
~>. Dubkii) (If KRIS M Pf'n)\iaii lialhi-
(•iiK>i;('n!r lolk honliitg a n o v e m i . ' w . In
[)!"• lii i'lK'til:' K \\c!Miian M. cd.s. P^^/•
vhuurtf PriHvedtng'^ iij the nth Umid
( nu/^ivs^ III l\yi:hw,tni. \'iil I. Amsicr
d.ini, Neiln'iiaink },\c('i]»la Mrdica.
I!17:i.ll89--n;i8
(i llohkist dc Hill.'; ,M The rion Wf";!
rill uss' o) lialliiniuiyt'nii' aj^mt.v In.
Ihiiii Vse in .'hiwnni. I'rohh'in ui l\-i
-.;HrUi'<'.\ii\ I \\ai-liiiijiU>!i. l){". Na
Ifiiiial {•(iiiinii'-siDd oji MH]-[liiiLyi:i a n d
Drug \Juisr: t!!7.1 1179 1L!Ub
I'SC (^1101 el sc] ;l9(^(r'
S Doiikiii df Kio^ \t Ih-H'IW
chothcnipi/ ll'itli till'Laliiiii hiii'iiijimii
Clit'in Bini;liaintiin X'l • I lawiirth Prcs^;

clients by (quoting proverbs, bibli- psychologized to their own

cal parables, ami rff'r/i'i.s—niiixims
representing the distilled wisdom
of tlie community. The shanian's
souici; oi'knowledge is saici to be
•} Wallace A K ' Ri- .\n ,\'ithi;<-
worliivii'w iinci beliefs, in tbe
(ireek myth of Procmstes, \isi~
tors to an inn were i'lirceti to fii 10 i)obk;ii <\v HK!,', ^k Wiiikflnian M.
into a iied by either having ihnir IHK. SliantMriiMii anil aJIcrfi! -tati". nl

15/8 Views on Comolei'ieiil.-irv AHemativo Peer Reviewed i Dabk:ti dc Rios cf Pu&:ic Heiiltti October 2002, Vol 92, No. 10