Atlas›Domain XIII · Contemplative & religious disciplines›Guide 251
Guide XIII-251

Rifa'i ecstatic rites

Aḥmad ar-RifāʿīBasra region, Iraq
A 37 · L 53 · M 1013 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the Rifa'i (Rifāʿiyya) dhikr as reference works describe it (Encyclopaedia Britannica), together with the present-day Balkan Rifa'i ritual in Kosovo as major news organisations describe it (Associated Press 2018, Al Jazeera 2015), with a note on Qadiri tekkes in Kosovo that hold a similar rite (RFE/RL 2023). This is a guide to an observance: it describes the rite as sources report it and then sets out the psychotherapist's own work alongside it. It does not teach or explain how any display is done.

What it is. The Rifāʿiyya is a Sufi order (tariqa) traced to Aḥmad ar-Rifāʿī of the Basra region in Iraq. Britannica gives his death as 1187 and describes the order as an offshoot of the Qādiriyya, known in the West as the "howling dervishes". It spread mainly in Egypt and Syria and in Turkey, where it was outlawed in 1925 with the other orders. A 2026 study gives his death as 578 AH (about 1182–83), and a visual-anthropology archive gives 1118–1183 [uncertain: dates differ across sources]. Britannica says the order emphasised poverty, abstinence and self-mortification. In its dhikr (remembrance of God), members link arms in a circle and rock the upper body until they reach ecstasy. Accounts say some members then fall onto dangerous objects such as swords, or handle snakes. Britannica attributes these extremes to Mongol-era influence and says orthodox Islam has always rejected them. A 2026 study of the order in Anatolia notes its reputation for "eating fire and snakes" alongside intense samāʿ (devotional listening) and dhikr. [source: Britannica; Kashan University study 2026; SAC archive]

Today. In Prizren, Kosovo, a Rifa'i tekke (lodge) holds its main ceremony at Sultan Nevruz, which falls at the spring equinox and also marks the birth of Imam Ali. Men process, chant and sway in Albanian, Turkish and Arabic to cymbals and drums. Near the end, the sheikh blesses long metal skewers (zarf) and pierces participants' cheeks, and some participants pierce themselves. Women watch from a balcony. AP reported that the sheikh pierced the cheeks of young boys as part of their initiation. Al Jazeera reported that the sheikh's young son and several other children were pierced, that there was a small amount of blood, and that older members had small scars. A weekly Friday dhikr is held as well. [source: AP via Fox News 2018; Al Jazeera 2015] RFE/RL reported a similar Nevruz rite at a Qadiri tekke in Gjakova, Kosovo, with neck piercing after the chanting. [source: RFE/RL 2023] Related Rifa'i-lineage displays are reported elsewhere, such as the ratib in South Africa and kuthu ratheeb in Kerala [uncertain: secondary, unverified]. Not every Rifa'i branch performs such displays. Ethnography of the transnational Qadiri Rifa'i order, which has Turkish roots, centres on poetry, conversation (sohbet) and zikr and makes no mention of piercing. [source: Krokus 2014]

Core idea of change, as participants state it. In the Prizren community, the sheikh describes the rite as an act of love and devotion that shows God exists. A participant described feeling spiritually strengthened and no pain, and said that those taking part act in full awareness, not in a trance. AP summarised the community's view as a way "to earn salvation and find a path to God." These are the community's own accounts. They are not presented here as fact, and they are not dismissed. [source: Al Jazeera 2015; AP 2018] In therapy, change comes from understanding what the rite means to the client and dealing with any clinical issues around it. The therapist does not evaluate or join the rite. [synthesis]

2. Framework

This is not a therapy and has no session count. The rite has its own calendar: a weekly Friday dhikr and a yearly Nevruz ceremony, led and authorised by the tekke's sheikh, who in the Prizren reports blesses the instruments and does most of the piercing. [source: Al Jazeera 2015; AP 2018] Leadership passes through a spiritual chain (silsila) that, in the order's own understanding, legitimises the current head. [source: SAC archive] Phases of a Damascus Rifa'i dhikr recorded on film: prayers and Qur'an recitation; a musical portion with drums and cymbals; reading of Sura Ya Sin and Rifa'i texts; the dhikr proper, including mortification practices; and a closing prayer and blessing. [source: SAC archive]

The therapist's work alongside the rite has no published protocol. The phases below are a working structure [synthesis]:

  • Phase A – Engagement and meaning (first sessions). Goal: hear how the client describes the order, the rite and their place in it, using their own words. Move on once you can state the rite's meaning back to the client in terms they accept.
  • Phase B – Cultural and risk assessment. Goal: use the CFI and its spirituality, religion and moral traditions module; ask about health, injury and infection; ask about safeguarding where children are involved; and tell ritual states apart from psychiatric presentations. Move on once any safeguarding or medical issue has been acted on and the formulation includes the client's religious life.
  • Phase C – Work on the presenting problem. Goal: treat the presenting problem (which may have nothing to do with the rite) while making room for religious practice. Use accommodation, scrupulosity work, grief and community work, and collaboration with the sheikh or other religious figures if the client wishes.
  • Phase D – Review. Before Nevruz, or after any injury or a change in membership, briefly review health questions for the doctor, consent and pressure, and children in the household.

The number and length of sessions follow whatever treatment you are giving for the presenting problem. No source gives figures for this context.

3. Guiding principles

  • Describe, do not adjudicate. Present the community's account (love, devotion, God's protection, the sheikh's blessing) as theirs. Do not argue about whether the wonders are miraculous. [synthesis]
  • The therapist is not a religious authority. Do not judge the rite's legitimacy within Islam. Mainstream disapproval exists (Britannica; Al Jazeera), but that debate belongs to the client and their scholars. [synthesis]
  • No technique, ever. Do not discuss how piercing, fire or glass displays are done, and do not help a client "do it more safely" in practical terms. Send medical questions to a doctor. [synthesis]
  • Child welfare overrides cultural sensitivity. Safeguarding guidance states that abuse is never acceptable in any culture and that cultural or religious sensitivity must not override a child's welfare. [source: NYSCP]
  • Understand the belief in context to establish what is happening to the child. Assess the actual practice, the people involved and the consent, not the belief system. [source: NYSCP]
  • Consent is individual. Practical meaning: check that adult participation is freely chosen and can be refused without penalty. [synthesis]
  • Health questions go to the doctor. Practical meaning: name possible infection, bleeding and tetanus issues and arrange medical follow-up. Do not give advice yourself. [source: HealthLinkBC; synthesis]
  • Don't assume trance is pathology. Participants may describe the state as full awareness and devotion. Assess for disorder only on clinical grounds. [source: Al Jazeera 2015; synthesis]
  • Minority-within-a-minority stress. Dervishes are a few thousand people in a mostly Muslim country, and some members face criticism from mainstream Muslims as well as from secular observers. Ask about stigma. [source: RFE/RL 2023; Al Jazeera 2015; synthesis]
  • Scope and dual roles. Do not attend ceremonies as a participant, and think hard before going as an observer. Disclose your own religious commitments only when doing so serves the client. Ethics codes on competence, multiple relationships and respect for religion apply [synthesis].
  • Collaborate only with the client's consent. Contact the sheikh or tekke only if the client asks, and agree with the client what may be shared. [synthesis]

4. Intervention inventory

These are the psychotherapist's interventions alongside the rite. None of them teaches or rehearses the rite. Where no source is given, the steps are [synthesis].

4.1 Understanding the rite's meaning in the client's life

  • Purpose / when: Early in therapy, and whenever the client mentions the tekke, the sheikh, Nevruz or zikr. It helps to know whether the client is a performer, an observer, a family member, a former member or a parent.
  • Steps: (1) Ask an open question about how the client belongs to the order and what it means to them. (2) Use their terms (tekke, sheikh, zikr, zarf, Sultan Nevruz) and check that you have understood them. (3) Ask what the rite gives them, for example devotion, closeness to God, family continuity or a sense of being Rifa'i. Participants have described love, devotion and spiritual strengthening. (4) Ask what is hard about it. (5) Summarise the meaning back and ask for corrections. [source for community meanings: Al Jazeera 2015; AP 2018]
  • Example language (illustrative): "You mentioned the tekke. Could you tell me what it means to you and your family, in whatever words feel right?" / "When you talk about the zikr, what is happening for you spiritually?"
  • Watch for: Curiosity that tips into fascination or voyeurism about the displays (redirect to meaning). Shame if the client expects you to judge the rite. It is working when the client corrects your summary freely and brings religious material without defending it.

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

  • Purpose / when: At assessment, to place the rite inside the formulation. The core CFI and the supplementary modules are published by the American Psychiatric Association. [source: APA CFI supplementary modules]
  • Steps: (1) Give the core CFI. (2) Give the spirituality, religion and moral traditions module, adapting the wording to the tradition the client names (for example "the Rifa'i way" or "the tekke"). Its domains are identity and affiliation; how practices shape daily, family and community life; how the tradition has helped with the problem, including through leaders and practices; and stresses, conflicts and discrimination linked to the tradition. (3) Add the Social Network, Cultural Identity and Coping and Help-Seeking modules where relevant. (4) For a child, interview the parents or caretakers using the school-age children module addendum, as the CFI directs, rather than using the child as informant on cultural matters. (5) Write the results into the formulation. [source: APA CFI supplementary modules] Do not reproduce the CFI items. Use the official form.
  • Example language (illustrative): "Some people find their religious community a support, and some find it a source of strain as well. How has belonging to the tekke been for you lately?"
  • Watch for: Discrimination the client has faced from other Muslims or from secular observers. Family conflict over membership. Whether the client turns to the sheikh for help. It is working when the formulation explains the presenting problem without reducing it to the rite or ignoring the rite.

4.3 Telling ritual ecstasy apart from psychiatric presentations

  • Purpose / when: When the client describes ecstatic, trance-like or numbed states during zikr, or when others ask whether those states are "illness".
  • Steps: (1) Start from the community's own account: news reports describe a "trance-like state" reached through chanting, while a participant described full awareness rather than trance. [source: AP 2018; RFE/RL 2023; Al Jazeera 2015] (2) Ask whether the state is bounded by the ritual, culturally expected, under the client's control and followed by a return to usual functioning. (3) Screen for features outside the ritual: dissociation in daily life, psychotic symptoms, mania, depression, substance use, or self-injury away from the rite. (4) Where the issue is religious rather than psychiatric, note that DSM-5-TR lists a religious or spiritual problem as a focus of clinical attention, code Z65.8. (5) Review this at intervals rather than labelling it once. [synthesis]
  • Example language (illustrative): "In the zikr, what is your experience like, and how do you feel afterwards?" / "Have you had states like that outside the tekke, when you didn't choose them?"
  • Watch for: Pathologising a normative rite, and also missing a true illness that is hidden by the religious frame. Challenging meditative and ecstatic experiences are documented in research such as Lindahl et al. 2017, PLOS ONE, and the review by Farias et al. 2020, Acta Psychiatrica Scandinavica [uncertain: not verified]. It is working when you can state, with evidence, whether the experience belongs within the ritual.

4.4 Health, injury and infection: raising the issues and routing them to the doctor

  • Purpose / when: With any client who is pierced or pierces others, or whose child takes part, and around Nevruz and Friday gatherings.
  • Steps: (1) Ask, without judgement, whether the client has had any problems after the rite: wounds slow to heal, swelling, scars or dental problems. (2) Name, at the level of public health information, the general risks of any skin piercing: local infection (signs include rising pain, swelling, warmth, redness, pus, fever or red streaks); blood-borne infection such as hepatitis B and C when instruments are not sterile; sepsis; tetanus risk depending on the wound and vaccination status; damage to nerves or blood vessels; scarring; and, for piercings through the mouth, damage to teeth or gums and problems with swallowing. [source: HealthLinkBC] (3) Point out the urgent signs that public guidance lists: trouble breathing or throat tightness, bleeding that will not stop with steady pressure, and rapid, severe swelling. [source: HealthLinkBC] (4) Encourage the client to talk to their own doctor about vaccination status (for example tetanus and hepatitis B) and any healing problems. You do not advise on medicines. (5) If the client has health conditions or takes medicines that might affect bleeding or healing, direct those questions to the doctor without commenting yourself. (6) With consent, coordinate with the doctor. [synthesis] Do not discuss technique, instruments, cleaning or aftercare methods yourself. Those questions belong with a doctor.
  • Example language (illustrative): "I don't advise on the practice itself, and I respect what it means to you. I'd be failing you, though, if I didn't ask: have you ever had trouble with healing afterwards?" / "Would you be willing to check your vaccinations with your GP before spring?"
  • Watch for: Shame about bleeding or infection, since the community account stresses little blood and no pain. Reluctance to see a doctor for fear of judgement. Untreated wounds. Al Jazeera described small scars on older members. It is working when the client has a medical contact and reports problems early. [source: Al Jazeera 2015; synthesis]

4.5 Child safeguarding

  • Purpose / when: Whenever a child takes part in piercing or other mortification displays, or is initiated in this way. News reports describe young boys being pierced as part of initiation in Prizren. [source: AP 2018; Al Jazeera 2015]
  • Steps: (1) Know your local safeguarding procedures and your duty to report, and keep in mind that cultural or religious sensitivity must not override a child's welfare. [source: NYSCP] (2) Assess what is actually happening: the child's age, who does the piercing, whether the child can refuse, any injury or infection, and whether siblings watch or are made to take part. Safeguarding guidance names siblings forced to witness or take part as an indicator. [source: NYSCP] (3) Understand the belief in context, with help from an independent adviser or community member where appropriate. [source: NYSCP] (4) Talk with the parents about the child's ability to say no, the health risks, and the law where they live. (5) Where there is a welfare concern, refer to children's social care under the local procedure. The relevant guidance also recommends a full health assessment, speaking to the child alone, and considering risk to other children in the household. [source: NYSCP] (6) Engage faith leaders where useful, but do not assume they will protect children, and do not take an apology as proof that the risk has ended. [source: NYSCP] (7) Record your reasoning. In England, the national action plan on child abuse linked to faith or belief (Department for Education, 2012) is the policy context. [source: gov.uk]
  • Consent and assent: A child's agreement given within a ritual, in front of the community, is not freely given in the way adult consent is. Assess it separately and in private. Parents' religious authority does not settle the welfare question. [synthesis]
  • Example language (illustrative), to a parent: "I can see how important passing this on to your son is to you. My job is to think about his health and his safety too. Can we talk through what happens for him and whether he could say no?" / to a child, alone: "Some children like being part of things at the tekke and some feel scared. However you feel is OK to tell me."
  • Watch for: Injuries, infection, fear, or the child being singled out. Pressure from the community. A family moving the child to avoid scrutiny. Signs that the case is being handled without referral when referral is required.

4.6 Consent, pressure and the sheikh relationship (adult clients)

  • Purpose / when: When an adult client feels unsure about taking part, or when the sheikh's authority affects decisions about health or treatment.
  • Steps: (1) Ask whether taking part is a free choice and what would happen if they declined. (2) Look at how authority works in the tekke: the sheikh blesses and pierces [source: Al Jazeera 2015], and leadership is legitimised by lineage [source: SAC archive]. (3) Look for signs of coercive control, such as isolation, restricted contact with outsiders, discouragement from medical care, or punishment for refusing. Do not label the order as a whole. (4) Support whatever the client decides, whether that is continuing, stepping back from the displays while keeping the zikr, or leaving. [synthesis]
  • Example language (illustrative): "If one year you decided only to chant and not take part in the piercing, what would that be like in your community?"
  • Watch for: A client who agrees in session but feels unable to change anything at the tekke. Loyalty conflicts. Your own bias, for or against the order.

4.7 Distinguishing ritual piercing from self-harm, and risk assessment

  • Purpose / when: When the client injures themselves outside the rite, talks about wanting pain or punishment, or when referrers mistake the rite for self-harm.
  • Steps: (1) Find out whether the piercing takes place only in the communal rite, with the sheikh's blessing and in front of the community [source: Al Jazeera 2015], or also in private. (2) Ask about the function: devotion and belonging, or relief of distress, self-punishment or numbing. (3) If there is self-injury outside the rite, or suicidal thinking, carry out a standard suicide and self-harm risk assessment and safety planning, following current practice. Lethal-means counselling covers storage and removal only. (4) Do not treat the communal rite itself as self-harm without clinical grounds. [synthesis]
  • Example language (illustrative): "What happens at the tekke is one thing. I'm also wondering whether you ever hurt yourself at other times, on your own."
  • Watch for: Private use of ritual objects. Wanting pain as punishment. Wanting to bleed. Escalation outside the ritual calendar. It is working when the two are clearly separated and any self-harm is being treated.

4.8 Accommodation in scheduling and treatment

  • Purpose / when: Planning around the weekly Friday zikr, the Nevruz ceremony and the days after it, and attendance at a tekke in another town or country.
  • Steps: (1) Mark the dates in the treatment calendar with the client. Nevruz falls around the spring equinox. [source: Al Jazeera 2015; RFE/RL 2023] (2) Avoid booking demanding sessions, such as exposure or trauma processing, right before or after the ceremony unless the client prefers otherwise. (3) Allow for tiredness after night-long gatherings: RFE/RL reports a ceremony running into the early morning. [source: RFE/RL 2023] (4) Offer remote sessions to clients who travel. [synthesis]
  • Example language (illustrative): "Nevruz is coming up. Would you like to shift our session that week?"
  • Watch for: The client hiding attendance to avoid seeming "difficult". A therapy timetable that clashes with the religious calendar.

4.9 Scrupulosity, shame and moral injury

  • Purpose / when: When the client fears that pain, bleeding or reluctance shows weak faith or God's displeasure, or carries guilt about leaving or staying, or feels caught between the order and mainstream Muslim criticism of it (Britannica; Al Jazeera).
  • Steps: (1) Separate the client's tradition from obsessive doubt: repetitive, distressing doubts about whether they were sincere, pure or worthy, reassurance-seeking and checking. (2) If OCD-type scrupulosity is present, use exposure and response prevention adapted to religious clients, agreeing with the client, and where they wish with a trusted religious authority, what counts as normal practice so that ERP targets compulsions and not faith [uncertain: not verified; IOCDF and similar clinical sources describe this approach]. Do not use the rite or any self-mortification as exposure material. (3) For moral injury, such as guilt about a child being pierced or about leaving the sheikh, use your usual moral-injury and compassion-focused work. [synthesis]
  • Example language (illustrative): "Is this a doubt that comes back again and again however much you pray, or a question you'd like to take to someone you trust in the tekke?"
  • Watch for: Reassurance-seeking aimed at you. Repeated confession-like disclosures. The rite turning into proof against doubt.

4.10 Grief, ritual and community support

  • Purpose / when: After the death of a sheikh or a family member in the order, after leaving or being excluded, or after migration away from the tekke.
  • Steps: (1) See the tekke as a source of belonging. Dervishes are a small minority in Kosovo [source: RFE/RL 2023], and the Prizren sheikh speaks of tolerance among religions and ethnic groups [source: Al Jazeera 2015]. (2) Explore which rituals, such as zikr, the Friday gathering or a broadcast of the ceremony, keep the connection going. RFE/RL reports a broadcast offered to those who cannot attend. [source: RFE/RL 2023] (3) Support grieving using the client's own frame. [synthesis]
  • Example language (illustrative): "What did the Friday zikr give you that you are missing now?"
  • Watch for: Disenfranchised grief when the community disapproves of the client's choices. Isolation after leaving.

4.11 Collaboration with the sheikh, imam or chaplain

  • Purpose / when: When the client wants their religious leader involved, for example over health checks, exemption from the displays, a child's participation, or a crisis of faith.
  • Steps: (1) Get written consent that specifies what may be shared. (2) Agree the purpose with the client beforehand. (3) Respect the leader's authority over the rite while keeping clinical and safeguarding duties your own. (4) When child safeguarding is involved, follow the referral route and do not let consultation with the leader replace it. [source: NYSCP; synthesis]
  • Example language (illustrative), to a sheikh, with consent: "Your murid has asked me to speak with you. I'm not here to comment on the zikr. I'm hoping we can support his health together."
  • Watch for: The client being drawn into a triangle between you and the sheikh. The leader asking for confidential details.

4.12 Leaving the order, and religious trauma

  • Purpose / when: When a client has left or wants to leave, or describes harm linked to the tekke.
  • Steps: (1) Validate both attachment and harm. (2) Assess for trauma related to painful initiation in childhood. (3) Support the client in rebuilding their spiritual life on their own terms, which may include another Sufi path, mainstream practice or none. Not all Rifa'i branches practise these displays. [source: Krokus 2014] (4) Use trauma-focused treatment where indicated. [synthesis]
  • Example language (illustrative): "You can keep what was precious to you about the zikr and still put down the parts that hurt you."
  • Watch for: Family rupture. Loss of identity. Grief for a community that is still active.

4.13 The therapist's own stance and reactions

  • Purpose / when: Throughout, and especially if you feel horror, fascination or the urge to rescue.
  • Steps: (1) Notice your reactions to the images: needles, blood, children. (2) Take them to supervision. (3) Do not ask to see videos or photos for curiosity. (4) Do not disclose your own religious views unless doing so clearly serves the client. (5) Build cultural competence through consultation. Professional spiritual and religious competencies (for example Vieten et al., 2013) set out the expected baseline [uncertain: not verified]. [synthesis]
  • Example language (illustrative), to yourself or a supervisor: "Am I reacting to the client, or to the images?"
  • Watch for: Voyeurism. Contempt. Over-identification. Avoiding safeguarding out of fear of seeming prejudiced.

5. Handling problems

Unless a source is given, the guidance in this section is [synthesis].

  • Client asks you to approve or bless the practice, or to call it dangerous. Stay neutral about the religion and clear about health and safety: "What it means is between you, your tradition and God. What I can do is help you look after your health and wellbeing."
  • Client asks how to pierce, or how to do the displays "safely". Decline to discuss technique. Refer health questions to a doctor and questions about the rite to the sheikh. Check for hidden distress or a wish to self-injure (4.7).
  • Injury or infection is disclosed. Name the urgent signs listed by public health guidance and send the client to medical care that day or as an emergency, as appropriate. [source: HealthLinkBC] Follow up at the next session.
  • A child is involved and the parents resist any discussion. Your safeguarding duty still applies. Explain your role without blame, consult your safeguarding lead, and refer if there is a welfare concern. [source: NYSCP]
  • Client minimises everything ("there's no pain, no blood"). Respect the account as the community's [source: Al Jazeera 2015] and keep the health questions open without arguing.
  • Rupture after you raise safeguarding or health. Acknowledge the hurt, restate respect for the faith, and be honest about the limits of confidentiality you set out at intake.
  • Overwhelm or flashbacks linked to childhood initiation. Ground the client, slow down, and make a plan for trauma-focused work. Avoid detailed retelling of the piercing until the client has enough stability.
  • Ecstatic states that keep going outside the ritual, or a decline in functioning. Reassess for psychosis, mania, dissociation or substance use (4.3), and refer to psychiatry if indicated.
  • Non-adherence near the religious calendar. Plan ahead (4.8) and do not interpret it as resistance.
  • Community pressure or threats against a client who leaves. Assess safety and use the usual protection routes.
  • Mainstream Muslim stigma against the order. Make room for the minority stress, and do not join either side of the theological dispute. [source: Britannica; Al Jazeera 2015]

Sources

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