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Guide XIII-260

Ziyara shrine visitation

A 37 · L 53 · M 1012 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: Sunni shrine visitation (ziyāra) of the tombs of saints (awliyāʾ) as set out in the etiquette guide by a Dar al-Iftaʾ al-Misriyya scholar on Mazarat Misr and in Egypt's Dar al-Iftaʾ statements, with South Asian dargah practice as documented by Khan (2018). Shia ziyārah to the shrines of the Imams (Najaf, Karbala, Kadhimiyya, Samarra) is noted in outline only, as I.M.A.M. publishes it. [source: Mazarat Misr; Dar al-Iftaʾ via Al-Watan 2025; Khan 2018; I.M.A.M. 2026]

This is an observance: a devotional visit, not a therapy. Ziyāra (Arabic, "visit") means visiting graves. In a narrower sense it means visiting the tombs of prophets, saints, the Prophet's family (Ahl al-Bayt) and righteous people. Sunni authorities ground grave visitation in hadith. In Sahih Muslim the Prophet says he had once forbidden visiting graves and now tells people to visit them, because graves make one mindful of death and the Hereafter. [source: Jabatan Mufti Wilayah Persekutuan 2015] Shrine visitors, in their own terms, seek closeness to God, the blessing (baraka, tabarruk) of a saint held to have high standing with God, and answered supplication. In South Asia the visit is lived as hāẓirī, "being present" before the saint. [source: Mazarat Misr; Khan 2018]

How change happens, as the tradition holds it: through remembrance of death, renewed faith and supplication made at a blessed place. These are religious claims and are attributed here, neither affirmed nor dismissed. Healing claims: many devotees and some shrine custodians hold that prayer at a saint's tomb can cure illness, including illness attributed to evil spirits or magic. Evidence status in one line: shrine visitation has not been shown to treat any physical disease or mental disorder. It is never a substitute for medical or psychiatric care. [source: World Bank blog 2016; Scroll 2022]

For the psychotherapist, the work runs alongside the practice. It covers what the visit means in the client's life, cultural assessment, accommodation, routing health questions to the doctor, scrupulosity, grief, safeguarding against restraint at some shrines, and working with religious authorities when the client wishes. [synthesis] For a related healing-site observance in another tradition, see 183 (Coptic and Ethiopian holy-water healing, tsebel).

2. Framework

The rite as its institutions publish it (Sunni, Egypt) [source: Mazarat Misr]

  • Preparation: a sincere intention to draw closer to God, and ritual purity (wuḍūʾ; ghusl is also mentioned).
  • Entry: remove shoes, enter calmly with the right foot first, and ask permission at the door.
  • Greeting and recitation: recite al-Fātiḥa for the saint and all saints, greet the saint, recite further Qur'anic chapters, and dedicate their reward.
  • Supplication: begin with praise of God and blessings on the Prophet, ask for good in this world and the next, and invoke the saint's standing with God.
  • Conduct and departure: respect the custodians, give if able, recite al-Fātiḥa again and leave calmly.
  • Avoid: the guide calls wiping, kissing or pressing against the tomb disliked, and calls circling (ṭawāf) or prostrating at the tomb prohibited. Egypt's Dar al-Iftaʾ treats touching or kissing tombs as a matter of scholarly disagreement and says such acts are not shirk for Muslims. It permits saints' mawlid festivals but denounces wrongdoing that may accompany them. [source: Al-Watan 2025]

South Asian dargah practice (as documented) [source: Khan 2018]

  • Visitors greet the saint, bow, touch or kiss the grille, and lay chādar cloths, garlands and petals. They burn incense, light lamps, distribute sweets and make supplication aloud.
  • State-run shrines in Pakistan are managed by the Awqāf Department, which posts recitation instructions. The ʿurs (death anniversary) brings festivals, samāʿ and qawwālī.

Shia ziyārah (outline only) [source: I.M.A.M. 2026] I.M.A.M. presents ziyārah as visiting places connected to God's chosen servants in order to draw closer to God. It publishes supplication guides for pilgrimages to the shrines in Iraq. Detailed Shia etiquette is not covered here [uncertain: not verified].

Who leads or authorises it. No ordination is needed. Individuals visit, and shrine custodians receive them. Custodians include hereditary families, the mujāwirs at Indian dargahs, and state Awqāf departments in Pakistan. Muftis and jurists rule on what is permitted. [source: Khan 2018; Scroll 2022; Mazarat Misr]

Contested status. Communities differ. Egypt's Dar al-Iftaʾ and Barelwī scholars defend shrine devotion and tawassul (seeking a means to God). Deobandīs accept a visit only as sending merit to the dead. Ibn Taymiyya's line of thought, the Ahl-i Ḥadīth and the Jamāʿat-i Islāmī treat shrine devotion as close to or equal to shirk. Clients may carry these disputes inside their own families. [source: Khan 2018; Al-Watan 2025]

Therapist's phases alongside the practice [synthesis]

  1. Assessment: establish what the visit means, using the Cultural Formulation Interview. Move on once the client's explanatory model and help-seeking are clear.
  2. Planning: agree accommodations, health routing and any collaboration. Move on once the client consents to a plan.
  3. Around visits: prepare for the visit and debrief it, including grief work and family dynamics.
  4. Review: integrate what the visit meant, and continue or end the work alongside it.

Sources give no session count or format. Fit the phases into ordinary treatment. [uncertain: no source]

3. Guiding principles

  • Attribute, don't adjudicate. Describe baraka, intercession and a saint's presence in the client's own terms. Do not endorse or refute them. [synthesis; Vieten et al. 2013 frame]
  • Know which community the client belongs to. Barelwī, Deobandī, Salafī, Egyptian Sufi and Shia clients hold different rules. Ask before assuming. [source: Khan 2018]
  • The visit is not treatment. Never present it as treating disease. Route bodily symptoms and medication questions to the doctor. [synthesis]
  • "Both" is often acceptable. Programmes at Indian dargahs placed psychiatric care beside prayer, and some custodians endorse doing both. Use that frame when the client accepts it. [source: Scroll 2022; World Bank 2016]
  • Restraint is a rights violation, not a rite. Human Rights Watch, India's NHRC and Indian courts treat chaining as abuse. Assess for it and act on it. [source: HRW 2020; NHRC; Scroll 2022]
  • Client-led. The client decides whether religion enters therapy and whether clergy are contacted. Get explicit consent for any contact. [synthesis]
  • Stay in role. You are not a mufti, pīr or spiritual guide. Refer rulings to the client's scholar. [synthesis]
  • Watch for OCD. Purity, recitation and permission rules can be taken over by scrupulosity. Treat it as OCD, with the faith respected. [source: IOCDF]
  • Respect the family's role. Families often decide on shrine visits, so involve caregivers with consent. [source: CFI Module 12; Scroll 2022]

4. Intervention inventory

These are the psychotherapist's own procedures alongside the observance. None of them is a shrine rite. [synthesis unless tagged]

4.1 Exploring the meaning of ziyara in the client's life

  • Purpose / when: Use at intake, or whenever a client mentions a shrine, a saint, an ʿurs, a vow or a pilgrimage. It establishes whether the visit is consolation, devotion, family duty, hope of cure, or a source of conflict.
  • Steps:
    1. Ask which shrine or saint is involved and who in the family goes.
    2. Ask what the client does there and what they ask for. Use their own terms, for example hāẓirī, duʿāʾ, Fātiḥa or mannat (vow) if they use them.
    3. Ask what they believe the saint or God does in response.
    4. Ask how the visit relates to the problem that brought them to therapy.
    5. Summarise this back to the client and check you have it right.
  • Example language (illustrative): "You mentioned going to the dargah before exams. What happens for you when you are there? What do you ask for, and what do you hope changes?"
  • Watch for: expectations of cure for a medical or psychiatric condition, which you should note and pass on to the health-routing work (4.4). Also watch for pressure from family, and for shame about visiting or not visiting. It is working when the client describes the practice freely and links it to their own goals.

4.2 Cultural Formulation Interview with supplementary modules

  • Purpose / when: Use during assessment to structure cultural and religious enquiry. [source: APA CFI Supplementary Modules]
  • Steps:
    1. Give the core CFI.
    2. Add Module 5, Spirituality, Religion and Moral Traditions. It has 16 questions on identity, the role of the tradition in daily and family life, its relation to the problem (coping, leaders, texts, prayer or ritual) and possible stresses or conflicts. Use the client's own name for their tradition, for example "Barelwī", "Shia" or "Chishti". Explore each tradition if there are several, and judge how involved the client is.
    3. Add Module 1, Explanatory Model, to cover cause, seriousness and effects on body, mind and spirit, which may include spirits or the evil eye.
    4. Add Module 7, Coping and Help-Seeking, to cover private practices, religious support, other healers and who suggested the current visit.
    5. Add Module 12, Caregivers, when a family member brings the client or decides on shrine visits.
    6. Paraphrase the items, skip repeats, and write a cultural formulation that names the shrine practice and its role.
  • Example language (illustrative): "Some people find their faith helps with problems like this, and some find it adds pressure. How is it for you?"
  • Watch for: reluctance to name spirit-based explanations for fear of being judged. Do not reproduce the instrument's item wording in handouts. It is working when the formulation includes the client's explanatory model and help-seeking pathway.

4.3 Accommodation in scheduling and treatment

  • Purpose / when: Use when visits, ʿurs festivals, mawlids or pilgrimages to Iraq interrupt sessions or medication routines.
  • Steps:
    1. Map the client's calendar of visits and festivals.
    2. Agree how sessions will be covered: rescheduling, remote sessions, or a planned break with a written coping plan.
    3. Plan medication continuity with the prescriber, including travel supply and time zones. The therapist gives no medication advice.
    4. Plan safety arrangements for travel periods.
    5. Respect purity and prayer times when booking appointments.
  • Example language (illustrative): "The ʿurs falls in your treatment weeks. Shall we plan around it now, so it supports what we are doing rather than interrupting it?"
  • Watch for: a planned break turning into a drop-out, and medication being stopped during the visit. It is working when visits happen without loss of contact or treatment.

4.4 Routing health issues to the doctor

  • Purpose / when: Use when the client expects the visit to cure an illness, plans to stop treatment, or faces physical strain from travel, crowds, heat, long walks or staying overnight at a shrine.
  • Steps:
    1. Note the health hope with respect.
    2. Separate it from the medical question: "What has your doctor said?"
    3. With consent, ask the client's doctor or prescriber about travel, exertion and continuity of care.
    4. Invite the "both" frame (4.5).
    5. Never advise on medicines or tell the client to stop or start them.
  • Example language (illustrative): "Prayer at the shrine matters a lot to you. Many families there also keep the doctor's treatment going at the same time. Would you be willing to check the travel plans with your doctor?"
  • Watch for: treatment stopped in favour of prayer alone, which Scroll (2022) reports in some families after medication had earlier failed. Watch also for vulnerable relatives (older, pregnant, chronically ill) undertaking strenuous visits. No specific clinical guidance for shrine travel appears in the sources consulted. It is working when the doctor is informed and treatment continues.

4.5 Integrating care with shrine devotion (the "Dawa-Dua" frame)

  • Purpose / when: Use when the client or family is committed to a healing shrine and is wary of psychiatry.
  • Background: In 2008 Gujarat's health department set up the Dawa-Dua ("medicine and prayer") programme at the Hazrat Saiyed Ali Mira Datar dargah. Traditional custodians (mujāwirs) were persuaded to encourage professional help alongside prayer. Tamil Nadu adapted it at Erwadi, with an outpatient centre inside the dargah gates from 2014 and a mental hospital on donated land from 2016. There, some patients have medicine blessed by shrine attendants and families stay with patients. Results are reported as mixed. Custodians and families range from "try both" to prayer only. [source: Scroll 2022; World Bank 2016]
  • Steps:
    1. Explain, without contesting the client's spiritual explanation, that clinical care and prayer are often combined.
    2. Ask whether a shrine-linked or faith-sensitive clinic is available and acceptable.
    3. With consent, identify a respected religious figure who supports "both".
    4. Agree a care plan that names prayer, the shrine visit and clinical treatment together.
    5. Review the plan at each visit.
  • Example language (illustrative): "You see the problem as having a spiritual side, and you also want your son to sleep and eat again. Could we work on both, side by side?"
  • Watch for: splitting, where the custodian is cast as the healer and the clinician as the opponent. Watch also for attribution of any relapse to a lack of faith. It is working when attendance and treatment continue alongside visits.

4.6 Safeguarding: restraint and detention at healing shrines

  • Purpose / when: Use when a client, or a relative they care for, has stayed or may stay at a shrine or faith-healing centre for mental illness. This applies especially in South Asia or in diaspora families who send relatives "back home".
  • What is documented:
    • Human Rights Watch's 2020 report Living in Chains found shackling in 60 of 110 countries researched. It cites a BBC report of people with mental health conditions from poor families "chained to trees" at a Sufi shrine near Burewala, Punjab, Pakistan. It notes that India's 2017 mental health law prohibits chaining and that a 2019 Indian Supreme Court ruling held that chaining violates human rights. Its recommendations to faith-healing centres include an immediate end to chaining, non-consensual fasting and detention, and residents' freedom to leave and to refuse treatment. [source: HRW 2020]
    • India's NHRC acted on a complaint about patients at the Sultan Alayudeen Durgah, Madurai. After 28 inmates of a private asylum at Erwadi, Tamil Nadu, died in a fire on 6 August 2001, the NHRC directed all States and Union Territories to certify that no mentally ill patient was kept in chains. It stated the deaths were "due primarily to the fact that they were chained." [source: NHRC]
    • The Supreme Court took suo motu cognisance of Erwadi, and unlicensed homes there were closed. Scroll reported in 2022 that families still chained relatives to trees on a dargah-owned plot despite the dargah's rules against tying patients. [source: Scroll 2022]
  • Steps:
    1. Ask neutrally where a relative is staying and how they are cared for. Ask whether they can come and go, and whether they are tied, locked in or denied food.
    2. If restraint or detention is current, treat it as a safeguarding emergency. Follow local adult or child protection law, and in India the Mental Healthcare Act route as local services advise. Involve a supervisor.
    3. Help the family find voluntary clinical care, including faith-sensitive options (4.5).
    4. Address the family's distress and lack of alternatives without blame. HRW links shackling to stigma, spirit beliefs, fear and scarce services.
    5. Document carefully.
  • Example language (illustrative): "While your brother is at the shrine, is he free to walk around and leave if he wants? Is he ever tied or locked in?"
  • Watch for: minimising ("only at night", "for his safety"), the belief that chains come off when God cures the person (reported at Erwadi), and children held at such sites. Mark the client's own experience of restraint as trauma. It is working when the person is released and voluntary care is in place.

4.7 Scrupulosity screen and adapted ERP

  • Purpose / when: Use when shrine etiquette becomes compulsive. Examples are repeating wuḍūʾ before a visit, re-reciting al-Fātiḥa until it feels "correct", fearing that a visit (or touching the grille) was shirk, or vows (mannat) that feel binding and catastrophic if unmet.
  • Steps:
    1. Separate ego-dystonic doubt and rituals from ordinary devotion. IOCDF notes that OCD conflicts with the person's values while healthy practice aligns with them.
    2. Give the standard OCD assessment and offer exposure and response prevention (ERP). Treatment is the same as for other OCD subtypes.
    3. Frame ERP as tolerating uncertainty, which IOCDF notes is part of faith, and not as opposing religion.
    4. With consent, consult the client's chosen scholar to set the religiously adequate standard, for example "one wuḍūʾ" or "one recitation", which then becomes the response-prevention target.
    5. Give the scholar brief education about OCD. In a survey of 64 imams, 37% had been approached about scrupulosity, most were unfamiliar with it as OCD, and only 9% referred to mental health professionals. [source: IOCDF; Jones, Harris & Esfahani 2019]
  • Example language (illustrative): "Your scholar said one recitation is complete. This week, can we practise reciting once and then leaving, even if it doesn't feel right?"
  • Watch for: reassurance-seeking moving to the scholar or the custodian, and the client's fear that ERP is sinful. It is working when time spent on rituals falls and the client experiences the visit as devotion again.

4.8 Working with religious conflict and moral distress

  • Purpose / when: Use when the client is torn between family members or communities who disagree, for example one parent devoted to a dargah and a spouse who calls it shirk. Also use when the client feels guilty for visiting, or for no longer visiting.
  • Steps:
    1. Map the positions without taking sides. These include Barelwī and Sufi defence, Deobandī acceptance of the visit only as sending merit to the dead, and Ahl-i Ḥadīth or Salafī objection. [source: Khan 2018]
    2. Clarify the client's own values.
    3. Refer questions of ruling to a scholar the client trusts.
    4. Work on communication within the family and on boundaries.
    5. Where guilt is linked to acts the client sees as betraying their deepest values, assess for moral injury.
  • Example language (illustrative): "It isn't for me to say who is right about the shrine. What matters is what you believe, and how to live with your family while you hold it."
  • Watch for: the therapist being drawn into theology, and the client using the therapist's view as a ruling. It is working when the client acts from their own position with less distress.

4.9 Grief, ritual and community support

  • Purpose / when: Use with bereaved clients who visit family graves or a saint's tomb, and around anniversaries, Eid and ʿurs.
  • What the tradition says: Malaysia's Federal Territory Mufti office presents grave visiting as remembering death, remembering God and asking mercy for the deceased. It restricts visits made to renew grief, and wailing. Scholars differ on women visiting graves, with views ranging from disliked to prohibited when lamenting is likely. [source: Jabatan Mufti Wilayah Persekutuan 2015]
  • Steps:
    1. Ask how the client remembers the dead and what visiting means to them.
    2. Support continuing bonds through permitted acts, such as supplication for the deceased and giving in their name, as the client's tradition allows.
    3. Where the client feels barred from visiting, for example by their community's view on women's visits, explore grief that has no outlet and alternatives their scholar accepts.
    4. Link the client to community support around visits.
  • Example language (illustrative): "When you stand at your father's grave and pray for him, what do you feel? Is there anything you wish you could do there that you can't?"
  • Watch for: prolonged grief, guilt at being "too sad" for religious norms, and isolation. It is working when visits bring comfort and connection rather than renewed collapse.

4.10 Collaboration with scholars, custodians and chaplains (when the client wishes)

  • Purpose / when: Use when the client wants their religious authority involved. This might be for a ruling, for support, for ERP standards (4.7) or for integrated care (4.5).
  • Steps:
    1. Obtain written consent that specifies what will be shared and with whom.
    2. Agree the purpose with the client in advance.
    3. Contact the authority, or a hospital chaplain where available. Ask about the tradition, not about the client's private material.
    4. Agree who does what: the scholar on rulings, the clinician on symptoms and treatment.
    5. Report back to the client.
  • Example language (illustrative), to a scholar: "Your congregant has asked me to check with you what counts as a complete wuḍūʾ before a shrine visit, so we can use that as the standard in treatment."
  • Watch for: advice from religious figures that is inconsistent with ERP or that discourages treatment, as Jones et al. (2019) document for some imams. Watch also for breaches of confidentiality. It is working when advice from both sides is consistent. [source: IOCDF; Jones et al. 2019]

4.11 Assessing intense experiences linked to shrine visits

  • Purpose / when: Use when a client reports overwhelming experiences at a shrine or ʿurs, such as states during qawwālī or samāʿ, felt presence of the saint, or experiences the family calls spirit affliction.
  • Steps:
    1. Explore the experience in the client's terms and ask how their community regards it.
    2. Assess whether it is time-limited and culturally sanctioned, or whether it carries persistent impairment, psychotic features, mania, dissociation or depression.
    3. Where no disorder is present but there is religious distress, note that DSM-5-TR lists a religious or spiritual problem as a focus of clinical attention, code Z65.8.
    4. Refer to a psychiatrist where illness is likely, using 4.5 to keep faith and treatment together.
  • Example language (illustrative): "In your community, how do people understand what happened to you during the qawwālī? And how have you been since, sleeping, eating, thinking?"
  • Watch for: pathologising a normative devotional state, and missing psychosis because it is framed spiritually. Published research on adverse contemplative experiences (Lindahl et al. 2017, PLOS ONE; Farias et al. 2020, Acta Psychiatrica Scandinavica) concerns meditation rather than shrine visitation [uncertain: not verified]. It is working when the assessment is acceptable to the client and clinically sound. [synthesis]

4.12 Role clarity and the therapist's own position

  • Purpose / when: Use throughout, and especially when the client asks "Do you believe in saints?" or asks you to pray for them.
  • Steps:
    1. Reflect privately on your own religious or secular views about shrine devotion, including any received polemics.
    2. Decide what to disclose. Any disclosure should be brief and serve the client.
    3. Decline the role of religious adviser and redirect rulings to scholars.
    4. Avoid dual relationships, for example meeting clients at your own shrine or mosque in a religious role.
    5. Seek training in spiritual and religious competencies. Vieten et al. (2013) propose 16 competencies across attitudes, knowledge and skills. [source: Vieten et al. 2013]
    6. Act within your profession's ethics code on competence, respect for religious difference and multiple relationships [synthesis].
  • Example language (illustrative): "My own views matter less here than yours. I'll respect what the shrine means to you, and for questions of what is permitted, your scholar is the right person."
  • Watch for: countertransference, whether contempt or idealisation, and drifting into spiritual direction. It is working when the client feels respected and roles stay clear.

5. Handling problems

The sources address restraint, shrine-clinic integration and scrupulosity. The rest of this section is [synthesis].

  • The client or family relies on the shrine alone and stops treatment. Do not argue against the belief. Use the "both" frame (4.5) and the CFI explanatory model (4.2). Involve the doctor (4.4) and, with consent, a religious figure who supports treatment. Scroll (2022) reports that some families believe only prayer cures, often after medication failed. Explore that history of failed treatment openly. [source: Scroll 2022; synthesis]
  • Restraint is disclosed or suspected. This is a safeguarding matter, not an issue of cultural accommodation. Follow 4.6, consult a supervisor, and use mandatory routes. Do not delay because the family means well. [source: HRW 2020; NHRC]
  • The client fears the therapist will judge them as superstitious, or as a bad Muslim. Name neutrality explicitly and ask about past experiences with clinicians. Hesitancy often eases once the CFI questions show genuine interest. [synthesis]
  • The therapist is asked for a religious ruling, or to pray with the client. Decline the ruling and redirect it (4.12). On joining in prayer, use professional judgement and supervision, and keep the boundary clear. [synthesis]
  • Rupture after a perceived slight to the saint or the tradition. Acknowledge it, apologise for the impact, ask what was hurtful, and repair. Example (illustrative): "I think I spoke about the dargah in a way that felt dismissive. I'm sorry. Can you help me understand what I missed?" [synthesis]
  • Non-adherence around festivals or pilgrimages. Plan ahead (4.3). Treat missed sessions around an ʿurs as predictable rather than as resistance. Use remote contact where lawful. [synthesis]
  • Overwhelm after a visit, such as intense emotion, a grief surge or an unusual experience. Ground the client and assess (4.11). Rule out psychosis or mania without dismissing the meaning. Refer if needed. [synthesis]
  • Scrupulosity resists ERP because it "feels sinful". Return to the scholar-set standard. Frame the work with IOCDF's point that tolerating uncertainty is part of faith. Slow the exposure hierarchy rather than abandon it. [source: IOCDF]
  • Family conflict over whether visiting is shirk. Use 4.8. Do not ally with either side. Refer the theological question to a scholar. [source: Khan 2018; synthesis]
  • Healing claims made by a custodian or a shrine-linked healer. Attribute them to the tradition. Never present the visit as treating physical disease. Keep medical care routed to the doctor, and watch for financial exploitation or detention (4.6). [synthesis]
  • Children taken to healing shrines. Children's wellbeing and protection come first. Where restraint, deprivation or detention is involved, follow child protection procedures. [source: HRW 2020 recommendations; synthesis]

Sources

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