Atlas›Domain VII · Transpersonal, psychedelic & altered states›Guide 026
Guide VII-026

Sufi psychology

Robert Frager, Saloumeh DeGood1999
A 31 · L 48 · M 2115 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: two published Western strands, each named where it is used. (A) M.T.O. Sufi Psychology, an integrative approach from the Sufi Psychology Association (SPA; president Dr Saloumeh DeGood, per Templeton 2023), based on the teachings of the M.T.O. Shahmaghsoudi School of Islamic Sufism, with its adjunct concentration method Tamarkoz. (B) Robert Frager's model of heart, self (nafs) and soul (Heart, Self, and Soul, Quest Books, 1999). Frager holds a Harvard doctorate in social psychology, founded the Institute of Transpersonal Psychology (now Sofia University, Palo Alto), was initiated into the Halveti-Jerrahi order by Muzaffer Ozak, teaches as Sheikh Ragip al-Jerrahi and leads a Jerrahi community in Redwood City, California [source: Wikipedia, Robert Frager]. Founding and ordination years and further titles are unverified [uncertain]. Sources: Frager's book is cited from the publisher page, a review and two Indonesian secondary analyses (Sukma 2025; Riyadi et al. 2026); its own exercises are not reproduced here. The APA handbook chapter on Sufi psychology (Bozorgzadeh, ch. 15, 2023), Javad Nurbakhsh's psychological writings (Nimatullahi Order) and Ibn Arabi-derived "psycho-Sufism" are not used as sources [uncertain]. The meditation adverse-effects literature (Lindahl et al. 2017; Farias et al. 2020) is used in 4.14, 4.15 and section 5. All Steps in section 4 are [synthesis]. [source: Red Wheel/Weiser; archive.org record; Templeton 2023; MTO SPA page; Sukma 2025; Riyadi et al. 2026]

What it is. Sufi psychology is not a single manualised therapy. It is a family of approaches that take the Sufi tradition's own theory of the person and use it as a frame for growth and, in some schools, for psychotherapy. That theory is a heart (qalb) that can be veiled or polished, a self (nafs) that can be refined through stages, and a soul or spirit (ruh). These are the tradition's concepts, not empirical facts. Each school attributes them to its own lineage. Religious authority over Sufi practice belongs to the orders and their teachers: M.T.O. Shahmaghsoudi, the Halveti-Jerrahi line Frager belongs to, the Nimatullahi Order and others. Clinicians do not hold it. [source: Templeton 2023; Spirituality & Practice review; Sukma 2025]

How change happens, as the schools put it.

  • The SPA/M.T.O. approach combines evidence-based secular methods (cognitive behavioural therapy is named) with spiritually integrated work. That work explores the client's spiritual history and needs and helps the client tell "heart values" from "brain values". The aim is to reorganise the person's inner hierarchy so the heart leads. [source: Templeton 2023]
  • In Frager's model as Sukma reports it, distress comes from a heart closed by greed, envy and anger, and from an unrecognised ego-driven "tyrannical" self. Change comes from purifying the heart, refining the nafs and harmonising seven levels of soul. [source: Sukma 2025, pp. 56–59]
  • Yazid & Ihsan (2026) describe the Ibn Arabi-derived model in a similar way. Distress is spiritual veiling through attachment and the dominance of base desires, and it is remedied by purifying the self, spiritual discipline, remembrance and ethical change. [source: Yazid & Ihsan 2026, abstract]

Regulatory status. This is not a regulated therapy title. The practitioner is regulated by their own professional licence, and the clinician's usual ethics on integrating religion and spirituality apply [synthesis].

2. Framework

No school has a published session-by-session protocol in the sources used. Templeton (2023) reports only that an initial study by DeGood found self-reported distress fell over a course of therapy sessions. It gives no session count, format or sample size [source: Templeton 2023]. The fullest professional account, Bozorgzadeh's chapter "Sufi Psychology: A Heart-Centered Paradigm" (APA, 2023), is not used here, so any session structure it gives is not reflected [uncertain]. The only published session counts are for Tamarkoz classes (see Phase 3 and 4.14). The structure below is therefore a practical scaffold built from the elements the sources name. The phase sequence and all session numbers are [synthesis]; the content of each element is sourced where marked.

Phase 1: Assessment and consent (1–2 sessions) [synthesis for structure]

  • Goals: a standard clinical assessment and risk screen; the client's spiritual history and present spiritual needs [source: Templeton 2023]; whether the client wants Sufi concepts used, and how far.
  • Also establish the client's relationship to any order or teacher. In Frager's model a shaykh's guidance is considered essential within the path [source: Sukma 2025, p. 59], so the therapist must not take that role.
  • Move on when there is a shared formulation and explicit consent to integrate spiritual material. Without that consent, deliver standard therapy only.

Phase 2: Mapping (about 2–4 sessions) [synthesis]

  • Goals: shared psychoeducation using the school's map the client resonates with. For SPA this is heart values versus brain values. For Frager it is the stations of the heart and the levels of the nafs [source: Templeton 2023; Sukma 2025].
  • Begin locating current problems on the map, e.g. which patterns are driven by the commanding self.
  • Move on when the client can name their own patterns in the chosen language and link them to the presenting problem.

Phase 3: Active work (the bulk of therapy; length set clinically)

  • Goals: secular symptom-focused methods (CBT named by SPA) alongside the reflective practices in Section 4, including mirror reflection on irritations, self-reckoning, gratitude and service.
  • Where wanted, add a referral to a concentration programme such as Tamarkoz, taught only by teachers approved by the M.T.O. Sufi Master.
  • For format reference, published Tamarkoz courses ran as a weekly class. One was a 16-week course of 50-minute weekly sessions at UC Davis. Another was a class assessed at 12 weeks, with follow-up at 18 weeks, at UC Berkeley. [source: Templeton 2023; ICPSR 137281; UC Davis]
  • Move on when there is symptomatic improvement on standard measures and the client is using the reflective practices independently [synthesis].

Phase 4: Consolidation and ending [synthesis]

  • Goals: relapse planning, and linking ongoing spiritual practice to the client's own community or teacher rather than to the therapist.

Format. Individual outpatient sessions are assumed [synthesis]. Tamarkoz is also delivered through group classes and a guided app [source: MTO Mental Health Response].

3. Guiding principles

  • Integrate; do not replace. SPA pairs spiritual work with evidence-based secular methods. In practice, keep the standard treatment for the disorder, with the Sufi frame as context and motivation. [source: Templeton 2023]
  • Start from the client's own spiritual history. Ask before you frame. Use Sufi language only if the client brings or accepts it. [source: Templeton 2023]
  • The heart leads. SPA and Frager both place the heart at the centre. In practice, ask what the client's heart, not only their reasoning, values in a decision. [source: Templeton 2023; Sukma 2025]
  • Irritations as a mirror. Drawing on Rumi's mirror image, SPA treats irritations as possible material for self-insight. Explore what a reaction reveals before trying to remove it. [source: Templeton 2023]
  • Growth, balance and harmony, not only symptom removal. Frager's book is framed around harmonising the person with the Divine, in contrast to adaptation alone. Set goals that include values and meaning where the client wants that. [source: Red Wheel/Weiser]
  • The ego as a tool to be seen and mastered, not attacked. In Frager's model the ego pushes towards separation and blocks transformation [source: Sukma 2025, p. 58]. In practice: help the client notice ego-driven patterns with curiosity rather than self-condemnation. Keep ordinary psychological work (defences, symptoms) in the therapist's role, and leave the wider spiritual aim with the client's tradition. The non-shaming tone and the role split are [synthesis].
  • Love and sincere intention matter. Frager's sources hold that actions without love and sincere intention have little meaning, and that serving with love opens the heart. Attend to motive, not only behaviour. [source: Sukma 2025, p. 57]
  • Restraint as choice. Frager's example is hunger: a natural drive where the question is whether the person chooses restraint or indulgence. Frame self-regulation as a free choice the client makes, not as suppression. [source: Sukma 2025, p. 59]
  • Know the limits of the role. The shaykh, teacher or order holds spiritual authority and transmits practice; Tamarkoz requires approved teachers. The therapist supports, refers and integrates but does not initiate, assign devotional litanies or act as a spiritual guide. [source: Sukma 2025; ICPSR 137281] [synthesis for the role boundary]
  • Train before you use contemplative methods clinically. Isgandarova advises that clinicians using muraqaba be properly trained in classical Sufi traditions. Do not improvise Sufi meditations. [source: Isgandarova 2019, abstract]
  • Attribute, don't assert. Present nafs levels, heart stations and seven souls as "in this tradition…", never as established psychology [house rule; synthesis].

4. Intervention inventory

How to read this section. The sources name these interventions and give their purpose. Not one gives in-session step-by-step instructions. So in every entry below, the Steps and the example language are [synthesis]: one practical way of carrying out what the source names. They are not a procedure published by SPA, Frager or any order. Example therapist language is illustrative throughout. Frager's book reportedly contains its own meditations and journaling exercises [source: Red Wheel/Weiser]; neither secondary analysis (Sukma 2025; Riyadi et al. 2026) reproduces them, so their content is unknown [uncertain].

4.1 Spiritual history and spiritual-needs assessment (SPA)

  • Purpose / when: At intake and whenever spiritual material comes up. It finds out whether and how the Sufi frame fits this client. SPA names exploring "spiritual history and present spiritual needs" as a core method. [source: Templeton 2023]
  • Steps [synthesis]:
    1. Ask about religious or spiritual upbringing, current practice, and any affiliation with an order or teacher.
    2. Ask how their faith helps and how it hurts in relation to the problem.
    3. Ask what they hope therapy will do spiritually, if anything.
    4. Ask what they do not want: no religious language, or no challenge to a teacher.
    5. Record explicit consent to integrate, and the limits of that consent.
  • Example language (illustrative): "Some people want their faith to be part of therapy and some don't. Where are you with that?" "Is there a teacher or community whose guidance you follow? I'd like to work alongside that, not over it."
  • Watch for: pressure from family or community to attend. Spiritual struggle (feeling abandoned or punished by God) needs careful exploration, not reassurance. Note any wish for the therapist to act as a spiritual guide. It is working when the client can say clearly how much spiritual integration they want.

4.2 Heart values versus brain values (SPA / M.T.O.)

  • Purpose / when: For decisions, value conflicts, burnout and over-intellectualising. SPA uses it to help clients tell the two kinds of value apart and "reorganize" the inner hierarchy so the heart, as the gateway to the spiritual dimension, leads. [source: Templeton 2023] In a 2020 interview, SPA's president described a related self-inquiry: examining whether one's actions come from habit, custom or family expectation, and clarifying one's own purpose; she presented Sufi psychotherapy as adding this spiritual dimension to conventional work on thoughts, emotions, relationships and trauma, not replacing it [source: Psychology Today 2020].
  • Steps [synthesis]:
    1. Pick a live decision or recurring conflict.
    2. On two columns, list what the reasoning mind says matters (status, safety, approval, calculation) and what the heart says matters (love, sincerity, meaning, conscience).
    3. Ask the client to slow down, attend to the chest and notice which column feels true. Keep any body focus brief and optional.
    4. Identify where brain values are overruling heart values, and the cost.
    5. Choose one small action this week that is led by a heart value.
  • Example language (illustrative): "If your head had no vote, what would your heart choose here?" "Which of these is about being seen well, and which is about what you love?"
  • Watch for: Clients may treat "heart" as permission for impulsivity. Distinguish heart values from passing urges (see 4.7). Depressed clients may report an empty heart column; treat that as a symptom, not a spiritual failure [synthesis]. It is working when decisions feel more congruent and conflict lessens.

4.3 Mirror reflection on irritations (SPA, drawing on Rumi)

  • Purpose / when: For interpersonal irritation, resentment and anger patterns. SPA invites clients to consider whether irritations may sharpen self-insight, using Rumi's image of polishing a mirror. [source: Templeton 2023]
  • Steps [synthesis]:
    1. Take a recent irritation.
    2. Describe the trigger, the reaction and the urge.
    3. Ask what quality in the other person most provoked them, and whether they recognise any trace of it in themselves or a wound it touches.
    4. Ask what the irritation reveals about what they value or fear.
    5. Choose a response that comes from that insight rather than the reaction.
  • Example language (illustrative): "In the tradition you're drawing on, an irritation can be friction that polishes the mirror. What might this one be showing you?"
  • Watch for: Never use the mirror frame with abuse, discrimination or ongoing harm. Victims must not be invited to look for their own fault in mistreatment [synthesis]. It is working when the client reacts less and has more choice in recurring irritations.

4.4 Integrating secular evidence-based methods (SPA)

  • Purpose / when: Throughout. SPA explicitly combines CBT and similar methods with spiritually integrated ones. [source: Templeton 2023]
  • Steps [synthesis]:
    1. Deliver the standard protocol for the diagnosis, e.g. CBT for depression or anxiety.
    2. Where the client consents, frame homework and cognitive work in the client's own spiritual terms, e.g. examining a thought for sincerity or arrogance as well as for evidence.
    3. Use spiritual meaning to support motivation for exposure or activation, never to replace them.
  • Example language (illustrative): "Let's test this thought the usual way, then also ask whether it comes from the heart or from the commanding self, as you described it."
  • Watch for: Spiritualising a treatable disorder and delaying effective care. It is working when standard outcome measures improve.

4.5 Psychoeducation: the levels of the self (nafs) (Frager; classical scheme)

  • Purpose / when: In the mapping phase, for clients who accept the frame. It gives a non-pathologising developmental language for self-observation.
  • Content (attributed):
    • Frager's seven levels, as Sukma reports them: commanding/tyrannical, regretful, inspired, tranquil/secure, content, pleasing-to-God and pure/complete [source: Sukma 2025, pp. 57–58]. Riyadi et al. give the same seven (tyrannical, self-reproaching, inspired, tranquil, contented, God-pleased, purified) [source: Riyadi et al. 2026]. Wikipedia's Sufi psychology article cites pp. 54–88 of Frager's book for the scheme [source: Wikipedia, Sufi psychology]. The book's own wording is [uncertain].
    • A Threshold Society page (author not named) gives a devotional version of the same seven, with traits and a recommended spiritual work for each. [source: sufism.org]
    • Frager also uses an oval diagram with a lower unconscious, a middle zone with the ego at its centre, and an upper unconscious. [source: Sukma 2025, p. 58]
  • Steps [synthesis]:
    1. Present the scheme briefly, as the tradition's map: "in this tradition…".
    2. Ask which descriptions the client recognises in themselves, at different times.
    3. Normalise movement up and down. The sufism.org text itself describes slipping back as possible.
    4. Link recognisable patterns to the presenting problem.
  • Example language (illustrative): "In this map, most of us move between the self that wants its own way and the self that regrets and turns back. Where do you notice each this week?"
  • Watch for: Scrupulosity, shame or a spiritual hierarchy ("I'm stuck at the lowest level"). Keep the map descriptive. Do not grade the client [synthesis]. Leave the devotional content attached to each level, such as specific remembrance formulas, to the client's teacher (see 4.12).

4.6 Recognising the commanding ("tyrannical") self

  • Purpose / when: For compulsive, ego-driven or destructive patterns: anger, envy, greed, addiction-like pursuit, grandiosity. Sukma reads Frager's model as helping therapists support clients to recognise destructive drives and the conflicts within the tyrannical nafs. [source: Sukma 2025, pp. 57, 61]
  • Steps [synthesis]:
    1. Name the pattern and its typical triggers.
    2. Track a daily log of moments when the drive took over: situation, urge, story told to justify it, outcome.
    3. Help the client give the drive a non-shaming name.
    4. Practise a pause between urge and action, and identify the heart value at stake (4.2).
    5. Review the log each session for patterns and successes.
  • Example language (illustrative): "Let's catch the commanding self in action this week, not to punish it but to see how it talks you into things."
  • Watch for: Harsh self-attack that mimics the regretful self. Reframe that as part of the same ego drama [synthesis]. It is working when urges are caught earlier and acted on less.

4.7 The stations of the heart and "opening the eyes of the heart" (Frager, via al-Tirmidhi)

  • Purpose / when: For clients seeking inner calm and meaning, or a sense of being closed off. Sukma reports Frager's four layers of the heart, drawn from al-Tirmidhi: shadr (the outer breast, where struggle occurs), qalb, fu'ad and lubb (innermost core). She reports that greed, envy and anger close the heart and that cleansing the outer layer opens the inner. She also quotes the aim of cultivating calm by opening the eyes of the heart. [source: Sukma 2025, pp. 56–57, 61]
  • Steps [synthesis]:
    1. Introduce the layers as the tradition's metaphor.
    2. Identify what currently "crowds the outer heart": grievances, envy, anxieties.
    3. Pair each with a cleansing practice the sources name: gratitude (4.9), self-reckoning (4.8) or service (4.10).
    4. Track moments of inner quiet or openness as markers of progress.
  • Example language (illustrative): "What's sitting at the doorway of your heart right now, taking up the room?"
  • Watch for: Bypassing grief or anger by labelling them "impurities". Process the emotion first [synthesis].

4.8 Self-reckoning (muhasaba)

  • Purpose / when: For self-honesty, values consistency, and catching patterns early. Sukma names self-reckoning, with gratitude and remembrance, among the ways of cleansing the heart in Frager's account. [source: Sukma 2025, p. 56] A published mainstream Islamic outline (Yaqeen Institute, Suleiman 2023, drawing on al-Mawardi and the saying attributed to Umar ibn al-Khattab about holding oneself to account) pairs a few minutes of morning reflection on blessings with a few minutes of evening review: what was good, what displeased God, where there was ingratitude; the person then resolves to do more of the good and seeks forgiveness for the rest [source: Yaqeen Institute 2023]. This is a general Islamic form; no SPA- or Frager-specific procedure is published in the sources used [uncertain].
  • Steps [synthesis]:
    1. At a fixed time each evening, take a few minutes for review.
    2. Recall the day's main interactions.
    3. For each, note where the client acted from the heart's values and where from the commanding self.
    4. Name one thing to repair and one thing to be glad of.
    5. Close without a verdict on oneself.
    6. Bring the notes to session.
  • Example language (illustrative): "Think of it as an honest account, not a court case: what went well, what needs mending, and what you'll do tomorrow."
  • Watch for: In OCD, scrupulosity or depression this can become rumination or a compulsive moral check. Shorten it, time-limit it, or drop it [synthesis]. It is working when it ends with a concrete repair or intention rather than with guilt.

4.9 Gratitude (shukr)

  • Purpose / when: For a closed or bitter heart, low positive affect, and entitlement. Sukma names gratitude as a way to cleanse the heart. [source: Sukma 2025, p. 56]
  • Steps [synthesis]:
    1. Each day, note a few specific things received: from people, from circumstances and, if the client is religious, from God.
    2. Write down what each one makes possible.
    3. Weekly, express thanks directly to one person.
  • Example language (illustrative): "What came to you today that you didn't earn?"
  • Watch for: Being used to dismiss legitimate grievances ("I should just be grateful"). Validate the grievance alongside the gratitude [synthesis].

4.10 Service with love

  • Purpose / when: For isolation, self-preoccupation and loss of meaning. Frager, as Sukma reports, holds that serving creation with love opens the heart, and that acts without love and sincere intention have little meaning [source: Sukma 2025, p. 57].
  • Steps [synthesis]:
    1. Identify a small, regular act of service that fits the client's capacity.
    2. Before it, set the intention.
    3. Afterwards, reflect on the motive (love, or wanting to be seen as good) and on its effect on mood.
  • Example language (illustrative): "Small and sincere beats big and for show. What's one kindness you could do this week where no one would need to know?"
  • Watch for: People-pleasing, over-giving and caregiver burnout. Service must not become self-erasure; build in boundaries [synthesis].

4.11 Harmonising drives: restraint as choice (Frager's seven souls)

  • Purpose / when: For appetite and impulse problems, but not as a stand-alone treatment for eating disorders or addiction. Frager, as Sukma reports, describes seven levels of soul: mineral, vegetable, animal, personal, human, secret and secret of secrets. The aim is balance among them, with instinctual drives sited at the vegetable and animal levels and negative ego at the personal level. Natural drives harm when excessive. Frager's example is hunger, where the person can choose restraint over indulgence. [source: Sukma 2025, p. 59]
  • Steps [synthesis]:
    1. Normalise the drive as natural and good in proportion.
    2. Identify when it becomes excessive and what it is serving, e.g. soothing or status.
    3. Rehearse a moment of free choice: pause, notice the urge, name the value, choose.
    4. Review what restraint and what indulgence each did to stability.
  • Example language (illustrative): "Hunger isn't the problem; it's part of being alive. The question is who's choosing."
  • Watch for: With eating disorders, avoid restriction framing completely and follow standard ED care [synthesis]. With substance use, combine with standard treatment.

4.12 Supporting the client's own devotional practice (not prescribed by the therapist)

  • Purpose / when: Only for clients already in or entering a Sufi or Muslim practice who want it integrated.
  • What the sources name:
    • Frager's book has sections on fasting, retreat, adab (spiritual etiquette), prayer, remembrance of God and recollection of death. [source: Spirituality & Practice review]
    • Sukma reports remembrance (dhikr); a bedtime practice of gently repeating short phrases of God's presence and protection; fasting as a way to restrain instinctive drives; and retreat (khalwa) as a practical therapy distinguished from relaxation by its prayers. [source: Sukma 2025, pp. 56–60]
    • The Threshold Society text attaches specific remembrance formulas to each nafs level. [source: sufism.org]
  • Steps [synthesis]:
    1. Ask what practice the client already has, from whom they received it, and how it relates to the problem.
    2. Help them schedule and protect it if they want that.
    3. Explore their experience of it in session.
    4. Questions about form, content or intensification of practice go back to their teacher or community. The therapist does not assign litanies, retreats or fasts.
  • Example language (illustrative): "How does your evening remembrance affect your sleep and worry? Would it help to keep that time protected?" "That sounds like a question for your teacher; what would they say?"
  • Watch for:
    • Fasting raises medical issues with diabetes, pregnancy and eating disorders, and with medication timing. Coordinate with medical care [synthesis].
    • Retreat or isolation is unsuitable during acute depression, psychosis or suicidality [synthesis].
    • Recollection of death needs caution with suicidal or health-anxious clients [synthesis].

4.13 Sufi stories, poetry and journaling

  • Purpose / when: For indirect work on stuck patterns and for meaning-making. Frager's book is described as full of stories, poetry, meditations, journaling exercises and everyday examples. Sukma notes that knowledge of the innermost heart is often conveyed through poetry rather than argument. The book's specific exercises are not reproduced here. [source: Red Wheel/Weiser; Sukma 2025, p. 56] [uncertain]
  • Steps [synthesis]:
    1. Offer a short teaching story or poem relevant to the theme, from a published source the client can own.
    2. Ask what stands out and where the client sees themselves in it.
    3. Set a short journal prompt drawn from it.
  • Example language (illustrative): "Which character in that story are you most like right now?"
  • Watch for: Stories as lectures. Let the client find the meaning [synthesis].

4.14 Tamarkoz (M.T.O.): referral or adjunct, not therapist-delivered

  • Purpose / when: Stress, low positive emotion and spiritual seeking. M.T.O. describes Tamarkoz as the art of self-knowledge through concentration and meditation. Its listed components are deep breathing, mind relaxation, slow meditative movement, visualisation and heart concentration. Teachers must be approved by the M.T.O. Sufi Master, and delivery is by class or a guided app. [source: MTO Mental Health Response; ICPSR 137281; UC Davis] The trial report describes it as a concentration method that can be applied to any task, meant to discipline mind, body and emotions so as to limit distraction, and practised in everyday activities such as studying or eating as well as on the Sufi path to self-knowledge. [source: Bahadorani, Lee & Martin 2021, abstract]
  • Published trial frame:
    • Bahadorani, Lee & Martin (2021) ran an 18-week quasi-experimental study with university students aged 18–30. It compared Tamarkoz with a wait-list and with campus health-centre stress resources.
    • Exclusions were third-shift work, diabetes, PTSD, liver or autoimmune disease, and severe psychiatric disorder such as treatment-resistant severe depression or schizophrenia.
    • Reported results were lower perceived stress and heart rate, and higher positive emotion and daily spiritual experience, compared with both the wait-list and the campus-resources group. [source: ICPSR 137281; Bahadorani, Lee & Martin 2021, abstract]
  • Steps [synthesis]:
    1. Discuss fit and the client's attitude to a religious organisation's programme.
    2. Screen against the trial exclusions as a cautious guide.
    3. Refer to an approved class or the app.
    4. Review the client's experience and any adverse reactions in session. Do not teach Tamarkoz yourself.
  • Example language (illustrative): "There's a concentration programme from this Sufi school with some early research behind it. It's taught by their own approved teachers. Would you want to try it alongside our work?"
  • Watch for: PTSD and severe mental illness were excluded from the trial, so there is no evidence of safety for those groups [source: ICPSR 137281]. Meditation in general can produce adverse effects, including in people with no psychiatric history, and anxiety and depression are the most often reported [source: Farias et al. 2020, abstract]. Body- and breath-focused practices can bring up trauma material, dizziness or panic. Ask about such effects at every review; slow down, ground, or stop [synthesis]. See section 5, Overwhelm.

4.15 Muraqaba (watchful contemplation) as a mindfulness-type therapy

  • Purpose / when: Isgandarova proposes muraqaba, adapted from Sufi practice, as potentially useful for symptomatic anxiety, depression and pain, though not for all conditions. It is related to MBSR, MBCT and mind-body approaches. [source: Isgandarova 2019, abstract]
  • Steps: Isgandarova's 2019 procedure is not reproduced here [uncertain]. Her later book, Mindfulness Techniques and Practices in Islamic Psychotherapy: The Power of Muraqabah (Routledge, 2025), is described by reviewers as combining muraqabah with CBT and DBT, using movement, dhikr (remembrance) and music as routes to stillness, and addressing anxiety, depression and attention difficulties [source: Iqra review 2026; secondary]. Isgandarova states that clinicians must be properly trained in classical Sufi traditions before using it. Without that training, use a standard secular mindfulness protocol you are trained in, with the client's spiritual framing, and do not label it muraqaba [synthesis].
  • Watch for: Meditation-related adverse effects. A systematic review of 83 studies (6,703 meditators) found at least one adverse event reported in 65% of studies. Overall prevalence was 8.3% (3.7% in experimental and 33.2% in observational studies). The commonest were anxiety, depression and cognitive anomalies, and they also occurred in people without prior mental-health problems [source: Farias et al. 2020, abstract]. Neither this review nor Lindahl et al. (2017) studied Sufi practices, so applying them to muraqaba is [synthesis]. Screen and respond as in section 5, Overwhelm.

5. Handling problems

The sources do not address problem handling. Everything in this section is [synthesis] unless a source is tagged.

  • Stuck client:
    • Check that the standard treatment for the disorder is actually being delivered, since SPA's model is integrative [source: Templeton 2023].
    • Re-measure symptoms.
    • Check whether the spiritual frame has become intellectual. Move from the map (4.5, 4.7) to concrete daily practice (4.6, 4.8–4.10).
    • If stuckness is framed as "my nafs is too low", treat that as a depressive or shame cognition and work with it cognitively.
  • Resistance or ambivalence about religion in therapy:
    • Drop the vocabulary and keep the underlying work in secular terms: values clarification, self-monitoring, gratitude, prosocial action.
    • Consent to spiritual integration is revisable at any session.
  • Overwhelm during contemplative, breath or heart-concentration work:
    • Possible signs are panic, dizziness, flashbacks, depersonalisation or derealisation, unusual perceptual experiences, or mania-like elevation.
    • Stop the exercise and orient to the room: eyes open, feet on floor, naming objects, normal breathing.
    • Shorten or end the practice. Assess for trauma reactivation, panic disorder, bipolar or psychotic vulnerability.
    • What the adverse-effects literature reports. Lindahl et al. (2017) interviewed nearly 100 Western Buddhist meditators and teachers. They coded 59 kinds of challenging experience in seven domains (cognitive, perceptual, affective, somatic, conative, sense of self, social), including fear, anxiety and panic, loss of emotion, hypersensitivity to light or sound, insomnia and involuntary movements. Effects lasted from days to more than a decade and sometimes impaired work. They were shaped by practitioner factors, practice intensity, the relationship with the teacher, and sleep, diet and exercise; psychiatric and trauma history mattered for some meditators but not all. Having someone knowledgeable to talk to, and learning that such experiences are not unique or the person's fault, helped [source: Brown University summary of Lindahl et al. 2017]. Farias et al. (2020) found adverse events in 8.3% of meditators across 83 studies, most often anxiety and depression, including in people with no psychiatric history [source: Farias et al. 2020, abstract]. In practice: ask about these effects routinely rather than waiting for the client to raise them, reduce intensity or duration first, and normalise without minimising [synthesis]. Neither study examined Sufi practices, so the transfer is [synthesis].
    • Tamarkoz's trial excluded PTSD and severe psychiatric disorder, so do not assume safety in those groups [source: ICPSR 137281].
  • Spiritual emergency or possible psychosis:
    • If a client reports visions, voices, special missions or lights, assess as you would any perceptual change: onset, distress, function, sleep, substance use, family history.
    • Do not interpret experiences through Sufi categories, which would confirm a delusion, or dismiss them, which would rupture the alliance.
    • Consult psychiatry promptly, and with consent, the client's teacher.
  • Non-adherence to practices:
    • Scale down to one practice of a few minutes.
    • Link it to an existing routine, and explore obstacles without moralising.
    • Never frame non-adherence as spiritual failure or weakness of the nafs.
  • Scrupulosity, shame and self-condemnation:
    • The nafs language and self-reckoning can feed religious OCD and depressive guilt.
    • Signs are long nightly reviews, checking whether intentions were "pure", and repeated reassurance-seeking.
    • Suspend self-reckoning (4.8).
    • Treat with standard ERP or CBT for scrupulosity. Where the client wants it, involve a religious authority they trust to speak to legitimate leniency.
  • Spiritual bypassing:
    • Gratitude, contentment or surrender ideals can be used to avoid grief, anger or necessary action. The content self in the classical scheme is described as content with whatever is decreed [source: sufism.org].
    • Name the pattern gently, and validate and process the emotion first.
    • Distinguish acceptance from tolerating harm.
  • The client wants the therapist as shaykh, or the therapist is in the same order:
    • Spiritual guidance in these schools belongs to the shaykh and the order [source: Sukma 2025, p. 59], and Tamarkoz teaching needs the M.T.O. Master's approval [source: ICPSR 137281].
    • Decline the guide role explicitly.
    • If you belong to the client's order, or SPA is linked to the order you belong to (SPA sits within M.T.O. Shahmaghsoudi's charitable activities [source: MTO SPA page]), manage dual relationships. Disclose the affiliation, keep therapy separate from community roles, avoid recruiting, and consider referral.
  • Conflict between a teacher's guidance and treatment:
    • If the client reports being advised to stop medication, avoid psychiatric care or keep abuse private, explore the client's own view first.
    • Give clear clinical information. Offer, with consent, to talk with the teacher.
    • Prioritise safety; mandatory reporting duties override confidentiality as your law requires.
    • No source opened documents such concerns for any particular order [uncertain]. This is general guidance, not a claim about any named group.
  • Abuse or coercion in a spiritual community:
    • Assess for undue influence: isolation, financial demands, sexual contact with a teacher, punishment for questions.
    • Support the client's autonomy, safety-plan where needed, and follow safeguarding duties.
  • Contested esoteric claims:
    • The SPA approach reportedly includes an esoteric idea about electromagnetic forces affecting one's circumstances [source: Templeton 2023].
    • Present such ideas only as the school's teaching. Do not endorse them as science, and do not let them displace practical problem-solving.
  • Cultural and religious mismatch:
    • Western universalist Sufism and Islamic Sufism differ. Frager calls the path of the heart "a spiritual discipline for all peoples and cultures" [source: Spirituality & Practice review]. M.T.O. stresses both direct experience and orthodox Islamic practice [source: Templeton 2023].
    • Ask which framing the client holds.
    • Do not impose Islamic practice on a non-Muslim seeker, or a universalist reading on an observant Muslim.
  • Ruptures:
    • Ruptures are likely when the client feels their faith is judged, pathologised or appropriated, or that the therapist is "not spiritual enough".
    • Acknowledge it directly, ask what felt wrong, take responsibility for your part, and renegotiate how much spiritual material to use.
  • Suicide risk:
    • Assess with standard tools and structured clinical judgment regardless of frame.
    • Religious beliefs can be protective or can add shame. Explore both.
    • Avoid recollection-of-death practices while risk is elevated.
    • Use standard safety planning, including lethal-means counselling focused on storage and removal. Make sure the client knows where to get help between sessions: in the US, call or text 988 (Suicide and Crisis Lifeline); in the UK and Ireland, Samaritans on 116 123.

Sources

Pages consulted

Books and papers cited

  • Frager, R. (1999). Heart, Self, and Soul: The Sufi Psychology of Growth, Balance, and Harmony. Quest Books. Cited through the publisher page, a review and secondary analyses [uncertain].
  • Bozorgzadeh, S. (2023). Sufi psychology: A heart-centered paradigm. In P. S. Richards, G. E. K. Allen & D. K. Judd (Eds.), Handbook of Spiritually Integrated Psychotherapies (ch. 15). American Psychological Association. Chapter number, title and single author as given in the book's published contents list. A 2020 Psychology Today post names Dr Saloumeh Bozorgzadeh as SPA president, and Templeton (2023) names Dr Saloumeh DeGood as SPA president and a contributor to this handbook, which supports their being the same person [uncertain].
  • Bahadorani, N., Lee, J. W., & Martin, L. R. (2021). Implications of Tamarkoz on stress, emotion, spirituality and heart rate. Scientific Reports, 11(1), 14142. Cited from the abstract and the ICPSR project page.
  • Azeemi, K. (2005). Muraqaba: The Art and Science of Sufi Meditation; Badri, M. (2000). Contemplation: An Islamic Psychospiritual Study. Cited by Isgandarova.
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