Bektashi and Alevi cem and semah

1. Introduction

Version followed: the Anatolian Alevi-Bektaşi cem and semah as published by UNESCO's 2010 inscription of the semah (nominated by Türkiye), by Turkish scholarship on cem practice (Öcal and Pelikoğlu 2024 on a Samsun association; Üneş 2025 on the Abdal Musa cem in Tokat) and by Alevi organisations (Alevi Foundations Federation; Cem Foundation). Balkan and other Bektashi orders, led by babas rather than hereditary dedes, are not covered in detail. [source: UNESCO; Öcal and Pelikoğlu 2024; Üneş 2025; Doğan 2025]

This is a religious observance, not a therapy. The cem is the central communal worship of Alevis and Bektashis. Alevi organisations describe it as a gathering that combines music, poetry, spiritual teaching and symbolic ritual. It is held in a cemevi ("house of gathering"), where men and women worship side by side. [source: Doğan 2025] The semah is the ritual movement within the cem. UNESCO describes semahs as mystical and aesthetic body movements in rhythmic harmony, danced by men and women together to the saz (long-necked lute), and counts them among the twelve services of the cem. [source: UNESCO] As the tradition holds it, the rite rests on unity with God within a cycle in which people come from God and return to God. [source: UNESCO] Alevi oral tradition links the cem to the Prophet's night ascent (miraç) and the "Assembly of the Forty" (Kırklar Meclisi), where the forty declare "we are one of forty, forty of one" and dance in ecstasy. The cem and semah are understood as re-enacting this assembly. [source: Diken 2025; Wikipedia, uncertain: secondary, unverified]

In the tradition's own terms, change happens through the community. Participants stand before the dede and the congregation, settle grievances, receive the community's consent (rıza), renew their vow (ikrar), and share food and the semah as equals. [source: Üneş 2025] For the psychotherapist, the guide below covers the clinical work alongside this observance: understanding what it means in the client's life, assessing it with the Cultural Formulation Interview, accommodating it, routing health questions to the doctor, recognising scrupulosity and moral injury, supporting grief and community, and working with dedes when the client wishes. The therapist does not lead, interpret or replace any part of the rite. [synthesis]

2. Framework

2a. The observance as its institutions describe it

Who leads and authorises. The dede leads the cem from the post (the seat treated as the place of the Pir and of Ali's authority). In Alevism the dede's office passes by lineage. Participants of the Samsun study contrasted this with Bektashism, which has no such lineage rule and is led by a "father" figure (baba). [source: Öcal and Pelikoğlu 2024; Üneş 2025] Secondary sources describe the dede as descended from Ali and Fatima and as officiating at funerals, weddings and musahiplik (chosen ritual kinship) as well as the cem. [source: Wikipedia; uncertain: secondary, unverified] The lineage of dedes is commonly called an ocak, and the lay follower a talip. [source: Öcal and Pelikoğlu 2024 for talip; ocak uncertain: not verified] Alevi organisations stress that the dede gives moral and spiritual guidance, not legal rulings, and that women can serve as spiritual leaders. [source: Doğan 2025]
The twelve services (on iki hizmet). Twelve named roles serve the cem. The sources consulted agree on these roles: dede, rehber (guide), gözcü (keeps order and announces the dede), zakir (plays the saz and sings the poems), ferraş or süpürgeci (sweeps the floor), ibrikçi (pours water over hands), çerağcı (lights the lamps), kurbancı or lokmacı (sacrifice and shared meal), peyk or peyikçi (calls people to the cem), and semahçı (semah dancers). Lists differ between regions and sources: one secondary list adds kapıcı (door-keeper), meydancı, niyazcı and sakacı (water and drinks) and links each role to a figure of early Islam. [source: Üneş 2025; UNESCO; Wikipedia, uncertain: secondary, unverified]
The order of a cem (Abdal Musa cem in Tokat, as one documented version). (1) The peyk tells the community, and the cemevi is cleaned as both physical and spiritual purification. (2) The gözcü announces the dede and reminds everyone of proper conduct (edep-erkân); talips stand in dar, a posture of self-examination. (3) The dede gives a blessing and asks whether anyone holds a grievance against him; if so, he must himself stand in dar before the cem proceeds. (4) Talk (muhabbet), then the zakir's poem calls the twelve servants, each blessed by the dede. (5) Sweeping, water service (in the "path ablution" a man and a woman pour water for each other in turn), setting the post, and lighting the lamps. (6) Görgü and reconciliation: each talip stands in dar and is questioned on loyalty to the path, duties and any harm done to others; reconciliation follows and the community confirms its consent. (7) Sacrifice and the shared meal (lokma), which is not sold, wasted or taken outside. [source: Üneş 2025] The semah, deyiş, duaz, miraçlama and mersiye (lament) are sung or danced within these services. [source: Öcal and Pelikoğlu 2024]
Kinds of cem. Scholarship distinguishes cems with ikrar (vow or initiation) from cems without ikrar; the görgü cemi is held to clear grievances and "clear one's name" before God and the community. [source: Öcal and Pelikoğlu 2024; Üneş 2025] The ikrar and its words are given within the community by the dede; this guide does not describe them. [synthesis]
Two kinds of semah. İçeri (inner) semahs are performed only in cems among adherents; dışarı (outer) semahs are performed outside worship to pass the culture on to young people, often by youth groups and cultural associations. UNESCO calls the semah the most important means of transmitting the tradition, orally. Forms and rhythms vary by region. [source: UNESCO]
The calendar. The Muharrem fast (Yas-ı Matem or Twelve Imams' fast) is kept at the start of the month of Muharrem, mourning Imam Hüseyin and his companions killed at Karbala. During it many Alevis also abstain from water and from meat, weddings and entertainment; it ends with the cooking and sharing of aşure. [source: Cumhuriyet 2026, quoting the Malatya Hacı Bektaş Veli Cultural Foundation and Cem Foundation chairmen] Other observances (for example Hızır fast, Nevruz) are [uncertain: not verified].
Context. Cemevis have no legal status as houses of worship in Türkiye; a state Alevi-Bektashi Culture and Cemevi Presidency set up in 2022 treats the belief as cultural heritage, which Alevi federations contest. [source: Doğan 2025] The 2 July 1993 arson attack on the Madımak Hotel in Sivas, where Alevi writers and musicians had gathered, killed 37 people and remains central in Alevi collective memory. [source: USCIRF 2021; Markussen 2026]

2b. The therapist's work alongside it

No source gives session counts or a phase model for therapy alongside the cem. The structure below is [synthesis]:

Assessment (first sessions): religious and cultural identity, the client's place in the community (talip, servant, dede family, cultural member only, lapsed), and the observance's role in the presenting problem, using the CFI and its Module 5. Move on when you and the client agree what the cem and community mean to them and whether they help, hurt, or both.
Integration and accommodation (throughout): schedule around cems and Muharrem, use the client's own resources (poems, music, community), and route health questions to the doctor. Move on when practical clashes are settled and the client feels their faith is respected in the room.
Targeted work where indicated: scrupulosity, moral injury, grief, minority stress and collective trauma, community conflict. Use the evidence-based treatment for the disorder, adapted in the client's frame. Move on when symptoms ease and religious practice is chosen rather than driven by fear.
Collaboration and ending: liaise with the dede or community only with consent; plan how the client's community and practice will carry them after therapy.

3. Guiding principles

The client defines their Alevism. Alevi identity can be religious, cultural, political or all three, and organisations disagree about how it relates to Islam. → Ask, do not assume; use the client's words (Yol, the path, cem, can). [source: Doğan 2025; synthesis]
Attribute, do not adjudicate. Concepts such as the Kırklar, the miraç, the dede's lineage and the semah as union with God are described as the tradition holds them. → Never call them true or false; ask what they mean to the client. [synthesis]
The dede is the religious authority, not you. → Do not interpret ritual, rule on obligations, or act as a confessor; refer such questions to the client's dede or community. [source: Doğan 2025 on the dede's guiding role; synthesis]
Rıza (consent) is a core value. The cem cannot proceed while a grievance stands, and the dede's authority rests on community consent. → Use consent explicitly in your own practice: ask before raising faith, before contacting anyone, before suggesting change. [source: Üneş 2025; synthesis]
Equality of women and men is central to the rite. → Do not import assumptions from other Muslim settings about segregation or women's roles. [source: UNESCO; Doğan 2025]
Inner practice stays inner. İçeri semahs and the ikrar belong to adherents. → Never ask the client to perform, teach, record or explain restricted parts of the rite; let the client choose what to share. [source: UNESCO; synthesis]
Minority status and collective trauma are real context, not pathology. Alevis describe structural discrimination and the memory of state-sanctioned violence. → Assess minority stress and collective grief without reducing the client to it. [source: Doğan 2025; Markussen 2026; USCIRF 2021]
Health questions go to the doctor. → Fasting, water abstention and physical exertion are discussed qualitatively and routed to medical care; no practice is presented as treating physical disease. [synthesis]
Separate disorder from devotion. → Use the IOCDF markers (excess beyond the tradition's own standard, distress-driven, impairing) to tell scrupulosity from ordinary practice. [source: IOCDF]
Know your competence and your own position. → Work to the published spiritual and religious competencies (attitudes, knowledge, skills) and consult when your own beliefs or politics about Türkiye, Islam or religion pull at you. [source: Vieten et al. 2013]

4. Intervention inventory

All interventions below are the psychotherapist's own work alongside the cem; none is part of the rite. Steps are [synthesis] unless a source is named. Example language is illustrative.

4.1 Opening the topic and mapping meaning

Purpose / when: At intake with any client of Alevi or Bektashi background, or when the client mentions cem, cemevi, dede, semah, Muharrem or Sivas. Establishes what the observance means to this person. [synthesis]
Steps: (1) Ask whether religion, spirituality or the Alevi path matters to them, and how they name it. (2) Ask where they stand: regular cem participant, holder of a service (zakir, semahçı, rehber), from a dede family, member of a cultural association, or rarely involved. (3) Ask what the cem gives them (belonging, music, reconciliation, mourning, identity) and what it costs (obligations, conflict, scrutiny). (4) Ask how the presenting problem shows up there, for example avoiding the cemevi since a loss. (5) Reflect back in their words and confirm. (6) Record their preferred terms. [synthesis]
Example language (illustrative): "Some people I see from Alevi families describe it as their faith, some as their culture, some as both. How would you describe it for yourself?" / "When you go to a cem, what do you come away with?"
Watch for: the therapist assuming Sunni Muslim practice (mosque, five daily prayers, Ramadan) is the client's frame; a guarded answer, which may reflect experience of discrimination rather than resistance [source: Doğan 2025]; working signs are the client using their own terms freely and linking the observance to their difficulties unprompted.

4.2 Cultural Formulation Interview with the Spirituality, Religion and Moral Traditions module

Purpose / when: Structured cultural assessment, at intake or later as trust grows. The DSM-5 supplementary Module 5 (16 questions) covers spiritual, religious and moral identity; the role of the tradition in daily and family life; how it has helped the person cope (leaders, texts, practices); and stresses or conflicts linked to it, including discrimination. It can be used alongside the core CFI or alone, and can be repeated. [source: APA CFI Supplementary Modules]
Steps: (1) Use the core CFI first (definition of the problem, cultural perceptions of cause, stressors and supports, role of cultural identity, coping and help-seeking). (2) Add Module 5, substituting the client's own words (for example "the Yol" or "Alevilik") for the placeholders, as the module instructs, and skipping what is already covered. (3) For migrants or refugees, consider Module 11 (Immigrants and Refugees); for identity questions, Module 6 (Cultural Identity). (4) Ask specifically, in your own words, about the dede or ocak, cemevi membership, Muharrem, and any experience of discrimination because of being Alevi. (5) Write a short cultural formulation and share it with the client. [source: APA CFI Supplementary Modules for steps 2–3; synthesis for 4–5]
Example language (illustrative): "You've told me about the cemevi. Has your faith or community helped with what you're going through, or made it harder, or both?" / "Have you ever been treated differently because you are Alevi?"
Watch for: do not reproduce the instrument's items in handouts; use the official APA form. Working signs: the formulation names both supports (community, music, mourning rites) and stresses, and the client recognises themselves in it.

4.3 Mapping roles, authority and the dede relationship

Purpose / when: When the client's problem involves the community, the dede, a service role, or family lineage. The dede leads the cem and grants consent; servants hold named duties; Alevi dedes hold office by lineage. [source: Üneş 2025; Öcal and Pelikoğlu 2024]
Steps: (1) Draw a simple map with the client: their ocak or dede, the cemevi or association, the service they hold, family members' roles. (2) Ask how decisions are made and how disputes are settled (görgü, reconciliation, rıza). (3) Note where the client feels supported and where they feel pressure or exclusion. (4) Ask whether they would want you ever to speak with the dede or association, and record their answer. [synthesis]
Example language (illustrative): "Who would you go to in your community if something was wrong between you and another family?" / "Is being from a dede family something that weighs on you, or supports you, or both?"
Watch for: expectations placed on members of dede families or on young servants; rivalry between associations or federations; the client's sense of the dede as guide rather than judge, which sources stress. [source: Üneş 2025; Doğan 2025]

4.4 Accommodation in scheduling and treatment

Purpose / when: Throughout. Prevents avoidable clashes and shows respect.
Steps: (1) Ask which evenings the client attends cem, and when Muharrem falls this year (it moves with the Hijri calendar; it began in mid-June in 2026). [source: Cumhuriyet 2026] (2) Avoid booking exposure-heavy or emotionally demanding sessions on fasting days or just before a cem if the client prefers. (3) During Muharrem, ask whether the client wants to avoid celebration-related homework (social events, music for fun) in line with the mourning customs. [source: Cumhuriyet 2026] (4) Offer gender of therapist preference, language (Turkish, Kurmanji, Zazaki) and interpreters from a trusted background; ask before assuming that a Turkish-speaking interpreter is acceptable. (5) Allow the client to bring deyiş, nefes or recorded saz music into sessions as a resource if they wish. [synthesis]
Example language (illustrative): "Are there any weeks coming up, like Muharrem or cem nights, where we should plan sessions differently?"
Watch for: interpreter mismatch (for example political or sectarian tension); the client feeling they must hide practice. Working sign: fewer missed sessions around observances.

4.5 Health issues: Muharrem fasting, water abstention and semah exertion

Purpose / when: When the client fasts in Muharrem, has a medical condition, is pregnant, takes regular medicines, has an eating disorder, or is older or frail. The sources describe a mourning fast during which many Alevis also abstain from water. [source: Cumhuriyet 2026] Medical exemptions for this fast, as Alevi authorities state them, are [uncertain: not verified].
Steps: (1) Ask how the client keeps the fast and whether they have any health conditions or take medicines. (2) Do not advise on fasting, fluids or medicines. Encourage the client to speak with their doctor before Muharrem, and offer (with consent) to write to or speak with the doctor about mental-health aspects such as mood and sleep. (3) If the client wonders whether they may modify the fast for health, refer the religious question to their dede. (4) For eating disorders, discuss with the client and the treating team how fasting interacts with the treatment plan. (5) For semah, ask about physical limits (dizziness, cardiac or balance problems) and suggest they discuss these with their doctor. [synthesis]
Example language (illustrative): "I'm not the right person to advise on fasting and health, but I'd like you to check with your doctor before Muharrem. Would it help if I wrote to them about how your mood has been?"
Watch for: dehydration-related confusion, low mood, irritability or poor sleep during the fast [synthesis]; fasting used as cover for restrictive eating; the client feeling judged for fasting or for not fasting. No practice should be presented as treating physical disease.

4.6 Scrupulosity around görgü, dar, vows and purity

Purpose / when: When the client's religious practice is driven by fear, excessive doubt or compulsive checking. Cem includes standing in dar for self-examination, questioning on loyalty and harm done to others, vows (ikrar) and reconciliation, all of which can become foci for scrupulosity. [source: Üneş 2025] The IOCDF describes scrupulosity as religious or moral obsessions (having sinned, blasphemy, damnation, doubt) with compulsions such as repeated prayer, excessive confession, reassurance-seeking, purification and mental neutralising, and avoidance of services. [source: IOCDF]
Steps: (1) Screen using the IOCDF markers: is the behaviour beyond the tradition's own standard, fixated on one area while neglecting others, distress-driven, and impairing? [source: IOCDF] (2) Assess with a standard OCD measure (not reproduced here). (3) Explain that the aim is to separate OCD from the client's own religious values so they can live by them. [source: IOCDF] (4) With consent, ask the client's dede (or have the client ask) what the tradition actually requires, for example whether a grievance already settled must be raised again; the IOCDF notes leaders can clarify the institution's position. [source: IOCDF] (5) Build an ERP hierarchy that stays within what the tradition permits: for example attending cem without mentally re-confessing, tolerating uncertainty about whether a past act harmed someone, reducing reassurance-seeking from family or the dede. (6) Never design exposures that require the client to break their own vows or to act against the community's norms. [synthesis for 5–6]
Example language (illustrative): "Your dede said the matter was settled and the community gave its consent. OCD keeps asking you to go back. What would it be like to let the dede's answer stand?"
Watch for: the client recruiting the therapist as a confessor or source of reassurance; avoidance of the cemevi; working signs are reduced checking and confession, and the client attending cem with less dread.

4.7 Moral injury and reconciliation

Purpose / when: When the client carries guilt or shame for harm done, or betrayal by people they trusted (including community members, the state, or relatives), not driven by OCD. The cem's own frame of görgü, reconciliation and community consent (rıza) may be a resource. [source: Üneş 2025; synthesis]
Steps: (1) Distinguish moral injury from scrupulosity (realistic guilt about a real act versus intrusive doubt). (2) Explore the act or betrayal and the values it violated, in the client's own moral language (for example the ethic of being master of one's hand, conduct and speech, which Üneş links to Abdal Musa). [source: Üneş 2025] (3) Ask whether the client wants to seek reconciliation through their community or dede, and leave that process to them. (4) In therapy, work on self-compassion, repair where possible and meaning-making. [synthesis]
Example language (illustrative): "In your tradition, a grievance is brought into the open and settled with consent. Is there someone with whom you'd want that kind of settling, and is it something you'd want to take to your dede?"
Watch for: fear of social exclusion if the matter is brought to the community (community sanctions are described in scholarship [uncertain: not verified]); the client wanting the therapist to grant absolution.

4.8 Grief, mourning rites and collective trauma

Purpose / when: Bereavement, anniversaries, or distress linked to collective violence. The tradition already holds structured mourning: the Muharrem fast mourns the Karbala martyrs, laments (mersiye) are sung in cem, and aşure is shared at the end of the fast. [source: Cumhuriyet 2026; Öcal and Pelikoğlu 2024] The 1993 Sivas arson attack remains a reference point of cultural trauma in Alevi life stories. [source: Markussen 2026; USCIRF 2021]
Steps: (1) Ask how the client's community marks death and loss, and whether they took part (funeral led by the dede, cem, lokma). (2) Ask whether Muharrem or the 2 July anniversary of Sivas is a time of heightened grief for them or their family. (3) Use evidence-based grief or trauma treatment as indicated, and invite the client to draw on their own rites (attending cem, sharing lokma or aşure, listening to mersiye) if they wish. (4) Treat collective and family stories of persecution as testimony, not as symptoms; distinguish them from personal PTSD symptoms by assessing the client's own exposure and current symptoms. [synthesis; Markussen 2026 frames such life stories as counter-narratives]
Example language (illustrative): "Muharrem is a time of mourning in your tradition. Does this year's Muharrem feel different since your father died?" / "Your family has spoken about Sivas. What does that memory carry for you?"
Watch for: anniversary reactions; grief made harder when a death occurs abroad or the client cannot return for rites; the client feeling that their community's suffering is dismissed. Working signs: the client re-engages with rites that comfort them and can speak of losses without being overwhelmed.

4.9 Minority stress, discrimination and identity

Purpose / when: When the client reports discrimination, concealment of identity, or conflict about whether Alevism is Islam, culture or a separate faith. Alevi federations report non-recognition of cemevis in Türkiye, bias in religious education and unequal access to public institutions. [source: Doğan 2025; USCIRF 2021]
Steps: (1) Ask directly and respectfully about experiences of prejudice, at school, work, in the military or in migration. (2) Ask whether the client hides being Alevi in some settings and what that costs. (3) Explore the client's own position on contested identity questions without taking a side. (4) Work on shame, hypervigilance or anger with standard methods, and help the client find affirming community (cemevi, youth semah groups, cultural associations). [synthesis]
Example language (illustrative): "Some Alevi clients tell me they learned to stay quiet about it. Has that been part of your life?"
Watch for: the therapist's own views about Türkiye, Kurdish politics or Islam colouring the work; working signs are less concealment where it is safe, and less self-blame.

4.10 Client-led use of the tradition's resources

Purpose / when: When the client wants their faith or culture to help with recovery. The tradition is transmitted orally through semah, music and poetry. [source: UNESCO]
Steps: (1) Ask which poems (deyiş, nefes), songs or saz music matter to the client. (2) If they wish, invite them to bring a piece and say what it means to them. (3) Use it as they choose: for comfort, for meaning-making, for behavioural activation (returning to cem, joining a semah group, learning saz). (4) Do not perform, teach or ask the client to perform an içeri semah in therapy. [source: UNESCO for the içeri/dışarı distinction; synthesis]
Example language (illustrative): "Is there a deyiş you turn to when things are hard? Would you like to tell me about it?"
Watch for: the therapist turning the tradition into a technique; the client feeling pressure to be religious. Working signs: the client chooses the resource and reports it helps.

4.11 Ecstatic experiences in semah and telling them apart from illness

Purpose / when: When the client reports intense states during semah or cem (ecstasy, union, visions, weeping) or when family or clinicians wonder whether such states are illness. The tradition itself describes the forty dancing the semah "in ecstasy" (vecd) and the semah as dissolving the self into union with God. [source: Diken 2025; Wikipedia, uncertain: secondary, unverified]
Steps: (1) Ask what happened, how the client and their community understood it, and whether it fits experiences others have in cem. (2) Assess for features that point to illness rather than devotion: persistence outside ritual, loss of function, sleep loss, grandiosity, disorganisation, command hallucinations, or the community itself being worried. (3) If the problem is religious or spiritual and not a disorder, DSM-5-TR lists a religious or spiritual problem as a focus of clinical attention, code Z65.8. (4) If illness is suspected, refer for psychiatric assessment while respecting the religious meaning. (5) Published research on challenging contemplative experiences (Lindahl et al. 2017, PLOS ONE; Farias et al. 2020, Acta Psychiatrica Scandinavica) concerns meditation rather than semah [uncertain: not verified]. [synthesis for 1–4]
Example language (illustrative): "That sounds like a powerful experience. How did people at the cem understand it? And since then, how have you been sleeping and managing day to day?"
Watch for: pathologising a normal ritual experience; missing mania or psychosis; dizziness or falls during turning in older or medically unwell clients (route to doctor). [synthesis]

4.12 Collaboration with dedes, cemevis and chaplains

Purpose / when: When the client wishes, for scrupulosity (4.6), religious questions about fasting (4.5), reconciliation (4.7), grief, or re-engagement with community. The dede guides rather than rules, and community consent is central. [source: Doğan 2025; Üneş 2025]
Steps: (1) Get written, specific consent: who, what may be shared, and for what purpose. (2) Ask the client whether they prefer to ask the dede themselves, with you preparing questions together. (3) If you make contact, introduce your role, ask about the tradition's position, share only what was agreed, and do not ask the dede to diagnose or treat. (4) In hospitals or prisons, ask whether chaplaincy services include an Alevi contact; do not assume a Sunni imam is appropriate. (5) Review the contact with the client afterwards. [synthesis]
Example language (illustrative): "Would it help to know what your dede thinks about this? You could ask, or, if you'd like, I could, with only what you're happy for me to share."
Watch for: confidentiality in small communities; dual roles where the dede is also a relative; the client's choice overriding the therapist's wish to involve others.

4.13 Boundaries, self-disclosure and competence

Purpose / when: Throughout, and especially when the therapist shares (or is assumed to share) the client's community, or holds strong views about religion.
Steps: (1) Do not act as dede, rehber or confessor; do not attend the client's cem in a professional role. (2) If you are Alevi or from Türkiye, discuss with the client whether shared background helps or worries them (confidentiality, family links, politics). (3) Disclose your own beliefs only when it serves the client. (4) Work to the published spiritual and religious competencies and seek consultation or cultural input when unsure. [source: Vieten et al. 2013 for 4; synthesis for 1–3] Professional ethics codes on multiple relationships, competence and respect for religion apply [synthesis].
Example language (illustrative): "I'm not a religious guide, and I won't tell you what your path requires. What I can do is help you think through what you want and what's getting in the way."
Watch for: meeting clients at cemevi events; being drawn into community disputes. Working sign: the client is clear about what you are and are not.

4.14 Doubt, distance, mixed families and leaving

Purpose / when: When the client is unsure of belief, has moved away from the community, is in a mixed Alevi–Sunni or interfaith family, or is in conflict with relatives about religious identity. [synthesis]
Steps: (1) Normalise that people relate to the tradition in many ways. (2) Explore values the client wants to keep, whatever their belief. (3) Work on family conflict with standard family or systemic methods, inviting each person's account. (4) Where wedding, funeral or child-rearing decisions arise, help the client explore options without directing them. [synthesis]
Example language (illustrative): "It sounds like you can feel close to the music and the people without being sure about all of the beliefs. Is that right?"
Watch for: grief at loss of community; pressure from either side of a mixed family. Working signs: the client makes choices that feel like their own.

5. Handling problems

The published sources on the cem do not address therapy problems. All guidance in this section is [synthesis] unless a source is named.

The client will not talk about faith. Possible reasons: experience of discrimination, fear the therapist will see Alevism as deviant, or simply low relevance. → Say once that you are open to it, explain why you ask, and drop it; revisit with the CFI module later, which is designed to be repeated as rapport develops. [source: APA CFI Supplementary Modules for repetition]
The client tests whether you see Alevism as "real" religion. → Do not debate. Acknowledge that the question matters and is contested in public life, and that here the client's own definition counts. [source: Doğan 2025 for the public contest]
Rupture after a misattribution (for example, the therapist mentioned mosque prayer, Ramadan or headscarves as if they applied). → Name the mistake plainly, apologise, ask what you should know, and do not over-apologise. Correct the record in notes.
Stuck scrupulosity work. The client seeks reassurance from the dede between sessions, or reads every exposure as sinful. → Return to the IOCDF aim of separating OCD from values; with consent, agree one clear message from the dede on what the tradition requires and then treat further checking as a compulsion; slow the hierarchy rather than drop it. [source: IOCDF for the aim and leader involvement]
Non-adherence during Muharrem or around cems. → Expect it; plan lighter homework in those weeks and agree this in advance rather than labelling it avoidance.
Overwhelm at anniversaries or in cem laments. → Use grounding and stabilisation from your trauma model; help the client plan support around Muharrem and 2 July; respect a choice to stay away from cem for a period, or to go with a trusted person.
Community conflict or fear of exclusion. → Map the conflict (4.3); help the client prepare for reconciliation steps they choose; do not mediate community disputes yourself. If the client describes coercion, threats or abuse by anyone in a religious role, follow your safeguarding and reporting duties as for any other setting.
Children and young people. Young people learn semah and music in associations (dışarı semah is aimed at passing culture to younger generations). [source: UNESCO] No harmful practice involving children is linked to the cem in the sources cited. Apply ordinary safeguarding and age-appropriate consent and assent if a young person's distress involves community activities.
Health complications during the fast. If the client reports fainting, confusion, severe mood change or inability to take prescribed treatment while fasting, advise prompt medical contact; if the client is at risk, follow your usual emergency procedures. Do not negotiate the fast yourself; the religious question belongs with the dede.
The therapist shares the community. Risk of dual relationships, gossip and pressure. → Discuss at the start, agree how to handle meetings at cemevis or events, and offer referral to a therapist outside the community if the client prefers.
Interpreter difficulties. → Check that the interpreter is acceptable to the client (language, gender, background); brief the interpreter on terms such as cem, dede, semah, rıza and dar so they are not mistranslated as mosque or prayer terms.
Ecstatic experience versus illness disputed by the family. → Assess (4.11), give the family and client a shared explanation that respects religious meaning, and involve psychiatry if risk or illness is present.

Sources

Key sources:

Further references [uncertain: not verified]: Lindahl et al. 2017, PLOS ONE; Farias et al. 2020, Acta Psychiatrica Scandinavica; DSM-5-TR code for a religious or spiritual problem, Z65.8; APA Ethical Principles of Psychologists and Code of Conduct.

ICD-10-CM Z65.8, Other specified problems related to psychosocial circumstances (includes 'Religious or spiritual problem'), https://www.unboundmedicine.com/icd/view/ICD-10-CM/945432/all/Z65_8___Other_specified_problems_related_to_psychosocial_circumstances

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