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This article is from the Winter 2021 issue of the Nonprofit Quarterly, “We Thrive: Health for Justice, Justice for Health.”
If anything has the potential to alter the grievous state of mental health and well-being and move us toward “visionary, transformative and liberatory realms of possibility,” it is the psychedelic renaissance we are on the cusp of today.1 The prospects for individual mental health and the transmutation of trauma alone are encouraging, but it is the potential for rebirth that keeps me engaged in and inspired by this work: the promise of our ego dissolving into its rightful place as steward of the soul; increased awareness of both our interconnection to one another and this planet, and thus the emergence of a more responsible, respectful, and reciprocal society; and expanded access to the creativity needed for systems change and eco-innovation. Psychedelic and plant medicines, some of which have been used in ceremonial contexts for thousands of years to transform consciousness, may be one of the only viable tools we have available that can properly awaken us from the illusions we currently occupy, keeping us stuck in the patriarchal, capitalistic, supremacist paradigms that govern our experience of life on this planet. Understanding and learning from plant-based or synthetic psychedelics is a quest to understand consciousness, the mystery of the universe, and our place within it.
As a forthright advocate for the safe use of psychedelics, and psychedelic psychotherapy in particular, my hope is that we can reintroduce these healing modalities to society, with great care—making sure to avoid the usual profit-driven pitfalls that ravage our mental healthcare system and make “wellness” accessible to few. For health justice to succeed, we need to heal the past and step intentionally and attentively into new models and standards of care. This medicine space, like most other spaces that humans engage with, is ripe with opportunities for exploitation, misuse, and abuse, and it would be remiss not to address this fact.2 The greatest harm caused rests on the shoulders of the policy-makers who relegated this work to the shadows in the first place, criminalizing the use of psychedelics, incarcerating countless humans (mostly people of color), suppressing research, peddling misinformation, and all but guaranteeing that much of this work would be conducted in secret, where unsafe usage and abuses of power run amok.3 Few people question that the war on drugs has been a disaster of epic proportions, and it is our collective opportunity to encourage decriminalization, medicalization, and legalization of psychedelic and plant medicines, so that appropriate safeguards can be established.4
It is important for me to name at the outset that I am not a member of one of the many Indigenous communities that hold great wisdom on the topic of plant medicine; nor am I one of the experienced and revolutionary psychedelic guides who have been courageously practicing this form of healing underground for the last half century.5 I am a white-bodied, cisgender, transpersonal psychotherapist and trauma specialist with extensive experience in community and private mental-health practice. Though I was once optimistic about our human potential to survive adverse experiences and thrive beyond them, my years of treating trauma within the confines of a limited and limiting mental healthcare system—combined with the increasing collective distress brought on by political unrest, gross inequality, climate crisis, and pandemic disease—have challenged my confidence. Despite mounting frustration, I hold out hope; and my commitment to finding creative solutions to the problems I see plaguing us has led me to psychedelic psychotherapy.
I began my training with the Multidisciplinary Association for Psychedelic Studies (MAPS) in MDMA-assisted therapy for post-traumatic stress disorder (PTSD), in 2018. MAPS, a pioneer in the field of psychedelic psychotherapy, conducts extensive research in the United States, Canada, and Israel; is engaged in drug policy reform; trains diverse cohorts of therapists; prioritizes health equity; and privileges public benefit over profit. Most important, MAPS is steadily moving the work forward using evidence-based research to establish the safest and most ethical legal “container” possible for working with expanded states of consciousness.6 My training, the final elements of which require FDA approval, opened the door to a world of possibility and hope once diminished by the mental health system.7 I have spent the three years since my initial training with MAPS ended continuing my studies with various educators and elders in the field—working to integrate and balance Indigenous wisdoms with the latest science, and learning and practicing in legal contexts to develop my skills as a psychedelic guide.
The Mushroom as a Mirror
While there are a variety of molecules in the psychedelic category currently being researched in the laboratory, including but not limited to MDMA, Ibogaine, Ketamine, and 5-MeO-DMT, the psilocybin mushroom beautifully illuminates the potency of this work. A wise teacher of mine describes the various principles of the mushroom as a mirror. Mushrooms are the fruit of a large subterranean organism, their underground growth reflecting the unconscious shadow material we are unearthing each time we ingest their medicine. This organism and its underground mycelium, a network that connects all plant life and serves to transfer nutrients and minerals among them, reflects and teaches the interconnectivity of all living things and the idea that the exchange of love, care, and mutual regard are necessary for our health, well-being, and survival. Mushrooms are ephemeral—they fruit and die off quickly, reflecting and teaching the brevity of life and the impermanent nature of all things. They communicate to us the importance of letting go and embracing cycles of death and rebirth. Mushrooms are composters: filterers of toxicity that discard waste, they transform one thing into another in much the same way we in the healing professions work to transmute trauma and support the flow of grief as a means to make space for the integration of a renewed sense of meaning and purpose. While the mushroom provides us with plenty of useful metaphors, each psychedelic and plant medicine has its own unique spirit, and the molecules most aligned for one’s growth can only be determined by oneself or with the support of a therapist or experienced guide.
Psychedelics, known for their mind-expanding and often heart-opening qualities, create opportunities for us to zoom out and witness our humanity from a wider perspective—an otherwise tall order for a person contracted by depression, anxiety, and/or traumatic injury. Furthermore, psychedelic medicines can induce powerful mystical experiences or glimpses into realms of the unknown, the contents of which have the potential to initiate the reorganization of our perception of reality and liberate us from the injuries that confine us.
Intention, Preparation, Set and Setting, and Integration
The singular act of ingesting psychedelics, however, is not where the real magic unfolds. It is in several other important elements of this work that the conditions for transformation are created: Intention, preparation, set and setting, and integration are necessary agents when working with psychedelic medicines for the purpose of healing. Without these cornerstones in place, the experience lacks the container to yield truly meaningful results, and, in some cases, harm can result.
I once read the words “Be careful where you are headed, or you may end up where you’re going”8—a humorous but cautionary reminder of the importance of establishing an intention when doing any kind of healing work. We must first know why it is we are taking these medicines—what it is we seek to heal, change, or understand about ourselves, our relationships, the universe. Intention aligns the journey with purpose and grounds the journeyer. Journeying with intention almost always leads to insights directly or symbolically related to the intention itself, and can serve as a powerful anchor point to return to when traversing difficult terrain and when engaged in the integration process.
Preparation is the practice of preparing the journeyer (client) and establishing trust between journeyer and guide (therapist). The guide starts with a thorough intake and client history, assessing for potential contraindications. Once it is determined that a client can safely move forward with the journey, the client’s mental, emotional, physical, spiritual, and environmental situation is explored, and the guide shares details of what to expect within the journey space. It is important that the client be of sound mind and have sufficient ego strength to enter an expanded state. They must be capable of creating space inside themself for the journey and for the process that follows.
Set and Setting refers to both the mindset of the journeyer and the container within which the journey itself takes place. Insofar as mindset is concerned, the journeyer must be prepared to surrender to the experience. While nervousness is inevitable, excessive fear and anxiety about the journey itself may interfere with a client’s capacity to loosen their grip and give way to the process. If conditions have changed and an acute crisis or life challenge has emerged between the prep sessions and the intended journey date, a person’s mindset may be compromised. Ensuring the client is stable and resourced enough to enter the journey space is essential, and will be evaluated in preparatory sessions and on the day of the journey.
It is the guide’s responsibility to establish a safe container and to communicate what that entails. The therapist or therapists (the MAPS protocol calls for two) communicate standard rules and steps for the journey, prepare music, control environment, temperature, and other such details, and monitor client needs throughout the process. Most important, the guide will have two feet in this dimension of reality, creating a safe space for the client to surrender to the effects of the medicine and retreat into the unconscious. If the therapist or client emerges from a particular lineage/culture and/or wishes to include a ceremonial- or ritual-based practice in the session, space is made to honor whatever spiritual or earth-based wisdom tradition that calls to be honored.
In addition to establishing trust with the guide and being of sound mind, the environment is an exceptionally important aspect of creating a safe container for the work taking place. Journey spaces and treatment rooms should be tranquil, calm, and inviting—safe sanctuaries with limited outside interference. Natural environments can also provide a deeply healing and supportive cocoon for this work. In many cases, access to nature is limited, and some studies are incorporating digital content as a way of simulating an experience of the natural world. According to renowned cinematographer and Fantastic Fungi director Louie Schwartzberg, a current study being conducted at the Pacific Neuroscience Institute on the use of psilocybin for alcohol abuse is incorporating elements of his Moving Art nature cinematography in sessions with subjects.9
And lastly, there is integration. By far the most important aspect of this work, integration is the key to ensuring that a psychedelic journey leads to meaningful change. Integration is the process of both embodying and “actionizing” the insights derived from a journey. It is one thing to adventure off to a supernatural world that defies the boundaries of this dimension of reality, and quite another to make use of that experience in a way that enhances the quality of our lives and benefits those around us.
Because psychedelic experiences often reveal information symbolically and have the potential to open difficult doors, it’s important that a competent and well-trained therapist provide a solid container of love and compassion as the client works to interpret the content of their journey after the fact and heal whatever material may have surfaced in the journey space.
As a therapist, I know all too well how slow the healing process can be, especially as we contend with increasingly complex trauma and an overmedicated and underresourced population. Psychedelic therapy cuts through many of the interpersonal and neurobiological self-protective mechanisms established in response to injurious experience. Those default modes are barriers to our healing and often need a powerful interruption to initiate change.10 Inducing a non-ordinary experience can speed the healing and life transformation process along, producing insights within hours that might otherwise take years to access in traditional psychotherapeutic models. In that way, a journey is like a wormhole, or passage through space and time. The insights and experiences clients emerge with then require attentive exploration in service of organization and integration.11 Integration grounds us back into our bodies and physicalizes the spiritual or ethereal wisdom we touch. Without integration, a psychedelic experience is just that: an experience—and the degree to which it is useful is up for debate. Integrating a psychedelic experience with psychotherapy or other mindfulness-based integrative modalities helps us to lay new cable and create healthier connections in the brain and extended nervous system, and in our relationships.12 This work, if done intentionally and integrated effectively, is extremely powerful and fast acting. It can liberate a person from pain and restore vitality, creativity, and a sense of meaning.13
As this work travels from its Indigenous birthplaces to the Wild West underground to the laboratory to the therapy room, it continues to evolve—and so, too, does our understanding of how to best be in a responsible and respectful relationship with these modalities. Recognition that traditional mental health models continue to fail our most vulnerable populations helps to build momentum and support for alternative approaches like psychedelic psychotherapy. Many questions remain unanswered around how this work can be conducted safely, cost- effectively, and at a scale that provides the greatest benefit for all. However, with the second phase 3 clinical trial for MDMA-assisted psychotherapy in process (MAPP1 is complete; the second trial, MAPP2, is underway) and studies being conducted all over the world at leading research institutions, it is only a matter of time before this is an accessible treatment option and self-actualization tool.14 Psychedelic medicines will not work for everyone, but we can do better where whole health is concerned. We have all the necessary instruments at our disposal for a radical shift in human consciousness and the cultivation of a more harmonious human family. I continue to look to organizations like MAPS that are learning from the past and leading the way with intention to a future where visions of equitable access to mass mental health are realized, and health justice prevails.
Andrea Anderson, “LSD May Chip Away at the Brain’s ‘Sense of Self’ Network,” Scientific American, April 13, 2016, www.scientificamerican.com/article/lsd-may-chip-away-at-the-brain-s-sense-of-self-network/.
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Robin L. Carhart-Harris et al., “Psilocybin with psychological support for treatment-resistant depression: six- month follow-up,” Psycopharmacology 235, no. 2 (February 2018): 399–408.
Robin L. Carhart-Harris et al., “The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs,” Frontiers in Human Neuroscience (February 2014).
Daniel Collerton, “Psychotherapy and brain plasticity,” Frontiers in Psychology (September 2013).
James Fadiman, The Psychedelic Explorer’s Guide: Safe, Therapeutic, and Sacred Journeys (Rochester, VT: Park Street Press, 2011).
Ingmar Gorman et al., “Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice,” Frontiers in Psychology (March 2021).
Stanislav Grof, The Way of the Psychonaut, Vols. 1 and 2 (Santa Cruz, CA: MAPS, 2019).
Carl L. Hart, Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear (New York: Penguin Press, 2021). Albert Hofman, LSD: My Problem Child (New York: McGraw Hill, 1980; repr., Oxford, UK: Oxford University Press, 2019).
“Voices of Esalen: Psychedelic Integration, Pt. 3: Rick Doblin on MAPS, MDMA, Esalen, and PTSD,” Voices of Esalen, podcast, July 19, 2019, maps.org/2019/07/19/voices-of-esalen-psychedelic-integration-pt-3- rick-doblin-on-maps-mdma-esalen-and-ptsd/.
Ralph Metzner, Opening to Inner Light: The Transformation of Human Nature and Consciousness (Los Angeles: Jeremy P. Tarcher, 1986).
Michael Pollan, How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence (New York: Penguin Press, 2018).
Michael Pollan, This Is Your Mind on Plants (New York: Penguin Press, 2021).
Tim Read and Maria Papaspyrou, eds., Psychedelics and Psychotherapy: The Healing Potential of Expanded States (Rochester, VT: Park Street Press, 2021).
Tom Schroder, Acid Test: LSD, Ecstasy, and the Power to Heal (New York: Blue Rider Press, 2014).
Ben Sessa, The Psychedelic Renaissance: Reassessing the Role of Psychedelic Drugs in 21st Century Psychiatry and Society (London: Muswell Hill Press, 2012).
Daniel J. Siegel, Aware: The Science and Practice of Presence—The Groundbreaking Meditation Practice
(New York: TarcherPerigee, 2018).
Daniel J. Siegel, Pocket Guide to Interpersonal Neurobiology: An Integrative Handbook of the Mind (New York: W. W. Norton & Company, 2012).
Bessel A. van der Kolk, “Posttraumatic Therapy in the Age of Neuroscience,” Psychoanalytic Dialogues: The International Journal of Relational Perspectives 12, no. 3 (2002): 381–92.
Bessel van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (New York: Viking Press, 2014).
Roger Walsh and Charles S. Grob, eds., Higher Wisdom: Eminent Elders Explore the Continuing Impact of Psychedelics (Albany: State University of New York Press, 2005).
Ayelet Waldman, A Really Good Day: How Microdosing Made a Mega Difference in My Mood, My Marriage, and My Life (New York: Knopf, 2017).
- Maddy Reinert, Theresa Nguyen, and Danielle Fritze, The State of Mental Health in America 2022 (Alexandria, VA: Mental Health America [MHA]) October 2021). And see Alison Darcy and Timothy Mariano, “Mental Health in America: A Growing Crisis,” Psychiatric Times, August 6, 2021, www.psychiatrictimes.com/view/mental-health-america-crisis; Ben Sessa, The Psychedelic Renaissance: Reassessing the Role of Psychedelic Drugs in 21st Century Psychiatry and Society (London: Muswell Hill Press, 2012); and “Special Edition Bulletin, The Emergent Psychedelic Ecosystem,” MAPS Bulletin XXXI, no. 2 (2021).
- William Brennan et , “A Qualitative Exploration of Relational Ethical Challenges and Practices in Psychedelic Healing,” Journal of Humanistic Psychology (September 16, 2021); and Brian T. Anderson, Alicia L. Danforth, and Charles S. Grob, “Psychedelic medicine: safety and ethical concerns,” Lancet Psychiatry 7, no. 10 (October 2020): 829–30.
- Mo Costandi, “A brief history of psychedelic psychiatry,” The Guardian, September 2, 2014, www.theguardian.com/science/neurophilosophy/2014/sep/02/psychedelic-psychiatry.
- Brian Mann, “After 50 Years Of The War On Drugs, ‘What Good Is It Doing For Us?,’” Morning Edition, NPR, npr.org/2021/06/17/1006495476/after-50-years-of-the-war-on-drugs-what-good-is-it-doing-for-us; Graham Boyd, “The Drug War is the New Jim Crow,” ACLU, accessed December 2, 2021 (first published in NACLA Report on the Americas, July/August 2001), www.aclu.org/other/drug-war-new-jim-crow; and Alana Rosenberg, Allison K. Groves, and Kim M. Blankenship, “Comparing Black and White Drug Offenders: Implications for Racial Disparities in Criminal Justice and Reentry Policy and Programming,” Journal of Drug Issues 47, no. 1 (2017): 132–42.
- For more on underground practitioners, see Carey Dunne, “Welcome to the trip of your life: the rise of underground LSD guides,” The Guardian, December 6, 2018, theguardian.com/society/2018/dec/06/lsd-guides-psychedelic-assisted-psychotherapy.
- “Psychedelic Research for Mass Mental Health,” MAPS, maps.org; and see “Take a Trip Down Memory Lane,” About, MAPS, accessed November 26, 2021, maps.org/about-maps/.
- “Therapist Training Protocol Submitted to FDA,” News, MAPS, June 22, 2009, maps.org/2009/06/22/mdma-news-id845/.
- Author unknown.
- See “Louie Schwartzberg: PNIF Special Advisor,” Pacific Neuroscience Institute, accessed November 30, 2021, pacificneuroscienceinstitute.org/people/louie-schwartzberg/; and “Psilocybin and the TRIP Program at Pacific Neuroscience Institute,” Blog, Pacific Neuroscience Institute, June 14, 2021, www.pacificneuroscienceinstitute.org/blog/trip/psilocybin-and-the-trip-program-at-pacific-neuroscience-institute/.
- See for example Jasmine Virdi, “Psychedelics and the Default Mode Network,” Psychedelics Today, February 4, 2020, psychedelics com/2020/02/04/psychedelics-and-the-default-mode-network/; and Robin L. Carhart-Harris et al., “Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin,” PNAS 109, no. 6 (February 7, 2012): 2138–43. For more on the workings of self-protective mechanisms, see Bessel van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (New York: Viking Press, 2014).
- See for example Michael Pollan, How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence (New York: Penguin Press, 2018).
- See Daniel J. Siegel, Pocket Guide to Interpersonal Neurobiology: An Integrative Handbook of the Mind (New York: W. W. Norton & Company, 2012); Daniel J. Siegel, Aware: The Science and Practice of Presence—The Groundbreaking Meditation Practice (TarcherPerigee, 2018); and Virdi, “Psychedelics and the Default Mode Network.”
- See Jennifer Mitchell et al., “MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study,” Nature Medicine 27, no. 6 (June 2021): 1025–33.
- See Mitchell et al., “MDMA-assisted therapy for severe PTSD”; Imperial College London, Centre for Psychedelic Research, www.imperial.ac.uk/psychedelic-research-centre; Johns Hopkins Medicine, Psychedelic Research and Psilocybin Therapy, www.hopkins medicine.org/psychiatry/research/psychedelics-research.html; Massachusetts General Hospital, Center for the Neuroscience of Psychedelics, www.massgeneral.org/psychiatry/treatments-and-services/center-for-the-neuroscience-of-psychedelics; and “Meet Our Team,” Icahn School of Medicine at Mount Sinai, The Center for Psychedelic Psychotherapy and Trauma Research, icahn.mssm.edu/research/center-psychedelic-psychotherapy-trauma-research/team.