Category: Psychotherapy

When life looks fine, but something deeper feels unsettled

Picture someone with what looks like a good life: a promising career, people who love them, a full calendar, and a life that checks every box from the outside. Yet they may still wake up with a quiet, unsettling question: Is this really my life? Is this as good as it gets?

That question points toward what is often called existential anxiety in psychology. It is not necessarily a sign that something is wrong with you. It is a deeply human response to becoming aware of uncertainty, freedom, death, meaning, and the burden of taking ownership. We are all called to be fully alive, but often we do not know how.

Existential anxiety can be painful, even baffling, especially in a culture that rewards productivity, certainty, and the appearance of having “made it.” But some questions are not solved by better planning, another achievement, or the newest app. They ask us to pause and consider how we are living, what we value, and whether the life we have built still feels connected to something true inside us. Are the goals we are chasing really ours? Are they still worth it?

Key takeaways

  • Existential anxiety often arises when we confront meaning, freedom, mortality, isolation, or the responsibility of choosing a life.
  • It is not pathological, but it can become painful, persistent, overwhelming, and even paralyzing.
  • Therapy can help by listening to these questions and helping you find, or update, your own answers.

The questions beneath the anxiety

Existential anxiety is often hard to spot. It may first appear as restlessness, dread, boredom, indecision, irritability, or a sense that life has become strangely flat. It can surface as disappointment after finally achieving something we worked hard for, or unsettle us after a divorce, illness, birthday, career change, spiritual experience, accident, or the death of someone close.

On the surface, the questions may be practical: Should I stay in this job? Leave this relationship? Move? Change my life? But underneath, deeper undercurrents are at play. What really matters to me? What am I avoiding? What part of me have I ignored? Is this how I want to live the rest of my life?

Not all anxiety is existential. It can be shaped by trauma, stress, biology, social pressure, health concerns, family history, and the nervous system doing its best to protect us in a chaotic world. An integral approach does not romanticize anxiety. It asks what is happening at all the relevant levels: body, relationship, history, culture, circumstance, meaning, and soul.

Freedom and responsibility

Although it may sound paradoxical, one source of existential anxiety is freedom. We often imagine freedom as carefree, but real freedom bears responsibility. To choose one path is to let other paths go, at least for now. To stay in a relationship, leave one, become a parent or not, change careers, or admit that a former identity no longer fits, is to feel the weight of authorship. Sartre somewhat poignantly said that we are “condemned to be free.”

Many of us wish someone could tell us the right answer: “Just tell me what to do.” But while advice can be useful and guidance necessary, no one can live our life for us. We are responsible for our choices and their consequences, which is both nerve-wracking and the source of agency. The question shifts from “How do I avoid choosing wrong?” to “How can I take charge of this life that is actually mine?”

Meaning and the feeling that something is missing

This feeling usually does not arrive as a dramatic flare. It creeps into awareness while answering emails, sitting in traffic, preparing dinner, or scrolling through other people’s carefully edited lives. The question may not be “What is the meaning of life?” in some grand philosophical sense. It may be more personal: What do I really want to do? What matters enough to my limited time and attention?

Meaning can be found in relationship, work, service, creativity, devotion, family, community, play, spirituality, and care for the world. But it is different to each of us, and it changes over time. What was significant at twenty-five may not be enough at forty-five. What once felt like healthy ambition may later feel like a burden. What felt exciting may feel uninspiring.

There is no single purpose hidden somewhere that, once found, will solve the rest of life. Meaning is discovered, created, revised, lost, and found again.

Isolation, belonging, and being known

Even in close relationships, each of us carries an inner world that cannot be fully accessed by another: memories, sensations, longings, fears, and private meanings that remain ours alone. This recognition sometimes hurts, but it also makes intimacy more precious.

To know someone, and to be known, is a never-ending enterprise. It means risking being seen in our beauty, quirkiness, and uniqueness, while accepting that the seeing will never be complete. This is not an argument against relationship. It is an invitation toward deeper, more honest forms of it.

Mortality and loss

Sometimes existential anxiety emerges after a loss, a medical scare, becoming a parent, aging, or simply noticing time passing. Suddenly we face the fact that we are vulnerable and finite, something we work hard to keep below awareness. It can bring fear, sadness, urgency, or a sharper appreciation for life. These waking-up moments are often uncomfortable, but with proper support they can become opportunities to remember who we really are and what matters to us.

Since time is limited, what conversation has been postponed? What apology, creation, repair, project, or act of love matters now? The clock is always ticking. What you waiting for?

How therapy can help

Existentially informed psychotherapy offers a space for the mundane and the profound. We may talk about work stress, grief, heartbreak, family expectations, cultural identity, spiritual questions, or fear about the future.

Being seen and understood by someone can reduce the sense of isolation and create a holding space where these questions can be explored openly. There are no ready-made answers. But together, you can find your own.

Facing existential anxiety does not mean you have failed or that you made the wrong decisions. It may mean that life is knocking at your door, asking for better or updated answers. Do not ignore the call.

Sometimes existential anxiety feels never-ending or unbearable. You do not have to go through it alone. With support, things can get better. If it turns into thoughts of harming yourself, or you feel unable to stay safe, reach out immediately: call 988, contact emergency services, or seek urgent local support. There is help.

If this sounds familiar, existentially informed therapy can help you stay with the questions long enough to discover what they are asking of you. Let’s explore together meaning, relationships, grief, freedom, mortality, and the choices that shape your life. Become who you really are.

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An integral approach to meaning, spirituality, expanded states, and the deeper questions of life

A person can be outwardly competent and still feel that something essential has gone missing. Work may be stable, relationships may look fine, and life may appear to be functioning reasonably well. Yet inwardly there may be a quiet sense that life has become narrow, disconnected, or strangely without meaning.

People often come to therapy feeling anxious, depressed, stuck, overwhelmed, or lost in their job, their life, or their relationships. These are real concerns, and they deserve careful attention. But often, underneath them, deeper questions are lurking. Who am I, really? What am I here for? What is the point of it all? Why do I feel lost? What is missing?

These are the kinds of questions that often bring people toward transpersonal or integral psychotherapy1.

Key takeaways

  • Transpersonal psychotherapy is a whole-person approach that makes room for spirituality, meaning, expanded states, and mystery, without abandoning clinical care.
  • Besides focusing on the body, relationships, history, culture, grief, and present life, it also addressing existential and spiritual concerns.
  • The goal is not for me to tell you what to believe, but to help you listen more deeply to your own life and find your way.

Beyond the personal does not mean ignoring the personal

The word transpersonal means “beyond the personal”. It is an integral approach covering the many dimensions of what it means to be human. This can sound abstract, but it simply means that you and your story are more complex, and more expansive, than what you may have been told. You are more than your personality, your childhood, and your nervous system. You also include your culture, your ancestral history, your relationships, your dreams and aspirations, and perhaps something larger beyond all of these.

To heal deeply, and to move toward your potential, all these aspects deserve attention. A good transpersonal therapist will meet you exactly where you are. We may begin with your current anxiety, grief, confusion, loneliness, relationship pattern, painful memory, or the sense that what used to give your life meaning no longer does. From there, we use a larger frame to understand how your circumstances are not obstacles to spiritual or existential work. They are the ground where life unfolds.

Human beings are not only bundles of symptoms. We are also meaning-making, relational, playful, creative, imaginative, spiritual, and mysterious creatures. A dream, a loss, a book, a song, a meditation retreat, a psychedelic experience, the birth of a child, an encounter with death, or a moment in nature can expand the way we see ourselves and the world. Sometimes these experiences are blissful and healing. Other times they are confusing or destabilizing. And sometimes the sense that something is missing comes from no identifiable experience at all. It simply sneaks up on us as a quiet but persistent sense that there is something else.

How transpersonal therapy is different

Good therapy should address meaning, values, grief, and spiritual questions. What makes transpersonal therapy different is that it treats them not as secondary, but as central. If questions of Spirit, soul, purpose, death, freedom, isolation, mystery, or belonging matter to you, they are welcome in the room.

For example, someone may come to therapy after the death of a parent and say, “I had a dream where she came to me. It felt real, and since then I cannot stop thinking about it.” A therapist could explore grief, attachment, trauma, anxiety, sleep disruption, or the psyche’s way of metabolizing loss. All of that may be useful. But a transpersonal therapist would also make room for the dream’s symbolic, existential, or spiritual meaning within the client’s own worldview.

It is not about choosing spirituality over psychology. It is about engaging the whole experience of being human before reducing it to symptoms or pathology. A person can be grieving, anxious, sleep-deprived, and spiritually moved, all at the same time. They may need grounding, rest, clinical assessment, ritual, conversation, or a deeper exploration of meaning. As multifaceted human beings, we need a therapy approach that acknowledges every aspect of who we are.

Not spiritual advice

Transpersonal therapy is not spiritual advice. My job is not to tell people what their experiences mean, what they should believe, or which path they should follow. It is to help you listen more deeply to the undercurrents of your own life. Therapy can become a place where you are seen, heard, challenged, and supported while you discover what is true for you, and what kind of life wants to be lived through you.

It is not only about functioning. It is about self-realization.

Psychedelic integration and expanded states

Properly trained transpersonal psychotherapists are particularly suited to work with the integration of psychedelic and other expanded states of consciousness. These experiences are often described as unitive, transcendental, sacred, paradoxical, ineffable, and inspiring. They may involve grief, beauty, terror, forgiveness, ancestral material, or a changed relationship to death, all territory familiar to transpersonal psychotherapy.

Because we understand these experiences and their potential, we also know that, by themselves, they are not necessarily healing. A powerful experience can bring forward unresolved trauma, relationship questions, spiritual confusion, inflated certainty, or the sudden recognition that ordinary life needs to change. Integration is the slow work of helping what happened become embodied, relational, ethical, and livable.

Because integral therapists are trained to hold paradox through a trans-rational lens, they can support someone through this process without forcing the experience into either a purely clinical or purely spiritual box.

A larger room for your life

Transpersonal therapy does not need to include unusual interventions, though it may. From the outside, it can look like an ordinary conversation. But it may also include attention to dreams, symbols, body awareness, grief work, values exploration, mindfulness, journaling, creative expression, ceremonial aspects, or reflection on spiritual practices and experiences. For some, the work is straightforward and practical. For others, it becomes a significant reorientation of identity, purpose, or belonging. For many, it is a much-needed opportunity to gain a broader view of themselves.

Although this approach applies to all aspects of life, it becomes particularly useful during life transitions, bereavement, illness, aging, spiritual crisis, psychedelic integration, loss of meaning, existential crises, or the persistent feeling that familiar achievements no longer answer the deeper questions.

The value of transpersonal psychotherapy is not that it offers a grand explanation for every difficult moment. It does not. Its value is that it reminds us there is more to our story. It makes room for the possibility that suffering may contain meaning without romanticizing pain, that spiritual experience may matter without dismissing psychological realities, and that healing may involve more than symptom relief without abandoning safety and care.

Sometimes people need therapy spacious enough to take the deeper movements of the inner life seriously, while remaining grounded enough to help them live more honestly, responsibly, and fully in the world. That, to me, is the promise of transpersonal psychotherapy at its best.

Does any of this sound familiar? If your life looks like it is working but something deeper feels missing, transpersonal psychotherapy may help you explore meaning, grief, relationships, spirituality, expanded states, and the larger questions of your life with care and discernment.

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  1. Although these two approaches have certain technical differences, they cover similar ground, so for practical purposes I use them interchangeably in this article. ↩︎

What therapy and ancestral wisdom can learn from each other without destroying what makes each unique 1

Imagine a client who comes to your office after losing her mother. She tells you her mother appeared to her in a dream, clear, luminous, with a message she does not fully understand. Since then, she cannot sleep.

Is this grief? Trauma? Spiritual experience? Psychosis? A call to pay attention?

The honest answer is: it might be all of those things. And the way you respond will depend, more than you might realize, on which shore you are standing.

Two shores. One river. No bridge.

Western psychotherapy and ancestral wisdom traditions have, for most of modern history, operated as if they were on opposite banks of a wide river, occasionally peering at each other with curiosity, suspicion, or misplaced enthusiasm, but rarely building anything solid across the distance.

On one shore: the language of the wounded self. Unconscious patterns, attachment wounds, trauma stored in the body, the slow and careful work of making the implicit explicit. At its best, psychotherapy is a disciplined act of love, witnessing someone’s interior life with rigor, ethics, and presence.

On the other shore: the language of the sacred web of life. Community as medicine, ritual as container, ancestors as living fields of influence, illness as disharmony rather than deficit. Traditions that have never believed the self ends at the skin, or that healing is something you receive alone in a room.

Both shores see something real. Both also have their blind spots. And in our rush to integrate everything, we have often done something that helps neither: we have put it all in a blender.

A blender makes puree. A bridge respects distance.

The wellness industry loves a blender. A little mindfulness from this tradition, a ceremony from that one, a chakra system loosely attached to a somatic protocol, shamanic language grafted onto a trauma model. The result is something that sounds whole but has been stripped of the very thing that made each element powerful: its context, its ecology, its relational and ethical demands.

A bridge works differently. A bridge does not collapse the distance between two shores. It honors the distance. It makes movement possible without pretending the shores are the same place.

This is the question I keep returning to in my clinical and personal life: How do we learn from both traditions without reducing either one?

Not “how do we merge them into a new spiritual product.” But how do we allow psychotherapy to become more soulful, more ritually aware, symbolically alive, culturally humble, without abandoning the rigor that protects clients from harm? And how do we approach ancestral wisdom with enough respect to leave its roots intact?

What each shore actually offers

Psychotherapy, at its core, teaches us to listen to the wounded self. It gives us a language for the unconscious, for developmental wounds, for the patterns that repeat because they were learned before we had words. It shows us that healing often happens through relationship, not technique, and that the body keeps score long after the mind has moved on. It brings ethics, boundaries, evidence, and the kind of careful container that protects the most vulnerable moments in a person’s life.

Ancestral and wisdom traditions teach us to listen to the sacred web of life. They remind us that the human being is not a private ego floating in an indifferent universe, but a relational, ecological, ancestral, and spiritual creature. They remind us that illness can be a form of disharmony, not just pathology. That healing sometimes requires community, not just technique. That some forms of suffering respond not to interpretation but to ritual, to offering, to being witnessed by something larger than the therapeutic dyad.

Where they meet is quietly remarkable: both understand that healing happens in a field, not in isolation. Both know that relationship is medicine. Both work with symbols, one through dreams and transference, the other through ceremony and cosmology. Both recognize the body as essential, not incidental.

Where they do not meet, and why that matters

Here is where most integrative conversations go wrong: they maximize the similarities and minimize the differences. But the differences are real, and pretending otherwise is its own kind of harm.

Psychotherapy generally works within a secular frame: the person, their history, their nervous system, their relationships. Many ancestral traditions operate within a cosmological frame: the person within the community, within the land, within the ancestors, within the spirit world. When a client’s “ancestral vision” gets translated into “part of the psyche” without asking whether that translation fits, something is lost, and something is taken.

The goals also diverge. Therapy often aims to restore function, coherence, and integration. Traditions may aim at liberation, awakening, balance, or right relationship with the sacred. A psychologically healthy person is not automatically an awakened one. A spiritually intense person is not automatically integrated. Conflating these two is one of the more common errors in transpersonal practice.

And the authority structures are entirely different. Therapy protects autonomy, consent, and the right to question. Many traditions involve apprenticeship, lineage, community recognition, and earned surrender. A healer in most Indigenous contexts is not self-appointed. The community recognizes the role, slowly, over time. Modern spiritual culture tends to invert this: brand first, authority claimed second.

Standing in the middle

There is a Nahuatl word that describes what it feels like to stand between two worlds: Nepantla. Gloria Anzaldúa used it to name the liminal space between cultures, identities, and ways of knowing, not a comfortable middle ground, but a living threshold. Uncomfortable, generative, and demanding.

Nepantleros, those who inhabit that in-between space, do not belong entirely to either shore. They are called to hold the tension without resolving it prematurely. To resist the blender.

For therapists and practitioners who move between these worlds, this is the actual work. Not to choose a camp, but to develop what Mi’kmaw Elder Albert Marshall calls “Two-Eyed Seeing”: the capacity to look simultaneously from the strengths of Indigenous ways of knowing and the strengths of Western ways of knowing, using both eyes together, without forcing one to see through the lens of the other.

A different definition of mental health

What would it mean to redefine mental health not as the absence of symptoms, but as restored participation? Participation in your body. In your relationships. In your community. In the natural world. In meaning and mystery.

This definition does not dismiss symptom relief. That matters enormously. But it expands the frame. It asks not only “what is broken?” but “what relationship has been severed?” Not only “how do we reduce suffering?” but “how do we restore belonging?”

How this looks in practice

A bridge-oriented clinician does not try to become a shaman or a guru. That is not the point, and it can be its own form of harm. What shifts is the quality of listening, and the humility with which you hold your own framework.

Before a client’s spiritual or cultural experience gets translated into clinical language, a few questions help:

What world does this experience belong to? Whose lens fits it better, the psychologist’s or the tradition’s? What does healing mean from inside this person’s cosmology? And perhaps most importantly: what is my framework missing that this client’s tradition might supply?

This is not relativism. It is clinical precision. Recognizing that the tools you bring to the room were built for a particular kind of suffering, and that some suffering requires different tools.

A bridge takes two shores

Let me end where I started: with the woman whose mother appeared in her dream.

The most useful thing I can bring to that moment is not a diagnostic category or a spiritual interpretation. It is the willingness to sit with her in the not-yet-knowing, the Nepantla, to listen with what one eye sees as a clinician and what the other eye recognizes as something that exceeds clinical categories.

A bridge is not built so one shore can conquer the other. It is built so that we can move, with care and respect, between worlds.

That, I think, is what good mental health care can look like when it is brave enough to hold the tension.

Interested in a talk or workshop on this theme? I offer presentations and trainings on transpersonal psychotherapy, ancestral wisdom, cultural humility, psychedelic integration, and the bridges between clinical care and spiritual traditions.

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  1. This article is a synopsis of my presentation “Wisdom Bridges: Modern Psychotherapy and Ancient Traditions,” presented at FITRA’s 2nd International Transpersonal Conference. ↩︎

What MFTs Need to Know

I just finished teaching a six-month training for Marriage and Family Therapists (MFTs) on Psychedelic-Informed Care, in collaboration with Sacramento Valley CAMFT. These trainings are needed for a simple reason: increasingly, the topic of psychedelics comes up in therapy sessions. Should I do it? Would it help? What are the risks? Can you help me think this through? This is why psychedelic-informed care for MFTs matters.

The fact is that, with a few exceptions, therapists are not trained to answer these questions. If psychedelics are discussed at all, it is usually in a psychopharmacology class as “drugs.” Very few programs address their healing potential, and even fewer teach clinicians how to work skillfully with clients who are curious about them, considering them, or trying to integrate an experience afterward.

As a result, many MFTs are clinically, ethically, and legally underprepared. We may feel curious, nervous, excited, skeptical, or unsure. And yet, the client is already there. Invited or uninvited, psychedelics are finding their way into the therapy hour.

This is why MFTs need to learn Psychedelic-Informed Care (PIC).

To be clear, PIC is not psychedelic-assisted therapy (PAT). PAT refers to clinical work that includes administering a psychedelic substance within a legal, medical, or research structure.

Psychedelics may also come up through underground ceremonies, psychedelic tourism, ketamine clinics, religious practice, or solo use. Regardless of where the client’s interest originates, PIC provides licensed clinicians with tools to discuss, educate, reduce harm, clarify motivation and risk, and support integration, while respecting self-determination and avoiding the encouragement of illegal behavior.

In brief, PIC helps therapists help clients think clearly, make informed decisions, and integrate psychedelic experiences while remaining ethically and legally grounded.

Base Camp, Not Sherpa 1

A useful metaphor for the MFT’s role is that of the Sherpa and the base camp. The Sherpa helps the client climb the mountain. That is not our role. Our job is not to dose, source, guide, or facilitate the psychedelic session. We are base camp: a stable place where clients can prepare thoughtfully, assess risk honestly, and return when the experience needs integration, or if something goes wrong.

This is not a small role. Clients do not need us to be enthusiastic cheerleaders or frightened gatekeepers. An acronym I developed to explain this is that PIC therapists listen to WCIG. We must be:

  • Warm enough that clients tell the truth.
  • Curious enough not to impose our agenda.
  • Informed enough not to minimize risk.
  • Grounded enough not to cross legal or ethical boundaries.

Some questions clients often ask:

“Should I Do It?”

When a client asks whether they should use a psychedelic, the temptation is to answer too quickly. But underneath one question, there are often deeper ones: Can you help me? Will you reject me? Can you hold my uncertainty? Aware of the power differential, we must be careful not to lead the client in either direction. Instead, we can welcome the conversation without judgment and help them explore their assumptions, alternatives, motivations, and risks.

“What Are the Risks?”

MFTs do not need to become physicians, pharmacologists, or attorneys to be helpful. Still, we need enough literacy to know when something may be risky and when to consult or refer. Clinician and educator Kristina Hunter offers a useful concept here: the three mirrors: body, mind, and life context.

  • The body: medical issues, medications, substance interactions, cardiac concerns, pregnancy, neurological factors.
  • The mind: history of psychosis, mania, severe dissociation, suicidality, or current crisis. Is the client sufficiently resourced to handle intense material?
  • The life context: housing stability, relational support, time to recover. Or isolation, impulsivity, secrecy, and the hope that one experience will fix everything.

We should not medically clear clients or encourage use, even if we think it might help. We are helping them think more honestly and, when warranted, inviting them to discuss medical concerns with a qualified professional. And although we should not tell clients what to do, it is part of our duty of care to name our clinical concerns.

“Can You Assist Me?”

A client may ask for our involvement in many ways: “I’d feel safer if you were there.” “Can you talk to the underground guide?” “Can you help me figure out how much to take?” These requests may express attachment needs, fear, hope, or trust and should be explored rather than dismissed. But they also require boundaries.

We must clearly separate preparation and harm reduction, exploring intention, expectations, support systems, and aftercare, from facilitation, dose coaching, procurement, or participation in an unregulated session. The latter falls outside our role and can move dangerously close to ethical and legal transgressions. Being clear about this protects the client, the therapist, and the profession.

The Morning After

Clients may show up the following week and report that they used psychedelics over the weekend and now want, or desperately need, to process the experience. When things go well, they return inspired, tender, and full of insights to propel therapy forward. Other times they return confused, inflated, ashamed, or dysregulated. “I saw God.” “I think I remembered a trauma.” “I haven’t slept for two days.”

Integration is not about forcing the experience into a neat clinical interpretation. It is the slow, vital process of helping raw experience become embodied, relational, and livable, turning psychedelic states into psychological traits.

Sometimes this means supporting meaning-making. Other times, it means grounding or assessing whether consultation, psychiatric evaluation, or medical intervention is required. This is not always easy. Separating a spiritual emergency from a psychotic break requires real care and expertise. Psychedelics do not exempt us from ordinary duty-of-care responsibilities. Safety always comes first. Do not hesitate to reach out for support when needed.

Why PIC Matters for MFTs

MFTs understand relationships, systems, attachment, trauma, and the complicated ways people change and resist change. Psychedelic experiences may open doors, but clients still have to walk through them in real life, with partners, children, parents, and responsibilities.

Every therapist working in this area should be able to say clearly what they do and do not do. Our role is to provide PIC, not PAT: to help clients explore motivations, risks, expectations, meaning, and integration, while avoiding providing, recommending, sourcing, or facilitating psychedelic use.

The psychedelic landscape is changing quickly. Laws differ by jurisdiction, research findings keep emerging, and public enthusiasm often outpaces regulation and training. We need more than opinions. We need ethical steadiness, clinical humility, and a robust consultation network. Part of our role is to help clients separate hype from reality.

As I have said elsewhere, even for experienced guides, psychedelics are terra incognita. Old maps used to warn us that there may be dragons out there. Psychedelics can be powerful, healing, destabilizing, and sacred, sometimes all at once. We need to be prepared.

Psychedelics do not make therapy irrelevant or outdated. They can amplify our impact on a client’s healing process. Our training gives us a reliable compass to keep clients safe within ethical and legal boundaries, helping them think, prepare, integrate, and stay connected to themselves and their relationships. By maintaining solid boundaries, we can support the client’s journey without losing our own way.

I offer talks, workshops, and consultation for MFTs, clinicians, and organizations navigating Psychedelic-Informed Care, integration, ethics, boundaries, and clinical risk.

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  1. A note on language: Sherpa refers both to an Indigenous Himalayan ethnic group and, in common usage, to a profession associated with high-altitude mountain guidance. I use the term here in the latter way, with respect and awareness of both meanings. ↩︎

Part of the raw musings of a psychotherapist

The Buddha proclaimed that there is no self. Buddhism encourages us to realize that our sense of who we are is an empty construction. There’s even a Ram Dass film called Becoming Nobody.

In contrast, the West wants us to become somebody. That is, to develop a cohesive, functional self, capable of setting boundaries, regulating affect, relating, and working well.

Today I want to focus on the Western side of this equation; on something I habitually see in therapy, though it is often hard to spot: the fear of not existing, which has nothing to do with the Buddhist no-self.

It sounds kind of weird, doesn’t it? Like something out of a fairy tale. Alice fearing that she might be nothing but some sort of figure in the Red King’s dream. But this is no fantasy.

Have you ever met someone constantly needing to be acknowledged or even admired? I’m sure you have. We may even be among them! Some find ways to get it through legitimate means. They find a platform that provides much-needed validation: performing, teaching, helping, creating… Others look for it, or even demand it, from those around them: parents, partners, children, co-workers, lovers…

I often meet them in therapy when their loved ones grow tired of having to prop them up, or, for the most successful among them, when they realize that all the fame, adulation, and acknowledgment are never enough to fill what feels like a hole within.

It is tempting to label them as narcissistic, and some may be, but when we dig deeper, we often find a deeply wounded and scared person facing an unbearable emptiness. A dread that, no matter how successful, funny, accomplished, or accommodating they are, they don’t matter. They feel unsubstantial, lacking matter. Nobody really cares. They could cease to exist, and nobody would even notice.

Although rarely articulated, they seem to fear that, if not noticed, they could dissolve like a dream upon awakening. To be clear, they don’t fear they would literally fade away; but a strange compulsion keeps them demanding attention because the alternative terrifies them.

How can this be?

Psychologically, we develop our sense of being real in relationship. Early on, we need to be seen, recognized, and responded to, not as stars, but simply as beings whose feelings, presence, and existence register in someone else’s mind. This is why young children yell things like, “Look, Mom, no hands!”

When that recognition (known as mirroring) is reliable enough, a person slowly develops an inner sense of solidity: I am here. I count. I remain myself even when no one is looking. But when that kind of acknowledgment is missing, inconsistent, or conditional, the person may continue to depend on outer confirmation to feel real. Then, being noticed starts to feel less like a satisfaction and more like a necessity.

That is why, for some, the hunger to be seen carries such desperation. What they are really fighting is not anonymity, but the old terror of feeling expendable, forgettable, irrelevant, as if they had no psychological weight. In milder forms, this manifests as shame, emptiness, or a chronic sense of not being important. In more serious forms, it feels like a threat to existence itself: If I do not register anywhere, if nobody notices me, do I even exist?

To put it simply, the fear of not mattering can devolve into something primal: the fear of not being, of becoming nothing in the eyes of others and, finally, in one’s own.

How can therapy help?

In a therapeutic relationship, a good-enough therapist offers a new kind of experience: one of being truly seen, perhaps for the first time. Over time, as the client is met by someone who notices them, takes them seriously, and does not reduce them to performance, usefulness, or image, they begin to internalize a steadier sense of being real.

They no longer need quite so much external proof to feel that they exist, count, and have weight. The therapist may also help them develop ways to self-validate, with affirmations such as: “I matter,” “Even when nobody is there, my existence matters,” or, if they are spiritually oriented, “I matter because God sees me, loves me, and cares about me.” 1

It is interesting that, in psychedelic sessions, a recurrent insight is precisely how significant we are, how much we are loved, and how trivial our daily struggles can be. We learn that we are bigger, brighter, and more amazing than we can ever conceive.

Back to the Buddha.

So, should we build the self or see through its illusory nature? Do we matter, or are we empty? As often happens in therapy, the answer is both/and. Jack Engler famously said, “You have to become somebody before you can become nobody.”

Most Western psychotherapy focuses on helping people function in this material world. A healthy ego helps us remember where we parked the car, our Social Security number, and to pay our taxes. Eastern traditions aim toward liberation, toward becoming free from the limitations and illusions of this same world. Their goal is to go beyond the ego. But that’s a topic for a future article.

If you often feel like you need people’s acknowledgment, or if you have been accused of being too needy, insecure, or self-centered, you may have lacked the mirroring every single one of us needs. The good news is that this can be healed.

Remember that you matter and you are loved (and that you should not take yourself too seriously). If you are struggling, therapy can help you heal the fear of being inconsequential and free yourself from the harmful patterns that keep you from seeing who you really are.

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Tired of needing others to prove that you matter? If you often feel unseen, too needy, or dependent on others’ acknowledgment to feel real, therapy can help you build a steadier sense of self.
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  1. However, it is worth noting that such affirmations alone won’t be enough if the wound from early childhood runs deep, as often happens in these cases. ↩︎

How therapy can help us face uncertainty, grief, and meaninglessness.

In Before IT Hits the Fan… I wrote about how, as a therapist, I hear a version of the question that gives this article its title at least once a week; depending on what is going on, often many times per day.

Things Look Disheartening

We are living through what has been called a polycrisis: multiple crises that interact with and amplify one another. But you don’t need me to tell you that. Almost every conversation, if long enough, turns to politics, money, isolation, or the environment. Let’s face it: things look disheartening.

It is easy to lose hope when everything around us reminds us how bad things are. Crises breed helplessness, numbness, panic, and fatalism. It is tempting to disconnect through mindless scrolling, or to convince ourselves we must keep watching the news to stay informed. Cynicism and despair can feel almost rational when it seems there is nothing we can do.

Yet here we are. Do I wish things were different? Absolutely. I worry about my young daughters. I feel sad thinking they may inherit a worse world than the one I grew up in. So when clients, quietly or explicitly, ask me whether humanity will make it, my honest answer is that I don’t know.

This is not the first time things have looked grim. I find it hard to imagine how our predecessors endured wars, invasions, and upheavals throughout the ages. As a Mexican, I have tried to grasp how Native Americans must have felt when settlers and conquistadores shattered their cultures, or how European Jews must have felt during the Second World War. This is no consolation, but things have been worse1.

The Question Beneath the Question

And still, it is hard to make existential sense of any of it. When a client looks me square in the eye and asks, “What is the point?” I understand why Camus thought life was absurd. Is there a plan? Is this some god’s test? Karma? An illusion? Does humanity deserve it? Are we doomed to follow the dinosaurs as just another curiosity in the history of this planet? Again, I don’t know.

Fortunately, as a therapist, my job is not to reassure clients or provide neat answers, but to witness and accompany them on their life path. Therapy does not solve the polycrisis, but I deeply believe it serves a purpose. This is not me justifying my profession, but trying to understand how I, and all of us in the helping professions, can help from our trench.

How can therapy help?

How can meeting privately with another person possibly help? For one, nobody should suffer alone. Crises heighten isolation and powerlessness. We may ask: Am I the only one seeing this? What can one person possibly do? It is easier to fall prey to doomsday news and despair in isolation.

Therapy offers a place to grieve together. A place to regain dignity, lucidity, and perspective; to figure out what matters and how to proceed. It offers a potential space to stay present in the face of doubt and to wonder what life is asking of us now. It also offers the possibility of reclaiming agency and deciding how to act, how to relate, and what not to become. Despair deepens when we become spectators instead of agents.

A Different Kind of Hope

It is also a place to rekindle hope. Not the naïve hope that everything will be okay. History provides no guarantees. Mature hope is a choice (Macy). The decision to keep going without surrendering is already a victory. As Václav Havel suggested, hope is not the conviction that things will turn out well; it is the conviction that something makes sense, regardless of how it turns out.

Not Becoming Cynical

When, in therapy, we face anxiety, adversity, despair, and meaninglessness together, we claim the “courage to be” (Tillich). In the presence of another person, the client confronts fear and desolation. This can revitalize us and keep us from becoming insensitive. We may not be able to save the world, but we can prevent our souls from becoming cynical, cruel, or inert.

Furthermore, as Jung suggested, evil flourishes when humans repress their shadow. The unconscious person is easy prey to fear, hatred, and mass ideology. In therapy, we stay present instead of avoiding reality; we metabolize grief, rage, and fear. Only then can we move from protection or paralysis into action.

It is in relationship that we remember we hurt because we belong. With that clarity, we can decide how to proceed, how we choose to show up in times of crisis, and how to uphold our values and the dignity of life.

When therapist and client courageously affirm life in the face of suffering and uncertainty, we connect with a deeper dimension of identity within us that is more spacious than fear. We remember that we are more than a frightened, skin-encapsulated ego.

Facing Uncertainty Together

So, are we gonna make it? I still don’t know. I hope we will. In the meantime, let’s walk together, meet our pain, find meaning amid the meaningless, and trust, not in a Pollyannaish way, but, as Tolkien suggested, with the clarity that we have the opportunity, and perhaps the obligation, to decide who we choose to be in the time given us.

Facing uncertainty with support

If you are moving through some version of this yourself, you are welcome to reach out. Therapy can help you stay grounded and make meaning. We don’t have to face it alone.

Book a Free 15-Min Call or Contact Sergio

Related reading: Why the Relationship Heals

  1. We must remember that how we experience crises is relative to our level of privilege. Even if we are all going through this polycrisis, there are significant differences between how each group is being affected by it. Those differences matter. ↩︎

Why psychedelic guides need training, humility, supervision, and ethical accountability

There is an ongoing discussion in different forums about the problem of abuse in psychedelic circles and the need to train guides better. I could not agree more.

We all need to make a solid commitment to safety, professionalism, and accountability in the field of psychedelic-assisted guiding and psychotherapy, insisting on the importance of comprehensive training for guides. It is my hope that the psychedelic community worldwide, both aboveground and underground, takes notice and keeps this conversation going.

Helping others work with expanded states of consciousness is not an easy job. I’ve been at it for over 20 years now, and I’ve seen a lot. Of course, every profession has its occupational hazards. Still, I am convinced that, due to what it attempts to achieve, being a psychedelic guide is not for the faint-hearted. Aspiring guides should take note of this.

Psychedelics can be understood as nonspecific amplifiers or catalysts that make it possible to take a journey into one’s psyche and explore otherwise inaccessible deep recesses of the unconscious. This means that they can bring whatever is hidden deep in the unconscious to the surface. As any psychotherapist can tell you, this has incredible healing potential and, conceivably, is also a recipe for disaster.

It is common knowledge that the unconscious holds all kinds of repressed and disowned material. Among other things, it includes our darkest impulses, hidden wounds, and private fantasies, often of a sexual or aggressive nature. If that were not enough, we must add archetypal and transgenerational forces dwelling in the collective unconscious.

The psychedelic guide’s job description includes the willingness and ability to work with these wild subterranean currents, operating both in the client and the guide, to facilitate healing and growth. A good guide must be able to engage not only at the mental-emotional level, but also with the body, energetic, archetypal, and spiritual dimensions of experience.

To do this, guides need more than enthusiasm. They need clinical literacy, ethical grounding, relational maturity, somatic awareness, cultural humility, and a respectful understanding of the spiritual and ceremonial traditions they may encounter. Quite an undertaking.

With such a high bar to meet, mistakes are bound to happen. In Mexico, an old proverb says: “In the soap maker’s house, everybody either falls or slips,” meaning that one should not be quick to judge others because, sooner or later, we too will make a blunder.

In a way, guiding happens at the soap maker’s house.

But how can we reduce the risk of making such mistakes? The answer is quite simple: training, training, training. Or, more specifically, learning, doing our inner work, staying humble, and getting plenty of supervision.

Being fully aware of the pitfalls of guiding, any guide training should begin by discussing ethics. Then it should continue talking about ethics throughout and end by reminding trainees again about the value of ethical behavior and their responsibilities toward clients.

When I teach, I spend time talking about transference, including erotic transference, and countertransference; working with shadow material, both the client’s and the guide’s; working with physical touch; respecting boundaries; working with childhood and attachment wounding; and appreciating the power differential in the guiding relationship. I put particular emphasis on reminding students how and why the stakes are even higher when clients are in expanded states of consciousness.

However, talking about ethics is never enough. I help students understand why these ethical principles and healthy boundaries are needed. Experience has shown that ethical principles rarely work when presented as a list of “thou shalt not.” They only function when guides internalize and commit to upholding them.

As is often pointed out, psychedelics are going through a renaissance. Among the many aspiring practitioners who want to become guides, a few always want to do it for personal, often unconscious, reasons. There is often a guru or messiah syndrome somewhere to be found, or old hidden childhood wounds crying for attention.

I see my job as an opportunity to teach them that being a guide requires profound humility, endless openness to learning, and an unwavering commitment to serve others.

As expressed earlier, being a psychedelic guide or a psychedelic-assisted psychotherapist is not for the faint-hearted. It demands standards of care, ethics, and practice well above those in many related professions. The stakes are higher, and the potential for damage, and healing, is formidable.

Let us all reiterate our pledge to continue working to become guides devoted to such standards. Let’s do it together.

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