Category: Therapy

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. ↩︎

On the therapist-client relationship, empathy, and the courage it takes to begin therapy

Part of the raw musings of a psychotherapist

When two people relate to each other authentically and humanly, God is the electricity that surges between them.
Martin Buber

I have been revisiting my thoughts on the relationship between therapist and client, and the importance of empathy during the first meeting.

It has been over 30 years now, but I remember the first time I went to therapy. Although I had no prejudice against going to a “shrink,” I still felt a bit funny. I guess the way I dealt with it was by convincing myself that I was not crazy, but only needed some help with certain specific issues. In fact, I prepared a list with the five items that, in my opinion, needed to be addressed.

I do not remember my therapist’s attitude in detail, but I do believe that she made me feel comfortable. She acknowledged my areas of concern, whether she agreed with them or not, I do not know, and also made me feel that my problems were solvable. Had she tried to go another way, for example, trying to convince me not to stick to a specific agenda, or letting me know that there might be other issues to consider, I might have felt like she was trying to sell me something I did not need and most probably would have said, “No thanks,” and walked away.

As therapists, we need to develop, from the first visit, a sincere appreciation for the client. We should acknowledge the client’s courage in being there: taking action, accepting that they need help, and trusting a perfect stranger with their deepest and darkest secrets and struggles. That is a lot! We would do well to provide some assurance that coming to therapy was the right move, that they are not crazy, and that there is hope.

The keyword is sincere. As humans, we can feel when someone is faking appreciation or support. In many ways, beneath such sincere support, authenticity and openness are required.

The other topic that keeps coming back, and that I relate to openness, is the need to remember that, even if the client comes to me looking for magical solutions or to be “fixed,” just as they might go to a priest, a guru, or a tarot reader, I should not receive them with a sense of superiority, but welcome them as an equal. As a fellow traveler on the path.

We therapists first have to clear our own trail (healer, heal thyself!), and then invite others to walk along with us, not as an example to be followed, but more like a traveling companion. Someone who, although they may have already visited this specific “country,” is a traveler nonetheless, still learning and discovering new things.

This means encouraging clients to try their own solutions, and walking together in the therapeutic relationship, where therapist and client meet, relate, and, through this meeting, healing occurs.

Yes, to be fully honest, I often find myself suspended in an inner tension. On the one hand, I notice my desire to present myself as wise, capable, insightful, and worth the money I am being paid. On the other hand, I hold the goal of meeting my client, and everyone, for that matter, as an equal, in an I-Thou way. Yes, we may be playing therapist-client roles right now, but underneath that, we are two human beings trying to figure out this thing called life the best way we can.

I remember attending a lecture a few years ago by Rabbi Michael Lerner, in which he discussed two different visions of the world. The first was the market-based society, where fear is the underlying feeling, and every time I meet someone, I evaluate how he or she may be of use to me. Basically, an I-It world. In such a world, it is clear that I, the evaluator, must assume myself to be better than the “its” to which I relate, the “its” I objectify.

The second was the love-based society, where the criteria for a relationship are love, mutual support, equality, and compassion. An I-Thou world. He seemed to suggest that most of the time we engage with each other in an I-It world, treating others as means to an end rather than acknowledging the miracle of having a living, thinking, feeling, unique human being in front of us.

It is as if, instead of appreciating something, a work of art, a sunset, a flower, a person, we are fixated on figuring out what we can get out of it.

It is sad.

May each of us keep remembering that every human encounter is a unique opportunity and a miracle. May you find, in your own therapy and in all your relationships, the joy of being seen and known, and of seeing the other as they are: radiant.

But then again, what do I know…

Therapy works best when you feel seen, respected, and met as a whole person. If this reflection resonates, we can explore whether working together feels like a good fit.

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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 work calls for humility, preparation, and respect.

Psychedelic-Assisted Therapy Essentials | Part 1

Psychedelic-assisted therapy is often discussed in terms of promise. And rightly so. For many people, it has opened doors that had long seemed sealed shut. It has helped illuminate buried pain, soften rigid patterns, and reconnect people with meaning, wonder, and life itself.

And yet, this promise can be misleading if it is not held alongside another truth: this work is not easy terrain.

As beneficial as it can be, psychedelic-assisted therapy, or PAT, can also be arduous, perilous, and thorny. The same processes that may support healing can also become destabilizing when approached without adequate preparation, support, or discernment. This is one of the reasons I find the old phrase hic sunt dracones so fitting here: here be dragons.

The point of such a warning is not to frighten people away. It is to invite seriousness. It is to remind us that there are forms of terrain we do not cross casually. Just as one would prepare carefully before entering difficult and unfamiliar terrain, deep preparation, respect for the journey ahead, and trustworthy guides are strongly recommended here as well.

Psychedelics can be profound teachers, but they are not a shortcut. They are not a silver bullet. They do not do our growing for us. At their best, they may help reveal what is true, loosen what has hardened, and open a path. But what happens next depends on many things: the participant’s readiness, the quality of preparation, the guide’s skill and maturity, the relational container, and the care taken to integrate what emerges.

This is why I often compare psychedelics to fire, or perhaps to a dragon. They are fascinating, powerful, and never fully tamed. One does not truly master fire. One learns how to work with it, how to respect it, and how not to be careless in its presence. The same is true here.

If this field is to mature, it will not do so through enthusiasm or good intentions alone. It will require humility, ethical clarity, thoughtful training, cultural respect, and a willingness to move more slowly than the hype might prefer. It will require us to remember that healing is not manufactured by intensity alone, and that deep work deserves deep preparation.

There is much to be hopeful about. I hold that hope. I have seen the healing psychedelics can support. But hope, by itself, is not enough. In a field like this, reverence must be accompanied by responsibility.

Perhaps that is one simple way of saying what this series is about: to prepare, to learn how to approach the dragon wisely, and to remain mindful of its unpredictable nature.

Next: Psychiatry and Psychotherapy on why we need psychiatrists to be part of this quest to the dragon.

Why California LMFTs need psychedelic-informed care1

The relationship between psychedelics and psychotherapy has always been… complicated. In the late 50s and early 60s, LSD was distributed to mental health professionals to explore its therapeutic potential. Sandoz suspected there was something there, but couldn’t quite pin down where it fit. When Tim Leary later “discovered” psilocybin mushrooms, he framed them as psychologically significant. MAPS, from the beginning, assumed therapists would be at the bedside for MDMA experiences. With the 70s, prohibition made the relationship illegal, but it didn’t make it disappear. Many clinicians simply went underground.

Now, in the current psychedelic renaissance, while most psychedelics remain illegal, mental health professionals face a familiar dilemma: how do we support clients without stepping outside legal and ethical boundaries?

With support from CAMFT Sacramento Valley, I’m teaching a six-session series on Psychedelic-Informed Care (PIC)—how clinicians can respond when psychedelics enter the therapy room without fueling hype or reinforcing taboo. Should we lean in? Set boundaries (which ones)? Redirect? The series is designed to help you answer those questions with precision.

The topic will show up.

It arrives in many forms: questions about legality, reactions to a news story, curiosity about a ketamine clinic, plans for a retreat abroad. “Would you recommend it?” “What are the risks?” “Would microdosing help?” And, of course, the therapist’s favorite: “Is it true it’s five years of therapy in one night?” Clients are often confused, and they want orientation from someone they trust—you.

De-mystification

Right now there’s cultural noise, mixed messages, and outright misinformation. As clinicians, we don’t need to endorse or condemn. We need to help clients differentiate—between curiosity and compulsion, hope and inflation, meaningful experience and destabilizing aftermath. PIC begins with demystification: separating evidence from hype, and myth from clinical reality.

The legal landscape patchwork

Part of the surge is legal ambiguity. The picture is no longer a single, clear “no.” It’s a mixed bag: regulated access models in some places, research pathways, tightly controlled international frameworks, religious-use carve-outs, and—closer to home—local reforms and “decriminalization” language.

Even in California, where classic psychedelics remain illegal, several jurisdictions have deprioritized enforcement around entheogenic “plant medicine” (including places like San Francisco, Oakland, and Santa Cruz). But deprioritization is not legalization. It doesn’t change state or federal controlled-substance law—and it doesn’t change LMFT scope.

Why psychedelics? Why now?

The “why now” isn’t mysterious. Psychological suffering keeps rising, and so does the hunger for new solutions (especially when many mainstream antidepressants remain variations on monoamine modulation). Add promising research signals, a primed cultural zeitgeist, and media acceleration—and you get momentum.

But when a society is suffering and hungry for relief, it becomes vulnerable to shortcuts. Psychedelics, when framed as shortcuts, become especially seductive.

Potential benefits—and real risks

It’s hard to deny that psychedelic research is promising. Across trials at different stages, psychedelics have shown potential relevance for trauma-related suffering, depression and anxiety, existential distress and end-of-life fear, relational patterns, and spiritual meaning-making.

At the same time, potential benefits are not guaranteed, and they are not risk-free. Alongside positive outcomes are reports of harm: destabilization and disorientation after experiences, inflation, bypassing, aftercare gaps (no containment, no follow-up, no integration), and boundary/exploitation risks—especially in unregulated contexts.

This isn’t fear-mongering. It’s clinical realism. The psychedelic ecosystem is still maturing. Ethical failures occur. And when they do, the cleanup often lands back in traditional therapy.

So where do LMFTs stand?

Every clinician know to keep this distinction front and center: scope of practice is what California law authorizes; scope of competence is what you personally are trained to do safely.

California’s LMFT scope includes assessing and treating substance use and related mental/behavioral concerns, and explicitly includes client education, consultation, and clinical case management. But legal permission does not equal clinical readiness, and clinical readiness does not grant legal permission. In plain language: just because you can talk about psychedelics doesn’t mean you should, unless you have the training.

PAT vs. PIC (and the underground)

To stay grounded, it helps to separate three different situations:

  • Psychedelic-Assisted Therapy (PAT): administration plus a protocolized, regulated setting.
  • Psychedelic-Informed Care (PIC): what LMFTs can do ethically—discuss, educate, harm-reduce, integrate.
  • Underground work: unregulated and often illegal “guided” psychedelic work, with wide variability in competence and ethics.

Here’s the key takeaway: to remain within ethical and legal grounds, LMFTs must stay in the green zone—discussion, education, case management, referrals (for education, not sourcing) and integration—and avoid the red zone: using, offering, facilitating/administering, or coaching sourcing/dosing for illegal substances. Yes, there are yellow areas and nuance. But clarity protects clients and therapists alike.

Your stance matters

Beyond scope, not every therapist feels the same about psychedelics—and that’s okay. Within professional boundaries, there’s a spectrum of reasonable stances: cautious, curious-but-boundaried, harm-reduction oriented, or integration-focused. The goal isn’t ideological alignment. The goal is ethical, competent care.

The PIC toolkit

PIC is practical. It boils down to three skill areas:

  1. Psychoeducation (balanced, reality-based, myth-correcting)
  2. Preparation (scope-appropriate: intentions, supports, safety planning, consult triggers—without “how-to”)
  3. Integration (meaning-making, relational repair, values-to-action, stabilization)

A simple response flow helps: Discuss → Educate → Harm-reduce → Integrate. If you can remember that loop, you can respond with confidence even when the topic is charged.

And it should go without saying, but it doesn’t: documentation is your shield. When psychedelics come up, chart the discussion, state client goals, document boundaries, note risks reviewed, and record consults/referrals. That’s not bureaucracy—it’s ethical self-respect and license protection.

In closing: your license gives you a clear road to walk with clients, and a reliable compass to stay oriented—so you can support their journey without losing your way.

In future sessions, we’ll cover the state of the art (research/legal/ethics), cultural context and humility, what to do when the client brings it up, what to do when things go sideways, and—finally—a clear vision of the LMFT’s role in the psychedelic landscape.

Now you know. If you have questions or want to explore this topic further, feel free to contact me.

  1. Although many of these principles apply to all LMFTs, note that this article focuses in California law. ↩︎

As I wrote in Should ChatGPT be your therapist? there is hardly a week when a client doesn’t tell me they consulted AI about something therapy-related. I think that’s fantastic. AI can help by providing psychoeducation, which in turn allows us to deepen our healing work.

AI is an excellent information resource, even in the field of therapy, however, I don’t believe artificial relationships should replace human connection. We also need to keep in mind that this technology is so new that it’s still impossible to know what the long-term impact of such a replacement could be.

Every day we hear about the many things AI can do—both the unprecedented promises and the potential perils. As someone who has been studying the evolution of consciousness for decades, I’ve been following both trends with great interest. Below you’ll find a non-exhaustive list of resources (prepared with ChatGPT’s help) that includes some cases where things have gone wrong. It may help keep things in perspective.

I’ve also been working on an AI companion for therapy. I figured that if my clients are going to keep using AI, they might as well have access to one I can trust. More on that soon.

One-stop incident trackers (good “master links”)

Suicide / self-harm–linked interactions

Harmful or unsafe advice

Manipulation / paranoia / “grandiose” dynamics

Youth safety & companion platforms (policy actions)

I’m fascinated by this topic and its evolution. Are we witnessing a new step in the evolution of consciousness, the birth of the transhuman, or, as James Barrat has suggested, are we on the verge of the end of the human era? What do you think?

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