psychedelic-assisted therapy Archives

On the numinous quality of psychedelic work, and why awe and humility belong together.

Psychedelic-Assisted Therapy Essentials | Part 3

In the previous articles in this series, I suggested that psychedelic-assisted therapy (PAT) is not a walk in the park. Old maps warned travelers with the phrase hic sunt dracones, here be dragons. It was a warning suggesting that beyond this point, the map becomes uncertain. Beware. Do not assume you know what you are entering.

That warning applies to psychedelic work.

Psychedelics open fascinating possibilities for healing, insight, grief, forgiveness, and spiritual meaning. They can help people encounter parts of themselves that have been exiled for years, soften rigid defenses, bring forgotten memories into awareness, and reconnect with something larger than the isolated self.

But fascination alone is not enough.

The theologian Rudolf Otto used the phrase mysterium tremendum et fascinans to describe the numinous: that which is simultaneously mysterious, awe-inspiring, frightening, and deeply attractive. This applies to psychedelic work. Often, before a ceremony, people feel both fear and curiosity. This is fitting. Something in us is drawn toward it, while something else trembles before it.

In many ways, psychedelics are like fire. Fire warms us, feeds us, protects us, and illuminates darkness. Around fire, stories are told, meals are shared, rituals are held, and communities are formed. And yet, we remain cautious around it. We do not assume that because fire is good, more fire is always better. We do not hand a torch to someone without preparation. Fire requires knowledge, respect, containment, and care.

Psychedelics do too.

The dragon is also a fitting image. Dragons are powerful, mysterious, unpredictable, and often guard treasures. In many stories, the task is not simply to defeat the dragon but to become worthy of the encounter.

The psychedelic renaissance is full of promise, but also of peril. We may reduce psychedelics to techniques, experiences, or shortcuts. We may oversell them as miracle cures. We may even assume that, since they can bestow so many blessings, nothing can go wrong.

That is simply not the case.

Psychedelics are not silver bullets. They won’t solve our problems for us. In some Indigenous traditions, natural psychedelics are referred to as plant teachers. This makes sense. Good teachers show what needs to be done, but do not do it for us. They reveal, challenge, support, and sometimes confront us.

We still must do the heavy lifting.

This is one of the great misreadings of PAT. Many want to believe that the substance will eliminate their problems just like paracetamol eliminates a headache. But there is more to this story. Psychedelics can make healing more possible. They open the door, but we still have to walk through it.

We may experience unconditional love, but then have to learn how to live from it. A painful memory may be recovered, but still needs to be integrated. A mystical experience may occur, but must be understood without inflation. Insight is not transformation. As Ken Wilber suggests, we need to convert altered states into permanent traits.

This is why preparation and integration are fundamental, not as annoying add-ons, but as part of the work itself. The experience is never separate from the container that holds it. The medicine should not be separated from the person’s mindset, the relationship with the guide, the setting, the boundaries, and the commitment to growth.

The fire needs tending. The dragon asks us to become deserving of the boon.

Enthusiasm without humility can lead to carelessness, inflated claims, naïve expectations, poor boundaries, and even harm to the very people seeking healing. A mature approach must hold awe and discernment together. Awe reminds us that something profound may be taking place. Discernment reminds us that fireworks do not mean healing. Fascination opens the heart. Responsibility keeps the feet on the ground.

Training is crucial.

Psychedelic practitioners require more than information; they require formation. The person preparing, guiding, and integrating these experiences needs more than technical knowledge. They need maturity, self-awareness, ethical clarity, relational skill, cultural humility, and the ability to remain steady when the unexpected appears.

We cannot truly tame the dragon, but we can learn how to work with it. We can approach it, listen to it, respect it, and join forces with it wisely. Not as master, worshipper, or conqueror, but as an ally.

The field does not need hype, panic, dismissal, blind devotion, or pollyannish naïveté, but a grounded orientation. PAT has enormous potential. But if we want this renaissance to mature, we need to remember that what can heal can also harm. We need maps, training, ethics, cultural respect, and honest conversations about risk.

The dragon usually guards a treasure. But it is not given gratuitously. It asks to be approached with humility, preparation, and respect.

Next: Experience Is Not Healing. On why powerful psychedelic experiences do not automatically become transformation.

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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.

Psychedelic-Assisted Therapy Essentials Series

An introduction to the Psychedelic-Assisted Therapy Essentials series

Psychedelic-Assisted Therapy (PAT) carries real promise. It also asks a great deal of everyone involved.

This is not a walk in the park. As beneficial as it can be, and research continues to suggest that it can be, the path can also be arduous, perilous, and thorny. Old maps warned travelers with the phrase hic sunt dracones—here be dragons. That image feels fitting here. Psychedelics can open doors to healing, insight, and transformation, but without adequate preparation, guidance, and integration, the same processes that may help can also harm.

This series is meant as a grounded orientation to PAT: what it is, what it is not, what makes it helpful, and what makes it risky. We will explore some of its core elements: set and setting, the medicine, intention, preparation, the guide, the participant, and integration; as well as the wider questions that surround them: ethics, relationship, culture, spirituality, and the humility this work requires.

To borrow a phrase from Rudolf Otto, psychedelics are a mysterium tremendum et fascinans; both fascinating and daunting. In that sense, they are a bit like fire, or perhaps a dragon: powerful, compelling, and never fully tamed. We do not master them so much as learn, with care and respect, how to work with them wisely. You can choose to befriend or confront a dragon; it will certainly impact your journey.

I write these reflections not as a detached observer, but as someone who has spent many years studying, teaching, and participating in this evolving landscape. My hope is simple: to serve as your guide, someone who knows the terrain, who can help you explore it more safely, point out what matters, and warn of the perils, so the path may feel clearer and steadier.

If you are new to this work, welcome. If you have been walking this path for some time, welcome as well. Either way, I hope these writings offer something useful for the journey.

Begin with: Here Be Dragons — why psychedelic-assisted therapy requires humility, preparation, and respect.

About fifteen years ago, whenever someone invited me to talk about the healing value of meditation, I would start—somewhat mischievously—by saying, “If you’re still wondering whether meditation is healing, you haven’t been paying attention. Its benefits have been proven beyond reasonable doubt.” Even with today’s ever-growing body of research pointing strongly in that direction, when it comes to psychedelics, we’re not there yet.

Psychedelics are being explored for a wide array of purposes: fibromyalgia, dementia, brain injury, Parkinson’s, ALS, Alzheimer’s, and chronic pain. More specifically in mental health (which will be our focus): anxiety, PTSD, depression, anorexia, alcohol and substance use, eating disorders, OCD, bipolar II, smoking, and existential distress. Researchers clearly suspect that these substances hold significant potential across many conditions¹.

Not “what”, But “How”.

Although “What can psychedelics heal?” is an important question, there’s another one that’s not asked as often: How do they heal?

Of course, a neuroscientist could answer that psychedelics temporarily loosen rigid brain networks and boost neural plasticity by binding to serotonin receptors—creating a window to reconfigure entrenched pathways into new, more adaptive patterns.

However, I am not a neuroscientist, and I am not sure how many of my readers are, so let’s take a different route. If we look beyond the brain into current research and what I’ve observed with clients, growing evidence shows that psychedelics and psychotherapy heal through the same core mechanisms—the difference being intensity, not kind. Integrated wisely, each strengthens and completes the other. Let’s unpack it:

Beyond neuropsychological explanations, there are several theories that try to explain the mechanisms involved in psychedelic healing:

Set & setting: Mindset, expectations, the quality of the relationship, and the surrounding environment shape and enhance the healing potential of the experience.
Network reset: Psychedelics disrupt entrenched neural patterns—and the fixed beliefs they sustain—promoting neural flexibility and the restructuring of pathways.
Receptivity: Heightened openness and reduced defensiveness allow for deep exploration, insight, and the learning and retention of new ways of being.
Cognitive updating: By widening perspective, old organizing principles are revised into more adaptive meanings, greater agency, and healthier narratives.
Emotional release/catharsis: By relaxing the brain’s control systems within a safe relational container, traumatic memories, repressed emotions, and somatic tension trapped in the body can surface, to be completed or reconfigured in an improved emotional context.
Mystical insight and self-transcendence: The sense of self expands beyond the wounded ego, merging or identifying with a larger Self or Cosmos, offering a broader perspective and reducing existential fear.

While painted with broad strokes, these ideas form the backbone of how many researchers now understand psychedelic healing.

So, there you have it. That’s how they heal. Now we know… or do we?

Let’s explore it a bit longer. These theories are elegant and plausible, but much of the research is still young. Serious scientific study has only recently resumed, and since the only way to know what’s happening inside someone’s mind is to ask them, researchers usually rely on questionnaires and interviews to access participants’ inner worlds.

Let’s try another approach. Since we already know that psychotherapy works (trust me on that, okay?²), let’s explore how it brings about change and see if we can find some parallels.

How Therapy Works

Even before Freud, this question has been heatedly debated³. Although we don’t have a definitive answer, decades of research have produced a set of “common factors” that play a part in healing⁴:

A reasonable expectation that therapy, through specific methods, will actually work.
A meaningful, safe relationship where the client feels seen, accepted, and understood.
The facing, correction, and integration of painful or unresolved emotional experiences, often—but not necessarily- linked to childhood.
Insight, meaning-making, and the creation of new personal narratives.
Updating of rigid beliefs and practicing new behaviors and ways of thinking.
Development of accountability, agency, and self-efficacy.
Desidentification beyond limiting self-stories and an expansion of the sense of self.

Although the language differs, it’s easy to spot the parallels. Both emphasize the importance of the relationship (part of the setting), the value of positive expectations (part of the mindset), and the opportunity to face and correct painful past experiences, often through emotional release. Both emphasize insights, updated beliefs, the chance to create new narratives, try new behaviors, expand perspectives, and reclaim agency.

It seems that what helps people change in therapy may be the very same processes at work in psychedelic healing. This would also explain the popular meme that psychedelics are like three (or five, or even ten) years of therapy in one night. But if that were true, why would anyone choose psychotherapy at all?

Old Habits Die Hard

Good question. First, psychedelics are still illegal in most of the world. But even setting legality aside, this isn’t really about choosing one over the other—it’s about understanding their respective strengths and limitations.

The “three years in one night” meme captures only part of the truth. There’s more to it. Over decades, psychotherapists have learned that change is hard. We cling to old—even painful—ways of being. Old beliefs, like habits, die hard.

Psychedelics are intriguing because they seem to produce immediate results. I often hear a version of the meme. This may stem from heightened receptivity, intense emotional release, and powerful, luminous insights—often mystical in nature—that appear to open a broad window of neural plasticity. Psychotherapy, on the other hand, relies on slow, repeated emotional nudges and controlled exposure to unresolved issues. Growth is painstakingly slow and cannot be rushed. It takes time to develop a strong relationship where a person feels safe enough to challenge old patterns and belief systems. Insights must be practiced repeatedly before they become part of who we are.

Therapy, through weekly sessions and the continual revisiting of core themes, consolidates and deepens this process. This slow phase is often frowned upon in a society where “faster” is assumed to mean “better”.

It is misleading to say that psychedelics work faster than psychotherapy. Yes, the openness, catharsis, and insights feel dramatic when compared with regular therapy, but those transient and extraordinary psychedelic states need to be converted into enduring psychological traits. In other words, experience shows that to ensure the jewels gathered in psychedelic sessions aren’t lost, we must develop the necessary structures to help them take root in our lives. This is why, like other experts in the field, I emphasize the importance of preparation and integration as absolutely essential parts of any healing psychedelic process.

Complementary, Not Better

So, how do psychedelics heal? As I explain to my clients, this is not an either/or dilemma but a both/and integration. The change mechanisms of psychotherapy and psychedelics alike foster openness, enhance plasticity, reduce reactivity, facilitate insight, help complete unfinished emotional business, generate new narratives, strengthen agency and responsibility, and expand—or decenter—the sense of self.

Both rely on the same healing principles: psychedelics amplify; psychotherapy stabilizes. Together, they create a more complete path to transformation.

Beyond Psychology

Before ending, it’s worth remembering that it is in the modern West that psychedelics are seen almost exclusively as therapeutic tools, as “psychedelic-assisted therapy”. In contrast, shamanic traditions, which have worked with sacred plants for millennia, the concept of healing includes and transcends the psychological. There, psychedelics are seen as wise teachers in the broadest sense of the word. In my work, I try to honor both approaches.

The West could learn much from these ancient traditions—if only we approach them with respect and humility, but that is a topic for another article…

You’ve probably guessed from the title that this article is ambitious, thus a bit longer than others. Please note that every claim is backed by scientific research, but to avoid making it even longer, I’ve left out the references. If you’re curious, just reach out — I’ll be glad to oblige. ↩︎
Many may question this assertion; however, there is solid evidence that the average therapy client ends up doing better than about 75% of comparable people who receive no treatment. See https://pubmed.ncbi.nlm.nih.gov/921048/ ↩︎
Making the unconscious conscious, reworking old relationship patterns, strengthening the ego, through a corrective emotional experience, catharsis, replacing unhealthy beliefs, taking responsibility, bringing closure to unfinished emotional business, self-transcending egoic patterns, etc. All of these have been advanced as reasons why therapy heals. ↩︎
Of course, beyond these, there are many other alleged factors, but these are generally agreed upon. ↩︎