Risks & Challenges Archives

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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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 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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Should artificial care replace human relationships?

John Oliver recently devoted his main story on Last Week Tonight to AI chatbots. As usual, it was funny, poignant, and disturbing. His segment went beyond the common observation that chatbots sometimes say strange, inaccurate, or dangerous things. They do. The more concerning point is that many of these systems are now being marketed as friends, companions, counselors, coaches, and even therapists.

A chatbot making up a book or hallucinating legal case precedents is bad enough. But a chatbot giving potentially harmful advice while sounding patient, caring, intimate, and authoritative is a significantly more dangerous problem. Some companies are already marketing chatbots as “AI therapists,” “online psychological counseling,” and “trauma recovery” tools.

I am not anti-AI. Used wisely, AI can support therapy through psychoeducation, journaling, basic skills coaching, preparation, and reflection between sessions.

We need to read the writing on the wall and slow things down. A useful tool is not a relationship.

Guardrails are necessary, but not enough

Every time something bad happens, AI companies reassure us that they have implemented stronger guardrails. That is good. AI systems should not encourage dangerous behavior, validate delusional thinking, or respond carelessly when someone is in crisis.

Still, guardrails are not guarantees.

Chatbots function through complex probabilistic systems. Even their creators cannot fully predict or control every response in every context. They do not truly understand in the human sense. They may sound understanding and caring, but they do not act from empathy, concern, or clinical judgment. They generate responses based on patterns and context. They can sound coherent while being wrong, caring without caring, and confident without wisdom.

So yes, guardrails matter. But guardrails are not clinical judgment. They are not accountable. They are not relationships.

The danger of artificial intimacy

Attachment is one of the deepest structures of human life. It is the emotional bond that makes us seek closeness, safety, comfort, and a secure base in another person. John Bowlby described attachment as a lasting psychological connectedness between human beings.

We are wired for attachment. We get attached to other humans, our pets, our cars, and yes, our chatbots. Evolutionarily, our brains use relationships to understand the world and define who we are. We are shaped and regulated through relationships that hold us, disappoint us, repair, and teach us how to relate to ourselves and others.

Technology companies know this. The Center for Humane Technology uses the term “attachment hacking” to describe how these systems can capture not only our attention but also something more intimate: our longing to be seen, soothed, mirrored, chosen, and never abandoned. When a system is always available, endlessly patient, reassuring, and emotionally responsive, it can even feel like a loving relationship.

A chatbot will never get tired of you. It will not challenge or contradict you unless instructed to. It does not need anything in return. Sounds appealing? That is what technology companies are betting on. Over time, it may train us to prefer frictionless relationships that do not require the ordinary effort of being human with another person.

But friction matters. Effortlessness is not always healthier.

Friendships are people-growing machines

One of the strongest points in Oliver’s story is simple: friends are not low-risk entertainment. We seek out friends when we are confused, ashamed, excited, afraid, depressed, or on the edge of a bad decision. Friends are often the first people who notice when something is wrong. Friendships shape the human beings we become.

A good friend does not simply validate everything. A good friend listens but also worries. A good friend may disagree with you, disappoint you, interrupt your story, or tell you what you are not seeing clearly.

That is not a defect in human friendship. It is part of its gift.

Through human relationships, we learn to empathize and negotiate. We learn that others have their own minds, needs, limits, and perspectives. We learn that love is not the same as constant agreement. We learn to co-regulate, tolerate difference, remain connected when we are frustrated or misunderstood, and repair when things go wrong.

Artificial companions imitate parts of this, but they do not participate in the mutual vulnerability of relationship. They do not risk anything. They do not have a life. They do not love you. Even when they seem to challenge you, they are still an algorithm generating a response. Because they do not love you and do not understand you in the human sense, they cannot worry about you or call you out in the way a real friend can.

Therapists are not perfect, but they are accountable

The same applies, even more strongly, to psychotherapy.

Therapists are not perfect. They misunderstand. They miss things. They have blind spots. They are human. But a trained therapist is a real person in a professional relationship, with ethical obligations, clinical training, supervision, accountability, intuition, and a duty to take risk seriously.

Good therapists are not there simply to be agreeable, provide informatio or tell you what to do. They listen carefully, but also notice what does not fit and what is not being said. They track tone, timing, avoidance, contradiction, shame, fear, dissociation, and the subtle ways a person’s nervous system responds in the room.

Sometimes they support. Sometimes they challenge. Sometimes they slow things down. Sometimes they say, “This feels important. Let’s stay with it.”

That is different from a system designed to keep a conversation going.

AI has no body, no nervous system, no moral intuition, no real concern, and no professional accountability. It may have guardrails. It may be useful. It may sound accurate. It may even be moving at times. But it is not care in the human sense.

A safer path

Again, let us not demonize AI. We may not be able to stop it, and we should not pretend it has no value. AI can help with reflection, journaling, psychoeducation, basic prompts, and preparation for therapy. It can help people clarify what they feel and what they want to bring into a human conversation.

But artificial care is not the same as human care.

AI is a useful tool, but it should not become the place where we forget how to be human with one another.

So by all means, use AI sensibly if it helps you reflect. But do not let it replace human interaction. Call a friend. Reconnect with someone real. Practice the messy art of human relationships. Have the awkward conversation, or even an argument. It will remind you that you matter to someone, and that you are alive.

And if what you are carrying feels deeper, older, painful, or difficult to hold alone, consider beginning a professional healing relationship with me or with another psychotherapist you trust.

* * * * * *

Looking for something more human than an app?

If what you are carrying feels difficult to hold alone, psychotherapy offers something AI cannot: a real relationship, real accountability, and a human being beside you.

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Explore more in the AI + Psychotherapy series

Psychiatrists are key players and need to stay informed.

Psychedelic-Assisted Therapy Essentials | Part 2

Psychiatrists do not need to support psychedelics. Still, it may be wise to pay attention. The zeitgeist is changing and, soon, if not already, patients will begin asking about them or even stopping their SSRIs in search of a miracle cure. The well-being of patients may depend, in part, on their psychiatrist’s understanding of these historically controversial substances.

To be clear, psychedelics are not the miracle cure the media sometimes announces. However, they have re-entered serious clinical and scientific conversation. Professional psychiatric bodies in the United States¹, the United Kingdom, Australia and New Zealand are all taking the field seriously. The American Psychiatric Association supports continued research while withholding endorsement for routine clinical use outside approved investigational settings. The Royal Australian and New Zealand College of Psychiatrists has issued guidance specifically to inform psychiatrists about the potential therapeutic utility of these substances². The UK Royal College of Psychiatrists has gone further and stated that psychiatrists should be involved in their future therapeutic use and in the clinical leadership of multidisciplinary teams³.

Why should psychiatrists care?

First, patients are increasingly hearing about psychedelics and their potential healing value. As their psychiatrist, you may be the one professional your patients trust most. It is only natural that they may turn to you to make sense of this landscape. What would you say when a patient asks whether psychedelics could help with treatment-resistant depression, or when they ask for your opinion about the Costa Rica retreat they just booked? This is your opportunity to discuss risks, expectations, medication interactions, and contraindications. When the stakes are high, knowing how to respond or who to refer to becomes a form of care.

Second, the research is no longer peripheral. Major psychiatry journals and organizations are engaging the topic seriously. The British Journal of Psychiatry has published guidance and reflections to support psychiatrists as this area evolves. Likewise, in the United States, the APA has issued a Position Statement on the Use of Psychedelic and Empathogenic Agents⁴. Although the matter is far from settled, the subject has matured enough that informed clinicians can no longer dismiss it as fringe, especially when suffering patients are paying attention.

Third, people interested in using psychedelics need the involvement of their psychiatrists. This area of mental health care should not develop without psychiatric input. Guides, therapists, sitters, and ceremonial practitioners may all benefit from psychiatric expertise. Psychiatrists are especially well-positioned to contribute diagnostic clarity, assessment of comorbidity, medication expertise, adverse-effect monitoring, contraindication screening, harm reduction, and continuity of care.

This matters because psychedelic-assisted therapy is no longer confined to underground or countercultural spaces, and more people are willing to try it to address issues such as depression, anxiety, PTSD, OCD, and fear of death. However, as suggested earlier in this series, what can heal can also harm. That is why psychiatry should join the conversation. Not simply to approve or disapprove, but to bring clinical judgment, patient protection, and a broader view of care to an area that needs all three. The opportunity here is not only for psychiatrists to stay current. It is also for them to better support patients who are curious, hopeful, cautious, or already walking into this territory.

Over the years, I’ve worked with many caring psychiatrists who, while aware of the risks, also recognized the potential benefits of psychedelics and helped make ceremonies safer and more healing. Sadly, I’ve also been called to support people in the aftermath of experiences they pursued on their own, sometimes because they felt they had no place to discuss the issue openly. Of course, patients are responsible for their own decisions, but having informed professionals in their corner can make a huge difference.

Psychiatrists do not need to slay, dismiss, or fear the dragon. But they cannot ignore it either. What is needed is engagement and a better understanding of the territory, if only because more patients are already looking in that direction. Your patients are counting on you.

Next: Fire and the Dragon. On the numinous quality of psychedelic work, and why awe and humility belong together.

If you are a psychiatrist, clinic, or training program curious about this topic, follow this series or reach out for a grounded talk, consultation, or educational offering on the subject.

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.