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Psychedelics and Psychotherapy
The Healing Potential of Expanded States
Table of Contents
About The Book
• Examines the therapeutic potential of expanded states, underground psychedelic psychotherapy, harm reduction, new approaches for healing individual and collective trauma, and training considerations
• Addresses challenging psychedelic experiences, spiritual emergencies, and the central importance of the therapeutic relationship
• Details the use of cannabis as a psychedelic tool, spiritual exploration with LSD, micro-dosing with Iboga, and MDMA-assisted psychotherapy for PTSD
Exploring the latest developments in the flourishing field of modern psychedelic psycho-therapy, this book shares practical experiences and insights from both elders and newer research voices in the psychedelic research and clinical communities.
The contributors examine new findings on safe and skillful work with psychedelic and expanded states for therapeutic, personal, and spiritual growth. They explain the dual process of opening and healing. They explore new approaches for individual inner work as well as for the healing of ancestral and collective trauma. They examine the power of expanded states for reparative attachment work and offer insights on the integration process through the lens of Holotropic Breathwork. The contributors also examine the use of cannabis as a psychedelic tool, spiritual exploration with LSD, microdosing with Iboga, treating depression with psilocybin, and MDMA-assisted psychotherapy for PTSD.
Revealing diverse ways of working with psychedelics in terms of set, setting, and type of substance, the book concludes with discussions of ethics and professional development for those working in the field as well as explores considerations for training the next generation of psychedelic therapists.
by Rachel Harris, Ph.D.
Years ago, in a land far away, I was talking with a Jungian analyst about his female client whose mother had died when she was a child. It seemed clear to me, a young therapist at the time, that this woman should have a female therapist. I blithely made my point with the kind of confidence only an inexperienced therapist is naive enough to express. The older therapist, steeped in the wisdom that Jungians attain after listening to thousands of dreams, patiently responded, “Yes, it will be the woman in me who heals her.”
After decades in private practice, I often reflect back upon this snippet of conversation that turned out to be formative. The analyst exemplified how it’s the relationship that heals as opposed to the specific therapeutic technique (Wampold 2015), and it’s what we bring from our personal depths to that relationship that makes all the difference.
At some level, this is the essence of psychedelic psychotherapy. As therapists, we have to be able to meet our clients in those mysterious realms that both open from within and also blast into outer space. We have to know how to access these mystical territories within ourselves in order to connect with our psychedelic clients who are exploring these otherworldly worlds. We have to know in our bones what they’re talking about. It’s the mystical traveler in ourselves that we must bring to the therapeutic relationship.
Does this mean the therapist has to have personally attended an ayahuasca ceremony? Does the therapist have to be in her own healing process with this psychedelic medicine, attending regular ceremonies? Yes and no. Is this absolutely a requirement? No. A therapist can gain access to these states of consciousness in a variety of ways. Does it make a difference if the therapist has her own personal relationship with the spirit of ayahuasca? Yes.
We have now officially left the realm of evidenced-based treatments.
The spirit of ayahuasca may be referred to in different ways depending upon context--as a generic unseen other, as Grandmother Ayahuasca, or as a cosmic serpent. When I asked in a study of ayahuasca use in North America, “Do you have an ongoing relationship with the spirit of ayahuasca?” 74 percent of people reported yes (Harris and Gurel 2012). If both the therapist and the client have such a relationship with this mysterious plant spirit, the whole nature of the therapeutic alliance is qualitatively transformed.
Ayahuasca differs from many of the other psychedelics in that the plant spirit remains in the body long after the psychedelic effect fades or even the biochemical markers disappear. The sensation is that an intentional other has entered your body to scan your energy field, to balance, align, and repair your vibrational patterns. This is the shamanic healing process, and it continues, albeit with less intensity, for weeks or even months following a ceremony. Gorman (2010) captured this sensation with the title of his book Ayahuasca in My Blood. The medicine is not literally in the blood, but this phrase describes the lived experience of the presence of ayahuasca at a cellular level, at the level of DNA (Tafur 2017), which becomes a permanent aspect of the felt somatic sense.
The presence of ayahuasca in the therapist’s body and energy field changes the process of therapy. The therapist’s inner world is expanded into shamanic realms, imaginal landscapes, and the further reaches of the unconscious. The therapist is a knowledgeable traveler through these realms, experienced in maintaining equilibrium in the face of extraordinary emotions and psychedelic experiences. This enhanced inner capacity, with its access to the numinous, allows for a deeper and broader connection between the unconscious of the therapist and that of the client. Jung (1969, para. 544) described this elusive dynamic in the therapeutic relationship as “soul must work on soul.”
Recent work on intersubjectivity in neuropsychoanalysis describes this implicit connection (Schore 2011) as the therapist attunes nonverbally to the client on a moment-to-moment basis (Spezanno 2005). The therapeutic healing process is alive and present in both their bodies and energy fields. The process of therapy unfolds via implicit communication, nonverbal resonance, and somatic responsiveness between two human beings, beyond their roles as therapist and client. This implicit, embodied, and unconscious realm is ayahuasca’s prime territory, and the presence of the medicine creates a deeper connection between therapist and client, replete with mystery and meaning. The two share an appreciation for other realities and sources of insight and wisdom. At this level, cognitive behavioral techniques or analytical interpretations are irrelevant at best and harmful at worst. With ayahuasca present in both therapist and client, our understanding of the therapeutic alliance must be transformed.
I must admit I’ve been hesitant to state unequivocally that it’s better to see a therapist who has her own relationship with the spirit of ayahuasca. This is hardly a requirement in graduate school or for professional licensing. But I have experienced both sides of this equation and think it’s a critical aspect of the therapeutic relationship.
During research interviews for my ayahuasca study (Harris 2017), which admittedly bordered on brief psychotherapy, I could feel in the person-to-person connection when the spirit of Grandmother Ayahuasca arose in each of us and connected us at another level. I often asked the other person if they could sense her arrival, and they usually could. This otherworldly bond deepened our conversation and trust in each other as we talked about experiences that are difficult to capture in words or are outright ineffable.
I emailed a request to interview one of my research subjects five years after he had completed the questionnaire from that same study (Harris 2017, 289-98). He agreed, and we talked on the phone. I wanted to follow up with him because he had had a complex relationship with Grandmother Ayahuasca, feeling guilty that he hadn’t lived up to her recommendations. He had not attended an ayahuasca ceremony during that five-year period, and he continued to feel guilty. Fairly soon into our exploration of his relationship with this plant spirit, I asked him if he felt her presence in the moment, as we were speaking. He said yes, almost immediately. I agreed and could feel our connection deepen into our shared mystery.
It’s as though there’s a third-party present, a cotherapist for me and a supportive presence for the interviewee. Acknowledging my sense of the presence of ayahuasca between us is healing for the person I’m interviewing because it affirms their relationship with this plant spirit. Such recognition is important in our Western culture since the experience of the presence of a plant spirit is outside our consensus reality. Yet, it’s a significant aspect of the ayahuasca healing process that continues well after the ceremony ends.
On the other side of this equation, I’ve been seeing a Jungian therapist who has studied Hawaiian shamanism and even has an intimate connection with Hawaiian goddesses. I can sense that she’s connected to those particular spirit realms; however, as I’m not, I don’t join her in that other world. She understands these unseen realms, but that’s not the same as a shared energetic connection. We still have a good working relationship in therapy, and I have clearly benefited; at the same time, I know she cannot enter into my experiences with Grandmother Ayahuasca.
From an indigenous point of view, this concept of shared spirit realms is an accepted reality. Shamans can see into participants’ visions during ceremonies and guide them through these other worlds. Also, shamans have been known to impart teachings to their protégés by appearing in their nighttime dreams. The medicine seems to open a link that allows for this level of communication.
The 74 percent of people in my research study who reported an ongoing relationship with the spirit of ayahuasca described “a consistent presence in my life,” an ever-present guide and source of wisdom, both supportive and loving. A few people wrote that this was the first time they felt truly loved in their lives even though at times it was a tough love. They felt the spirit of ayahuasca always had their best interests at heart, “showing me how to forgive myself, how and why I should live healthier.” One person answered that the “relationship felt like a parental bond” and he “felt loved.” Another wrote, “She is my mother” (Harris 2017).
These quotes describe an attachment bond, the kind of affective relationship between baby and primary caretaker. The key elements of an attachment bond are that the child seeks to be close to the attachment figure, experiences distress at separation, turns to the attachment figure in times of stress, and feels that the attachment figure is a secure base from which the child can explore the world (Bowlby 1969). The descriptions of a personal relationship with the spirit of ayahuasca meet these criteria in the same way that Kirkpatrick has said that people with a personal relationship with God are also in an attachment relationship (2005).
Moreover, these attachment relationships with an unseen other have the capacity to repair old attachment wounds from childhood (Granqvist, Mikulincer, and Shaver 2010). People who grew up with parents who were not consistent, attuned, or responsive fall into avoidant, anxious, or disorganized attachment categories. They struggle with emotional dysregulation and have difficulty managing relationship distress. The narrative of their life story lacks coherence, purpose, and meaning, and they seem to have a diminished capacity for self-reflection and insight. About 50 percent of the population falls into these categories of insecure attachment.
In a relationship with an unseen other, these people heal enough to shift attachment categories and achieve an earned security attachment category with a better prognosis for long-term relationships and a coherent life story (Siegel 2010). Without equating the spirit of ayahuasca with God, both kinds of relationships are with an unseen other and are filled with a love that is always available.
When the experience of being loved peaks during an ayahuasca ceremony, it’s as if the universe embraces us with love. This is such a healing revelation, filling us with radiant light, that we emerge the next morning with great gratitude for Grandmother Ayahuasca. Receiving cosmic love in ceremony changes the person in a profound and permanent way. A mortal therapist, even with a strong therapeutic alliance, cannot cajole the heavens to open up and shower the golden light of love onto a client sitting in her office.
Veronica was in her early thirties but had not quite gained traction in her life. It wasn’t that she was lost; she just didn’t have the healthy self-confidence to find a way to move forward. Veronica didn’t have a college degree or independent career, so she got by on minimum hourly wages. She had been in an abusive relationship that took years to escape and was currently working on her recovery.
“Grandmother Ayahuasca is there for me in a way that no one else ever was. I can call on her day or night and she’ll respond. She’s always there and loving. So, for the first time in my life, I feel lovable,” Veronica said, as she explained her relationship with the spirit of ayahuasca.
As a therapist, I couldn’t help but ask myself if this was a textbook case of spiritual by-passing. Is Veronica relying on her relationship with an unseen spirit instead of working on healthy and realistic relationships with potential mates? Certainly, some people escape the developmental challenges of so-called real life by retreating into the spirit world and imagining personal fulfillment.
I didn’t think this was the case with Veronica. Instead, I saw her gathering her shattered sense of self into a new identity that deserved to be loved. Her relationship with Grandmother Ayahuasca was giving her a more positive foundation, allowing her to shift to a secure attachment category that would surely enable her to make better relationship choices in life. People who feel lovable create different life trajectories than people who don’t feel lovable, and Veronica was, in a sense, starting over.
For Veronica, ayahuasca ceremonies were taking the place of psychotherapy. Ideally, she could benefit from both, with therapy supporting and expanding her sense of being lovable and the ceremonies deepening her relationship with Grandmother Ayahuasca. But she couldn’t afford psychotherapy. Like a good-enough mother, ayahuasca can continue to heal Veronica so she can move forward with her life.
RUPTURE IN THE THERAPEUTIC PROCESS
Even with the presence of ayahuasca and a strong therapeutic alliance, it’s inevitable that a glitch will occur in the therapist-client relationship. One or the other will feel misunderstood, diminished in some way, and possibly frustrated, disappointed, or upset with the other. This disconnection is called a rupture in the moment-to-moment relationship between therapist and client, and it usually means that one or the other’s unconscious has been tweaked (Ginot 2012). It can be as small an interaction as:
Client after an ayahuasca ceremony, with awe: “The lights were incredible, like fireworks!”
Therapist, slightly impatient: “Yes, but what did you learn?”
A better response from the therapist would have simply been “uhhuh,” a neutral acknowledgment to allow the client to continue to share. But this particular therapist happens to value insight and achievement, and she wanted to get into the depth work immediately. Her timing was off. A very simple rupture.
Client, startled by the abrupt shift, stutters: “I’m not sure, I just wanted to enjoy the beauty.”
Therapist, realizing she’s out of step: “I’m sorry, I rushed you. Please go on.”
Client, accepting the repair: “Yes, the lights were different this time. I could feel them streaming into my body.”
The rupture was not only about timing; it was in the wrong modality. “What did you learn?” requires a cognitive answer with linear thinking. Lights streaming into a body comes from the shamanic realm where miracles happen beyond explanation. Note the seamless shift from seeing the lights to the somatically based experience of feeling the lights enter the body. A therapist without ayahuasca experience might at best consider “light streaming into a body” to be a metaphor. A therapist with experience recognizes that this is a direct description of the process of healing.
The challenge is how quickly therapists can catch themselves when they’re out of attunement. And then how quickly they can repair the disconnection and reconnect with the client.
From an intersubjective perspective, a rupture reflects both the client’s and the therapist’s psychic structure, what Bowlby (1969) called an internal working model. We have all constructed our egos to protect us and ensure our survival. Whatever our attachment experiences, we learned very early how to predict and understand our environment, how to survive and pursue a felt sense of safety (Pietromonaco and Barrett 2000). The egoic architecture we develop is typically rigid, unconscious, and reactively stubborn.
A rupture in the therapeutic relationship can entangle both the therapist’s and the patient’s ego. How the therapist responds in that moment can determine the course of treatment. Therapeutic skill is essential along with personal humility. In this moment, it is who the therapist is that is of utmost importance. How much awareness does the therapist have of her own psychic architecture and recurring patterns? How much flexibility does she have within her own ego structure to sidestep her most reactive patterns and find an elegant pathway to reconnection with the client?
It’s tempting to think that if the therapist is experienced with ayahuasca, then surely she is aware and flexible enough to respond artfully to the client. There’s plenty of research showing an increase in cognitive flexibility with psychedelics (Carhart-Harris et al. 2014). On the other hand, we all know people who have been sitting in ceremonies for years and are still stuck in their familiar, repetitive patterns. It’s our responsibility as therapists to catch ourselves in the moment when a rupture occurs and titrate a response specific for that client.
Ayahuasca gives us the objectivity and space to dis-identify with our feelings and thoughts so that we have a split second not to react but to consciously choose how to respond. This is what integration looks like, whether in our roles as psychotherapists or in our everyday lives. This is how we change our habitual patterns of perceiving and behaving.
- Publisher: Park Street Press (September 7, 2021)
- Length: 424 pages
- ISBN13: 9781644113332
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Raves and Reviews
“Training compassionate and effective therapists is the key to scaling psychedelic-assisted therapy. Psychedelics and Psychotherapy will contribute to the training of tens of thousands of therapists who will be able to treat millions of people.”
– Rick Doblin, Ph.D., executive director of MAPS
“There is a revolution happening in mental health. Read and Papaspyrou have gathered together the world’s experts on various medication-assisted psychotherapies to explain how these molecules facilitate transformational experiences.”
– Julie Holland, M.D., author of Good Chemistry
“A remarkable collection of sophisticated psychedelic therapists and integration specialists sharing new methods, new models, and theoretical underpinnings for both. What makes this volume invaluable is the wide range of solutions that the writers have come up with for helping and healing. There is a richness of ideas and case histories here, and no matter what your orientation is, you’re going to learn many other ways your own work might go.”
– James Fadiman, Ph.D., microdose researcher, author of The Psychedelic Explorer’s Guide
“This authoritatively written and beautifully illustrated book explores perfectly the complexities and benefits of interweaving these disparate subjects into a platform of hope for our patients with unremitting mental disorders. A highly recommended read for practitioners, patients, and anyone with a keen eye on the contemporary development of psychedelic culture and medicine.”
– Ben Sessa, MBBS, MRCPsych, chief medical officer at Awakn Life Sciences, Inc., and psychedelic thera
“This new book provides a rich education for those seeking wisdom about the deepest varieties of psychotherapy.”
– Robin Carhart-Harris, Ph.D., head of Centre for Psychedelic Research at Imperial College London
“As psychedelic drugs reintegrate themselves back into our lives how are we, in turn, to reintegrate them? This timely book will serve as a roadmap to those who walk this path, bringing together indigenous cultural knowledge and modern psychotherapeutic thinking to illustrate an ancient process of deepening inner awareness that so many feel has such contemporary potential to heal.”
– James Rucker, Ph.D., honorary consultant psychiatrist at the South London
“This edited collection of articles by seasoned experts in psychedelic- assisted therapy fills a critical gap. This book covers what every therapist needs to know in order to be competent in helping clients integrate their psychedelic experiences.”
– David Lukoff, Ph.D., professor of psychology at Sofia University
“A valuable collection of experiential discoveries and research findings. A guide for those who would fathom how the competent use of psychedelics may facilitate healing and illumine the dynamics and mysteries of human consciousness.”
– William A. Richards, Ph.D., author of Sacred Knowledge
“This groundbreaking volume is essential reading for all practitioners in the healing professions, especially those whose primary focus remains the biological facets of mental health. A paradigm shift--toward a deeper model of the human being recovering the soul, the feminine, and our need for a profound sense of social belonging and embeddedness in nature--is absolutely essential. Our multifaceted crisis can only be resolved through the kind of integrative approaches advanced here: those that start from the inner dimension and its corresponding outer expressions.”
– David Lorimer, MA, PGCE, program director at the Scientific and Medical Network
“I could not be more appreciative for the publication of Psychedelics and Psychotherapy. It should be essential reading for anyone interested in maximizing the healing potential of expanded states of consciousness and is a MUST for anyone considering the path of becoming a psychedelic therapist, sitter, or guide. These are the wise voices of dedicated and well-seasoned practitioners.”
– voices of dedicated and well-seasoned practitioners.” Diane Haug, MA, LPCC, senior staff membe
“An important book that unites the current vogue for medical application of psychedelics with the deeper spiritual understanding of humanity as interconnected, which is denied by the illness model of mental well-being. Psychedelics are identified as a means to face and heal the inner pain behind mental breakdown, and the theme is illustrated from a variety of therapeutic perspectives--using multiple ways of exploring expanded consciousness--the whole enlivened by the inclusion of artwork arising from the process.”
– Isabel Clarke, consultant clinical psychologist, and author of Madness, Mystery and the Survival of
“This rich, brilliant anthology is a must-read resource for anyone interested in psychedelic-assisted psychotherapy, covering areas such as preparation and integration, the use of evocative music, mandala drawing, bodywork, and archetypal astrology.”
– Renn Butler, author of Pathways to Wholeness and The Archetypal Universe
“Read and Papaspyrou have years of experience in the field of healing with expanded states of consciousness and, with keen observation of what is needed as psychedelics enter the mainstream, have chosen wise authors and essential topics to include in this book. Psychedelics and Psychotherapy reflects the multi-dimensional experience of both client and therapist in psychedelic therapy and the subtle issues that arise. This book is essential reading for those just joining this important healing work. Veterans in the field will appreciate the skillful articulation of the differences between psychedelic therapy and ordinary therapy, especially regarding training, ethical awareness, presence, and supervision in supporting the inner healing intelligence of clients in the therapeutic alliance.”
– Kylea Taylor, LMFT, author of The Ethics of Caring
“A wonderful mind-expanding book that has renewed my compassion, enthusiasm, and curiosity for the therapeutic experience. Authors with deep experience write beautifully about the transformative nature and process of psychedelic therapy.”
– Rachel Gibbons, psychoanalyst, group analyst, consultant psychiatrist, and organizational consultant
“An important, timely, and rich collection that should interest anyone with a serious interest in psychedelics.”
– Jeremy Narby, anthropologist and author of The Cosmic Serpent
“Research and reports of users in this field are gaining increasing awareness, yet the voice of those therapists who offered therapy is seldom heard. A rich, thorough resource of practitioners awaits the reader; collectively, they represent hundreds of years of experience in this growing field.”
– Manuel Aicher, psychotherapist
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