What is Psychedelic Assisted Therapy
What is Psychedelic-Assisted Therapy?
Psychedelic-Assisted Therapy (PAT) has recently been popularized and many of my clients come to this work already aware of its potential benefits. Perhaps you have read How To Change Your Mind, seen Fantastic Fungi, or followed the clinical research at Johns Hopkins or the Imperial College London. Remarkable Policy changes and recent media exposure have brought PAT into the spotlight, but what exactly is it?
PAT is a structured, four-phase process that combines psychotherapy with psychedelic medicines such as psilocybin or ketamine to help individuals improve their quality of life. There are a wide variety of reasons that people seek PAT. Some hope to address specific mental health conditions such as depression, anxiety, PTSD, OCD, or addiction. Others come with broader goals: to explore their inner world, to find wellbeing through expanded awareness, or to mark significant life transitions. Whether your intention is clinical treatment of a mental illness or personal growth and transformation, psychedelic therapy has something to offer.
A psychedelic experience itself is like rafting on a river inside a deep canyon. Once you're in, you can’t turn back and must continue paddling forward. Though certain drugs can cut or blunt the psychedelic experience, these are not kept on hand and their use is typically counter therapeutic. Once you begin, the only way out is through. For this reason, preparation is key.
Instead of planning to turn around, we want to create the internal and external conditions which are conducive to successful completion of the journey. You need to know your route, check your gear, and ideally have a guide. PAT works the same way. We use specific strategies to ensure that supportive internal and external conditions are in place that will allow safe and skillful navigation through the landscape.
The Most Important Factors in Psychedelic Therapy
Throughout the 1960’s, “Set & Setting” were the factors thought to most influence a psychedelic experience. “Set” refers to mindset; the content of the mind at the time of the experience including thoughts, emotions, beliefs, intentions, prior experiences. “Setting” refers to the physical location of the experience as well as the people that you are interacting with throughout. While these are still relevant, modern Psychedelic-Assisted Therapy offers an expanded perspective.
Research at the Imperial College of London has produced the “Imperial Psychedelic Predictor Scale” (IPPS). This 9-question survey measures “set”, “rapport”, and “intention” in order to predict how a psychedelic experience will unfold (Angyus et al, 2024). This is a useful scale, but it’s incomplete. Inspired by the IPPS and drawing from experience I have created a simple 4 category outline for successful psychedelic work. These are these 4 essential and interconnected pillars of Psychedelic-Assisted Therapy:
Safety
Connection
Intention
Surrender
Safety
Your safety, both physical and psychological, is the top priority. The psychedelic therapy process begins with screening to identify risks (such as a history of psychosis, bipolar I, or cardiovascular issues). Session environments are carefully curated to be hazard-free, calming, and supportive.
Emotional safety is equally important. You need to feel secure in expressing yourself fully without fear of judgment. Competent facilitators understand how to co-create spaces that foster trust, acceptance, and psychological containment in order to provide you the safety to feel whatever it is that you're feeling.
Connection
The quality of your connection to yourself and the people in your life will influence your psychedelic experience. A person who knows themselves well and has many meaningful connections will generally tolerate a psychedelic experience with more ease overall. A person who is a stranger to themselves, has never looked inward, and lives in social isolation may have a more intense time; especially during the integration phase. Without a good relationship with the facilitators, though, both kinds of people may have a more challenging experience during the medicine session.
In psychedelic therapy, it’s important to feel good about your relationship with your facilitators. A good psychedelic therapist will help you to feel seen, heard, and even honored. They will be attentive to your experience and work to meet your needs both as a client and as a human being. When you’re with a facilitator who is offering this kind of attention, it becomes possible to heal old relational wounds.
Much of our pain comes from attachment with other people. Connection is the place that we get hurt as well as the place that we heal. Wounds of relationship heal in relationship. For this reason, feeling good about your relationship with the facilitators and the other people who you will be taking the medicine with predicts more positive outcomes.
Intention
Having a compelling “Why” allows us to productively work with anything that arises as a part of our experience. Psychedelic work can be joyful and pleasurable, but it can also be challenging and uncomfortable. An intention gives us a reason for what we experience. It acts as an anchor which helps expand our capacity to tolerate adversity of all kinds.
“Who has a why can bear almost any how.” - Nietzsche.
Intentions can range from treating a particular illness to finding your soul’s purpose. Importantly, intentions are not guaranteed to come true like wishes. They simply offer an entry point, a way to consciously orient the mind towards having a meaningful experience.
A well crafted intention can become the center point of our life, a driving principle behind everything that we do. Intentions also serve as memory aids that help us to recall important details of the experience that may otherwise be forgotten over the course of Integration.
Surrender
Even after all of our preparation, there’s an element of the Psychedelic experience that is ultimately outside of our control. This is where surrender becomes important. Surrender refers to our willingness to meet reality, on reality’s terms. To allow what will be, to be. It’s our ability to give up preconceived notions of what should happen and to go with what is actually happening.
In traditional talk therapy, challenging topics can be avoided until you feel ready to address them. But in Psychedelic Therapy avoidance is less possible. Thoughts, emotions, sensations, and images may arise whether we invite them or not. If you resist them, you will struggle more.
Confrontation with inner material that you might have been avoiding is one of the core ways that psychedelic therapy helps you to heal and grow (Zeifman, 2022). Though it can be uncomfortable, facing the thing that we're afraid to face is ultimately therapeutic. It is our very avoidance of an issue that keeps us stuck in place. Like paddling against the current of a river, resistance is exhausting and counterproductive. You will cover much more distance by surrendering to the experience and allowing the current to move you.
Importantly, every session is unique. Clinging to expectations, especially those formed by reading trip reports or listening to other people describe their experience, can create disappointment. If you're unsure how to surrender, that’s ok! We will practice this in the preparation phase using somatic mindfulness techniques. Like any skill, surrender can be learned.
If you're considering psychedelic therapy, take time to find a facilitator who understands these principles and who you feel genuinely comfortable with. The quality of the therapeutic relationship matters as much as the medicine itself. Whether you're seeking support for a specific mental health condition or pursuing personal growth and transformation, psychedelic work is most effective when held within a container of safety, connection, intention, and surrender. To learn more about my approach to psychedelic-assisted therapy or to schedule a consultation, visit KykeonWellness.com
Sources
Angyus, M., Osborn, S., Haijen, E., Erritzoe, D., Peill, J., Lyons, T., Kettner, H., & Carhart-Harris, R. (2024). Validation of the imperial psychedelic predictor scale. Psychological medicine, 54(12), 1–9. Advance online publication. https://doi.org/10.1017/S0033291724002204
Zeifman, R. J. (2022). How does psilocybin therapy work? An exploration of experiential avoidance as a putative mechanism of change (Doctoral dissertation). Ryerson University.
Clayton Ickes, LSW, NMCF
Therapist & Founder
