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An exploration of the latest developments from the flourishing field of modern psychedelic psychotherapy 

• 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 from the flourishing field of modern psychedelic psychotherapy, 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 as well as addressing challenging psychedelic experiences and spiritual emergencies. They explain the dual process of opening and healing--how opening the mind and the heart with psychedelics and expanded states can help dissolve psychic barriers and encourage deep 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, micro-dosing 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 exploring considerations for training the next generation of psychedelic therapists.

From Chapter 2. Ayahuasca and Psychotherapy
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 other-worldly worlds. We have to know in our bones what they’re talking about. It’s the mystical traveler in ourselves that we must be able to bring to the therapeutic relationship. . . .

Personal Experience

I must admit I’ve been hesitant to state unequivocally that it’s better to see a therapist who has their 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 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 agreed. This other worldly 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. 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, “now as we speak.” 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 co-therapist 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 and, 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. . . .

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, “Uh huh…,” a neutral acknowledgement 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 can therapists catch themselves when they’re out of attunement? And then, how quickly can they repair the disconnection and re-connect 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 side step her most reactive patterns and find an elegant pathway to re-connection 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 (October 13, 2021)
  • Length: 424 pages
  • ISBN13: 9781644113325