A Beginner’s Guide to Intentional Work with Psychedelics
By: Alex Theberge
Tags: Ayahuasca, Personal Development, Healing From Trauma, Plant Medicine, Psychedelics

I get a lot of inquiries from people who are new to psychedelics and are interested in some form of intentional work with psychedelics but don’t know how to go about it.

The key word here is “intentional.” Intentional work with psychedelics is very different than recreational use. It is motivated by a desire for healing, learning, growth, or transformation of some kind. Having a sincere intention and a commitment to working with psychedelics in a purposeful way to address this intention makes a huge difference in how the psychedelic substance works with you.

Some have read Michael Pollan’s new book, How to Change Your Mind, and it piqued their interest in having a meaningful psychedelic experience. Others have heard about the healing benefits of plant medicines, such as ayahuasca, for things like depression and trauma but don’t know what their options are.

This article examines the 3 most common types of intentional work with psychedelics and looks at some of the benefits and challenges of each approach.

1. Psychedelic Therapy

There are currently two different categories of psychedelic-assisted therapy available: sessions provided by underground therapists operating outside of the law and psychedelic-assisted therapy provided legally within the purview of a clinical trial.

Above-board or legal psychedelic-assisted therapy currently only exist in the United States as part of FDA-approved clinical trials, although there are others being conducted in the UK and Europe as well. As such, they must adhere to a specific treatment protocol that is approved by the FDA for that specific trial. The basic protocol for how a psychedelic-assisted therapy session is conducted is very similar regardless of whether it is an MDMA-assisted psychotherapy for PTSD trial or a psilocybin-assisted psychotherapy for depression trial. The whole point is to make it reproducible and these trials are mainly being built on the backs of the Multidisciplinary Association for Psychedelic Studies’ psychedelic-assisted therapy training models and research protocols. It is a protocol-based treatment that adheres to the protocols defined in the treatment manual. These manuals are a matter of public record so you can actually read them to get an understanding of how the format works.

That being said there are considerable differences in how the preparatory and follow-up therapy sessions are conducted. These are based in traditional psychotherapeutic models of change and are designed to address the specific diagnosis that is the basis for the research study (e.g. addiction, anxiety, depression, or PTSD). Depending on the study and the mental health issue being addressed, they may use different psychotherapy interventions and include more or less sessions.

Finding a Clinical Trial

If you want to experience psychedelic-assisted therapy you can either find an underground psychedelic therapist in your area or you can participate in an FDA-approved clinical trial. The entire database of active FDA clinical trials can be found at: https://clinicaltrials.gov and a simple keyword search for MDMA or psilocybin will bring up every active psychedelics study in the USA and also tell you which are actively recruiting participants. The limitations of this are that you need to live near a study site, meet the trial diagnostic criteria (e.g. have diagnosable PTSD) and participate in a fairly lengthy intake process, which can take weeks just to determine if you are admitted to the study and the study itself can take 12–16 weeks. This obviously limits who can participate in these studies quite significantly, which is why so many people are seeking out the underground therapist route.

Expanded Access

MAPS recently applied to the FDA for approval of an expanded access protocol that would allow them to provide MDMA-assisted psychotherapy for PTSD to people that meet the clinical trial criteria but for which there are no spaces available in the trial. This could potentially massively increase access to MDMA-assisted psychotherapy but would only apply for those that have a bonafide diagnosis of PTSD. While a movement in the right direction, obviously this provides access to a very limited population.

And while the legal FDA-approved clinical trials don’t charge anything because they are conducting research, there is no telling what a for-profit company like Compass Pathways, whose main investor actively promotes the importance of creating monopolies, will eventually charge for access to their FDA-approved supply of psilocybin. Looking at Ketamine treatment for depression as a reference, I expect it will be in the thousands of dollars.

Underground Therapy

The other group of people providing psychedelic-assisted therapy are underground therapists operating outside the law. These types of therapists are hard to find as they tend to maintain a high degree of anonymity due to the legal risks they are taking and only work with people who are referred to them by a trusted source (note: please do not ask me for referrals to underground therapists, as I am not able to provide these.) Many of them are clustered in the larger metro regions (i.e. New York, SF Bay Area, Los Angeles, etc.) and are hard to find if you live in a smaller city or a rural area. This makes gaining access to an underground psychedelic therapist really difficult for most people.

Because these therapists are operating outside of a licensure or regulatory framework, there is no oversight and no barrier to entry. Literally anyone with access to illegal drugs and a sofa in their basement can offer “psychedelic therapy.” They don’t need training, they don’t need to actually be therapists. And there are many unqualified people like that operating. Therefore it is important to be very careful when working with an underground therapist and to critically assess their background, training, and supervision. Remember, this is someone that you are going to be opening your psyche to and that is a very vulnerable state to be in with someone. You want to make sure they have impeccable integrity and are highly skilled at working with whatever may come up in a psychedelic session.

Finally, underground psychedelics therapists aren’t cheap either. $1,500 to $2,000 for the initial preparatory session, the psychedelic session and the follow-up session is not unheard of. This cost compensates the therapist for the extensive time involved in providing psychedelic therapy as well as the risks they are taking in working outside the law but it also makes it unaffordable to the vast majority of people.

2. Plant Medicine Ceremony

A plant medicine ceremony is a completely different ball-game altogether. There is a wide diversity in terms of ceremonial styles but they mostly adhere to 3 common features that make them quite different to psychedelic-assisted psychotherapy and western psychotherapeutic models.

Ceremonial Framework

The first and most fundamental difference is that the framework is ceremonial. This means that the experience is held within a framework of spiritual rituals and beliefs. Some of the rituals and conventions found in plant medicine ceremonies include: defining the ceremonial space as sacred, cleansing the space being used for sacred work, invocation of spiritual protections, and the calling of the spirits of the plant medicine and other helping spirits such as deities or ancestors.

Not all ceremonies operate this way but these are common elements found in traditional plant medicine ceremonies in settings as diverse as the Sierra Mazateca, the Peruvian Amazon and the deserts of North America. More importantly, these are some of the elements of plant medicine ceremony that you will typically find in new-age or neo-shamanic “western” ceremonies, even if they are incorporated in a perfunctory manner.

A key feature here is that of spirit. These are spirit ceremonies and by definition have trappings of spirituality. One is not required to believe in spirits or have a spiritual inclination but it is a contextual element that will be present in some form or another. A plant medicine ceremony generally involves engaging with psychedelics in an overtly spiritual setting.

Group Experience

Second a ceremony is typically in a group setting, meaning that several participants ingest the plant medicine together. This is one of the key features of a psychedelic ceremonial experience. It is not always the case but it is the most common format that you will find. Going through an intensive experience with a psychedelic or plant medicine in a group setting creates a very different kind of experience. What the other ceremony participants go through will affect your experience in some way. If held well by the facilitators, this can be a very positive and beneficial experience. However, if poorly managed, it can result in a lot of commingling of people’s personal issues and energies that can lead to confusion as well as delusion.

There is also a deep bonding that occurs during ceremony that enables people to have an experience of true community, sometimes for the first time in their lives. The “we’re all in it together” nature of the ceremonial experience can be quite profound on its own, whether or not one is ingesting psycho-active substances, which is why it is a feature of many spiritual and religious traditions. And in plant medicine circles that meet regularly (e.g. one weekend a month) this can open the doorway to being part of a genuine ongoing spiritual community. That is not something that psychedelic-assisted therapy generally offers.

Actively Guided

Thirdly, plant medicine ceremonies are guided and directed affairs. There are no headphones and no eye masks. The individual’s experience is guided to a greater or lesser degree by the facilitators of the ceremony. This can be as lightly guided as someone playing soothing medicine bowls or gentle guitar songs in the background creating the sonic backdrop of the ceremony experience to something as involved as a full-blown shamanic ceremony where the shaman is directing the ceremony via the medicine songs that guide the medicine spirits to do specific types of work and actions and is doing active healing rituals on some or all of the participants using tools such as medicine songs, tobacco smoke, leaf rattles, perfumes, or plant herbs. In these formats, the facilitator is a major factor in the experience which means that the facilitator’s integrity, experience, and skill level are of vital importance.

Preparation & Integration

One final difference is that plant medicine ceremonies typically do not include individual preparatory or integration sessions as you would find in psychedelic-assisted therapy. Sometimes facilitators will hold pre-ceremony meetings that serve to prepare the participants for the upcoming ceremony and/or sharing circles after a ceremony to help participants process and share their experience. And some shamans will meet with or be available to meet with each ceremony participant prior to ceremony to hear about their complaints and identify how to address them. That is more commonly found in traditional shamanic healing settings and not something typically found in the US. Either way, the preparation and integration support is vastly different than having several one-on-one psychotherapy sessions with a therapist to identify the issues to be addressed in a psychedelic-assisted therapy session.

Plant Medicine Ceremony Availability

Plant medicine ceremonies are held around the US in informal underground settings year-round. Most major cities have multiple ayahuasca circles that meet on a monthly basis and accept new participants by referral. Similar to underground therapists, it can be challenging to find these if you are not connected to alternative health or spirituality communities or live far from a major metropolitan area. And all the caveats for underground therapists apply here as well (i.e. variability of skill and experience of the facilitator, lack of oversight or regulation, low barrier to entry, etc.)

There are also above-board plant medicines retreats held in settings where it is legal (eg Peru, Brazil, Costa Rica) and being led by highly trained facilitators . The most obvious option here is working with a reputable ayahuasca retreat center in the Peruvian Amazon, where it is not only legal but there is a very old tradition of working with ayahuasca for healing purposes (Full disclosure: I used to work at an ayahuasca retreat center in Peru). These week-long retreats are more expensive and involve foreign travel and time off of work. However, they also offer the opportunity to work much more deeply with these medicines under the guidance and direction of bonafide masters of the medicine. As in any other format, it is important to do your research in terms of what retreat center to work with.

3. Solo or Private Intentional Psychedelic Trip

The third category of intentional psychedelic experience is one where you are consuming a psychedelic privately for an intentional purpose either alone or with a sitter. Some people choose this route because they’re unable to find a practitioner to facilitate an experience or because they are comfortable experimenting with psychedelics on their own. The main features of this approach are that you are unassisted and do not have the support, guidance, or direction of a trained professional with a lot of experience handling the wide variety of experiences that occur. The settings for these tend to be people’s personal homes or a naturalistic setting. Sometimes these are done as part of a group experience (i.e. a group hike where everyone takes psilocybin mushrooms together) but group experiences tend to make it harder to do deep work since you are regularly being pulled out of your private experience into interactions with others.

True intentional work often involves an inward journey which means that this kind of solo work is typically done with an eye mask, headphones, and a pre-curated playlist of appropriate music to create the desired experience, similar to a psychedelic-assisted therapy session. Some people prefer this route because it offers them freedom and autonomy in their work with psychedelics and offers the flexibility of working with psychedelics in whatever manner one choses. And having a trusted and sober friend sit with them during the experience provides a sense of safety that allows people to relax into the psychedelic experience.

Challenges of Solo Work

However, there are a lot of challenges with working on one’s own with psychedelics. One of them is getting access to high quality psychedelic materials. Not everyone has those kinds of connections or is able to easily get their hands on psychedelics. And the quality of the material or substance is variable and unknown and appropriate dosing can be very tricky. People sometimes consume too little to enter a visionary state at all or consume so much that they end-up having a frightening and overwhelming experience. And without anyone to guide them through it, an overwhelming state can be traumatic.

I work with many people who come to see me after having a really negative, terrifying, or challenging experience doing solo work with psychedelics. As such I am well acquainted with the shadow side of psychedelics. And while for many people working with psychedelics intentionally on their own will be fine, for others it can lead to psychological harm that they will then need help to address. Unfortunately it’s very difficult to know ahead of time which camp someone will fall in to. However I do find that if you are looking for healing a particular issue or trauma in your life, it is definitely best to work with a professional guide of one form or another.

If one is going to attempt the solo route, going very slowly and very gradually is a safer approach that can reduce the risk of some of the potential harms. Having a sober friend that is familiar with psychedelics sit with you is also an important safety precaution.

Furthermore, I have found that continuous long-term experimentation with psychedelics outside of a community framework that supports it has the potential to de-stabilize an individual’s psyche and that this holds true even in traditional ceremonial work and settings. If you’re not working very hard at integrating these experiences over time it can lead you to feel disconnected from the rest of the world that isn’t on this journey with you. Returning home (or finding your new home) is an important part of any journey and integration is really the “coming home” stage. Going on an extended psychedelic journey can lead one to become really disconnected from ordinary daily life and can make the eventual inevitable coming home much harder.

Conclusion

Working with psychedelics intentionally can be incredibly life changing and transformative when handled responsibly. In the proper hands, its healing, consciousness-expanding, and spiritual growth potential are light-years ahead of recreational uses of psychedelics. And while there is no one right or wrong way to go about it, there certainly are best practices as well as contra-indications for each of these 3 approaches built on years of exploration and experimentation by countless people over generations. Which ever approach you choose, I would recommend studying-up on the best practices of that approach to the extent possible.

And one universal best practice is to work actively and conscientiously to prepare for and integrate a psychedelic or plant medicine experience. This includes reflecting on what it is you really want to address using this substance and making time to process and work with whatever came-up during the experience, either on your own, as part of a psychedelic integration group, or with the help of an experienced professional.