Psychedelics and Psychotherapy: Which Medicine and Method Are Right For You?

My thoughts on psychedelic healing have evolved, thanks in large part to the Apprentice Training I’m taking with the Psychedelic Somatic Institute. I want to offer my most up-to-date thinking because I believe it is useful for those who are considering or looking to expand their experience of psychedelic healing. As you likely know, psychedelic healing can be both very powerful and difficult. I can’t overstate how important it is to do your research.

Putting psychedelic medicines and healing modalities into different categories can help us better understand and choose which medicines and therapies to work with. Saj Razvi, the director of education at the Psychedelic Somatic Institute and my teacher for the Psychedelic Somatic Interactional Psychotherapy (PSIP) Apprentice Training, puts psychedelic healing into three tiers: Tier-1 is the realm of the nervous system, the body, and attachment trauma (relational wounding from childhood); Tier-2 is the realm of ego and identity and how these were and continue to be affected by childhood trauma, and Tier-3 is the realm of transpersonal and spiritual healing. Each tier has its healing benefits and challenging aspects. PSIP is a Tier-1 therapy that can be done with or without psychedelic medicine.

My overview below begins with a more concise description of Tier-3 and Tier-2 and ends with a more comprehensive description of Tier-1 because Tier-3 and Tier-2 are far more common in the world of psychedelic healing than Tier-1 and because I’m very focused on Tier-1 healing right now.

Tier-3

Increasingly, we hear of people with end-of-life anxiety who have benefited significantly from psilocybin-assisted therapy, to the point where, after their psilocybin ceremony and the supplementary pre- and post-ceremony counseling, they report being at peace with the prospect of dying. This peace comes, in part, because the deep spiritual or transpersonal connection that can happen during the psilocybin journey helps remove the fear of dying. This is Tier-3 psychedelic healing. Ayahuasca, psilocybin, synthetic 5-MeO-DMT, LSD, and other psychedelic medicines contribute to Tier-3 healing—given the appropriate intention, support, and dose.

One of the main challenges with Tier-3 healing comes in surrendering the parts of the ego that don’t want to give up control and self-identification. Such “ego death” can be tough work. The intensity of the emotions and sensations that may arise can be very challenging as well. However, as you can imagine, there are many benefits to feeling a deeper spiritual or transpersonal connection to something greater than yourself. I have found that Tier-3 healing has given me more clarity and guidance about my work and purpose and more trust that I am supported. My meditation and spiritual life have also strengthened and grown.

Tier-3 healing may give you a strong spiritual connection and may bring more clarity about your life, but it won’t heal how your nervous system holds your childhood wounding and attachment trauma. In other words, Tier-3 healing will not change how you feel within your body (how your nervous system responds) when navigating intimacy, boundaries, trust, and other fundamental relational dynamics. This is why people can experience significant Tier-3 healing without actually moving forward very much with their relationships. This was true for me: I noticed that, during the years that I was doing more Tier-3 healing, I reaped the benefits mentioned above but was unable to get to the root of my attachment trauma.

Tier-2

Whereas Tier-3 is a journey beyond the ego to something transpersonal or spiritual, Tier-2 is a journey into the ego and the deeper regions of the unconscious. A friend of mine once had a devastating realization during an Ayahuasca ceremony. He discovered that his entire adult life up to that point had been based on his mother’s dreams for him rather than his own (you can read more about my friend Bruce Sanguin’s psychedelic healing journey in his excellent book Dismantled: How Love and Psychedelics Broke a Clergyman Apart and Put Him Back Together). This sort of discovery—seeing and feeling how your ego and unconscious mind are formed and operate—is Tier-2 territory. The level and clarity of truth that is revealed, along with the emotions and sensations that are uncovered, can be very difficult to face and integrate. However, both knowing yourself more deeply and working through repressed emotions often increase the freedom to feel and express more of your true self.

Tier-2 healing is very good for deep shadow work. It has helped me better see my insecurities, my shameful places, and my blind spots. Several times I’ve been shown how I have the very same issues as the people who trigger me the most.

Although Tier-2 healing can give you a deep understanding of your ego and your shadow, it won’t help you work through your attachment trauma. One-on-one Tier-2 work can bring some relational healing, but it doesn’t go as deep into attachment trauma as Tier-1 healing does. Ayahuasca, psilocybin, LSD, and other psychedelic medicines can contribute to Tier-2 healing (again, given the appropriate intention, support, and dose).

Both Tier-3 and Tier-2 healing can happen within a group ceremony environment or within a one-on-one client and therapist setting. Traditionally, Tier-3 and Tier-2 psychedelic healing are predominantly inner journeys with eyes closed and music or ceremony songs contributing to the journey. Support is available from ceremony assistants or from the therapist - a hand to hold, guidance with breathing, encouragement to open to the feelings, etc. - but no therapeutic processes are involved.

Tier-1

Tier-1 psychedelic healing is centered around how the overwhelming and traumatic events of your life have impacted your nervous system and your ability to form healthy relationships. Whereas Tier-2 and Tier-3 are built more on trusting the spirit of the medicine (“Can I surrender and open to what this medicine is revealing?”), Tier-1 is built more on trusting your own body and your therapist (“Can I stay with powerful sensations and emotions? Can I let my therapist into my most vulnerable inner places?”).

Of all the Tier-1 psychedelic healing I’ve experienced, the approach offered by Psychedelic Somatic Interactional Psychotherapy (PSIP) is the most somatic and relational. With PSIP the healing only happens on your nervous system’s own terms. Though you might think you are good with boundaries, intimacy, and trust, and see yourself as strong, independent, and safe, your nervous system likely carries a different reality. Your mind (your secondary consciousness) and your nervous system (your primary consciousness) are often very much at odds with how they perceive others and life in general. (Note: Find more about the nervous system and primary and secondary consciousness in the White Paper at the PSI website noted below).

In order to get acquainted with how your nervous system holds your trauma and experiences relationships, you need the tools and capacity (and likely the support) to stay tuned into your body while working through difficult past events and relational wounding.

The PSIP process is so effective because it focuses on bodily sensations while inhibiting all of the coping mechanisms and distracting tools your mind uses to avoid a direct, felt sense of what is happening in your body. This focused, somatic attention unfolds with the support of a PSIP therapist who also helps you notice the coping and managing strategies of which you are unaware, given most of these take place unconsciously. The PSIP process can be quite intense as it allows the unresolved trauma that is stored in the nervous system to surface as strong sensations and energy in the body, or as dissociation. However, once the trust and connection are strong enough between client and therapist, the client can surrender the mind (secondary consciousness) to the body (primary consciousness) and let the nervous system metabolize the trauma through involuntary movement, much like a zebra does when its body involuntarily shakes out the trauma it experienced after escaping a lion that had captured it and almost killed it.

PSIP is quite different from the traditional ‘sitter’ model of one-on-one psychedelic healing, that is, the client lying on a couch, blindfolded, music playing through headphones, and a therapist or guide sitting close by for support if needed. In the PSIP model, there is no music (though blindfolds are often used). Instead, the therapist offers a great deal of attunement, empathy, resonance, and guidance as the client reports what they feel and notice throughout the session. This continuous back-and-forth exchange between client and therapist is crucial for the client to stay with what arises and allow their autonomic nervous system to process their unresolved trauma.

The strength of the connection between client and therapist is also fundamentally important. This model requires a secure attachment not only between the therapist and the adult part of the client but also between the therapist and the inner-child parts of the client. Not surprisingly, the client’s nervous system won’t go to the deeper layers of trauma unless there is immense trust in the therapist. This is particularly true when attachment trauma is involved.

As mentioned above, PSIP can be done with or without medicine, but medicine, in this case cannabis, significantly deepens the PSIP process. Most people are incredulous when I tell them that cannabis deepens PSIP. I had a hard time believing it, myself, when I first heard about the PSIP model. Now, I can say with confidence that cannabis, when partnered with PSIP, is a very powerful Tier-1 medicine. Cannabis is particularly good at revealing the trauma held in one’s nervous system. As with all psychedelic medicines, the experience of cannabis is determined greatly by the user’s intention, by whether or not a therapeutic or healing process is used, and if so what type, and by the training and personal healing work that the therapist or guide has done.

Along with cannabis, ketamine, and MDMA are useful in Tier-1 healing (as are some other psychedelics to a certain degree). However, cannabis is especially effective at working with any dissociation that is held in the nervous system. Working through dissociation is critical for processing trauma fully. And, as Saj says, unless you had very good parenting, you will have dissociation in your nervous system. (Note: Please stay tuned to future newsletters for more about using cannabis for dissociation.)

Tier-1 healing lays a strong foundation upon which to do Tier-2 and Tier-3 healing work. Not only does it allow you to process the trauma held in your nervous system, but it also supports you in better integrating Tier-2 and Tier-3 healing into your relationships and day-to-day life. We may be spiritual beings having a human experience, but I believe we are meant to experience all of the raw vulnerability, pain, depth, and beauty of our humanity and contribute as fully as we can to making this world safe and healthy for all of the forms of life that exist here.

My understanding of the three tiers of psychedelic healing will surely continue to evolve as I continue my formal training and my exploration of the deeper levels of psychedelic healing. If you are interested in receiving PSIP from me, please read all of the information on this page before contacting me. If you are interested in learning more about Psychedelic Somatic Interactional Psychotherapy (PSIP), Tier-1 psychedelic healing, and psychedelic healing in general, I strongly recommend all of the resources below.

Psychedelic Somatic Institute (PSI) website: find the White Paper and Videos about the PSIP theory and application

https://www.psychedelicsomatic.org/is-psi-training-right-for-me

Podcast interviews with Saj Razvi

Back from the Abyss

https://open.spotify.com/episode/7CnRbabZPNs1dzxcBIcbpS?si=0ccc223fb0e34852

Psychedelic Therapy Frontiers

https://open.spotify.com/episode/13rQME0I3owqwWIxNtTKOa?si=514d5d02c31546df

Elevating Consciousness

https://open.spotify.com/episode/3hlz5VnzKQZ6tULoaWPdhR?si=cbba6c22065f46dd

Books referenced above:

Dismantled: How Love and Psychedelics Broke a Clergyman Apart and Put Him Back Together, by Bruce Sanguin