This is the second in a series of articles called Revisioning Psychedelic Therapy, exploring what the current medical models for psychedelic therapy get wrong and what they could (and should) learn from depth psychology and spiritual traditions that are well-versed in working with ecstatic non-ordinary states of consciousness and archetypal energies. You can read the first one here.

“The fact is that the approach to the numinous (holy) is the real therapy and inasmuch as you attain to the numinous experiences, you are released from the curse of pathology.”

— CG Jung

Setting Intentions

In this article I’d like to offer some ways that psychedelic-assisted therapy providers could learn from indigenous, mestizo and neo-shamanic traditions to create truly transformative and healing experiences for their clients, rather than simply provide short-term symptom reduction.

It’s clear that at least some of the big players providing psychedelic therapy are more concerned with their financial bottom line and creating a base of repeat customers than providing truly transformative experiences, but I think that by educating those seeking psychedelic therapy we can empower them to choose which mode of treatment best suits their goals.

I believe that happy clients make for happy clinics, so really, improving efficacy and outcomes is in everyone’s best interest — whether that interest is in making money or providing real healing experiences for people who are suffering.

Something else to consider is the fact that not all “psychedelics” are created equal, and some of what makes them different requires that we take different approaches to their responsible and effective use. We simply can’t expect what works for one to work for all. I fear that in the rush and excitement to expand access to psychedelic-assisted therapy, providers might be too quick to adopt the established clinical models that are now status quo.

While organizations like MAPS have done a great job of developing sound and effective protocols for the use of laboratory-made psychotropics like MDMA and ketamine for treatment of PTSD and depression, there’s a growing interest in bringing the more visionary, naturally occurring psychedelics like psilocybin mushrooms, mescaline-containing cacti, and ayahuasca into the therapeutic fold.

I feel that this unique class of substances require a different approach to treatment and that we should look to the traditions that have used them as sacramental medicines over hundreds (or even thousands of years) for guidance on how to properly enlist them for healing and transformation.

Comparing Approaches
to Psychedelic Treatment

Scenario Number One: Ketamine Therapy

You take the subway to a ketamine clinic downtown. When you arrive, you meet the doctor who gives you a consultation and makes a recommendation for your treatment. After he’s done, you go back to the waiting room for a while and leaf through some magazines.

When it’s time for your treatment, you’re brought into a private room, made comfortable in a recliner and hooked up to an IV and monitoring equipment. Once the IV drip begins, you will “start to feel a deep sense of relaxation. Beyond the deep state of relaxation, you may experience some out of body sensations. This is due to your mind being active but you will not have much sensation throughout your body. You may also feel as though you are slightly inebriated. After the treatment ends, you will be able to relax for a while before having someone drive you home.”*

*Actual text from a ketamine clinic website

Scenario Number Two: Ayahuasca Ceremony

136_Temple_of_the_Way_of_Light_General_Images-1024x683.jpeg

You sign up for a weekend ayahuasca ceremony in the countryside near the city where you live. You meet with the facilitators beforehand to talk about the symptoms you’re hoping to resolve, work with you to set an intention and outline some guidelines to help you prepare.

In the weeks leading up to the ceremony you abstain from alcohol and recreational drugs and cut red meat and pork out of your diet. You dedicate yourself to the yoga and meditation practice they suggested, and keep a journal to reflect on your intention. When the weekend comes, you drive out to the retreat centre with some friends who are also participating in the ceremony.

After getting settled in your cabin, the group of participants meet in a circle with the facilitators to talk about what you can expect in the ceremony. You all take turns sharing a little about yourself, what you’re struggling with and what your intention is. The next morning, you wake up feeling refreshed from a night in the country, glad to be out of the city and enjoying some peace and quiet.

The group meets for a morning yoga practice, followed by a nutritious breakfast and another sharing circle. After fasting for the rest of the day, you all gather in the yurt for the ceremony. Everyone is wearing white, including the facilitators. There are musicians playing gentle music. Incense is burning and the space is lit by some candles and lanterns. The space feels sacred and peaceful. You get settled on your mat, sit quietly and reflect on your intention.

Soon, the facilitator calls each person up, one by one, to receive their cup of ayahuasca. When it’s your turn, you walk around the circle and sit in front of the facilitator. They blow a prayer into the cup and hand it to you. You take a deep breath, say a little prayer, and drink it down.

When everyone has taken the medicine, the facilitator blows out the candles and the musicians fill the space with sacred songs from a number of traditions.

The ceremony goes on until midnight, and you feel like you’ve been on a long journey — reflecting on events from your life, sitting and breathing through some challenging passages, and experiencing visions of intense colours and patterns. At the end of it all you feel a mix of relief, joy and elation. You feel somehow reborn.

After drinking some tea and eating fresh fruit with some of your new friends, you go to bed, exhausted but happy. In the morning you wake up and gather with the group to do some gentle yoga which helps you feel more settled in your body. After breakfast you meet for another circle where the facilitators offer some guidance on how to integrate the experience. They recommend that you attend the weekly integration circles that are offered back in the city and give everyone a sheet that has a list of counselors and a link to the private online network they host.

Before you leave, you take time to hug everyone, exchange phone numbers and promise to stay in touch. You return home with your friends, for the first time feeling like you’re part of a community that shares the same values and aspirations as you.**

**While not every ayahuasca ceremony goes as well as this one it’s a good example of a typical neo-shamanic ayahuasca experience, just as the other scenario is an example of a typical ketamine experience.

Now, which of these feels like it would be a more transformative experience?

If you chose the second scenario, it’s likely because you’ve experienced something similar, or simply because it seems to resonates with you on a deep level. There’s a good reason why it might. The second scenario follows a ritual form that has been tried and tested for hundreds of years in various cultures all over the world.

Anthropologists and scholars of comparative religion like Carl Jung, Mircea Eliade, Victor and Edith Turner, Joseph Campbell and Robert L. Moore have identified the key elements that are common to all transformational and initiatory ritual experiences. When they cross referenced all the stories and practices related to initiation and transformation across multiple cultures, a basic underlying pattern emerged that Campbell called The Hero’s Journey, and Moore called the Archetype of Initiation.

I prefer Jung’s term Archetype of Transformation because it suggests both a structure and an outcome for the journey. “Hero’s Journey” feels a little grandiose to me. I don’t think the quest to become a more full and balanced expression of one’s self is particularly heroic (although sometimes it can certainly feel that way).

The Archetype of Transformation

“The Archetype of Transformation pertains to a psychic process of growth, change and transition. It can express itself in many different images with the same underlying core of meaning.

Perilous journeys to unknown destinations, exploration of dark places, purposeful descent to the underworld or under the sea or into the belly of a monster to find a hidden treasure are expressions of this archetype.

The theme of death and rebirth as well as the symbolism of initiation rites in all of their various forms; the crossing of rivers or waters or chasms and the climbing of mountains; the theme of redemption, salvation or recovery of what has been lost or degraded, wherever it appears in mythological or unconscious symbolism — all of these are expressions of the archetype of transformation.

The theme of the birth of the hero or wonder-child also belongs to this archetype. This image expresses the emergence of a new, dynamic content in the personality presaging decisive change and enlargement of consciousness.”

— CG Jung, Symbols of Transformation

Every archetypal transformative experience consists of three distinct stages, each of which consists of key elements that lend it the power to heal and transform, effectively initiating the participant into a new, expanded way of relating to the world.

It’s my belief that we can, and should, consider the various stages and elements of the Archetype of Transformation as a basic blueprint from which to improve existing psychedelic-assisted therapy protocols and develop new ones that can catalyze real and lasting change for the individual.

Stage One: Pre-Ritual

01. The Call to Adventure

There are three distinct stages to an archetypal transformative experience. It begins with what Joseph Campbell referred to as “The Call to Adventure”. Now, that sounds pretty fun and exciting doesn’t it? In reality, this call is often heard as a time of crisis and upheaval in one’s life. It could be an illness, divorce, loss of a loved one or stage of life transition (adulthood, middle age, old age, death).

In my own life, this occurred when the symptoms I was experiencing (and desperately trying to numb through various strategies with varying degrees of success) got intense enough that I had to start paying attention. I call it my “mid-life wake up call.”

Modern living provides us with so many clever ways to ignore this call that some people go through their entire life without ever waking up and seeking healing and transformation. When it occurs and we have the courage to listen and follow it, it can feel like an act of grace (as it did for me). The famous yoga teacher TKV Desikachar used to say, “Thank God for my suffering because it brought me to yoga”, a sentiment that resonates deeply with me. It sounds absurd, but when we make it through a rough passage and find healing and transformation on the other side, we can look back at our suffering and actually feel grateful for the experience.

02. Preparing for the Ritual

These days when someone experiences a wake up call and has exhausted all the usual coping strategies, they are increasingly looking toward psychedelics for some kind of lasting healing and meaningful change. In the modern medical paradigm, you might get referred to a local ketamine clinic or MDMA trial by your psychiatrist or family doctor. Chances are you won’t be asked to do much preparation beyond trying some meditation, reading some articles about the therapy, and generally just trying to relax.

In traditional models, there are usually rigorous guidelines in place that the initiate or patient must adhere to on the days or weeks leading up to the ritual. These guidelines aren’t optional because they’re considered essential for a successful outcome. Think about the days of fasting an initiate undergoes before a Native American Vision Quest or Sun Dance.

In the Santo Daime, we’d have to avoid certain foods and abstain from alcohol and sex for three days prior to every ceremony. For the Shipibo and Ashaninkan ayahuasca ceremonies I participated in, it was recommended we follow these guidelines for 2-4 weeks leading up to the ceremony. On the day before those ceremonies we’d also undergo a ritual purging, either by drinking tobacco juice or another emetic.

Rigorous guidelines prepare the participant physically and mentally to receive the most benefit from the experience.
—

These kinds of guidelines prepare the participant physically and mentally to receive the most benefit from the experience. Part of it is that the patient or initiate is showing a commitment to the process to themselves and the ritual leaders. Active participation in one's own healing is in itself healing. It proves to us that we have the power to make choices in our life that support our health and wellbeing. It’s empowering.

Another reason why ascetic practices like abstinence or fasting are so powerful is that they focus and intensify our intention to heal or change. In Yoga this is called tapas, and is thought of as a kind of spiritual heat that catalyzes an alchemical transformational process.

I think that if psychedelic-assisted therapy clinics incorporated even very light versions of these kind of guidelines — such as abstaining from sex, alcohol and red meat for a few days prior to treatment — it would have a significant effect on patient outcomes.

Finally, I’ve found that another key aspect of following preparatory guidelines like these is that it puts you in a more open, sensitive and humble state. Which is exactly how you want to enter into the ritual space.

Stage Two: Ritual Space

Marsh Chapel where the famous Good Friday psilocybin experiment took place

“The experience of Sacred Space makes possible the founding of the world: where the sacred Manifests itself in space, the real unveils itself, the world comes into existence.”

— Mircea Eliade

In the MDMA-Assisted Psychotherapy Treatment Manual published by MAPS, the optimal setting should be quiet, free from interruption, aesthetically pleasing with artwork and fresh flowers, “similar to a comfortably furnished living room.”

The patient should be able to lie down and have access to snacks and art supplies. There’s an emphasis on minimalism, comfort and removing anything that might distract or disturb the patient.

By contrast, the ritual spaces I’ve been in have all looked and felt radically different to the antiseptic scene painted by the MAPS manual. All of these ritual spaces shared some common elements that in one way or another, played a part in some profoundly healing and transformative experiences. I’ll outline some of them here.

01. Separation

Heading into the jungle, Mayantuyacu, Peru 2019

A key element of the Archetype of Transformation is leaving the ordinary, day-to-day routine and surroundings and embarking into the unknown. It’s the “adventure” part of the “call to adventure.” In folk tales it’s when the hero leaves the safety of the walled kingdom and enters the dark forest in search of the Holy Grail (or the fair maiden, or the dragon).

Just about every experience I’ve had that resulted in a psychological transformation had that element of separation. I either had to leave the city and drive to a yurt out in the country, take a ferry from one island to another, or fly from Canada to the Amazon jungle.

While it’s not financially or ecologically reasonable to expect everyone to make a pilgrimage to the Amazon or the deserts of Mexico for their psychedelic therapy, it is possible to build clinics outside the city in a more natural environment. Sure, it may be more inconvenient, but that’s exactly why it works. For a ritual to be truly transformative you need the opportunity to leave your old self behind and open to new possibilities for the future. For that to happen, you need to enter into a state of liminality for a period of time.

02. Liminality

Liminality is “the quality of ambiguity or disorientation that occurs in the middle stage of a rite of passage, when participants no longer hold their pre-ritual status but have not yet begun the transition to the status they will hold when the rite is complete.”*

The concept of liminality was first developed in the early twentieth century by folklorist Arnold van Gennep and later expanded on by American anthropologist Victor Turner, who wrote extensively on rites of passage and initiation.

Liminality is what differentiates secular space from sacred space, the ordinary from the extraordinary. Where everything in secular space is structured to help us feel safe and secure, sacred space opens us to the great unknown. Sacred space isn’t meant to feel all cozy and comfortable, it’s meant to straighten your spine and sharpen your senses. After all, you’re about to meet the sacred, so you better pay attention.

When taken all together I can see how some key elements in the ritual spaces I’ve encountered contributed to producing a state of liminality.

* Turner, Victor (1974)

03. Communitas

Liminality contributes to a state which Victor Turner called communitas, which is the feeling of unity and togetherness that is possible when we check our social roles and status at the door. There are many ways communitas can be evoked.

In the Santo Daime, initiates wear a uniform. Guests wear all white, which is also common in neo-shamanic circles, West African ritual practice and even karate classes. In the sweat lodge everyone is naked and crawls through the same hole to enter. One of the features of Catholic school that I appreciated most was that everyone, rich or poor, wore the same uniform. It had the effect of evening out social hierarchies and putting everyone on (more or less) the same level.

Sitting in a circle also creates a sense of communitas. When I visited famed ayahuasquero Juan Flores’ center outside of Pucallpa Peru, people would come from villages up and down the river to participate in his bi-weekly ceremonies. Everyone sat in a circle around the edge of the maloca, even Juan himself. During the ceremony he gave everyone who was brave enough the opportunity to sing a song from their tradition, moving clockwise around the circle. On the last night I remember finally getting up the courage to play a little melody on my wooden flute. It was the most nervous I’d ever felt playing for others and it was an incredibly humbling and empowering experience.

In a culture where race, gender, social and economic status are such dominant markers of power, communitas can be an incredibly healing and restorative experience for the community.
—

In the Daime, everyone is encouraged to sing the Portuguese hymns, which can be doubly challenging when you don’t speak the language and you’re flying high on ayahuasca. I learned a lot about containment and focus in those ceremonies, developing what they call firmeza, or “firmness”. The ability to stay centered and grounded even when it feels like you’re standing on a ship in the high seas is a capacity that I’ve been able to carry into my life ever since. I owe a lot of that to the ego-dampening structure of those rituals.

Another way to evoke communitas is to practice the ritual in the dark. When the ayahuasquero blows out the candle it marks the beginning of the ritual. Suddenly we’re all invisible and yet, we know that we’re all in this together. That’s communitas.

In a culture where race, gender, social and economic status are such dominant markers of power, communitas can be an incredibly healing and restorative experience for the community. Imagine if psychedelic therapy clinics acted more like community acupuncture clinics. It would lower costs and provide greater access for more people while contributing to unity and equality among community members.

04. Altars & Axis Mundi

Maria Sabina preparing her altar for a mushroom ceremony

In every sacred ritual space there is always an altar of some kind to focus attention and remind participants of their intention to heal and learn.

In ayahuasca ceremonies held in the jungle, it’s the central column of the maloca that stands in for the axis mundi, or world tree, that unites heaven and earth. In the peyote tipi it’s the sacred fire, representing the Eye of God, and a mound of earth, representing Grandmother Moon. In the Santo Daime there was always a central altar with a cross, usually surrounded by photos of elders and deities as well as fresh flowers.

I can understand why psychedelic therapy clinics wouldn’t have pre-made altars in their treatment rooms — how could you account for all the various traditions of your patients? — but I think it could be a powerful practice if they had participants create their own personal altar with photos and objects that are meaningful to them. The act of gathering items for the altar would be a healing ritual in and of itself.

05. Ritual Music

Music is has been an essential and important part of every ritual since the dawn of time.

I don’t think there’s been enough consideration of its role in transformative experiences within the clinical psychedelic therapy paradigm. Currently the trend is to assemble a playlist of music that either doesn’t have lyrics or has lyrics in a language other than the patient’s mother tongue. The MAPS manual recommends selecting music “to support emotional experience while minimizing suggestion.” This is antithetical to just about everything I know from personal experience.

A key element of most ritual music is the lyrics. Lyrics can reassure, reinforce intention and inspire new insights. I can’t tell you how many times a lyric in a Santo Daime hymn triggered a profound revelation. Or all the times I felt comforted when Juan Flores sang about the beauty and power of the plant spirits that had come to heal us. Even a Beatles song in the right moment can offer deep insight and wise instruction: “Turn off your mind, relax and float downstream. This is not dying…”

The capacity to sit with discomfort is very often a key learning for people who work with psychedelics.
—

As a lifelong musician and someone who integrates music into my own spiritual practice and the shamanic circles I facilitate, when I hear the kind of music that’s being recommended for psychedelic therapy, I find it disheartening that much emphasis is placed on not “disturbing the patient.” If a particular track does make the patient uncomfortable, they’re given free reign to skip it. Can you imagine someone in a traditional ritual saying, “Excuse me, I wonder if you could stop playing that rattle? It’s making me feel uncomfortable.” The capacity to sit with discomfort is very often a key learning for people who work with psychedelics. Yes, it is sometimes an uncomfortable experience, but so is life. We either learn to adapt, or we adopt numbing and distracting coping strategies.

When it comes to incorporating ceremonial music to psychedelic-assisted therapy, the optimal situation would be to have real live musicians in the space who are able to pick up on and respond to the energy of the experience. In every town or city where there’s a psychedelic therapy clinic there are ritual musicians and music therapists who would be able to skillfully accompany a therapy session. Think of the financial support this would offer the local musicians who have to otherwise struggle or resort to playing in bars and restaurants.

At the very least, clinics could hire ritual musicians to record playlists for this purpose. If you’re working with psilocybin, why not hire musicians and singers who come from a mushroom-using tradition to create music for your sessions? As we incorporate psychedelic medicines from other cultures it would be a great show of reciprocity to find any way to involve and support the healers and wisdom-keepers of those traditions.

Again, I feel this is an opportunity for community involvement and support of the healing process that the psychedelic therapy mainstream is missing. If they really value the Bio-Psycho-Social-Spiritual model of healing, then there’s plenty of room to do more, better.

Stage Three: Returning Home

Heading out of the jungle, Peru, 2017 (photo Tony Hoare)

“The returning hero, to complete his adventure, must survive the impact of the world.

Many failures attest to the difficulties of this life-affirmative threshold. The first problem of the returning hero is to accept as real, after an experience of the soul-satisfying vision of fulfillment, the passing joys and sorrows, banalities, and noisy obscenities of life.

Why re-enter such a world? Why attempt to make plausible, or even interesting, to men and women consumed with passion, the experience of transcendental bliss?”

— Joseph Campbell, Hero with a Thousand Faces

While the most important aspect of the Archetype of Transformation is the quality of the ritual experience itself, in order for it to be a catalyst for lasting change in the participant, they need to be welcomed and supported when they return home.

Anyone who has been on a transformational retreat or pilgrimage knows all too well how the magic of the experience evaporates as you get further from the sacred space and the ordinary world starts pressing its demands upon you. It’s imperative that they are met by others who understand their experience because they’ve been through a transformative journey themselves.

Even though I work as an integration specialist, I think it takes more than what I can offer to support people in this stage. It not only requires the person to maintain healthy lifestyle practices and incorporate spiritual ritual into their life, it takes supportive and understanding friends, family and community of peers to recognize, affirm and hold the transformed person as they grow into their new self.

Again, I think this is where the psychedelic therapy clinics could be doing better. I sincerely hope that as this industry (ugh) continues to grow, clinics invest some of their profits into creating real and online networks that connect their patients to a community of peers, counselors and coaches that can acknowledge their transformation and hold them accountable to their intention. Why not subsidize the many community-led integration circles that are happening in cities all over the world? Again, giving back to the wider community would be an act of good faith and integrity.

Conclusion

If the so-called psychedelic renaissance is truly a “rebirth”, then I think we need to seriously consider what kind of culture this new thing is being born into, and who is acting as its midwife.

From where I stand, the dominant culture that is going to shape and guide psychedelic therapy as it grows and develops is one that is almost totally devoid of ritual elders and effective rites of passage. We only have to look at the mental health epidemic in our young people to know what the effect of their absence is.

If what’s being reborn was conceived with truly good intentions to provide healing and regeneration of individuals, communities and the planet, then I think it’s imperative that the psychedelic mainstream starts listening to the ancestors and traditions who understand what it really takes to affect lasting transformation, because the stakes are higher than ever and this might be the last chance we get.

1. Turner, Victor (1974). "Liminal to liminoid in play, flow, and ritual: An essay in comparative symbology" (PDF). Rice University Studies. 60 (3): 53–92.

Revisioning Psychedelic Therapy

“The fact is that the approach to the numinous (holy) is the real therapy and inasmuch as you attain to the numinous experiences, you are released from the curse of pathology.”

Setting Intentions