Reflections on Psychedelic Therapy

In working with clients in altered states – deep mindfulness, medically assisted, and hypnotic states – I’ve often noticed something curious and profound: a client may appear serene, still, neutral in muscle tone and expression, yet they’re processing something deeply emotional or painful. It’s not disconnection—it’s something else. Something sacred.

What’s going on there and what does it tell us about the compassionate edge of therapeutic work?

The Power of Compassion-Based Frameworks

Compassion-Focused Therapy (CFT) offers a grounded model for understanding how people regulate emotions. Its three-system framework—threat, drive, and soothe—helps explain why so many clients feel stuck in chronic self-criticism or anxiety. They’ve been living inside a hyperactive threat system, with little access to internal soothing.

MDMA, in its own way, shifts that balance. It softens the edges of threat and opens the door to warmth, tenderness, and acceptance—toward others, but also inwardly. What emerges is often a raw, unguarded sense of self-compassion that can feel unfamiliar and astonishingly natural at the same time. The very thing CFT helps clients train toward through practice, MDMA allows them to taste directly.

The Inner Journey vs. Relational Engagement

Within psychedelic therapy, there are different stances on how to engage. One honours the quiet, inward journey—a deep, unfolding process with the therapist as a steady, unobtrusive presence. Another involves more relational contact, using the therapeutic alliance to work directly with material as it arises in the space between.

Both are valid. Both can be transformative. Sometimes what’s needed is simply silence and safety. Other times, it’s the alchemy of connection: eye contact held just a moment longer, a gesture gently offered when words fail, or the simple witnessing of something long hidden.

Psychedelic Somatic Interactional Psychotherapy (PSIP) adds a layer here, bringing the body into focus, and helping clients stay with what’s arising somatically, without automatically reaching for escape routes.

Riding the Edge of Discomfort

In any modality, being in the sweet spot of emotional engagement is essential. This is often referred to as the “window of tolerance.” Not so overwhelmed that the system shuts down. Not so detached that nothing gets touched. Just enough. Right on the edge.

MDMA helps widen that window. Emotions that might otherwise feel terrifying become accessible, touchable. There can be tears with no panic, sorrow without collapse, a kind of gentle clarity even in the middle of the hard stuff.

By selectively inhibiting certain instinctive behaviours, like laughing something off, or crossing our arms in defiance, we can connect more deeply with emotional material that we would rather avoid. This is an essential part of PSIP.

For example, a client might feel the urge to look away in shame. But in an altered state, or in a tender moment, they might choose to hold the therapist’s gaze. Just for a breath. Just long enough for the shame to soften into something else—vulnerability, sadness, or perhaps relief.

That’s the kind of moment that lives in the body. It’s not cognitive. It’s not narrative. It’s the felt experience of staying present with something that once felt unbearable—and discovering that it can, in fact, be survived. Even transformed.

There’s no performance to it. No “breakthrough” to announce. Just breath. A slow thawing. A sense of dignity returning.

Stillness is Not Numbness

When a client lies still, relaxed, and calm, it doesn’t mean nothing’s happening. Quite the opposite.
From a polyvagal lens, they may be in a state of ventral vagal regulation—connected, safe, and present—even as they revisit old wounds or long-held sorrow. The nervous system isn’t fighting anymore. It’s allowing.

The muscles may not be tensed. The face may be neutral. But the body is doing its work: unwinding, reprocessing, integrating. It’s what happens when defences drop, and feeling returns, but overwhelm doesn’t.
From the outside, it may look like nothing much. From the inside, it can feel like something quietly enormous.

Final Reflection

In the subtle shifts of breath, in a glance not averted, in a body that chooses to stay… healing is underway. Whether facilitated by compassion-focused frameworks, somatic depth work, or the gentle neurochemistry of MDMA, what matters is that people are met—kindly, clearly, and without force.
Sometimes the most significant change isn’t loud. It’s not cathartic. It’s in the moment someone discovers that they can feel… and still be safe.