Psychedelic-assisted therapy holds promise in transforming mental health. The term psychedelics was created by Osmond Humphrey, a Canadian psychiatrist in the 1950s, which means mind-manifesting (Walther & van Schie, 2024) or mind-revealing (Carhart-Harris & Goodwin, 2017). Psychedelic-assisted therapy involves using psychedelics in the context of therapy. Psychedelics are psychoactive medicines that allow one to transcend into an altered state of consciousness (Barber & Aaronson, 2022). These medicines were being used in a clinical setting in the late 1940s and over “40,000 clients were treated using psychedelic psychotherapy over a period of 15-20 years” (Alyahya & Al Saleem, 2024, p.1).
Although studies conducted during those decades were not held to the same standards as those conducted today, it is notable to mention that 79% of individuals who took part in psychedelic treatments between 1949-1973 experienced improvements in depressive symptoms (Alyahva & Al Saleem, 2024).
The first double-blind study on psychedelics is known as the Good Friday experiment which explored the relationship between psychedelics and spirituality. Participants who were given psilocybin had “profound spiritual experiences, including a sense of unity, transcendence of time and place, deeply felt positive mood, sacredness, ineffability, and persistent positive changes in attitude and behavior towards themselves, others, and life” (Gobbi, 2024, p. E303). For the past two decades, there has been a renaissance of research on psychedelics, and it has been indicated that these medicines have the potential to treat anxiety, addiction, terminal illness distress, depression, post-traumatic stress disorder, and obsessive-compulsive disorder (Wheeler & Dyer, 2020).
Classical serotonergic psychedelics include LSD, psilocybin, and DMT. These medicines primarily work on the 5-HT2A receptor, causing a release of dopamine and glutamate. Upon stimulation of the 5HT2A receptor, there is an alteration in neural connectivity and information processing. The cortico-straito-thalamo-cortical model is one of the models used to explain this phenomenon as psychedelics disrupt thalamic gating, increasing bottom-up flow from the thalamus to the cortices while at the same time decreasing the top-down flow of information. The default mode network plays a role in self-reflection and constructing a sense of self. This network of brain regions has been found to be influenced by psychedelics which has led to the development of relaxed beliefs under psychedelics (REBUS) to understand how the brain becomes more flexible following psychedelic use, supporting the notion that psychedelics “enhance bottom-up flow of sensory information, while reducing the precision of previous beliefs, expectations, and past experiences that normally constrain neural processing” (Gobbi, 2024, p. E307). These changes in functional connectivity are therapeutically valuable and could potentially provide relief from mental health issues by re-wiring or “resetting dysfunctional brain networks” (Concerto et al., 2024, p. 2).
MDMA is an entactogen and increases levels of serotonin, norepinephrine, dopamine as well as oxytocin, which creates a different experience than classical psychedelics.
Classical psychedelics also cause a release of brain-derived neurotrophic factors (BDNF) which is a protein vital for neuronal growth (Concerto et al., 2024). The release of BDNF contributes to the increased neuroplasticity seen following a psychedelic experience (Walther & van Schie, 2024). Neuroplasticity is the brains’ ability to adapt and create new synaptic connections. Although not a classical psychedelic, MDMA is also used in psychedelic-assisted therapy. MDMA is an entactogen and increases levels of serotonin, norepinephrine, dopamine as well as oxytocin, which creates a different experience than classical psychedelics. The unique properties of MDMA lend itself well to emotional processing as it enhances feelings of empathy, sociability, and openness. Ketamine is another medicine being used for psychedelic-assisted therapy and is considered an N-methyl-D-aspartate (NDMA) receptor antagonist with dissociative and psychedelic properties. Similar to classical psychedelics, both MDMA and ketamine cause a release of BDNF leading to increased neuroplasticity following treatment.
MDMA-assisted therapy
MDMA has been designated as a breakthrough therapy for treatment-resistant PTSD by the Federal Drug Administration (Feduccia & Mithoefer, 2018). MDMA-assisted therapy allows clients to process their traumas in a therapeutic setting. This medicine causes a release of serotonin, dopamine, norepinephrine, and oxytocin, which lend themselves to creating a sense of empathy, love, and safety as one processes their experiences. It also reduces Amygdala activation, which tends to be hyperactive in those with PTSD which is responsible for the expression of intense emotions and plays a role in the trauma response. These attributes allow clients to access traumatic memories without becoming retraumatized when MDMA is used in a clinical setting with a licensed practitioner. Sustainable improvements in PTSD symptomology are possible with MDMA-assisted therapy (Barone et al., 2019; Mithoefer et al., 2013). Following treatment, improved clinical outcomes were found to be sustained for an average of 45.4 months (Mithoefer et al., 2013) and another study supports these findings as participants experienced enhancement in their relationships and quality of life which were sustained one year after the treatment (Barone et al., 2019).
MDMA-assisted therapy not only holds great promise in healing past relational traumas, but it also has the potential to enhance current relationships. When used in the context of couples therapy, MDMA allows couples to communicate from a place of love, rather than fear, as it reduces one’s defense mechanisms. This enables couples to cultivate a secure connection as both partners cultivate more love, empathy, and understanding for one another. It is thought that MDMA can help our fundamental need for connection, enhance romantic relationships, reduce loneliness, and when used in adjunct to therapy, it can help build a stronger therapeutic alliance (Lyubomirsky, 2022). The relational healing effects of MDMA have been supported by research (Monson et al., 2020) as couples who participated in MDMA-assisted therapy experienced higher levels of relational functioning, relationship satisfaction, as well as relationship happiness following their treatment.
Psilocybin-assisted therapy
Psilocybin has been recognized for its transdiagnostic potential and Oregon is the first state to legalize its clinical use (Zeifman et al., 2023). The FDA designated psilocybin-assisted therapy as a breakthrough therapy for major depressive disorder and treatment-resistant depression (Bird et al., 2021). Psilocybin-assisted therapy has been found to provide one with a sense of connection as well as emotional acceptance whereas psychopharmacological interventions used to treat depression contributed to avoidance and feelings of disconnection (Watts et al. 2017). Psilocybin has also been found to be well tolerated by clients with anxiety and can be used to treat anxiety disorders (Corrigan et al., 2022). Furthermore, it has been reported that clients experience promising results following a single dose of psilocybin (Al-Naggar et al., 2021).
It is thought that the ability of psilocybin to enhance feelings of connectedness and reduce avoidance could be attributed to its transdiagnostic potential (Zeifman et al., 2023). Beyond addressing symptomology, psilocybin-assisted therapy could also enhance spirituality. Griffiths et al. (2006) found that those who took part in the treatment deemed their experience as being spiritually profound and meaningful and “67% of the volunteers rated the experience of psilocybin to be either the single most meaningful experience of his or her life or among the top five most meaningful experiences of his or her life” (Griffiths et al., 2006, p. 9).
Ketamine-assisted therapy
Ketamine also shows transdiagnostic potential in the treatment of psychiatric disorders (Ragnhildstveit et al., 2023). Ketamine is not a classic serotonergic psychedelic, rather it is an N-methyl-D-aspartate (NDMA) receptor antagonist which has psychedelic and dissociative effects. The FDA originally approved Ketamine for clinical use as an anesthetic, and it is presently being used throughout the United States for its fast-acting antidepressive effects which can be felt within hours of the treatment. It also holds promise in the treatment of PTSD since it increases synaptic connection and reduces pain-related memories. Studies have indicated that ketamine is effective for clients who have chronic trauma symptomology as well as depressive symptoms (Feder et al., 2014, 2021). Clients with obsessive-compulsive disorder have also experienced relief from ketamine-assisted therapy, however the mechanisms of action are unclear (Grabski et al., 2020). Ketamine is being used off-label as a psychedelic and is currently the only psychedelic medicine that is federally legal for clinical use, thus further research should be devoted to understanding its mechanisms of action.
The future of psychedelic-assisted therapy in family therapy
Synchronicities exist between psychedelic-assisted therapy and family therapy. We heal through connection and psychedelics have the potential to teach us this firsthand. Beyond the neuroplastic gains from psychedelics, the insights revealed from these experiences can provide clients with a new way of being in the world as well as enhance feelings of love, empathy, compassion, forgiveness, acceptance, and spirituality. Psychedelic-assisted therapy has transdiagnostic applications, and given the systemic approach of family therapists, licensed MFTs could add incredible merit to facilitation and integration. Successful psychedelic integration supports the client in connecting with their inner healing intelligence, honors the client’s uniqueness, and requires readiness of both the client and the clinician (Cahill, 2024). Given the popularity of psychedelic use in society, MFTs should seek training in psychedelic-assisted therapy to best support their clients. The future of psychedelic-assisted therapy in family therapy is promising given the medicine’s potential for relational healing when used in a clinical setting with a licensed mental health professional.
Photo Credits: istock/ma_rish

Jen Cahill, PhD, MBA, is an AAMFT Professional Member specializing in psychedelic integration.
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