How Guided Psychedelic Therapy Works

Medically reviewed by 
Chelsea Tersavich, PA-C
Published on 
June 16, 2021
Updated on 

A crucial part of the psychedelic therapy experience is trusting the professional(s) you're working with. If the trust isn’t there, it will prove to be a major obstacle when doing the work.

While each professional may come to their practice with a different training background or approach, they all ultimately have the same intention: to help the client on the right path to self discovery and healing.

Just as there are a number of ways to experience psychedelic therapy, there are a range of professionals to help you through your journey. Some of these include clinicians, licensed therapists who leverage psychedelics, guides, and shamans.

A Guide’s Experience is Paramount

Set and setting —your mind-frame, and held space or location— are important factors to consider when engaging with psychedelic therapy, and in all cases, guidance is equally paramount. Journeying into this type of therapy requires the direction of someone with experience, otherwise there’s high potential for things to go sideways, fast.

Dr. Leonard Vando is a New York-based board certified psychiatrist, addiction psychiatrist, and Medical Director at Mindbloom.

He says that an experienced guide can help determine the direction in which the medication is going to evolve and unfold within the patient.

“When a person with experience in this area has more tools, they'll help you develop your intentions,” he says. “That’s super useful because like everything else, where the intention is and how you come into this experience will make all the difference in what you get out of it."

At Mindbloom, experienced guides are able to give a client the support and direction needed throughout their ketamine therapy experience, should challenging emotions or insights come out of their sessions, which sometimes happens.

“If you run into some emotional difficulty, an experienced guide who has helped people in a situation like this before will make a difference between a healing session and a terrible session,” Dr. Vando says.

Retreating and Treating

Outside of Mindbloom's at-home treatment, there are many options to experience guided psychedelic therapy at alternative medicine retreats. They’re found all over the world, but are particularly abundant in countries like Mexico, Peru, and Costa Rica.

The facilities can vary when it comes to environments and resources. Some are resort-like settings that offer all-inclusive amenities while others are rustic, no-frills facilities with only the bare minimum provisions on hand. What these resorts have in common is access to a variety of spiritual healing practices, like “magic” mushrooms, ayahuasca and ibogaine.  

Depending where you go, the person leading these sessions can be referred to by different monikers. Some common ones are curandero, healer, shaman or guide.

Guided ayahuasca retreats

With ayahuasca, the therapeutic work takes place during a formal ceremony —usually amongst a group— where guests ingest the medicine and wait for the effects to kick in. This is where an experienced guide is crucial, as they will help the guest navigate the effects of the medicine. The experience often brings various psychological and emotional insights and challenges to the surface.

The experience is intense and long lasting: Ayahuasca can last up to six hours. A skilled guide will know how to help anyone having a distressing experience steer through unearthed fears so that they can take away meaningful connections and revelations.

Guided ibogaine retreats

Ibogaine is a psychoactive alkaloid found in the root bark of the Iboga shrub, which is native to central Africa. It’s been used in rituals by native populations and passed on through the Bwiti tradition for centuries.

Ibogaine retreats can be found across North America, Central America and Europe. Some position themselves as detox centers, while others offer more of a getaway experience.

Ibogaine ceremonies are often focused on helping the patient with addiction issues. Mental and physical health conditions, medications they’re on, and use of recreational drugs may factor into whether a patient is qualified to take part in this treatment.

As ibogaine is considered a spiritual plant medicine, facilitators who are guiding the ceremony should be experienced and properly trained in the Bwiti tradition.

Doing the Work

Justin Townsend is the CEO and head facilitator of MycoMeditations, a psilocybin mushrooms retreat based in Treasure Bay, Jamaica. His retreat staffs licensed therapist facilitators, clinical psychologists, a nurse, and a social worker. He says having trained professionals on hand during treatment is essential.

“In the same way a commercial pilot needs hours of experience under their belt before they can fly people around in the plane, the same can be said for anyone working as a facilitator, guide, and therapist in the dosing space,” he says.

The people who come to the facilities typically are there to treat issues like depression, childhood trauma, PTSD and/or anxiety. Over the course of a week, and three formal group dosing sessions, they work with the professionals at the center.

He admits that someone who isn’t properly trained to navigate the unknown and chaos that’s unearthed after dosing can end up intimidated, fearful, and even judgmental if they don’t trust the process or understand the experience.

“If they bring that to the equation, it can send the whole experience for the guests sideways,” he says. “As facilitators and therapists, we can often end up being a lightning rod for people’s repressed anger, so another key facility for the professionals is to not take things personally.

The professionals who work at the retreat also dose regularly, as an opportunity to ‘clear out’ their own basement.”

“We’re constantly working on ourselves so we can be very present for our guests as well,” Townsend says.

The Future of Facilitated Dosing

Psychedelic therapy involving psilocybin may not be exclusive to foreign retreats for much longer.

As more American states decriminalize magic mushrooms, it clears the way for psychotherapy-based practices involving the drug. In 2020, Oregon became the first state to legalize magic mushrooms for therapeutic use in licensed facilities, so it’s only a matter of time before this becomes an option for clients who want to explore psychedelics as an integrative treatment.

In Canada, a non-profit coalition helps offer psilocybin-assisted psychotherapy for patients with terminal illnesses. Dr. Bruce Tobin, a registered clinical counselor with Victoria B.C.-based TheraPsil, explains in one of the facility’s YouTube videos the importance of trust between a guide and a patient.

“You can’t open up inside very much further than you can trust the person who’s next to you,” he says.

He goes on to explain that there’s opportunity for this trust to be built in preparation sessions prior to dosing. First the patient is encouraged to examine what they want from the sessions and what areas they want to explore in their life. Then, there is the medicine session, when the patient doses and is monitored by a registered professional. That session is followed by at least three integration sessions, where the patient is helped to understand the nature of their experience with psilocybin and how it relates to their personal challenges. It’s meant to help the patient reflect on the therapeutic content of their psychedelic therapy experience and weave it into the context of everyday life.

Finding the Right Source

Finding the right treatment, facility and facilitator may take some time.

Go about it as you would when you’re looking for other medical services - through recommendations and reviews. Be wary of services, retreats, or guides who offer suspect pricing, as it’s often the sign of a cash grab. When doing the research, look for platforms or facilities with positive reviews and ones that have come from recommendations.

Venturing into psychedelics for therapeutic use is an intense process that shouldn’t be done alone. Just like any kind of therapy, it takes guidance and trust to start to feel an impact on your life.


This article is for informational purposes only and is not intended to be a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. If you are in a life-threatening situation, call the National Suicide Prevention Line at +1 (800) 273-8255, call 911, or go to the nearest emergency room.

Important FDA Safety Information

Ketamine is not FDA-approved for the treatment of depression or anxiety. Learn more about off-label uses here.

Side effects of ketamine treatment may include: altered sense of time, anxiety, blurred vision, diminished ability to see/hear/feel, dry mouth, elevated blood pressure or heart rate, elevated intraocular or intracranial pressure, excitability, loss of appetite, mental confusion, nausea/vomiting, nystagmus (rapid eye movements), restlessness, slurred speech, synesthesia (a mingling of the senses).

Do not proceed with ketamine treatment if any of the following apply to you:

  • Allergic to ketamine
  • Symptoms of psychosis or mania
  • Uncontrolled high blood pressure
  • CHF or other serious heart problem
  • Severe breathing problem
  • History of elevated intraocular or intracranial pressure
  • History of hyperthyroidism
  • Other serious medical illness
  • Pregnant, nursing, or trying to become pregnant

Ketamine has been reported to produce issues including, but not limited to, those listed below. However, lasting adverse side-effects are rare when medical protocols are carefully followed.

While ketamine has not been shown to be physically addictive, it has been shown to cause moderate psychological dependency in some recreational users.

  • In rare cases, frequent, heavy users have reported increased frequency of urination, urinary incontinence, pain urinating, passing blood in the urine, or reduced bladder size
  • Ketamine may worsen problems in people with schizophrenia, severe personality disorders, or other serious mental disorders.
  • Users with a personal or family history of psychosis should be cautious using any psychoactive substance, including ketamine, and discuss potential risks with your MindBloom® clinician before proceeding with treatment.
  • The dissociative effects of ketamine may increase patient vulnerability and the risk of accidents.

To promote positive outcomes and ensure safety, follow these ketamine treatment guidelines:

  • Do not operate a vehicle (e.g., car, motorcycle, bicycle) or heavy machinery following treatment until you’ve had a full night of sleep
  • Refrain from taking benzodiazepines or stimulants for 24 hours prior to treatment
  • Continue to take antihypertensive medication as prescribed
  • Avoid hangovers or alcohol intake
  • Refrain from consuming solid foods within 3 hours prior to treatment and liquids within 1 hour prior to treatment
  • Ketamine treatment should never be conducted without a monitor present to ensure your safety

Is it Time for A New Story?

If you think ketamine treatment can help you create lasting transformation, complete the form below to get started.

Take the AssessmentTake the Assessment