Psychedelic-Assisted Therapy: What Remains Unconscious and Hidden

The use of psychedelics for the purpose of therapy and personal growth has seen a significant increase in recent years. While the body of research supporting their therapeutic potential is expanding, much of the discussion regarding effectiveness and adverse effects remains reliant on the subjective, personal experiences of users. While some data suggests favourable outcomes in treating mental health issues such as depression, PTSD, and substance use, questions remain regarding the durability of these effects. There are also questions about whether we are witnessing genuine structural change or merely a sophisticated form of symptom reduction.

In this article, however, I do not intend to discuss the clinical efficacy of psychedelics. Instead, I wish to shed light on the unconscious motives that often accompany their use—motives often unseen and neglected but frequently encountered in clinical practice. These motives appear to be closely tied to the pursuit of an unconscious fantasy: specifically, an unconscious escapism from the hard reality of internal change and how such change may impact one’s life. Rather than examining the evidence base for psychedelic-assisted therapy, I want to point toward the unseen and neglected internal resistances that drive individuals toward it.

Before We Ask “Does It Work?”

Before we can address whether psychedelic-assisted therapy is effective—a complex question worthy of its own exploration—we first need to think about the context of its use.

Advocates of psychedelic-assisted therapy often report of emerging research and also anecdotal success stories to argue for its benefits, which some studies do seem to point towards. For instance, some studies indicate positive effects of psilocybin in the treatment of depression (Andrade et al., 2025; Barnett et al., 2025; Borgogna et al., 2025; Fang et al., 2024; Marchi et al., 2024) and substance use disorders (SUD) (Piper et al., 2025; van der Meer et al., 2023). Beyond psilocybin, substances such as ayahuasca, LSD, and MDMA have shown promise—however to a lower extent—in addressing anxiety and depression (Fluyau et al., 2024; Yao et al., 2024). MDMA, in particular, appears to hold potential for the treatment of Post-Traumatic Stress Disorder (PTSD) (Shahrour et al., 2024; Sze Jing Yong et al., 2025; Žuljević et al., 2025).

However, this list is illustrative, not exhaustive. Also, the interpretation of this data demands caution. Much of the current research, unfortunately, faces methodological challenges, questions regarding transferability to the general clinical population, and the ever-present risk of researcher bias.

The Discrepancy Between Research Evidence and Hidden Expectations

Defining the Objective of Treatment

So, when considering whether psychedelic-assisted psychotherapy works, we not only need to keep in mind that some of the research is dubious, controversial, and inconclusive, but even when that is not the case, we also need to ask ourselves what is it that we are looking to treat.

So far, the research demonstrates potential primarily in the management of specific psychiatric conditions—predominantly severe depression, PTSD, and substance use disorders. The data remains concentrated on the efficacy of psilocybin and MDMA within controlled settings. Consequently, psychedelics cannot yet be clinically regarded as a universal panacea for the broader spectrum of psychological distress.

The Illusion of Off-Label Resolution

While isolated studies suggest that psychedelic-assisted therapies may influence attachment styles (Stauffer et al., 2021), the current evidence does not support such broad application. Largely research focuses almost exclusively on symptom reduction rather than the restructuring of the underlying internal conflicts that underpin an individual’s suffering.

Consider, for example, an individual coping with depression. If this depression is the psychic residue of early developmental (childhood) trauma or the experience of parentification in childhood, current psychedelic protocols mainly target the symptom of depression. They do not address the internal residues, or the unconscious consequences, of that developmental trauma encapsulated in one’s personality and affecting their sense of self, others and the world.

However, we need to know that clinical reality often diverges from isolated clinical research protocols. In practice, we observe individuals resorting to psychedelics either on their own accord—without professional facilitation or with unprofessional facilitation—and driven by hopes that far exceed what the research supports. This means that we can frequently encounter the dangerous assumption that psychedelics can serve as a substitute for psychotherapy rather than a form of its facilitation—a technique.

One of the most pervasive fantasies is that a psychedelic experience can replace the slow work of psychotherapy in processing internal conflicts related to developmental trauma. Too often clients will believe psychedelics will help them “resolve” or “purge” their childhood traumas. For instance, a person battling toxic relationships, codependency, and abandonment fears may turn to psychedelics in an attempt to “fix” the underlying childhood adversities that underpin the “toxicity” of her relationships and the perpetual lure of such “toxicity”.

Unfortunately, without the container of a therapeutic relationship, this rarely results in deep internal change. While it may provide profound insight, it seldom offers resolution. In fact, undergoing such “treatment” without the containment of a qualified professional often exacerbates the very confusion and internal chaos the individual seeks to escape.

The Critical Deficit: Integration is Essential

As noted by Soares et al. (2022), many users engage with psychedelics as a form of “self-care” or existential exploration within private settings, far from formal psychotherapeutic spaces. Their motives often drift away from clinical outcomes and toward spiritual growth or a search for meaning (Schutt et al., 2025).

And here lies the critical deficit: the necessity of psychotherapeutic integration of the psychedelic experience. Research highlights that integration is a core component of effective treatment (Horton David et al., 2021). Users who pursue psychedelics for purely experiential purposes, bypassing the rigorous work of integration, often find themselves with revelatory insights but no structural change. They are left with a new awareness of their internal pain, but no new capacity to contain it, leaving them in a vulnerable and potentially unsafe psychological position.

The Neglected and Hidden Side: Unconscious Motives in Psychedelic Pursuit

My purpose here is not to litigate the effectiveness of psychedelics as a tool for psychological treatment. Rather, the aim is to highlight observations gathered through my own clinical experience and that of colleagues regarding clients’ hidden motives when resort to psychedelics—whether independently or through external of facilitation.

So, to clarify my position: While I have worked with individuals who have used psychedelics for mental health purposes, their psychedelic treatment was facilitated independently. I do not personally provide any form of psychedelic-assisted treatment.

Insight Is Rarely Resolution: The Illusion of Immediate Transformation

What often remains neglected in research, but is frequently observed in clinical practice, is the pervasive prevalence of “off-label,” unsupervised use of psychedelics for personal growth. This pursuit is largely predicated on an ambiguous assumption: that gaining insight and awareness into one's internal conflicts and traumatic experiences will automatically result in their processing and resolution. This means that the intense psychedelic experience is often misconstrued as a substitute for psychotherapy itself.

The clinical consequence of this dynamic is that the newly gained awareness of one’s unconscious internal shadow is, without integration, rarely more than insight. Emotional re-experience of past traumas is insufficient for their deep, structural resolution—in fact, it can be re-traumatising. This seems crucial, especially considering that the majority of users turn to psychedelics seeking a deeper transformative experience rather than mere symptom relief (Ley et al., 2025).

In clinical reality, we can often observe individuals resorting to psychedelics with the hope that awareness combined with a profound emotional discharge will inevitably lead to internal resolution. However, the use of psychedelics as facilitators of resolution is no different than the role of insight in conventional therapy: they are simply the catalyst. Insight initiates the process; it does not complete it.

Furthermore, while the motive to equate insight with resolution may operate on a conscious level driven by a desire to bypass effort, we also need to consider the unconscious is playing a significantly more important role—one that is often highly defensive.

The Need to Escape: Psychotherapy is Disappointing; The Reality is Boring

One of the most potent unconscious motives driving people toward psychedelics is the perception—often unconscious—that the experience will deliver a sudden, profound “aha” moment, resulting in a brand-new life. This new existence is fantasised as one freed of all past restraints and characterised by a life that is purposeful, fulfilling, and full of meaningful relationships.

When we analyse the deeper motives for the use of psychedelics, this perception surfaces as an unconscious fantasy—the desire for a panacea that fulfils all unmet needs and grants instant resolution without the painful engaging with past traumas or past injustices.

The promise of this exciting and quick resolution is a stark antithesis to the boring and painful dragging process of deep psychotherapy. This can be seen especially in analytically-oriented treatments, where the focus is deliberately placed on the resolution of underlying internal conflicts rather than merely symptomatic improvements.

The reality, however, is that deep psychological work is inherently boring, tedious, a drag, and anti-climaxing. You return to the same place week after week, and while internal shifts occur, the work is slow and repetitive, the increments are small. But it’s real.

What is often more devastating for the client is the ultimate realisation: beyond the internal change, the life changes one desires in their external life are solely theirs to make. The freedom acquired also comes with acknowledging that one is fully responsible for their life. Psychotherapy does not magically alter one's reality; it merely brings one closer to the reality many have spent a lifetime avoiding. It strips away the defences and leaves the individual with a terrifying degree of freedom to choose, putting them squarely in charge of their own life.

The sobering effect of this realisation often triggers therapeutic resistance, dropout, and self-sabotage. In its essence, psychotherapy is a process of disillusionment and disappointment. What could be more disappointing than learning that, while you hoped for a radical new beginning, therapy merely revealed the reality you already live in, leaving you with the autonomy and choice to decide what to do with it?

Because psychedelics offer a direct antithesis and sobriety to the boredom of psychotherapy, they are easily cast as the ultimate quick-fix panacea—seemingly promising a solution without demanding any fundamental change to one’s way of living.

Consider the adult client struggling with immense anxiety, later understood as separation anxiety, fears of abandonment, and an inability to separate from her parents and family of origin. Early in treatment, she realises her aim was for therapy to “make it all better”—to grant her a secure, anxiety-free life and a family that would finally “see her and let her be free.” After realising that the responsibility for change lay with her, not her family, the internal change would naturally need to evolve into external action. This, however, is when conventional psychotherapy suddenly became a threat to the life she knew. The slow, painful work of emotional separation and individuation was too much and the psychedelics gained their appeal.

The Illusion of Autonomy: Escaping Dependency, Relying, and Lack of Control

Deep, analytically-based psychotherapy is fundamentally relational. Through the constancy of the therapeutic setting, it establishes an enduring therapeutic relationship that evokes attachment and, crucially, healthy reliance. Clients often seek therapy precisely because their formative years involved violations of trust where they were most vulnerable—disruptions to their earliest attachments. Therefore, long-term relational work inevitably reactivates these core, attachment-related wounds and vulnerabilities.

What commonly follows is a reappearance of early relational dynamics, wherein the client may experience themselves as completely dependent and overly reliant on the therapist. This therapeutically necessary, albeit uncomfortable, reliance evokes powerful feelings of vulnerability and lack of control.

• For individuals with an anxious attachment style, this may trigger acute fears of abandonment and an overwhelming need for proximity.

• For those with a more avoidant attachment style, it often evokes intense anxieties of engulfment, being smothered, trapped, or losing control of the therapeutic dynamic.

The individual, often unconsciously, struggles with the reality that, in their effort to change, they must be reliant on another person—the very position that caused them pain in childhood. While the dependency they experience is a prerequisite for working through their past—a form of healthy reliance—their subjective experience of it is one of profound discomfort and a fearful feeling of forever becoming captive or controlled.

If these feelings remain unexplored, the discomfort within the therapeutic relationship can cause a flight from the therapeutic relationship. The use of psychedelics offers a stark contrast to the vulnerability required in the therapy room. Consequently, the individual may unconsciously resort to psychedelic treatment because it is experienced as a means to achieve internal change without giving up control to the therapist.

Psychedelics, in this context, are chosen precisely because they offer the illusion of autonomy, allowing the pursuit of deep change while maintaining a defensive independence.

Spiritual Bypass: The Misuse of Spirituality to Avoid Deeper Change

Spiritual bypass refers to the conscious or unconscious misuse of spiritual practices and beliefs to avoid confronting the deep internal conflicts that are the true roots of psychological suffering (Cashwell et al., 2010; Welwood, 2000; Whitfield, 2003).

This mechanism involves the individual resorting to various forms of escapism—including spirituality, mindfulness, and various “personal growth” practices—under the illusion of “processing” their trauma. Their unconscious aim, however, is to bypass the intense pain and profound discomfort inherent in facing their past, which would be the inevitable requirement of deep psychotherapeutic work as well as seeing the reality of one’s life and their relationships.

By fleeing into spiritualised experiences, the individual paradoxically avoids working through their past. This defence against change is closely linked to the phenomenon of attachment to trauma: the unconscious need to avoid the existential crisis of identity, purpose, and meaning that may accompany the loss of the familiar, traumatised sense of self and thus emotionally cling to the past trauma.

It is, therefore, not uncommon to find one resorting to psychedelics—often in the form of repeated retreats—endlessly hoping to “heal” their traumas. Paradoxically, this behaviour often constitutes a continued re-enactment of the trauma, resulting in the individual remaining attached to their pain without achieving any genuine resolution. It can turn into life-long “trauma work”. For some, the reliance on such experiential “healing” extends to attending psychedelic and spiritual events purely to gain a feeling of belonging and community, which itself is a desperate search for the sense of self and meaning that their childhood and the trauma that coloured it stripped them of.

Conclusion

Once we move beyond the often-polarised debate surrounding the efficacy and potential harm of psychedelic-assisted therapy, we can begin to appreciate the neglected, unseen, and often unconscious motivations for engaging in psychedelic treatments.

What we observe in clinical practice is a stark divergence between controlled research protocols and real-world use: psychedelics are frequently sought to fulfil an unconscious fantasy. This fantasy is rooted in the pervasive assumption that the awareness of one's deepest traumas will automatically result both in their resolution and the emergence of a new life. As such, psychedelics seem to be seen as a quick, painless, and exciting alternative to the tedious, boring, and disappointing process of deep psychotherapy.

Ales Zivkovic, MSc (TA Psych), CTA(P), TSTA(P), Psychotherapist, Counsellor, Supervisor

Ales Zivkovic is a psychotherapist, counsellor, and clinical supervisor. He holds an MSc in Transactional Analysis Psychotherapy awarded by Middlesex University in London, UK. He is also a Teaching and Supervising Transactional Analyst (TSTA-P) and a Certified Transactional Analyst in the field of Psychotherapy (CTA-P). Ales gained extensive experience during his work with individuals and groups in the UK National Health Service (NHS) and his private psychotherapy, counselling, and clinical supervision practice in central London, UK. He is also a full clinical member of the United Kingdom Council for Psychotherapy (UKCP). Ales works with individuals, couples, and groups. In clinical setting, he especially focuses on the treatment of issues of childhood trauma, personality disorders, and relationship issues. A large proportion of his practice involves online psychotherapy as he works with clients from all over the world. Ales developed a distinct psychotherapeutic approach called interpretive dynamic transactional analysis psychotherapy (IDTAP). More about Ales, as well as how to reach him, can be found here.

References:

Andrade, F. R. T., Buchborn, T., Thalheimer, G., Meinhardt, M. W., Joca, S., & de Almeida, R. M. M. (2025). Therapeutic Use of Psilocybin in Depression: a Systematic Review of Clinical Evidence. Acta Neuropsychiatrica, 37, e86, Article e86. https://doi.org/10.1017/neu.2025.10039

Barnett, B. S., Mauney, E. E., & King, F. (2025). Psychedelic-assisted therapy: An overview for the internist. Cleveland Clinic Journal of Medicine, 92(3), 171-180. https://doi.org/10.3949/ccjm.92a.24032

Borgogna, N. C., Owen, T., Petrovitch, D., Vaughn, J., Johnson, D. A. L., Pagano, L. A., Aita, S. L., & Hill, B. D. (2025). Incremental efficacy systematic review and meta-analysis of psilocybin-for-depression RCTs. Psychopharmacology, 242(10), 2139-2157. https://doi.org/10.1007/s00213-025-06788-w

Cashwell, C. S., Glosoff, H. L., & Hammond, C. (2010). Spiritual bypass: A preliminary investigation [doi:10.1002/j.2161-007X.2010.tb00014.x].

Fang, S., Yang, X., & Zhang, W. (2024). Efficacy and acceptability of psilocybin for primary or secondary depression: A systematic review and meta-analysis of randomized controlled trials [Systematic Review]. Frontiers in Psychiatry,Volume 15 - 2024. https://doi.org/10.3389/fpsyt.2024.1359088

Fluyau, D., Kailasam, V. K., & Revadigar, N. (2024). Rapid and Prolonged Antidepressant and Antianxiety Effects of Psychedelics and 3,4-Methylenedioxy-methamphetamine—A Systematic Review and Meta-Analysis. Psychoactives, 3(4), 476-490.

Horton David, M., Morrison, B., & Schmidt, J. (2021). Systematized Review of Psychotherapeutic Components of Psilocybin-Assisted Psychotherapy. American Journal of Psychotherapy, 74, 140-149. https://doi.org/10.1176/appi.psychotherapy.20200055

Ley, L., Liechti, M. E., Becker, A. M., Straumann, I., Klaiber, A., Holze, F., Vogt, S. B., Arikci, D., & Schmid, Y. (2025). Motivation and retrospective appraisal of psychedelic study participation: a qualitative study in healthy volunteers. Psychopharmacology, 242(8), 1875-1892. https://doi.org/10.1007/s00213-025-06772-4

Marchi, M., Farina, R., Rachedi, K., Laonigro, F., Žuljević, M. F., Pingani, L., Ferrari, S., Somers, M., Boks, M. P. M., & Galeazzi, G. M. (2024). Psychedelics as an intervention for psychological, existential distress in terminally ill patients: A systematic review and network meta-analysis. Journal of Psychopharmacology, 02698811241303594. https://doi.org/10.1177/02698811241303594

Piper, T., Small, F., Brown, S., Kelleher, M., Mitcheson, L., Rucker, J., Young, A. H., & Marsden, J. (2025). Psychedelic-assisted treatment for substance use disorder: A narrative systematic review. Addiction. https://doi.org/10.1111/add.16762

Schutt, W. A., Exline, J. J., & Pait, K. C. (2025). How psychedelic experiences can cause, worsen, or resolve spiritual struggles: A mixed-methods study of psychedelic users. Psychology of Religion and Spirituality, 17(4), 398-414. https://doi.org/10.1037/rel0000562

Shahrour, G., Sohail, K., Elrais, S., Khan, M. H., Javeid, J., Samdani, K., Mansoor, H., Hussain, S. I., Sharma, D., Ehsan, M., & Nashwan, A. J. (2024). MDMA-assisted psychotherapy for the treatment of PTSD: A systematic review and meta-analysis of randomized controlled trials (RCTs). Neuropsychopharmacology Reports, 44(4), 672-681. https://doi.org/https://doi.org/10.1002/npr2.12485

Soares, C. M., Leite, Â., & Pinto, M. (2022). Self-care practices with psychedelics – a qualitative study of users’ perspectives. Journal of Psychoactive Drugs, No Pagination Specified-No Pagination Specified. https://doi.org/10.1080/02791072.2022.2071134

Stauffer, C. S., Anderson, B. T., Ortigo, K. M., & Woolley, J. (2021). Psilocybin-Assisted Group Therapy and Attachment: Observed Reduction in Attachment Anxiety and Influences of Attachment Insecurity on the Psilocybin Experience. ACS Pharmacol Transl Sci, 4(2), 526-532. https://doi.org/10.1021/acsptsci.0c00169

Sze Jing Yong, A., Bratuskins, S., Sultani, M. S., Blakeley, B., Davey, C. G., & Bell, J. S. (2025). Safety and efficacy of methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in post-traumatic stress disorder: An overview of systematic reviews and meta-analyses. Australian & New Zealand Journal of Psychiatry, 59(4), 339-360. https://doi.org/10.1177/00048674251315642

van der Meer, P. B., Fuentes, J. J., Kaptein, A. A., Schoones, J. W., de Waal, M. M., Goudriaan, A. E., Kramers, K., Schellekens, A., Somers, M., Bossong, M. G., & Batalla, A. (2023). Therapeutic effect of psilocybin in addiction: A systematic review [Systematic Review]. Frontiers in Psychiatry, Volume 14 - 2023. https://doi.org/10.3389/fpsyt.2023.1134454

Welwood, J. (2000). Toward a psychology of awakening: Buddhism, psychotherapy, and the path of personal and spiritual transformation. Shambala.

Whitfield, C. L. (2003). My recovery: A personal plan for healing. Health Communications.

Yao, Y., Guo, D., Lu, T.-S., Liu, F.-L., Huang, S.-H., Diao, M.-Q., Li, S.-X., Zhang, X.-J., Kosten, T. R., Shi, J., Bao, Y.-P., Lu, L., & Han, Y. (2024). Efficacy and safety of psychedelics for the treatment of mental disorders: A systematic review and meta-analysis. Psychiatry Research, 335, 1-26. https://doi.org/10.1016/j.psychres.2024.115886

Žuljević, M. F., Viđak, M., Vukojević, J., Hren, D., & Peričić, T. P. (2025). MDMA-Assisted Psychotherapy for PTSD: Evidence Synthesis and Methodological Challenges in a Rapidly Evolving Field. Current Treatment Options in Psychiatry, 12(1), 33. https://doi.org/10.1007/s40501-025-00369-6