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How People Become Whole Through Psychedelic Therapy

"People discover they aren’t actually broken, that they have what they need."

Kelley O’Donnell has guided dozens of people through poignant visions and life-changing revelations. A psychiatrist and researcher, O’Donnell provides psychedelic-assisted psychotherapy at the NYU Langone Center for Psychedelic Medicine. Using her passion for poetry and philosophy, O’Donnell helps her patients process their pain and, in doing so, create new ideas about who they can become.

What was your pathway to psychedelic-assisted therapy?

Growing up I was always interested in poetry, philosophy, relationships, and my own inner life. One of the things I loved in college wasn’t just the content of the curriculum but the form, in which you were reading from the classics of western civilization and engaging in a conversation that has been going on for millennia. If you’re taking each work seriously, and inviting yourself to be a part of that conversation, it means that with each new work, as the conversation evolves, you do too.

From there I studied neuroscience at the National Institutes of Health. I got burnt out on research and realized that I find my bliss in the therapeutic relationship. I started hearing about psychedelic-assisted psychotherapy in supporting patients who have cancer and were struggling with existential dread, anxiety, and depression at the end of life. There’s a sense in which the one thing I care about in life is where we find meaning and how we can live out our experience of meaning. It seemed like that’s what the psychedelics were doing, allowing people to enter into conversations about what matters to them and who they are with less fear and greater compassion and acceptance. In doing that, they were able to feel more fully themselves, more fully alive, even as they still faced the possibility of dying.

How do you help patients prepare for their psychedelic experiences?

In those preparation sessions, I want to get to know who they are, how they frame their story, how they tell their story, what they see as the gems they hold in their personality, and what they see as their wounds. I try to get a sense of who they think they are, who they fear they are, what they fear they’ll find if they go looking.

What does the psychedelic session involve?

I think anyone doing this work will talk about how it is self-directed; there’s trust in the patient or participant’s inner wisdom. The therapist is there to provide a safe container to tend to any physical concerns that might arise and to be present as the patient or participant needs them to be. Usually there’s some combination of time in silence and time actively engaged in processing. The ratio of that will depend on the substance you’re using, the dose you’re using, and other factors.

When it comes to inviting them to share their experience, I never direct them. As a therapist, that was difficult for me in the beginning. You are learning to trust. In doing that, not only are you modeling for the other person that their inner life isn’t something to be afraid of, but you’re also giving them the opportunity to try that out and to discover that when we look our monsters in the eye, they aren’t scary anymore. Or at least we discover that our fear is an opportunity for courage.

Is there an example that comes to mind of a patient who confronted their fears in that way?

One of my patients has a decades-long history of anxiety and depression. She had a sense of energy that she likened to lava, a sense that there was something dangerous about her inner life. Over several sessions with ketamine and integration of that content, there was a beautiful unfolding of her inner world. She had an experience of swimming in an ocean and experiencing the vastness of being, herself within that ocean, others she cares about within that same space, and her pain therein. This vast ocean was enough to hold everything she loves and her pain and fear—and not stop her from swimming.

Psychedelic experiences give us embodied metaphors. They give us a rich library of images through which to access parts of ourselves, archetypes, and experiences that we might be afraid to imagine. There’s something about human suffering that for some people cognition alone can’t get around. For example, my patient knew theoretically that feelings weren’t fundamentally dangerous, but she didn’t have the imaginative repertoire to live that out.

How is that patient doing now?

She feels that the oppressive anxiety and depression have lifted. That doesn’t mean life is gravy, but she feels like she has discovered a way of being in the world and a way of being with herself that feels more authentic, more open, and more alive.

What themes have you observed in your experience as a guide?

Wholeness is the unifying theme. People discover that they aren’t actually broken, that they have what they need—they’re just cut off from it in one way or another. On some psychedelics, people have what we call mystical or peak experiences. They might have a sense of unity, of boundlessness, of love, of connection to oneself and to everything.

I like the metaphor of fungi. You have dirt, and you have mushrooms, and it looks like they’re all separate. All it takes is brushing away some of that dirt to discover that each of the mushrooms is a fruiting body of the same organism. They are all connected to one another.

How does that realization play out afterward?

It can open people up to greater trust or intimacy. When we feel alone, alienated from others, it is often because we are cut off from ourselves. As we discover that the things we’ve thrust into the shadows actually are not all that destructive, we allow ourselves to see them as they actually are. Once we come to discover more about ourselves, that opens us up to trusting others as well, because we aren’t limited by a sense of shame that comes from knowing there’s stuff in the closet. If we open up the closet and see what’s there, then we don’t have to worry about what other people are going to find if they actually see us.

What lessons can psychedelic therapy provide for people who haven’t experienced it?

I think that our task as individuals is to become more fully ourselves by bringing more of ourselves and our relationships into awareness, and we do that through courage. Fear is a prerequisite for courage. Aristotle puts courage as the middle way between cowardice and rashness. If you’re not afraid you’re dumb. You’re rash. But courage is what’s needed. Which is to say that what's needed is heart. And expanding beyond the intellect into the heart, into the intuition. Through an orientation of compassionate curiosity, we can transform our understanding not only of who we are but how we fit into the wholeness of things.

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