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Psilocybin Mushroom Therapy: Clinical Observations from Amsterdam (Part 2 of 2)

How to get the most out of psilocybin mushroom therapy, including set, setting, therapeutic relationship, and addressing disassociation.
By Saj Razvi, LPC
November 19, 2019(Updated: March 20, 2021)

Read part 1 here. Psilocybin mushroom therapy is an incredible medicine. What it asks of the person using it and what it provides is beyond anything I’ve experienced. This includes the MDMA, cannabis, and ketamine therapy world. It is absolutely an advanced medicine that will not reveal its true potential unless external and internal conditions allow for it. In other words, there are factors that will cause psilocybin to express its profound healing capacity or have very little effect regardless of dose. 


These observations are from experience in our Amsterdam psilocybin therapy program. They also originate from interviews with Psychedelic Society of the Netherlands‘ clinicians. They use this medicine in therapy on a regular basis. Through observations, a case can be made that there are two major factors determining the depth and usefulness of a psilocybin mushroom therapy session. 

To be clear, this article is for the mental health audience. It is for the person seeking to address their symptoms through psychedelic means. It doesn’t apply to the Michael Pollans of the world or the ‘betterment of the well’ seekers.

Set and Setting for Psilocybin Mushroom Therapy

With that caveat in mind, the first major factor is the appropriateness of your environment. This is commonly known as set and setting. Taking psilocybin in various settings yields different results. Being in a recreational setting versus a spiritual ceremony versus in a group versus individual therapy all affect the experience in unique ways. Does your intention relate to mental health? Want to use the session to go deep into your psyche, symptoms, history and structure? Then you will absolutely want to work in an individual therapy setting. Working with a two person therapist team (male and female) would be ideal. We ordinarily dislike being so prescriptive since there are so many different paths healing can take.

However, we reliably see that the container, processing, and individual focus required for deep personal healing is simply not available in a group setting. Nor is it available recreationally. Your system will naturally censor the depth and intensity of your process. This happens because you know you are in a group of people all needing facilitator time and attention. This is an appropriate evaluation of your environment and what it can hold. 

Wonderful things certainly do happen in a group or especially a ceremonial setting. People can have profound experiences. Although these are frequently transpersonal in nature. It’s awe and reconnection to the world, and not the realm of psychotherapy and your individual mental health. If you are there for personal mental health reasons, it helps for the container and focus to orientate towards you, as opposed to a general group environment.

Internal Readiness

The second major factor determining the outcome of your mushroom session is your internal readiness for it. Consider it an appropriate, advanced treatment. It works best for people who have moved through their foundational level healing. They have already worked with MDMA, cannabis or ketamine assisted psychotherapy.

Here is what we mean by this distinction between initial and advanced levels of psychedelic work. MDMA and cannabis focus on the events in your life. These can be very early, even preverbal events that you do not recollect. Psilocybin is an advanced medicine insofar as it addresses the very ‘you.’ Your identity and sense of reality that got constructed from these events. Psilocybin challenges the very fabric of reality that was put together quite early in life. This is significant insofar as your very sense of self and reality are a much deeper layer of programming. It is a layer of learning that is thought to be unchangeable.

It was a well-established belief in the MDMA clinical trials that MDMA does not affect personality level shifts. Rather it focuses on traumatic events. These starter psychedelic medicines are so effective for mental health due to a scope and depth limited to events. They are not asking anything more from the user, whereas psilocybin does.

Ego and Nervous System Synchrony Needed

So, what happens in this initial level of work that is a necessary condition for psilocybin to do its magic? We speculate psilocybin needs a foundational level of ego and nervous system integrity before it can do anything with a person’s system. We do this type of work with clients at Innate Path. The work focuses on autonomic nervous system responses to events. It also includes establishing somatic pathways for processing very intense emotional charge, and perhaps most importantly, dissolving through dissociation.

Part 1 of this article covers how dissociation is a generally, big factor in mental health. Dissociation is a big factor with psychedelic therapy, and it’s a big factor with psilocybin. We recommend reading part 1 before going on. But to briefly summarize, all mammals including humans involuntarily generate and release natural opioids. These opioids numb us out during a highly stressful or overwhelming event. Additionally, this dissociative, numbing response is active decades after these events happen. Essentially, a protective depressive, numbing reaction is present. This can block awareness, therapy and even psychedelic responses from taking place.  

Mushrooms Don’t Work Well with Dissociation

If you have dissociation, then psychedelic mushroom therapy is likely not going to be that useful for you. Many people with stubborn symptoms have dissociation. We find people retain their dissociation in 2 instances. People who have childhood trauma is the first example. The other are people who have never done therapy before, or their work has been limited to conventional forms of talk therapy. Yes, those years of expensive talk therapy can be interesting and helpful in some ways to your conscious mind. Yet talk therapy does not do much to crack through your system’s protective layers. It doesn’t get to the core of your symptoms, at least not in the manner that psychedelic therapy is able to accomplish.

If this is you and you engage in a psilocybin mushroom therapy session, it is likely going to be a fairly mild experience regardless of how much medicine you ingest. You will likely have peaceful prosaic images of nature, water, the dance of light, flowers, colors and psychedelic distortions. But none of these images will connect to your interior world and they will not engage you in a transformative process. Psilocybin is not the ideal medicine to crack dissociation. What it asks of you is too big for what your system is ready for. This is holds true if you are still inside of, or just emerging from, psychological numbing.

Mild Distortions

Whether it is the medicine making this choice or it is your own protective psychological mechanisms blocking it, the psilocybin will mostly pass you by with only mild psychedelic distortions. This is why the Netherlands is comfortable allowing packets of psychedelic mushroom truffles to be legally sold to roving bands of recreational spring breakers. Neither the set and setting, nor the person’s psyche are ready for a big process, and so it does not happen. It ends up being a relatively safe, visually interesting trip with laughter. 

We find this to be the case with our Amsterdam clients regardless of the dosage. This was confirmed in the interviews with the therapists at the Psychedelic Society of the Netherlands. It is infrequent here that clients are ready for the big sessions they expect. The protocol we’ve adopted in response to this is to begin with psilocybin therapy. But if the session is primarily dissociative in nature with the mild responses mentioned above we suggest an alternative. We’ll inform them about cannabis-assisted psychotherapy and what we typically see with that medicine.

We will often get a puzzled look. These people have gone through the trouble of flying to Europe for psilocybin therapy, when cannabis work is available in the United States. More often than not, these clients end up choosing to continue with the cannabis work instead of jumping back into another mushroom session right away. This is because cannabis and MDMA are more appropriate to the stage of work these clients are at. The cannabis process is able to grip into and crack the dissociative numbing in a way psilocybin does not. What ends up happening is that a client will engage in three or four cannabis therapy sessions on consecutive days. They then move back to a second psilocybin session after their dissociation has shifted. We find that the second psilocybin session compares quite differently to the first one.

At this point, the mushroom medicine can stretch its wings. It begins to express its potential in your system. It is just too big of an experience to do this with someone still at the very beginning of their work. Once you crack your dissociative structure and the massive opioid dumps end, the psilocybin can get traction in your system. Cannabis or MDMA moves you through enough of your trauma. Now your body is available to help you handle the much fuller contact with being that psilocybin beckons. 

Let me note another caveat here. Your body is very important in this process. Your cognitive capacity was not built to process big emotions. In contrast to your tip-of-the-iceberg cognition, you will go much further in a psilocybin session. That is if your body is available to conduct the powerful charge that comes with psilocybin’s revelations.

The mushroom therapy engages you, feeling it down to your DNA. You can finally feel the mountain of frozen grief in your chest. The lack of love or welcoming as a child surfaces. So do the layers of aggression, callousness and depression operating on top of this core experience. You can also feel the deliciousness of touching anything alive. You feel a hand, a face, your own soft body, leaves. It lovingly challenges your inability to love. The session can take you to your own birth. Or it can take you to your infancy and the utter freshness of the world through a child’s mind or body experience. 

Help for Personality Disorders

I hesitate to say this because of possible unintended consequences. However, we have seen it heal Axis 2 personality disorders. These are diagnoses like narcissistic or borderline personality disorder. The conventional treatment world offers very little for these. As we mentioned before, personality is considered stable and an unchanging trait. Even MDMA does not touch personality disorder. My hesitation in mentioning it is because it will take a lot to support this type of client to move through the first level of work. Not to mention the profound reactivity that psilocybin unleashes. I mention it only to say the mushroom work is big enough that it can alter what was previously thought unalterable. 

The big takeaway here is that therapeutic set, setting and relationship is essential. The medicine is essential and the readiness of your psyche is essential. These medicines can effect amazing healing. But we have to be ready for them. In other words, take your time and approach this endeavor. Understand that there are no magic pills. You are part of an amazing process that still adheres to natural principles in how it moves and unfolds. An integrated, associated, healthy ego structure is a good foundation to have before diving into the deep end. 


This is the second part of a two part article. Innate Path is a psychedelic psychotherapy training, research & clinical services organization. Contact innatepath.org or saj@innatepath.org



Published by:
Saj Razvi, LPC
Saj Razvi, LPC is the Director of Education at Innate Path. He was a clinical researcher in a MAPS Phase 2 trial of MDMA-assisted psychotherapy for post-traumatic stress disorder (PTSD). His primary focus is on the wide scale adoption and accessibility of psychedelic therapy through training therapists to work with cannabis and ketamine-assisted therapy in private practice settings. He has taught trauma studies as faculty at the University of Denver as well as being a national topic expert for PESI education seminars focusing on complex PTSD. Contact at innatepath.org or saj@innatepath.org

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