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

The first thing to say here is that psilocybin is an incredible medicine. What it asks of the person using it and what it provides is beyond anything I’ve experienced in the MDMA, cannabis, and ketamine therapy world. That being said, 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. 


The observations I’m about to make are from our experience in our Amsterdam psilocybin therapy program and from interviews with clinicians at the Psychedelic Society of the Netherlands who use this medicine in therapy on a regular basis. What seems to be the case based on observations is that there are two major factors that determine 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 is less applicable to the Michael Pollans of the world or the ‘betterment of the well’ seekers.

Set and Setting

With that caveat in mind, the first major factor is the appropriateness of your environment: what is commonly known as set and setting. Taking psilocybin in a recreational setting versus a spiritual ceremony versus in a group versus individual therapy will all yield different results. If your intention is mental health related and you want to use the session to go deep into your psyche, symptoms, history and structure, you will absolutely want to work in an individual therapy setting and you would ideally have a two person female and male therapist team. 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 (and obviously not available recreationally). Your system will naturally censor the depth and intensity of your process if you know you are in a group of people all needing time and attention from the facilitators. 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 your personal mental health reasons, it is helpful for the container and focus to be more oriented to you and not 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 advanced treatment to be engaged when people have moved through their foundational level healing with something like 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, even very early, preverbal events that you had no recollection of. Psilocybin is an advanced medicine insofar as it addresses the very ‘you’, the 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, but rather is focused on traumatic events. These starter psychedelic medicines are so effective for mental health because their scope and depth are limited to events. They are not asking anything more from the user, whereas psilocybin does.

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

As we noted in part 1 of this article, dissociation is a big factor in mental health in general, it’s 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 that not only numb us out during a highly stressful or overwhelming event but this dissociative, numbing response is active decades after these events have taken place. Essentially, a protective depressive, numbing reaction is present that can block awareness, therapy and even psychedelic responses from taking place.  

If you have dissociation as part of your structure, and many people whose symptoms are not easily resolvable do, psychedelic mushroom therapy is likely not going to be that useful for you…. 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.

If you have dissociation as part of your structure, and many people whose symptoms are not easily resolvable do, psychedelic mushroom therapy is likely not going to be that useful for you. We find that people who have trauma in their life, particularly in childhood, and have never done therapy before or the type of work they’ve done has been limited to conventional forms of talk therapy typically do retain their dissociation. Yes, those years of expensive talk therapy, while interesting and helpful in some ways to your conscious mind, will not have done much to crack through your system’s protective layers to 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 if you are still inside of or just emerging from psychological numbing.

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 government of 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 where it is infrequent 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’ll inform them about cannabis-assisted psychotherapy and what we typically see with that medicine.

We will often get a puzzled look since the cannabis work is available in the US and these people have gone through the trouble of flying to Europe for psilocybin therapy. 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 and then move back to a second psilocybin session after their dissociation has shifted. We find that the second psilocybin session is quite different compared to the first one.

At this point, the mushroom medicine can stretch its wings and begin 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.

At this point, the mushroom medicine can stretch its wings and begin 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 have cracked your dissociative structure and you are not having a massive opioid dump in response to the events in your life, the psilocybin can get traction in your system. You have moved through enough of your trauma with cannabis or MDMA and 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. In contrast to your tip-of-the-iceberg cognitive capacity, which was not built to process big emotions, you will go much further in a psilocybin session if your body is available to conduct the powerful charge that comes with psilocybin’s revelations.

You feel engaged by the mushroom therapy down to your DNA. You can finally feel the mountain of frozen grief in your chest at not being loved or welcomed as a child and the layers of aggression, callousness and depression operating on top of this core experience. You can also feel the deliciousness of touching anything alive: a hand, a face, your own soft body, leaves. It will lovingly challenge your inability to love. The session can take you to your own birth, your infancy and the utter freshness of the world as experienced through a child’s mind/body. 

I hesitate to say this because of possible unintended consequences but we have seen it heal what are known as Axis 2 personality disorders. These are diagnosis like narcissistic or borderline personality disorder that the world of conventional treatment has very little to offer. As we mentioned before, personality is considered stable and unchanging trait and 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 will be unleashed with psilocybin. 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 with an understanding 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