In Episode 48 of The Mental Wellness Practice Podcast, Dr. Shainna sits down with Amanda Gow — co-founder of Bendable Therapy and one of the earliest licensed psilocybin-assisted therapists in the U.S. — to explore what psychedelic-assisted therapy is, who it might help, and what rigorous, ethical practice in this emerging field looks like.
This is one of the most rapidly evolving areas in mental health, and it comes with both genuine promise and genuine complexity. The goal of this article is not to advocate for or against psychedelic therapy — it is to give you accurate information so you can think about it clearly.
Psychedelic-assisted therapy is not appropriate for everyone, and many substances discussed in this article remain federally controlled in the United States. Nothing in this article should be interpreted as medical advice. Please consult a licensed mental health or medical professional before pursuing any therapeutic intervention.
What Is Psychedelic-Assisted Therapy?
Psychedelic-assisted therapy is a clinical approach in which a controlled psychedelic substance is administered within a therapeutic context, under the guidance of trained mental health professionals. The substance is not used alone as a medication — it is paired with preparation sessions before and integration sessions after to help the person make sense of and apply the experience.
This is a crucial distinction. The substance is not the therapy. The therapy is the entire arc — the preparation, the guided session, and the integration work that follows. Research showing promising results has been conducted within rigorous clinical frameworks, not in unstructured recreational settings.
"The medicine opens a door. The therapy is what you do with what's on the other side. You cannot separate the substance from the container it's delivered in."
The Three Main Substances Being Studied
- Active compound in 'magic mushrooms'
- 4–8 hour sessions
- Strong evidence for depression and anxiety
- FDA 'Breakthrough Therapy' designation
- Legal for therapeutic use in Oregon and Colorado
- Empathogen / entactogen
- 6–8 hour sessions
- Primary research focus: PTSD
- Reduces fear response during trauma processing
- Phase 3 clinical trials via MAPS
- FDA-approved (as Spravato) for treatment-resistant depression
- 1–2 hour sessions
- Legal and widely available via providers
- Rapid-onset effects, sometimes within hours
- Often used IV or as nasal spray
How Does Psychedelic Therapy Work?
The mechanisms are still being studied, but current research points to several overlapping processes. Psychedelics appear to increase neuroplasticity — the brain's ability to form new connections and reorganize existing ones. This may be why effects can persist long after the substance has metabolized.
Psilocybin and other classic psychedelics appear to promote the growth of new synaptic connections in the brain. This may explain why a single or small number of sessions can produce changes that persist for months — the brain has been temporarily made more malleable and responsive to new learning.
Depression, PTSD, and addiction are all associated with deeply entrenched patterns of thought and behavior — sometimes described as the brain getting "stuck in a rut." Psychedelics appear to temporarily disrupt these patterns, creating a window in which new perspectives and connections become possible.
MDMA in particular reduces activity in the amygdala — the brain's threat-detection center — while increasing feelings of trust and connection. This creates a state in which traumatic memories can be accessed and processed without the usual overwhelming fear response that makes trauma processing so difficult in conventional therapy.
Many participants in psilocybin trials report experiences they describe as among the most meaningful of their lives — a sense of unity, interconnection, or profound insight. Research from Johns Hopkins and other institutions has found that the intensity of these experiences correlates with therapeutic outcomes. This raises genuinely interesting questions about how meaning-making intersects with neurobiological healing.
What Conditions Show the Most Promise?
The strongest current evidence is in three areas:
Treatment-resistant depression: Multiple randomized controlled trials, including those from Johns Hopkins University, Imperial College London, and NYU, have found significant reductions in depression scores following psilocybin-assisted therapy — with effects persisting for months after treatment. This is especially significant because treatment-resistant depression has very few effective options.
PTSD: Phase 3 clinical trials conducted by the Multidisciplinary Association for Psychedelic Studies (MAPS) found that MDMA-assisted therapy produced significant reductions in PTSD symptoms, with a substantial percentage of participants no longer meeting diagnostic criteria for PTSD after treatment. This is among the most promising findings in trauma treatment in decades.
End-of-life anxiety: People facing terminal illness often experience profound existential anxiety. Research at NYU and Johns Hopkins has found that psilocybin-assisted therapy significantly reduces this anxiety and can increase a sense of peace, meaning, and acceptance.
What to Look For in a Provider
Questions to Ask Before Pursuing Psychedelic Therapy
- Is this provider licensed in mental health or medicine, and do they have specific training in psychedelic-assisted therapy?
- Is the substance and approach they are offering legal in your jurisdiction?
- Do they conduct a thorough intake and screening to assess whether you are an appropriate candidate (including mental health history, family history of psychosis, medications)?
- Do they provide preparation sessions before and integration sessions after the experience?
- Are there two trained providers present during sessions (an important safety and ethical standard)?
- Is there a clear, written informed consent process?
- Do they have a clear policy about touch, physical contact, or restraint during sessions?
- Are they connected to professional organizations such as MAPS, ASKP3, or recognized training institutes?
Providers who do not include preparation and integration, who offer "underground" experiences outside legal frameworks, or who make guarantees about outcomes should be approached with significant caution. Ethical standards in this space matter enormously — and the history of psychedelic research includes genuine cases of harm from poorly conducted or unethical sessions.
Frequently Asked Questions
What is psychedelic-assisted therapy?
Psychedelic-assisted therapy is a clinical approach in which a controlled substance — such as psilocybin, MDMA, or ketamine — is administered within a therapeutic context, under the guidance of trained mental health professionals. It is paired with preparation and integration sessions. Unlike traditional psychiatric medications that require daily use, psychedelic-assisted therapies typically involve a limited number of sessions, and the effects can be lasting.
Is psilocybin therapy legal?
The legal status varies by location and is changing rapidly. As of 2025, Oregon and Colorado have passed laws allowing regulated psilocybin services for adults. At the federal level in the U.S., psilocybin remains Schedule I, though the FDA has granted it 'Breakthrough Therapy' designation. Ketamine is currently the only psychedelic substance fully legal and widely available for mental health treatment in the U.S. Always consult a qualified professional to understand what is available and legal in your specific location.
Who is a good candidate for psychedelic-assisted therapy?
It has shown the most research support for people with treatment-resistant depression, PTSD, and end-of-life anxiety. It is generally not appropriate for people with personal or family history of psychosis, bipolar I disorder, or certain heart conditions. A thorough evaluation by a trained, licensed professional is essential before pursuing any psychedelic therapy.
What is the difference between psilocybin, MDMA, and ketamine therapy?
Psilocybin (from mushrooms) is studied primarily for depression and anxiety — sessions last 4–8 hours and involve deep introspective states. MDMA-assisted therapy is being developed primarily for PTSD — it reduces fear response and sessions last 6–8 hours. Ketamine is already FDA-approved for treatment-resistant depression and is widely available — sessions are shorter (1–2 hours) with rapid onset. Each has a different mechanism, risk profile, and appropriate use case.
How do I find a reputable psychedelic therapy provider?
Start with a licensed mental health or medical professional who has training in this area. Red flags include providers who skip thorough intake and screening, promise guaranteed outcomes, don't include preparation or integration, or operate outside a clear legal framework. Reputable resources include MAPS (Multidisciplinary Association for Psychedelic Studies), the Psychedelic Medicine Coalition, and for ketamine, the American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP3).