When the Medicine Doesn’t Know Best
The Limits of Mystical Framing in Psychedelic Therapy for Resolving Complex Trauma
I recently had a conversation with my friend and colleague about some tropes we often hear in Westernized medicine circles and psychedelic communities: “the medicine only gives you what you’re ready for” or “the medicine only shows you what you’re ready to see.” These tropes can create an emotional safety net, invite the individual to “let go” into the experience, and help people trust that even disorienting or difficult experiences are “meant to be.” However, they can overlook the nuances and complexity involved when working with trauma. Some people can have profoundly disorganizing experiences that lead to further confusion or retraumatization—especially those who are desperately seeking these powerful experiences to resolve their early developmental wounding.
I want to be clear that my concern here is not a critique of Indigenous traditions or those who engage with these medicines to deepen spiritual connection, explore mystical experiences, or honor ancestral practices. Rather, my focus is on the Westernized contexts and trauma-affected populations, specifically developmental and complex trauma, where these tropes may inadvertently create blind spots or safety risks. In a future article, I will also explore the idealization of the medicine “telling” the guide how to best support participants, and the potential risks embedded in this belief when holding containers for this population.
One of the more clinically significant issues with these tropes is how they can lead people to misattribute psychological limitations to the medicine itself. For example, when someone says, “If I didn’t go deeper, it must be because the medicine didn’t want me to,” it can obscure what’s actually happening in their nervous system—such as dissociation, structural defenses, or the absence of an internalized good object1. Instead of exploring these underlying factors with skillful support, clients and facilitators alike may bypass important clinical material, assuming the limitation is mystical or fated, or continue to do medicine work with the hopes of “readiness” in the next session.
This brings me to another point. These tropes often position people in a kind of passivity, deferring agency to the medicine and its supposed agenda. On the other side of this lies a common proactive approach to respond to these perceived limitations — tweak dosage, adjust frequency, or stack compounds. If mushrooms didn’t “break through,” maybe adding ayahuasca will. My concern isn’t with these pharmacological approaches or the invitation to trust the medicine, since they can be useful when offered thoughtfully and in the right context. The deeper issue is when psychological constraints—such as dissociation, structural defenses, or the absence of an internalized good object—are overlooked, while the medicine’s intent is overly emphasized or mystified. This can obscure what's actually needed for integration and healing, and in some cases, lead to repeated psychedelic experiences that deepen disconnection rather than resolve it.
Here are some ways psychological constraints may present in a psychedelic session or post-session:
Diminished affect or limited immersion — The experience can feel like standing on a frozen lake: you can see vague sea creatures (affect, content, sensations) moving beneath the surface, hear the muffled resonance of their bodies bumping against the ice, but you can’t drop in. The lake stays frozen, likely due to dissociation, keeping the person on the outside of their own emotional world. This can be mistaken for a confounding or “uneventful” session when it may actually indicate how well-defended or fragmented the system is.
The “rubber band effect” — Sometimes the medicine temporarily overrides protective defenses and allows deep unconscious material to emerge, only for the psyche to snap back into old symptoms, protective structures, or even intensified dysregulation afterwards. This rebound can feel more turbulent than the pre-medicine baseline. It often reflects a lack of an internal infrastructure or the proper container necessary to metabolize and hold what was unearthed. Without a strong internalized good object or relational anchor, there is a limit to what our psyche can integrate.
The psychedelic cul-de-sac — Some clients reliably land in a psychological “corner” during sessions: a place filled with intensity (big charge, mixed emotions, overwhelming sensations) that gives the appearance of depth and progress. But over time, this territory proves repetitive and circular. Despite catharsis or emotional expression, nothing reorganizes or completes. It becomes a kind of affective purgatory: compelling, dramatic, even bonded-to, but ultimately static. This can reinforce frustration, foster dependency on the medicine, deepen hopelessness, or prompt attempts to force progress through higher doses or sheer will.
Outside of the blind spots this trope creates for the mental health community, I also find the phrase fundamentally inaccurate for some. I know people who dove headfirst into the psychedelic world only to find themselves stuck in that grey area between destabilization and decompensation for years afterwards. Destabilization can be a necessary and even productive state when trauma is being processed within the right conditions and container. But crossing into decompensation usually signals that those very conditions are missing, making the emergence of unconscious material more disorganizing than healing. When we outsource all our trust to the medicine to decide when to pause, we risk overriding our own internal signals—the very ones that were adaptively ignored for many in the population I’m speaking of.
The reality is that many people are seeking out psychedelics to resolve developmental and complex trauma, sometimes without fully recognizing the extent or nature of what they carry. My intention is not to discourage exploration of psychedelics, but to advocate for a more discerning, psychologically informed lens, especially in trauma-affected populations. For clinicians, this means staying curious about what might be driving a client’s engagement with these experiences, recognizing when sessions reflect protective structures rather than transformation, and supporting integration with an eye toward both the nervous system and primary consciousness2. It means being attuned to the difference between destabilization that leads to healing, and disorganization that signals a lack of necessary internal or external conditions. By understanding the deeper architecture of what shows up in psychedelic sessions, we can better support our clients in moving toward true resolution, rather than just revisiting the same terrain in a different altered state.
Psychedelic healing isn’t about forcing depth or waiting passively for transformation to arrive. It’s about building the internal and relational conditions that make real integration possible—during and after the session. As clinicians, our task is not to interpret what the medicine “chose” to reveal, but to stay present with what the nervous system is actually communicating and the unspoken words within the relational field. When we meet that material with precision and care, we open the door to lasting change—not just altered states.
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1 Internalized Good Object: A mental representation of a reliable, nurturing caregiver internalized during early development, which provides a template for emotional security and healthy relational functioning.
2 Primary Consciousness (Robin Carhart-Harris): A fundamental, immediate mode of awareness involving raw sensory and emotional experiences, without reflective thought or conceptual processing.
