Holding the Trip and Holding Yourself: Vicarious Effects of Mystical Experiences in Psychedelic-Assisted Therapy
In psychedelic-assisted therapy, the idea of "holding space" extends beyond the client's experience of their altered state. It also refers to how therapists hold their own inner space while witnessing these profound sessions. The vicarious effects—emotional, spiritual, and existential reverberations therapists experience—can deeply affect their own psychological well-being and professional identity.
Therapists in this field often encounter clients' mystical experiences that challenge their own beliefs and worldviews. These encounters demand a kind of emotional and intellectual flexibility, a readiness to hold space for experiences that may be unfamiliar or even unsettling. This article explores the impact of these vicarious experiences, how therapists manage them, and why recognizing their effects matters for both therapist and client.
Witnessing Mystical Experiences That Diverge from Your Own Beliefs
Many clients in psychedelic-assisted therapy report experiences rich in spiritual or religious symbolism, sometimes drawing from traditions completely foreign to the therapist. This can create what psychologists call "ontological dissonance," where the therapist faces realities or meanings that feel strange or contradictory to their own understanding of the world.
This phenomenon isn't unique to therapy. For example, religious leaders participating in a recent study described encounters with spiritual content outside their own faith traditions—like Aztec gods or feminine divinity. Similarly, therapists may witness clients who interpret their experiences through theological, metaphysical, or fantastical lenses that the therapist doesn't share.
Holding space in this context means accepting the client's meaning without trying to prove or disprove it. The skill lies in prioritizing curiosity over confirmation—encouraging clients to explore their experiences authentically without the therapist needing to validate those experiences based on their own worldview.
The Myth of the "Necessary" Mystical Experience
Popular culture often equates psychedelic-assisted therapy success with having a peak mystical experience—moments of awe, unity, or transcendence. But data suggest this expectation doesn't fit everyone. Studies show that while approximately 96% of participants report profound spiritual experiences during sessions, this is not universal, nor is it necessary for therapeutic benefit.
Therapists have an important role in dismantling the myth that only extraordinary mystical states lead to healing. Instead, they can focus on promoting cognitive flexibility—the ability to adapt one's thinking and openness to new perspectives. This flexibility is a key factor mediating positive outcomes in therapy, often more so than any singular mystical moment.
It's also essential to hold space for clients who find their experience "flat," confusing, or disappointing. These reactions are valid and can still be part of meaningful progress. Recognizing and normalizing this helps prevent feelings of failure or inadequacy in both client and therapist.
The Vicarious Impact of Listening to Awe and Despair
Therapists often find themselves deeply affected by the emotional weight of what clients share. Some clients recount ecstatic transformations that uplift the therapist; others describe encounters with "the abyss" or intense despair that can shake a therapist's sense of stability.
This empathic attunement can blur boundaries if therapists are not careful. It's a fine line between resonating with a client's experience and becoming overwhelmed by it—an aspect of countertransference. Therapists must develop an awareness of how much emotional resonance is healthy and when it may be too much.
One way therapists manage these vicarious effects is through integration spaces—supervision, peer support, or consultation groups designed specifically for metabolizing these intensely emotional experiences. Without such spaces, therapists risk burnout or compassion fatigue, which can impact therapy quality.
Navigating Power and Influence When Clients Are Spiritually Open
Clients in psychedelic-assisted therapy often enter sessions in a highly suggestible state, emotionally and cognitively open. This openness can make them look to the therapist for interpretation or confirmation of their experiences.
Therapists have an ethical responsibility to avoid imposing frameworks or premature meaning-making. Instead of guiding clients toward any particular spiritual conclusion, therapists act as co-explorers—supporting clients to find their own sense of meaning and integration.
This approach respects client autonomy and guards against the therapist inadvertently becoming a figure of authority or prophecy. Clear boundaries and ongoing reflection help maintain this balance in the therapeutic relationship.
Ethical guidelines for therapists in suggestible client states:
Avoid imposing personal or cultural interpretations on clients' experiences
Support client autonomy in finding their own meaning and integration
Maintain professional boundaries to prevent undue influence
Use reflective questioning rather than directive statements
Seek regular supervision to navigate complex relational dynamics
When the Sacred Turns to Chaos: Holding Clients in Crisis
Not all psychedelic experiences unfold smoothly, and psychedelic-assisted therapy includes protocols for managing difficult or destabilizing experiences. Some clients may experience temporary psychosis, mania, or profound existential collapse during or after psychedelic-assisted therapies. Others might have their fundamental systems of meaning shattered, leaving them in a state of psychological fragmentation or ontological shock.
These crisis situations test therapists' clinical skills while exposing them to intense vicarious effects. Witnessing a client's temporary loss of reality testing or their terror at ego dissolution can be deeply unsettling for therapists, especially those new to the field. Psychedelic-assisted psychotherapy and quality preparation can minimize the occurrence of adverse psychological events during psychedelic administration sessions, but when they do occur, therapists must maintain a calm presence while their clients experience extreme states.
The vicarious impact of holding clients in such fragile states can include therapists questioning their own capacity to help, experiencing anxiety about client safety, or feeling overwhelmed by the intensity of the work. Some therapists report having dreams about client sessions or finding themselves preoccupied with particularly difficult cases.
Therapeutic Humility and the Long Arc of Integration
Many clients experience shifts in identity and meaning long after the initial psychedelic-assisted therapy session. Long-term integration can be unpredictable and nonlinear, with ongoing evolution in how clients understand their experience.
Therapists may witness clients outgrow early narratives, challenging initial interpretations or even their therapist's professional assumptions. This requires humility—accepting that the therapist's role is not to provide answers but to accompany clients over time with openness.
Therapists themselves may also undergo existential shifts, reflecting on their own identity and worldview as a result of their work. Developing patience with this slow transformation is part of maintaining a sustainable practice in psychedelic-assisted therapy.
Final Thoughts
Psychedelic-assisted therapy offers profound healing potential but also places unique demands on therapists. Holding both the client's experience and one's own inner space is a complex, ongoing process. The vicarious effects—emotional and existential reverberations—require attention, boundaries, and integration.
Therapists are called to walk alongside clients with steadiness and openness, not as gurus or prophets but as steady companions in a shared human experience. Reflecting on their own inner processes and professional needs is essential for sustaining this challenging and rewarding work. The future of psychedelic-assisted therapy depends not just on the medicines themselves, but on the quality of presence and preparation that therapists bring to this profound and challenging work.