Supportive presence during ceremony

Criterion 26 completes the ceremony function with the practice of staying present throughout a participant's experience. The relationship developed during preparation now has to support someone who may have little capacity or desire for conversation. The facilitator offers reassurance when it is needed, respects the agreements made about touch, and continues watching for signs of distress. The teaching draws on Rogers' account of the therapeutic relationship and later research on empathy and positive regard. These sources help explain the value of compassionate presence while leaving room for the other factors that affect care.

Learning Objectives

By the end of this module, the trainee will be able to:

• Explain what distinguishes in ceremony attending from the alliance building of the earlier relational criteria.
• Describe the therapeutic conditions discussed by Rogers and the findings of later research on empathy and positive regard.
• Maintain a calm, steady, non judgmental presence through silence, difficulty, and chaos.
• Offer brief grounding guidance suited to the participant's needs.
• Offer reassurance in difficult moments, including the rules governing supportive touch.
• Monitor safety throughout the session, using the procedures developed in Criteria 1 and 2.
• Hold the experience without interpreting it, deferring meaning making to integration.
• Regulate the facilitator's own inner state, since presence begins with the facilitator's own steadiness.
• Assess sensory preferences, respond to discomfort during ceremony, and explain the evidence and limits around later use of sensory reminders.

Key Terms

Ceremonial attending behavior. Sustained attention to the participant during ceremony, including observation, reassurance, guidance, and practical support suited to their condition.

Compassionate presence. A calm, empathic, non judgmental way of being with a participant that communicates safety, drawing on the core therapeutic conditions of empathy, positive regard, and genuineness.

Therapist conditions. Empathy, unconditional positive regard, and congruence are three of the six conditions Rogers (1957) proposed for therapeutic change. Later research examines their relationship with outcomes.

Nondirective presence. Attentive support that leaves the participant room to experience and describe what is happening in their own terms.

Minimal guidance. Brief grounding cues, such as a reminder to breathe or return to an intention, offered when appropriate to the participant's needs.

Supportive touch. Grounding physical contact used only where explicit consent was established beforehand, governed by clear rules, and never assumed in the moment.

Deferring interpretation. Allowing the experience to unfold and returning to questions of meaning during integration, when the participant can lead that conversation.

Facilitator self regulation. The facilitator's management of their own inner state, since a steady presence depends on the facilitator's own centeredness and is undermined by their distraction or anxiety.

Sensory cue. A sound, smell, image, taste, or physical sensation that can become associated with an experience and later bring aspects of it to mind.

Core Teaching

Staying present during the ceremony

During preparation, much of the relationship develops through conversation. The participant asks questions, explains concerns, and has time to decide whether they trust the facilitator. During the ceremony, that same relationship may have to carry the person through hours when ordinary conversation is difficult. They may be frightened, absorbed in a memory, or unable to explain what is happening. A facilitator who stays close and pays attention gives them someone to turn to without requiring them to interrupt the experience.

That requires some tolerance for discomfort on the facilitator's part. Watching someone struggle can bring up an urge to fill the silence or make the feeling stop. Before acting on that urge, consider what the participant is communicating and whether help is needed. Distraction, visible anxiety, or judgment can leave them feeling that they have to manage the facilitator as well as themselves. Calm attention allows the facilitator to notice changes, offer support, and give the participant room to continue.

The preparation conversation can make this kind of attending more personal. Ask how the participant usually lets someone know they need help, whether being watched feels reassuring or uncomfortable, and what they tend to do when words become difficult. Someone may go quiet when frightened. Another may smile and agree while feeling overwhelmed. Record the preferences that affect care and make sure the people attending the session know them. During the experience, those earlier answers give the facilitator a starting point, while the participant's present response continues to guide the contact.

The MAPS treatment manual describes an approach in which therapists allow the participant's process to develop and offer more active help when circumstances call for it (Mithoefer, 2017). Its instructions were written for MDMA research with people experiencing PTSD. When drawing from that manual in another setting, explain the adaptation and retain the safeguards appropriate to the actual substance, participant, and program. The manual offers a developed account of therapeutic practice; its inclusion of a particular technique does not establish that the technique independently improves outcomes.

Compassionate presence and the therapeutic relationship

Rogers (1957) described empathy, unconditional positive regard, and congruence as part of the relationship that supports therapeutic change. In practice, empathy means trying to understand what the person is experiencing. Positive regard means continuing to treat them with respect when difficult material emerges. Congruence concerns the therapist's capacity to be present as themselves, without performing a response they do not feel. Those qualities give a useful basis for the kind of presence expected during ceremony.

Rogers proposed six necessary and sufficient conditions for therapeutic change; these three describe the therapist's contribution within that broader account. Later meta analyses found associations between outcomes and therapist empathy and positive regard (Elliott et al., 2018; Farber et al., 2018). Those findings support attention to the relationship, but they do not establish that warmth alone is sufficient treatment. The participant, the intervention, and the circumstances of care also contribute. Applying this literature to ceremonial attending is a clinical use of general psychotherapy research, and it should be described that way.

Guidance that is minimal and grounding

A participant who is deeply absorbed in an experience may find repeated questions or explanations disruptive. Often, a brief reminder to breathe or an invitation to return to an intention is enough to help them regain their footing. Offer a few words, then allow time to see how the person responds. Guidance can become intrusive when the facilitator continues speaking simply because silence feels uncomfortable.

Remaining quiet still involves active observation. The facilitator follows changes in breathing, movement, contact, and distress while staying available to respond. If a person can continue safely, there may be no reason to intervene further. If distress is escalating or a medical concern appears, the response changes. Restraint depends on attention and judgment throughout the session.

Suppose a participant keeps removing an eyeshade and looking toward the doorway. The facilitator could ask, “Is something in the room bothering you?” The participant might need the bathroom, want to see who is nearby, or feel frightened by having their eyes covered. A discussion about avoidance would be premature. Once the immediate need is understood, offer an appropriate adjustment and observe its effect. This small exchange can prevent the facilitator from building an interpretation around a practical problem.

Breathing suggestions also need to remain responsive. A person who finds attention to breathing uncomfortable may prefer looking around the room or hearing a familiar voice. Ask before continuing an exercise, and leave room for a different response. An invitation to open the eyes, change position with assistance, or pause the music may be easier to follow than a request to describe an internal experience. Give one suggestion at a time so the participant has a reasonable chance to understand and respond.

Attending to sound and the other senses

The participant spends the ceremony in a room that staff have helped arrange. The volume of the music, a fragrance in the air, the pressure of an eyeshade, and the feel of a blanket are all part of that experience. Preparation should include a conversation about sensory preferences and previous difficulties. Ask about hearing needs, sensitivity to light or noise, asthma, reactions to smoke or fragrance, and any sensory reminders the person already knows can be upsetting. Find out how they would like to request a change if speaking becomes difficult. Preferences can change during the session, so an earlier agreement needs to remain open to revision.

Kaelen et al. (2018) interviewed 19 participants in a psilocybin study for depression. Eighteen described welcome influences of music, and ten described unwelcome influences. Accounts included support and emotional connection, as well as irritation, fear, and a sense that the music did not fit what was happening. These categories could occur in the same person. The study gives us direct accounts of music affecting a session; its small, uncontrolled design does not establish which playlist or volume will produce a particular outcome.

Check the sound from where the participant will actually sit or lie down. A speaker close to one person may be much more forceful than it sounds across the room. Headphones also need an individual comfort check. Music should be audible enough for someone who wants to follow it, at a level they can comfortably tolerate. When it is difficult to hear, ask whether they want an adjustment. Silence may also be their preference. The research cited here provides no therapeutic minimum volume, and staff should avoid treating greater loudness as a way to deepen the work. Ordinary hearing protection still applies during an altered state.

Agree on a simple way to ask for quieter music, a different selection, or a pause. Check tracks for abrupt changes in loudness and make sure someone can reach the controls promptly. Ask about lyrics, religious content, and personal associations that may affect the person’s response. In a group, plan for differing needs before the session, including how someone can receive support in a quieter area without losing supervision. If a participant covers their ears or repeatedly removes headphones, make contact and ask what is uncomfortable. They should be able to request a change without having to explain the meaning of their distress.

Scent, smoke, and physical comfort

Incense and burning herbs introduce an exposure into shared air. In a study comparing 109 temple workers with 118 church workers, Ho et al. (2005) found more chronic cough and acute nose and throat irritation among the temple workers. That study concerned occupational exposure and cannot quantify the risk of a particular ceremony. It does give a reason to take irritation seriously. Sage and other ceremonial plants also require an individual discussion about tolerance; their cultural significance cannot tell us how a particular participant’s airways will respond.

Discuss any planned burning or fragrance use beforehand, including with people sharing the room. A practical starting arrangement is a room without smoke or added fragrance, with any proposed addition considered in light of the group’s needs and consent. Include perfumes, cleaning products, and scented bedding in that review. If someone reports discomfort, stop the source and arrange appropriate ventilation or supported movement to cleaner air. Adding another scent to cover the first makes it harder to remove the exposure. Coughing, wheezing, or difficulty breathing needs attention under the medical procedures in Criteria 1 and 2.

The same attention extends to light, temperature, clothing, and contact with surfaces. Offer a lighting adjustment if glare is uncomfortable, and explain how the participant can remove an eyeshade. Ask before adding a blanket or changing its position. A person may prefer an ordinary object to hold, space around their body, or a familiar voice. Taste belongs in the preparation discussion when food or drink is part of the setting. Do not introduce a strong flavor or an unfamiliar substance as a grounding technique without agreement and the relevant safety checks. Keep these adjustments simple enough that the participant can tell you whether they help.

Sensory memories after the ceremony

A piece of music or a smell may later bring back something of the session. Janata (2009) studied how familiar music evokes autobiographical memories and engages brain regions involved in relating experience to the self. Herz (2004) found that odor cues evoked more emotional autobiographical recollections than corresponding visual or auditory cues in the task studied. These were general memory studies. They support taking sensory reminders seriously when discussing what a participant carries away from a ceremony.

Associations can also develop around fear. In a human laboratory experiment, Li et al. (2008) found that aversive learning changed participants’ discrimination of odor cues and patterns of activity in olfactory cortex. Applying that finding to ceremony requires caution: the experiment did not study psychedelic sessions. It makes it reasonable to consider whether a cue present during frightening experiences could later be upsetting. A participant who asks for a sound or scent to stop should receive a response at the time. Staff cannot assume that continued exposure will turn it into a helpful association.

During integration, ask which sensory details the participant remembers and how they feel about encountering them again. If they want to revisit a piece of music, agree on a manageable setting and an easy way to stop. They might listen briefly, notice what comes up, and discuss or write about it afterward. Scent requires the same choice and attention to physical tolerance. The proposal that replaying these cues renews psychedelic neuroplasticity remains a hypothesis; the cited studies establish no such effect. A useful return to a memory or feeling can be described in the participant’s own terms without assigning it an unmeasured brain mechanism.

Reassurance, and the rules on touch

Reassurance should fit what is happening. A frightened participant may benefit from hearing that someone is beside them, that they can take their time, or that they can breathe along with the facilitator. The guiding principles introduced in Criterion 25 provide familiar language to return to. Avoid promising that everything is safe before assessing the situation; reassurance needs to remain believable when the participant is distressed.

Supportive touch requires explicit agreement during preparation about the type of contact, its purpose, and how the participant can decline or end it. An altered state can make a new request for consent difficult to evaluate, so the facilitator follows the boundaries already established. Prior agreement also leaves the participant free to refuse contact in the moment. Before touching, use the confirmation signal agreed upon, and stop if the participant withdraws, freezes, or otherwise appears uncomfortable. When prior consent is absent, offer support through voice and presence. These requirements apply to supportive contact; an emergency follows the site's established response procedures.

Continuous, discreet safety monitoring

The facilitator continues monitoring wellbeing throughout the ceremony, including when a participant appears settled. Watch for medical distress, psychological distress that is becoming unsafe, and behavior that could injure the participant or someone nearby. The pharmacological hazards taught in Criteria 1 and 2 remain relevant during this quieter work. A calm room does not remove the need for observation.

Monitoring can usually be carried out without standing over people or repeatedly interrupting them. Position yourself where you can observe, check as required by the setting, and explain necessary assessments in a calm manner. If a safety concern develops, address it promptly, even when doing so disrupts the atmosphere. Criterion 23 established this responsibility when preparing the space, and it continues for the duration of the ceremony.

Attending in a group requires an agreed division of responsibility. Before the session, identify who is watching each participant, how staff will request assistance, and who will take over when someone needs a break. A participant receiving quiet support can disappear from the attention of the wider team if everyone assumes somebody else is responsible. During a handoff, communicate what has changed, what the participant has requested, which support was offered, and whether clinical assessment is underway. Include the participant in the introduction whenever possible so that a new face does not arrive without explanation.

Notes should describe what staff could actually observe. “Asked twice to leave the room and said the music felt threatening” gives the next facilitator useful information. “Resisting the process” leaves them with an interpretation and little account of the event. Record the response to an adjustment as well. The same information can help the participant discuss the session later, especially if their memory is incomplete or different staff members saw different parts of it.

Interpretation and the facilitator's own state

A participant may say something that seems meaningful to the facilitator. That does not require an interpretation during the experience. Suggesting what a vision represents or why a memory has appeared can influence a person who is unusually receptive to the facilitator's words. Stay with the participant's immediate needs and return to meaning during integration, where they can consider it in their own time. The integration planning in Core Function VI and counseling work in Core Function VIII provide places to develop those questions.

The facilitator also has to monitor their own condition. Anxiety, distraction, fatigue, and personal distress can affect how they respond to a room. Preparation may include breathing, grounding, consultation with colleagues, or another practice that helps them arrive ready to work. If they cannot attend reliably, they need support or a change in responsibility. Participants should not have to compensate for a facilitator who is unable to remain attentive.

The facilitator's wording deserves the same care as their physical conduct. In a small placebo controlled study involving ten healthy volunteers, LSD increased suggestibility on the measure used by the researchers (Carhart-Harris et al., 2015). That finding supports caution about authoritative suggestions, although it does not establish the degree of suggestibility for every person or substance. When a participant describes a figure, a memory, or an unfamiliar bodily sensation, ask what they need and let their account remain their own. A confident explanation from the facilitator can become difficult for them to question.

Phelps (2017) includes therapist self awareness and ethical integrity among proposed competencies for psychedelic therapists. A useful supervision exercise is to examine a moment when the facilitator felt particularly effective, protective, or indispensable. What did the participant ask for? What did the facilitator add? Could the participant comfortably decline? These questions allow the practitioner to examine an intervention that felt caring while still checking its effect on the person receiving it.

After a difficult passage, ask the participant about the support when they are ready to discuss it. They may have appreciated the facilitator's presence and disliked a particular phrase or movement. Receive both parts of that account. Agree on changes, document them, and communicate them to the team. Their feedback can improve later care even when the original intervention seemed reasonable at the time.

Personal care during the session

A participant may need help reaching the bathroom, changing damp clothing, or adjusting a menstrual or continence product. Discuss likely needs privately during preparation and ask who they would feel comfortable receiving help from. Find out what they can usually do themselves, what assistance they want, and how they will indicate that they need privacy or want someone to stop. A preference recorded earlier helps the team prepare; the person’s willingness still needs to be checked when assistance is offered. The planning requirements in Criteria 23 and 30 should be familiar to everyone attending the session.

Describe the next action before moving closer or touching clothing. Offer the least assistance needed and allow the person to do what they can comfortably manage. If they pull away, become still, or cannot answer clearly, pause and check what is happening. Silence cannot establish agreement. Keep the person covered where possible, limit the number of staff involved, and use the program’s trained personal care procedures. An urgent medical need requires the emergency response appropriate to the situation and the staff member’s role. A facilitator’s wish to be helpful does not establish competence to perform a transfer or intimate care task.

When staff change, pass on the practical agreement discreetly: who is helping, how the participant requests assistance, and any adjustment still needed. Include the participant in that conversation when possible. Avoid asking them to repeat sensitive information to each new person or discussing it within hearing of the group. Check afterward whether the assistance was comfortable and whether the arrangement should change.

Clinical and Decision Tools

Tool 1. Therapeutic conditions in practice

Rogers' three therapist conditions provide a way to examine the quality of attending. Empathy and positive regard have support in general psychotherapy research, including the meta analyses cited in this module.

Tool 2. The attending stance: what to do, what to avoid

Use these examples to consider when a participant needs words, practical assistance, or quiet company.

Tool 3. Reassurance and the touch rule

Match reassurance to the participant's response. Any supportive touch must follow the consent arrangements established before the session.

Tool 4. Ceremonial attending checklist

Use this checklist before and during the session. Pay particular attention to the agreements about touch and to changes that require a safety response.

Worked Example: Attending Through a Difficult Passage

This fictional example follows the application of the practices discussed in this module.

Context: Midway through a group psilocybin ceremony, a participant becomes visibly frightened, breathing fast, gripping their blanket, clearly moving into a hard passage.

Initial contact: The facilitator approaches calmly, assesses the participant's condition, and sits nearby. The participant can see that someone is available without being surrounded or crowded.

Sensory check: The participant looks toward a speaker and says the music feels too forceful. The facilitator asks whether they would like it quieter or paused, then lowers it at their request. Another staff member remains available to the group. The facilitator continues checking the participant’s condition and asks whether the change helped.

Guidance: After checking for an immediate safety concern, the facilitator says, “I'm right here. Would it help to breathe with me?” They allow the participant time to respond and remain close without adding a stream of instructions.

Touch: During preparation, the participant agreed that a hand on the shoulder could be offered for grounding. The facilitator uses their agreed confirmation signal before making contact and remains alert for discomfort or withdrawal. Without prior agreement and present confirmation, support would continue through voice and presence.

Allowing the experience: The participant says a name and begins to weep. The facilitator allows time for the emotion and checks whether support is needed. Questions about the name and its meaning can wait until the participant is ready to discuss them during integration.

Safety checks: The facilitator continues observing breathing, responsiveness, and physical safety. Breathing gradually settles, and no immediate medical concern is apparent. The assessment remains ongoing.

Afterward: The participant says that having someone calm beside them helped them stay with the experience. The facilitator invites them to describe what felt helpful and whether anything should be handled differently in future sessions.

At the next integration meeting, the facilitator asks about the sequence without supplying a meaning for it: “You looked toward the door before you began crying. Do you remember what was happening then?” The participant explains that they had been worried about interrupting the group to ask for help. Together they agree on a simple signal for future contact. The facilitator records the preference and brings the staffing arrangements to supervision, where the team considers whether participants have enough ways to request support quietly.

Case Vignettes

For each vignette, identify the concern, consider the client’s needs, and describe how you would respond. Use the companion worksheet when available, or record your responses separately.

Vignette A

A participant enters a difficult passage, and the facilitator, uncomfortable with the distress, begins talking them through it in detail, asking questions and offering explanations. The participant is pulled out of their process and cannot return to the depth they were in.

Guided questions: What did the facilitator notice about their own discomfort? How did the amount of talking affect the participant? What support could have been offered with fewer words?

Vignette B

Seeing a participant in distress, a facilitator places their hands on the participant to comfort them, without any prior consent to touch having been established. The participant, in a vulnerable state, freezes and feels violated.

Guided questions: What rule did the facilitator break? Why is in the moment consent unreliable in an altered state? How should reassurance have been offered instead?

Vignette C

A facilitator repeatedly stands over participants and questions them in a manner that makes several feel watched and uneasy. The facilitator has not explained the monitoring procedures or considered how their proximity is being experienced.

Guided questions: How could staff explain and carry out necessary monitoring? What could they change about their manner or proximity? How would they respond if a medical concern required closer observation?

Vignette D

As a participant describes a vision, the facilitator offers an interpretation of what it means, explaining the symbolism in the moment. The participant adopts the facilitator's frame, and their own emerging meaning is lost.

Guided questions: How did the interpretation influence the participant? What could the facilitator say at this point? When could the participant explore the meaning in more depth?

Vignette E

A facilitator arrives at the ceremony anxious and distracted by events in their own life, unable to settle. Their unease is palpable to the participants, several of whom become agitated, picking up the facilitator's ungrounded state.

Guided questions: How might the facilitator's state affect their work? What support or preparation was needed? When should a facilitator ask another team member to take over?

Role Play and Practice Scripts

Practice in pairs, then switch. One simulates a participant in a difficult passage. The aim is steady presence, minimal grounding words, and engaged restraint. Note: practice regulating your own state first.

Offering brief grounding support

One partner portrays a frightened participant. The facilitator first checks what is happening, then offers a brief phrase such as, “I'm here with you. Would you like to breathe with me for a moment?” Allow silence afterward. Discuss whether the response felt reassuring and whether additional words would have helped.

Reassurance when there is no prior touch consent

The participant is frightened, and no agreement about supportive touch was made during preparation. Practice sitting nearby and saying, “I can stay here with you. Tell me if you need something.” Use your tone, position, and attention to provide support while respecting the existing boundary.

Holding without interpreting

The participant describes something vivid and asks what it means. Practice responding, “We can come back to that when you're ready. For now, how are you doing?” Remain available without supplying an explanation of the experience.

Regulating your own state first

Before taking the facilitator role, notice your breathing, posture, and attention. Take time to settle and identify anything that could interfere with the session. Practice telling a colleague when you need support or a brief handover, then discuss how the team would maintain coverage.

Responding to a sensory preference

One partner says the music has become uncomfortable and that the scent in the room is making them feel sick. Practice acknowledging the request, checking for a physical concern, and explaining the adjustments you can make. Use spoken descriptions only; do not introduce smoke, strong scents, or loud sound into the exercise. Afterward, discuss how the participant could make the same request with very few words.

Personal care during the session

A participant agreed during preparation to bathroom assistance but now pulls away when the designated staff member approaches. Practice pausing, checking their wishes, and finding an appropriate alternative while maintaining support. Explain what would change if an immediate medical emergency developed.

Self Assessment and Reflection

Knowledge check

Explain what distinguishes in ceremony attending from the alliance building of the earlier relational criteria.

Name the three therapist conditions within Rogers' six condition formulation and describe what the later research cited here examined.

Explain why guidance in ceremony is minimal, and what engaged restraint means.

State the rule governing supportive touch and why in the moment consent is unreliable.

Describe how you would carry out necessary safety monitoring and explain it to participants.

Explain how to support an experience while leaving interpretation for the participant to explore during integration.

Describe the facilitator's responsibility for attending to their own readiness and seeking support when needed.

A participant wants to use the session playlist during integration. What would you ask about their associations with it, how would they control the listening, and what could you accurately say about memory and neuroplasticity?

Reflection

When someone near you is in distress, is your instinct to do something or to be steady? How will you practice engaged restraint?

How grounded can you stay when others are in intense distress? What practice will you use to regulate your own state before and during a ceremony?

Where might you be tempted to interpret or to reach for touch? How will you hold those boundaries?

Summary

Ceremonial attending requires sustained attention to the participant and to the conditions around them. The relationship developed before the session now supports someone who may be unable to explain what they are experiencing. Rogers' account of empathy, positive regard, and congruence gives a useful foundation for that relationship, with later research supporting associations between empathy, regard, and therapeutic outcomes (Rogers, 1957; Elliott et al., 2018; Farber et al., 2018).

In practice, the facilitator offers brief guidance when needed, follows the agreements about touch, and leaves interpretation for integration. Observation continues through periods of both quiet and distress. A safety concern calls for an appropriate response even if it interrupts the ceremony. The facilitator's own preparation and regulation are part of this responsibility, because reliable support depends on being able to stay attentive throughout the session.

References

Sources

Carhart-Harris, R. L., Kaelen, M., Whalley, M. G., Bolstridge, M., Feilding, A., & Nutt, D. J. (2015). LSD enhances suggestibility in healthy volunteers. Psychopharmacology, 232, 785–794. https://doi.org/10.1007/s00213-014-3714-z

Elliott, R., Bohart, A. C., Watson, J. C., & Murphy, D. (2018). Therapist empathy and client outcome: An updated meta-analysis. Psychotherapy, 55(4), 399–410. https://doi.org/10.1037/pst0000175

Farber, B. A., Suzuki, J. Y., & Lynch, D. A. (2018). Positive regard and psychotherapy outcome: A meta-analytic review. Psychotherapy, 55(4), 411–423. https://doi.org/10.1037/pst0000171

Herz, R. S. (2004). A naturalistic analysis of autobiographical memories triggered by olfactory visual and auditory stimuli. Chemical Senses, 29(3), 217–224. https://doi.org/10.1093/chemse/bjh025

Ho, C.-K., Tseng, W.-R., & Yang, C.-Y. (2005). Adverse respiratory and irritant health effects in temple workers in Taiwan. Journal of Toxicology and Environmental Health, Part A, 68(17–18), 1465–1470. https://doi.org/10.1080/15287390590967405

Janata, P. (2009). The neural architecture of music-evoked autobiographical memories. Cerebral Cortex, 19(11), 2579–2594. https://doi.org/10.1093/cercor/bhp008

Kaelen, M., Giribaldi, B., Raine, J., Evans, L., Timmerman, C., Rodriguez, N., Roseman, L., Feilding, A., Nutt, D., & Carhart-Harris, R. (2018). The hidden therapist: Evidence for a central role of music in psychedelic therapy. Psychopharmacology, 235(2), 505–519. https://doi.org/10.1007/s00213-017-4820-5

Li, W., Howard, J. D., Parrish, T. B., & Gottfried, J. A. (2008). Aversive learning enhances perceptual and cortical discrimination of indiscriminable odor cues. Science, 319(5871), 1842–1845. https://doi.org/10.1126/science.1152837

Mithoefer, M. C. (2017). A manual for MDMA-assisted psychotherapy in the treatment of posttraumatic stress disorder (Version 8.1). Multidisciplinary Association for Psychedelic Studies. https://maps.org/wp-content/uploads/2022/05/MDMA-Assisted-Psychotherapy-Treatment-Manual-V8.1-22AUG2017.pdf

Phelps, J. (2017). Developing guidelines and competencies for the training of psychedelic therapists. Journal of Humanistic Psychology, 57(5), 450–487. https://doi.org/10.1177/0022167817711304

Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103. https://doi.org/10.1037/h0045357

Related workbook material

Guiding principles for participants: Criterion 25.

Pharmacological safety and monitoring: Criteria 1 and 2.

Safety in the ceremonial setting: Criterion 23.

Integration and exploration of meaning: Criteria 19 through 22.

Consent and professional roles: Criteria 2, 3, and 4.

Evidence and application

Rogers proposed six conditions, including three concerning the therapist. The later meta analyses cited here examine empathy and positive regard in general psychotherapy. Their application to ceremonial attending requires clinical judgment.

The sensory additions combine a small psychedelic interview study with research on ordinary autobiographical memory, laboratory odor learning, and occupational incense exposure. The suggested room checks and practice exercises are applications of that evidence and of participant consent. They have not been tested together as an intervention. No optimal therapeutic sound level or renewal of psychedelic neuroplasticity through sensory cues is established by these sources.