Mind Introspection and Therapeutic Relationship in Psychedelic-Assisted Psychotherapy. An Enhancement, Not a Revolution

Psychedelic-assisted psychotherapy (PAP) is a mental health intervention that combines the administration of a psychedelic substance, such as psilocybin, with psychotherapy. PAP was extensively studied and valued for its therapeutic potential as early as the 1950s and 1960s, before being abruptly discontinued due to restrictive and dogmatic U.S. regulations that rapidly spread worldwide. Over the past two decades, however, we have witnessed a «psychedelic renaissance», marked by a renewed and robust wave of research on PAP and growing evidence for its effectiveness across a wide range of mental disorders. In this essay, I argue that the innovation of psychedelic treatment – that could be an efficient answer to the therapeutic non-adherence, and to drug-resistant mental diseases – lies in its paradoxical function as a «channel-drug», rather than in its seemingly revolutionary character. Far from constituting a psychiatric revolution, in my opinion PAP should be understood as an enhancement of the conceptual and methodological foundations of existing psychotherapies, particularly analytic, psychodynamic, and cognitive-behavioral approaches. I contend that no single psychotherapeutic model – especially not CBT, as some scholars suggest – should be privileged, since the clinical framework of PAP aligns more naturally, and perhaps more coherently, with the psychodynamic tradition. In other words, the promising outcomes of psychedelic treatment in conjunction with psychotherapy do not establish a new psychiatric paradigm. Instead, they reinforce the foundations on which both psychodynamic therapy and CBT are built, beginning with the concept of the therapeutic alliance, articulated through the now-classic processes of transference, countertransference, attachment, and interpretation.