Category Archives: Psychotherapy

How does psychotherapy work?

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How does psychotherapy work? There’s no simple answer because there are multiple interacting factors. However, something crops up again and again across myriad therapeutic approaches; the capacity to be with an experience rather than being engulfed in it.

I’ll use my Experiential Iceberg model to illustrate how this works. The Experiential Iceberg is a simple but powerful representation of the bodymind. It shows our everyday awareness at the tip of the iceberg, and directly below, our gut feelings. How aware of these feelings we are tends to vary for each of us and in different circumstances.

The Experiential Iceberg

Let’s zoom in on how awareness looks when you’re feeling anxious, depressed or distressed. The first thing to notice is that awareness is stuck at the tip of the iceberg, which is only a tiny part of the bodymind.

The tip of the Iceberg

Anxiety or depression can feel tight or contracted, and in the diagram, the space at the Iceberg’s tip is quite cramped. You’ll notice that gut feelings are leaking in, but the direction is only one way. All these feelings are coming into awareness, but there’s nowhere for them to go; they circle around in this contracted space.

If there’s someone you can talk to about these feelings, the space of awareness tends to expand. Instead of having these feelings – and the thoughts they inevitably prompt – circling your mind, there’s an outlet. Hearing yourself say something can be surprisingly transformative. Sometimes, you hear yourself say something you didn’t realise you knew! The space of awareness expands when you voice your unspoken thoughts and hear their truth. The expanded space provided by being able to express yourself is the start of being with your feelings and thoughts instead of being caught up in them.

This capacity to be with your experience is essential, and different approaches to therapy offer different tools to help develop that ability. Acceptance and Commitment Therapy (ACT), which draws on mindfulness, teaches a strategy called ‘cognitive defusion’. This technique teaches you how to get some distance from thoughts and emotions. Instead of your sense of self being fused with an unhelpful thought, cognitive defusion expands your awareness so that there’s more space. This lets you notice what you’re experiencing and changes how you relate to it.

Ann Weiser Cornell and Barbara McGavin, who teach Focusing, recommend a different way to open up some space. Let’s imagine someone said something that’s upset you. If I asked you how you felt about it, you might say: “I feel really frustrated by what she said”.

Let’s try an alternative:
“Something in me feels really frustrated by what she said”.

Does that feel different? Instead of identifying with your emotions, which often means they overwhelm you, this helps you be with your feelings. You can learn to be present, in the moment and in relationship with your feelings. Remember; you are more than your feelings. You can be with your feelings and not get taken over by them.

To sum up, when we’re stressed or anxious, our experience is stuck at the tip of the Experiential Iceberg. Although we’re not paying attention to the ‘gut feelings’ hovering under the wavy line, they’re still having a significant impact on how we feel and act. When we’re in this state of mind, we’re likely to react rather than respond. The Iceberg tip is quite a tight space, and our awareness tends to get caught up with our experience. There isn’t room to find space between me and my experience. The iceberg tip is a place of contraction that breeds a sense of urgency, but when we open a little to what I call the ‘Deep Body’, we slow down and feel more spacious.

I’ve picked two techniques from quite different therapeutic approaches that can help you find more space in your bodymind. They are an excellent start, but your awareness can expand much more. The first step is to move a little way down the Experiential Iceberg and sense into those mysterious gut feelings. If you choose to drop your awareness further into the Deep Body, then wonders await; healing, spiritual growth and altered states.

The journey begins and ends with greater awareness: How far you decide to travel is up to you.

‘Inner Healing Intelligence’; an embodied therapeutic process

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Psychedelic-Assisted Therapy is already an accepted approach in some parts of the world, and several influential treatment protocols suggest that its healing power is rooted in an ‘Inner Healing Intelligence’ (IHI). The idea of an Inner Healing Intelligence is fundamental to the MAPS protocol for MDMA-Assisted psychotherapy, and the principle is echoed in the draft rules on how to prepare clients for a facilitated psilocybin experience issued by the Colorado Office of Natural Medicine. The rules state that preparation should include a discussion of “the concept of trusting inner guidance”, which may include references to Inner Healing Intelligence, Wise Mind, Soul, etc.

Although the idea of some kind of inner healer is widespread in psychedelic circles – and quite common in psychotherapy – there’s no agreement on what it actually means. Nese Devenot frequently rails against the whole concept of an ‘Inner Healer’, and in a recent article, Jules Evans and Sam Woolfe identify numerous problems with the notion.

Many perceived problems with the idea of an ‘Inner Healing Intelligence’ emerge from the name, as describing something as ‘intelligence’ sets the stage for confusion. It would be far better to talk about a therapeutic process. My PhD thesis identified several processes that helped environmental activists deepen their connection with the more-than-human world and supported their wellbeing (2008). I subsequently realised that the same processes are used in therapy. These processes, which I now call the Embodied Pathways of Connection, are therapeutic because they all enable greater access to our embodied knowing.

Eugene Gendlin was a philosopher and psychotherapist who researched Rogers’s non-directive approach extensively. Gendlin has much to offer to the conversation about IHI, and his somatic experiential model points to that process. Gendlin writes that “your body knows much that you don’t know” (Gendlin, 1981). Those embedded in the Western cultural tradition often baulk at the idea that the body might ‘know’ something. The absurd Cartesian split of mind and body is surprisingly resilient, and Western philosophy is grounded in what Grosz describes as a ‘profound somatophobia’ (Grosz, 1994). However, evidence of the importance of embodied ways of knowing can be found in a diverse range of disciplines, including anthropology, business studies, cognitive neuroscience and religious studies (Harris, 2024).

Psychedelics can facilitate the kind of embodied experiential knowing that I’m talking about. Mat, one of the participants in the first Imperial psilocybin trial, explains:


“Talking therapy helps you believe something to be true. Psilocybin helps you know it to be true. And I think that’s why I felt, in my case, psilocybin worked well for me, because it showed me so much that I now know to be true.”

(Eastall, 2021).

Recent discussions support the idea of IHI as a process that facilitates embodied knowing. In their recent paper on IHI, Peill J, Marguilho M, Erritzoe D, et al. conclude that it can be partly understood as a process “where ordinarily occluded, suppressed or compressed information arises into conscious awareness” (2024).

Jules Evans and Sam Woolfe (2004) invited several therapists to comment on IHI. Dr Inna Zelikman echoes Mat’s experience, stating that psychedelics give “people access to their unconscious material”. Dr Ingmar Gorman, commented that IHI is sometimes called “intuition” or “inner wisdom”. He concluded that we should understand it as “a psychotherapeutic process”. Dr Max Wolff believes we can make sense of IHI within “a coherent scientific model of psychological change” and relates it to the actualising tendency which underpins the Rogerian approach noted above.

I propose that ‘Inner’ more accurately means ’embodied’, ‘healing’ is more precisely rendered as ‘therapeutic’, and the word ‘intelligence’ actually refers to a process. While referring to ‘Inner Healing Intelligence’ may prove to be useful in our conversations with those being treated using Psychedelic-Assisted Therapy, calling it an ’embodied therapeutic process’ is more accurate and facilitates scientific validation.

Psychedelic group psychotherapy

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Just over a year ago, I wrote about the power of community to support psychedelic journeys. It’s well established that psychedelic experiences are characterized by a sense of connectedness, but sharing that journey with others can enhance those feelings. Community is fundamental to indigenous psychedelic healing, and it’s fundamental to the ACER integration program.

Seating in a circle: Room set up for a group psychedelic integration session.
Group psychedelic integration

Two recent research articles move the discussion forward. The first, ‘(Dis)connectedness, Suicidality and Group Psychedelic Therapies‘ (McAlpine & Blackburne), notes that social disconnectedness is a significant risk factor for suicidal thoughts or behaviours. They consider the “potent synergy“ of psychedelic group therapy and suggest that “such a collective space … has the potential to not only awaken a renewed awareness of social support but also to establish a sturdy framework of communal care”.

The second one takes a different route but comes to the same conclusion. ‘Psychedelics and neonihilism – connectedness in a meaningless world’ (Plesa and Petranker) highlights the tension between the “contemporary neoliberal” context most of us live in and the connectedness at the heart of psychedelic healing. The predominant psychological model reinforces this neoliberal ideology because it’s “based on the individual as self-contained, as atomic – a self which fashions itself as separate from the other” (Bhatia, 2020). Plesa and Petranker suggest that psychedelic group psychotherapy could help us overcome modern experiences of meaninglessness. It may offer “a collective confrontation of meaninglessness as a radical departure from individualizing therapeutic practices that further reinforce neoliberal forms of individualization, responsibilization, competition and self-governance”.

I’ve focused on psychedelic experiences here, but any of the embodied pathways of connection can disrupt the alienation fostered by neoliberalism because they reveal that we are fundamentally interconnected.

The Psychedelic Connection

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I’ve been very involved in work and research on psychedelics over the last year or so. I’ve mentioned psychedelics in a few of my posts here, but I wanted to flag up a couple of presentations. The first is online next week: I’m talking about Sacred Ecology: The Psychedelic Connection at the Embodied Spirituality event.

Back in 1996, I wrote Sacred Ecology. Now, nearly 30 years on, I’ll be exploring that territory through a psychedelic lens. Psychedelic experiences can be profoundly spiritual, often inducing mystical experiences. What does this tell us about the power of awe, nature connection and the future of therapy?

I started working as a Facilitator on psychedelic retreats in The Netherlands last year. This involved spending hours supporting people on their psychedelic journeys as well as helping them to prepare for and integrate the experience. Nature connection is widely recommended for psychedelic preparation and integration and as this is a particular interest of mine, I’ve begun to develop and refine this approach. In this presentation at the University of Exeter, I talk about the work I’ve done on psychedelic retreats and explain how we might apply ecotherapy to integration.

Psychotherapy – doing or being?

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There are dozens of different approaches to psychotherapy. My bookshelves overflow onto the floor with books about ACT, CBT, ecotherapy, Gestalt, psychoanalysis and more. But are all these approaches just the decoration on the cake?

Not long after completing my initial training in psychotherapy, I became aware that most other therapists had been taught specific approaches to many of the most common mental health challenges. They’d done modules on what we call ‘presenting issues’ like bereavement, anxiety, depression and whatever else. I felt somewhat confused, as my extensive training – a Masters degree and then Focusing-Oriented Therapy – hadn’t covered any of that. We’d considered some of the key approaches, but in each case highlighting their limitations and the danger of a theoretical ‘frame up’; fitting the client’s unique experience into the frame of a theory.

a big pile of books about psychotherapy

Keen to be a better therapist, I started to learn about all the things I thought I’d missed. I learnt about the techniques I might use to help with specific presenting issues. Then I ‘caught up’ on classic CBT and some of the newer approaches that have emerged from it. But the curious thing is I don’t use techniques very much and I’m beginning to suspect that my original training had it right all along: Psychotherapy isn’t about doing but simply being. What I remember most from my training are the hours we spent in group work and the years of personal therapy. We were being developed as people rather than taught techniques because theory, though fascinating, is just the icing on the cake.

To a large extent, the research backs this up. The Dodo bird hypothesis claims that all bona fide therapeutic approaches have much the same outcomes: “Everybody has won and all must have prizes,” just as the dodo insisted in Alice in Wonderland (Wampold et. al 1997). In fact, the therapeutic relationship is more important than the approach we use: It’s more about who you are than what you do.

Given all that, I’m wondering about the constant flow of new approaches. Almost every month I hear about some new technique which will transform my therapeutic work and will give my clients a unique healing experience. Do I need to sign up for the latest course or would I be better off spending more time just developing my capacity to be present?

Fathers and Sons

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How does a young man test his strength? Like a young stag, he locks horns with his father in a challenge. One of three things can happen next, depending on what kind of man that father is. An aggressive, arrogant father will push back hard and the youngster will be defeated, humiliated and possibly injured. A weak father won’t have the strength to do anything but fall back, leaving his son feeling mild contempt and perhaps confusion. But a strong and grounded father will steadily hold his ground, not pushing against his son but not yielding either. In this ideal case the youngster feels his father’s strength and his love. He can push against his father, testing his own emerging manhood. In this way he comes to learn something crucial about what it is to be a mature male.

My own father wasn’t ideal in many ways but somehow he was good enough at holding his ground against my adolescent challenges without defeating me. When a young man challenges his father, he’s effectively asking a question; “What is it to be a man?” If he gets the wrong answer – arrogant aggression or weakness – he may end up living the rest of his life in response to it.

In my work as a psychotherapist I sometimes see what happens when that adolescent encounter is mishandled. There are weak men, lacking self esteem and often searching for someone to replace their mother. Maybe their father’s answer to their challenge was capitulation, which told them that a man is a weak creature, born to servitude. Or perhaps his father was punishing, telling him that he has no right to challenge authority. The flip side of this weak soul is equally damaged. This is the son whose father taught him that being a man means beating the other guy, even if the contest is unfair. In an attempt to make sense of the way his father crushed him, he builds a strong defense and comes to fear vulnerability more than death itself.

I don’t meet the men whose fathers had the wisdom to stand with firm gentleness, offering strength to push against. They they are the lucky ones who know their place in the world, who feel comfortable in their own skin and know what real strength entails.

How to manage the psychedelic revolution

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The media is full of news about psychedelic therapy this week. There’s the opening of the new Awakn clinic in Bristol, which uses Ketamine to support psychotherapy for depression, anxiety and addiction. Another organization – Small Pharma – are trialing DMT in the UK as a treatment for people with depression. In the USA, Oregon has decriminalized all drugs and Washington D.C. now permits the cultivation and possession of “entheogenic plants and fungi.” It’s perhaps no exaggeration to say that we are at the start of a revolution and things have moved fast since I wondered if psychedelic psychotherapy might be the next big thing in psychiatry a mere 18 months ago.

You’d be forgiven if you have a deja vu feeling about all this; back in the 60’s Timothy Leary and others were proclaiming a psychedelic revolution. Sadly it all went badly wrong, as revolutions so often do. What happened back then and can we learn from the mistakes of those excited pioneers? The main problem was that there was no context for psychedelic experience. Many indigenous cultures have been drawing on the healing power of psychedelics for generations and they provide a supportive context to hold the experience. It’s not simply ‘Tune on, tune in and drop out’!

Context is vital at several levels. Stan Grof, a leading thinker in the field, suggested that psychedelics are “non-specific mental amplifiers of the psyche” (2000), which means that the location and your mindset are key. The psychedelic experience needs to take place in a carefully managed setting and ideally with someone who is there to support you. Most people who work with psychedelics know about set and setting, but there’s a larger context that’s sometimes neglected. Preparation for the experience can make a huge difference and integration afterwards can unpack the deeper significance of the journey. Without integration it’s too easy to miss the potentially life changing lessons of your psychedelic experience. Then there’s the wider social context. You’ve had this extraordinary experience that may well have been mystical in it’s profundity. How do you take that into the rest of your life? Do you have friends or a mentor who understands and supports you? Does your culture affirm or dismiss your experience? While many indigenous peoples have all of these levels of support integrated into the culture, Western Postmodernism most certainly doesn’t!

The good news is that there are organizations and individuals working to create these supportive contexts. There’s a lot to learn but we’re drawing on cutting edge scientific research and, with deep respect, indigenous wisdom. I’ve recently started working as the Director of Ecopsychology at the Synthesis Institute. Synthesis have been running psychedelic retreats in The Netherlands for several years and are now exploring a new approach to help manage depression. My role is to bring the powerful holding and healing of the natural world to this work. Ecopsychology has a lot of offer, especially with preparation and integration but this potential has been largely untapped. Although a special issue of the European Journal of Ecopsychology on the psychedelic experience came out in 2013, it was before the current renaissance in psychedelic therapy.

Psychedelic therapy is complex and requires an interdisciplinary approach that’s very unfamiliar for Western medicine. We need new frameworks, and it’s notable that the psychedelic experience and nature connectedness are two of the embodied pathways of connection; perhaps the EPoC model can help inform the way forward?

So it’s exciting and challenging times! We have a wealth of wisdom and research to draw on as we negotiate this journey. With the revolution well underway, I believe our community can rise to the challenge of creating a holding context for what may be the most powerful experience someone will ever have.

The Therapy Turf Wars

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“My therapeutic approach is better than yours!” All too often therapists with one particular approach criticize one – or all – of the others, and I’m sick of it. CBT is frequently involved in these turf wars, partly because it’s the favourite of the NHS. Some CBT therapists imply that their approach is vastly superior to all others, ignoring the evidence that supports the effectiveness of other schools of therapy. Humanistic therapists frequently respond in kind, suggesting that CBT is shallow, simplistic and unable to tackle deep rooted issues.

Ruby Wax is an especially irritating ‘turf war’ critic. Ruby is a passionate advocate of Mindfulness Based Cognitive Therapy, an approach I have a lot of respect for. Sadly Ruby feels it necessary to dismiss several of the most important ‘rival’ schools of therapy with funny parodies. Carl Rogers developed the Person Centred Approach (PCA) that unpins most Counselling in the UK today. According to Ruby the PCA is about repeating “whatever you said back to you like a parrot but with love” (Wax, 2013). She goes on to dismiss Gestalt, Existential and Psychoanalytic approaches. Ruby; it may be funny, but it’s not clever!

Triggering my ire today is a book about the Human Givens Approach, which claims that the PCA, Psychodynamic school and CBT are all “piecemeal approaches” and that none of them “are sufficient on its own” (Griffin and Tyrrell, 2007). Their solution is, of course, the Human Givens Approach! The research evidence suggests that PCA, Psychodynamic and CBT can all be effective in certain circumstances. CBT is backed by a robust research base and a Person Centred Approach is one of only four therapeutic modalities approved for the treatment of depression under the NHS.

All this frustrates and saddens me. The Human Givens Approach has a great deal to offer and I’ve integrated it into my own therapeutic practice. But I’m galled that those who developed it feel the need to dismiss other approaches as inadequate. It sometimes feels like I’m back in the school playground hearing one kid saying “My Dad’s bigger than your Dad!” Viewing all this though a psychodynamic lens, I wonder if some therapists have unresolved childhood issues?

The parable of the blind men and an elephant
We need a wide perspective

Given that the human mind is the most complex system in the known universe, is it really plausible that one school of therapy will have the definitive and complete answer to every individual’s unique mental health problems? Maybe one day, but most certainly not yet. Meanwhile I’m adopting a pluralistic approach, learning as much as I can about as many different paths to healing as possible. I try to take a wide perspective, asking myself the question; for this particular client, at this specific moment, which therapeutic lens is going to be the most helpful? This is usually called having an ‘integrative’ approach, but I think I’m best described as a pragmatic therapist: My only interest is what works?

Beyond relationship? The power of therapy outdoors

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The relationship between client and therapist is considered by many to be the single most important factor in successful therapy (Loewenthal, 2014). But what happens to that relationship when the therapy takes place outdoors? If you haven’t experienced therapy outdoors, you might wonder why it would make any difference to the therapeutic relationship. Isn’t it just like conventional therapy, but outdoors?

The short answer is, it depends. A few outdoor therapists strive to control the impact of the immediate environment, but most engage with it, often finding that nature becomes a kind of co-therapist. When nature enters into the therapeutic relationship, things get interesting! The client begins to form a relationship with the natural environment as much as with the therapist. The therapist is no longer “the professional with the answers and advice”, but instead becomes an “expert at facilitating therapeutic conversations” (Jordan & Marshall, 2010).

Ecotherapist Martin Jordan suggested that when we work outdoors “the myth that the self is somehow separate from nature becomes exposed as the fallacy it is” (Jordan, 2009). This complicates our understanding of the relationship between therapist and client even more. Once again – as so often in this blog – the question arises of where ‘self’ ends and the ‘other’ begins. But if the ‘self’ becomes “entirely entangled with the Other”, we might “risk losing the difference and thus any possibility of relationship” (Harris, 2013b).

David Key, an ecotherapist I interviewed for my MSc research, brings these questions to crisis point. David said:

“What actually happens when people go out into wild places, the thing that’s therapeutic, is something … I don’t know, it feels like it almost isn’t about relationships, it’s almost a Becoming […] that actually goes beyond relationship. […] Relationship is the process, not the product”.

This extract illustrates what I most like about this interview: you can hear David working with complex ideas and trying to force language to express something that refuses to be named. His ideas seemed to evolve as we spoke. David rhetorically asked “How do we as human beings even conceptualise the therapeutic relationship that the land or the sea offer us?” We can’t, but the attempt to do so is hugely illuminating.

The full interview was published in Self & Society: An International Journal for Humanistic Psychology (2015). The article is entitled “What impact does working outdoors have on the therapeutic relationship? An interview with ecotherapist David Key“

Wired to survive?

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According to evolutionary neuroscience we’re not wired to be happy or content but simply to survive. It’s a new science, so such judgements are subject to review, but it certainly seems that our bodymind system easily becomes dysfunctional in modern industrial societies.

Paul Gilbert is a clinical psychologist and developed a new therapeutic approach called ‘compassion focused therapy’ (CFT). Paul has identified three basic bodymind systems; one is focused on potential threats, another on finding resources, and the third on calm contentment & soothing. When the threat system is active our attention becomes like velcro for danger signs and teflon non-stick for anything positive: If you’re on alert for wolves then the fact that the moon looks fabulous is pretty irrelevant! Short-term that’s fine and once danger has passed we naturally shift to either the search and reward mode or the calm contentment system. As long as there’s a cycle between these three systems, we’re fine.

Adapted from Gilbert, 2019

Because the threat system has survival value it can override the other two and it’s activated whenever there’s a perceived danger. The threat system works on a ‘better safe than sorry’ basis so will trigger whenever we feel that a situation isn’t safe. Many people live in situations which don’t feel safe; low income, precarious or stressful work, discrimination, difficult relationships or just keeping abreast of the news. That means that the threat system is often over-active and many people don’t spend enough time in the regenerative contentment & soothing system.

Compassion focused therapy draws heavily on mindfulness to help people learn to rebalance themselves. By becoming mindful of when we’re stuck in the anxiety provoking threat system, we can learn to shift into calm contentment. Self compassion is hugely helpful in this, and though we all have compassion, we may not practice it much. In our culture it can be seen as a sign of weakness or a distraction from the busyness of our lives. But in fact compassion is a form of courage that inspires us to act. With practice we can develop more compassion for ourselves and others, healing within and making the world a better place in the process.

It’s worth noting that mindfulness is the key strategy in CFT. Mindfulness, like so many of the other approaches to alleviating mental distress, is an embodied pathway of connection. If we really are wired to survive, perhaps early humans developed the embodied pathways of connection as a route to a deeper thriving? Practices like mindfulness, ritual, dance, psychedelics and the deliberate use of trance emerged early in human evolution. These same practices are retained by many indigenous groups and have therapeutic value for them. The same is true for all of us: These ancient healing practices can take us beyond mere survival mode to a vibrant, joyful existence.