The Problem With Comparing a Psychedelic Experience to 10 Years of Therapy

A common narrative in the psychedelic space is that having a psychedelic experience is like undergoing 10 years of therapy (or another number of years), condensed into just several hours. A headline for a 2023 piece in The i Paper reads ‘How a five-day, £4,000 psychedelic retreat saved me 10 years of intensive therapy’. Mark Haden – the former Executive Director for MAPS Canada – told CBC, “It’s like taking 10 years of regular emotional therapy and compressing it into three sessions.” But this narrative is by no means recent. A Guardian article from 2003 ran with the headline ‘Ten years of therapy in one night’, in reference to the iboga experience.

You can find many psychedelic company owners, retreat leaders, websites, journalists, and users repeating the claim – often based on personal experience – that a single psychedelic experience is like going through ‘X’ years of therapy. If this comparison is so common, and it’s based on personal experience, this would seem to indicate that it’s accurate. However, I think while this comparison often feels natural, it is often misleading. A psychedelic experience is never really like 10 years of therapy. Long-term psychotherapy is distinct from what occurs during a psychedelic experience in several crucial ways. Moreover, comparing a single trip to long-term therapy can feed into boosterism and hype, leading to unrealistic expectations and disappointment for many users who are looking for healing.

The Relational Component of Psychotherapy

A major difference between having a therapeutic psychedelic experience and psychotherapy is the relational component. This is true even when the psychedelic experience occurs around others, such as loved ones, people and facilitators at a retreat, or with therapists present as part of psychedelic therapy. When people have therapeutic psychedelic experiences, this often involves ‘going inwards’ and not spending too much time engaging with others. This is why participants in psychedelic clinical trials wear eye masks and listen to a pre-selected music playlist. The aim is to direct attention inwards. Interactions with the therapists during the psychedelic sessions are kept to a minimum (they are there to provide psychological support if needed). 

Psychotherapy does not look anything like a psychedelic session. In the former, talking and interacting with the therapist is the focus. The experience is relational, and it is through this form of interaction that healing and progress can occur. The nature of this interaction, and the psychological material discussed, may differ based on the particular school(s) of psychotherapy the therapist subscribes to. This point notwithstanding, various schools emphasise building a therapeutic alliance, as this helps to work through difficult material as well as create a template for healthy self-talk and relationships going forward. Towards this aim, therapists should encapsulate qualities like empathy, compassion, honesty, non-judgemental acceptance, and unconditional positive regard. 

It is true that many therapeutic psychedelic experiences have a relational component, such as interactions with archetypes, entities, spirits, deceased loved ones, or oneself in the past. And it is also the case that such encounters may improve how one relates to oneself and others post-trip. Nevertheless, this relational aspect is not comparable to the relational nature of psychotherapy.

Long-term psychotherapy often goes through many ups and downs in terms of how one relates to the therapist, involving factors like defence mechanisms, transference, countertransference, attachment style, and attempts to be more authentic. This often means having difficult conversations – communicating what one honestly feels towards the therapist. 10 years of these experiences are not like a single psychedelic session. It is mistaken to conflate a therapeutic alliance – a strong predictor of therapeutic outcomes – with what occurs during a psychedelic experience.

Psychotherapy is Not All About Realisations and Catharsis

Following on from the last points, equating psychedelic experiences with psychotherapy is perhaps an understandable outcome of viewing psychotherapy as all about the ‘big moments’ – the moments of clarity (e.g. identifying the traumatic root of one’s distress) or emotional catharsis. On psychedelics, there can be several of these big moments: important personal insights and emotional release through crying. These moments are important in psychotherapy, too, but this is not exclusively what talk therapy is about. Again, it emphasises the relational component and all the difficulties and healing that come with that.

Furthermore, psychotherapy may involve goal-setting and the cultivation of coping skills. Of course, these future-oriented objectives can be part of sessions with a therapist before and after a psychedelic experience, or how one prepares for and integrates the experience. But it would not be accurate to say that this way of working towards a positive future with a therapist also occurs during a psychedelic session – that is, years of therapeutic work condensed into hours.

Long-Term Benefits

In the immediate aftermath of a psychedelic journey – as well as long after it – people may feel convinced that they underwent years of intensive therapy. However, beyond the anecdotes, we see that, for most participants in clinical trials, depression returns after six months following psychedelic therapy. Many participants experience much longer remission from depressive symptoms, but it’s important to acknowledge that the mental health benefits of psychedelics often fade. Further psychedelic and integration sessions may help to create much longer-lasting benefits, but if that’s the case, then a single psychedelic experience would not be equivalent to years of intensive therapy.

In contrast, long-term psychotherapy, for many patients, involves long-term remission from symptoms (although a caveat here is that patients may be using auxiliary treatment too, such as antidepressants, which can carry downsides that psychedelics don’t have). This doesn’t mean spending years in psychotherapy is superior to a single psychedelic experience in every instance. After all, many patients who benefit long-term from psychedelics are treatment-resistant, meaning they may have already tried talk therapy for years, but it provided inadequate relief. One experience can offer some unparalleled mental health benefits. However, the reason why the benefits of psychotherapy may outlast those of a single psychedelic trip is due to the sheer amount of time spent working through psychological material and building a healthy alliance with a therapist.

There are many variations in how people respond, in the long run, to long-term psychotherapy or a single psychedelic session. Because of these variations, it is too simplistic to equate the two. In some cases, 10 years of therapy may be insufficient; in other cases, it may lead to symptom management and reduction, rather than remission; and then we have accounts and studies illustrating long-term remission following long-term psychotherapy (which many people don’t experience after a single psychedelic session). For these reasons, it is unjustified to view long-term therapy and psychedelics as equivalent.

Also, ironically, if it were true that ‘a single trip is like 10 years of therapy’, this might not be a promising analogy. If someone was in therapy for 10 years, it’s possible (this isn’t true in all cases) that the therapist and/or the therapeutic approach is ineffective or a bad fit in some way. Some people who have been in therapy for 10 years find it hasn’t provided significant and long-lasting benefits. A more promising analogy would be that a psychedelic experience is like a year or a few years of therapy condensed into several ways. (This is not to say that this revised analogy would be accurate, however, given the points raised above.)

Avoiding Hype and Unrealistic Expectations

Despite the common trip reports about a single psychedelic experience being like ‘X’ years of therapy, repeating this narrative can set up unrealistic expectations for would-be users. Mental health problems are diverse and not all of them respond in the same way to psychedelics, if at all. Psychedelics may cause a worsening of symptoms or the development of new, troubling symptoms; or they may lead to minimally therapeutic or non-therapeutic experiences, or result in the so-called ‘nada effect’ (psychedelics don’t seem to work for everyone).

In addition, while a single session may alleviate one person’s depression, someone else with severe depression, PTSD, or CPTSD might not experience such alleviation, even after multiple sessions. Some mental health issues involve deep trauma and wounds that cannot be simply eliminated after a single psychedelic journey, no matter how profound it might be.

The problem with perpetuating the narrative that a single session brings about years’ worth of healing is that it may lead to intense disappointment in others who want the same for themselves. If such healing doesn’t occur, in addition to feeling disappointed, someone may thereafter feel hopeless, that they did something wrong, that they ‘failed’, or that they must be broken and ‘unfixable’. After this kind of disappointing outcome, a patient may give up on trying to get better. They may have viewed this single psychedelic experience as the only effective option left: the momentous occasion that will finally rid them of their emotional distress. It is unwise, therefore, for clinicians, guides, and retreat facilitators to create or encourage these expectations in those seeking out psychedelics for healing.

I understand that saying ‘a psychedelic experience is like years of therapy’ is often a colloquial and metaphorical way of describing what the experience was like. I also appreciate that a psychedelic experience can feel like becoming one’s own therapist – an experience that is commonly reported, indicated by the use of concepts like ‘inner healing intelligence’ – whereby one treats oneself with compassion and warmth.

Nevertheless, many people mean (and take) the statement above literally. The same issue applies when it comes to other sentiments that create psychedelic hype, such as the idea that psychedelics ‘reset’ or ‘reboot’ the brain. Even if such ideas are meant to be taken in a non-literal way, their common usage can nonetheless lead people to expect that a single psychedelic session will erase chronic patterns of negative self-talk and anxiety, never to return again.

Similarly, comparing a single psychedelic experience to a decade of therapy can lead people to expect that this experience is just like the hard work involved in this amount of therapy. But this isn’t the case. Often, healing from deeply rooted mental health problems is a long process, even when this includes psychedelics. This may involve multiple psychedelic sessions, many integration sessions, maintenance therapy, other healing modalities, and making other kinds of changes to one’s lifestyle and relationships.