Psychodynamic Perspectives on Psychedelic States and Treatment Contexts: A Conceptual and Clinical Introduction.
Nadav Liam Modlin, Zsofia Elek, Carolina Maggio, Manish Agrawal, Lauren Lepow, James Rucker, Joanne Stubley, Jeffrey Guss
Psychodynamic psychiatry June 1, 2026 DOI: 10.1521/pdps.2026.54.2.338 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Theoretical or philosophical paper Peer reviewed |
|---|---|
| Intervention | Psychedelic therapy |
| Topics | Altered states of consciousness |
| Keywords | MDMA-Assisted Therapy Classical psychedelics Psychedelic treatment Psychodynamic psychiatry Unconscious mental processes |
| Key points | Argues that psychoanalytic models offer valuable tools for conceptualizing mechanisms of change in psychedelic therapy beyond symptom reduction. |
Abstract
Recent clinical trials have suggested the safety and efficacy of psychedelic therapy for treatment-resistant depression, posttraumatic stress disorder, addiction, and end-of-life distress. While neurobiological mechanisms such as 5-HT2A receptor activation, increased neural entropy, and default mode network modulation have been well-characterized, significantly less attention has been given to the emergence of unconscious material within psychedelic states. This article introduces a psychodynamically informed framework for understanding and working with such material in clinical contexts. Drawing on psychoanalytic theory, we explore how psychedelic compounds may facilitate access to preverbal, dissociated, and developmentally embedded psychic content, often expressed through somatic experience, symbolic imagery, and unconstrained affect. Using the four standard phases of psychedelic screening, preparation, psychedelic treatment session, and follow-up or integration, we present a structured psychodynamic lens, integrating conceptual theory with illustrative clinical vignettes. These fictional composites, informed by publicly funded clinical research programs, highlight how unspoken experience, affective intensity, and shifts in psychic structure may unfold within the psychedelic experience. We argue that consideration of unconscious communication, symbolic processes, and defensive functioning can foster greater clinical depth. This article advances the position that psychoanalytic models, though underrepresented in current psychedelic research, offer valuable tools for conceptualizing mechanisms of change beyond symptom reduction. As psychedelic treatments approach regulatory approval and broader clinical use, such perspectives may play an important role in future research, training, supervision, and individualized care models.
Comparable studies
Other theoretical and historical papers on altered states of consciousness, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Altered States of Consciousness | 1966 | Theoretical or philosophical paper | |
| Functional neuroanatomy of altered states of consciousness: The transient hypofrontality hypothesis | 2003 | Theoretical or philosophical paper | |
| The Psychedelic Mystical Experience in the Human Encounter with Death | 1969 | Theoretical or philosophical paper | |
| A neurophenomenological approach to non-ordinary states of consciousness: hypnosis, meditation, and psychedelics | 2022 | Theoretical or philosophical paper | |
| Hypnotic phenomena and altered states of consciousness: a multilevel framework of description and explanation | 2003 | Theoretical or philosophical paper |
Citations in the library
Cites 55
- Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial Journal of Psychopharmacology November 30, 2016
- Psilocybin-assisted treatment for alcohol dependence: A proof-of-concept study Journal of Psychopharmacology January 13, 2015
- Psychedelics Promote Structural and Functional Neural Plasticity Cell Reports June 1, 2018
- Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression. New England Journal of Medicine November 3, 2022
- Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study American Journal of Psychiatry May 21, 2019
and 50 more in the library