Exploring Psychedelics and Consciousness through Psychodynamics

📖 What’s This Paper About?

This paper explores the psychodynamic perspective on the “set and setting” principle in psychedelic experiences, drawing on theories from Wilfred Bion and Donald Winnicott. The author examines how our internal mental state (set) and the external environment (setting) profoundly influence psychedelic experiences, offering insights for harm reduction and therapeutic potential.

Why This Matters

As research into psychedelic substances gains momentum worldwide, understanding the psychological frameworks that can help mitigate risks becomes crucial. This paper bridges psychodynamic theory with psychedelic experiences, providing valuable perspectives on how to create safer, more meaningful encounters with these powerful substances.

• Distinguishes between harmful recreational use and potential therapeutic applications
• Connects established psychological theories to modern psychedelic experiences
• Offers practical considerations for emotional containment and environmental safety

Top 5 Takeaways

2. Environment Creates Safety

Winnicott’s theories about holding environments apply directly to psychedelic experiences. Creating spaces that feel secure, with trustworthy companions and minimal disturbances, significantly reduces the risk of adverse psychological reactions.

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The Bigger Picture

This paper stands at the intersection of clinical psychology and psychedelic research, offering a nuanced middle path between categorical rejection and uncritical embrace of psychedelics. By applying established psychodynamic frameworks to understand these experiences, the author provides a language and conceptual structure that can help guide both clinical applications and harm reduction efforts in an increasingly psychedelic-curious world.

Final Thought

Psychedelic experiences, like the deep waters of our unconscious, contain both perils and treasures. With proper psychological preparation, supportive environments, and thoughtful integration, these powerful tools may offer unique opportunities for psychological growth and healing.

BION, WINNICOTT AND CONSCIOUSNESS-ALTERING SUBSTANCES: A PSYCHODYNAMIC PERSPECTIVE ON THE SET AND SETTING PRINCIPLE IN PSYCHEDELIC EXPERIENCES

Lior Scheinfeld – Clinical Psychologist

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Keywords: psychedelics, consciousness-altering substances, psychodynamic perspective, set and setting, containment, holding environment, Bion, Winnicott

As a clinical psychologist, I frequently encounter young men and women who arrive after harmful misuse and abuse of psychoactive substances, suffering from deep psychological crises following their inability to cope with experiences they had under their influence. The consequences of such crises can be destructive and irreversible, and it often takes years to pick up the pieces. Psychotic states, depressive crises, and anxiety disorders are just some examples, with usage sometimes even leading to chronic conditions like schizophrenia, bipolar disorder, and more. It is precisely because of my therapeutic experience exposing me to the many dangers inherent in irresponsible, immature, uncontained, or random use of psychedelic substances (or consciousness-altering substances), that I wish to stimulate discourse and thought that takes into account the many possibilities inherent in protected use of these substances as a gateway to deep connection with oneself and the world.

In this paper, I aim to sketch general guiding principles that can help derive the best from experiences with psychedelic substances by examining in depth one of the principles designed to reduce risk in using these substances: “the set and setting principle.” According to this principle, the experience of using psychedelic substances is significantly influenced by the context in which they are taken. The principle describes two central factors that affect the nature of the experience. The “set” (shorthand for mindset) refers to internal factors—the mood of the person taking the substance, their intention, readiness for the psychedelic experience, and expectations from it. In this paper, I will expand on the principle of set and in this context also address the influence of the person’s mental structure on the psychedelic experience, namely their inner world, emotional maturity, and personality structure. The “setting” refers to factors in the external world—the physical environment where the substance is taken, the people accompanying the process, and the personal, social, and cultural context in which the substance is taken (Hartogsohn, 2020).

The discussion of set and setting in the paper will focus on the personal and mental angle of the experience of using consciousness-altering substances and will rely on psychodynamic ideas. The assumption behind connecting the psychodynamic world with the psychedelic world is that both are characterized by immeasurable depth and great potential to contribute to human development, and therefore conceptualizations from the psychodynamic world can help deepen understanding of experiences from the psychedelic world. In the discussion on set, I will mainly draw on concepts from Wilfred Bion to examine the influence of the mental state on the psychedelic experience. In the discussion on setting, I will mainly rely on concepts from Donald Winnicott to reflect on the importance of space in its various shades and its influence on psychedelic journeys.

The ideas of Bion and Winnicott both touch with sensitivity and wisdom on many essential aspects of mental development that are also relevant to the experience of using psychedelic substances. Bion dealt extensively with the development of thinking and its dependence on responses provided in primary and regressive states, as well as with building emotional meaning and the critical importance of being able to connect with “mad” parts that exist in all of us. Winnicott focused on the infancy period and early years, the significant role of the maternal figure, the importance of interaction between mother and infant, the paradoxes that make up our lives and psyche, the ability to play, and the connection of these to mental health and creativity.

The writing will be accompanied by examples from cases of people I have met along the way, whose details have been disguised. In the final part of the paper, I will share a personal experience intended to demonstrate the importance of the set and setting principle and the possibility inherent in using consciousness-altering substances as a path to mental and spiritual development.

Set and the Psychedelic Experience

As described above, set refers to the intra-psychic aspects of the context of using consciousness-altering substances and refers to the necessity of paying attention to internal factors when planning the experience. Preparation that takes set into account will address both practical details such as setting the date and method of substance consumption, and deeper aspects, such as the intention with which one arrives and the thought about what the person would like to receive from the psychedelic experience, what might happen to them during use, and what they might need.

An important component of the set is the intention and expectation with which the person comes to the psychedelic experience. Many times, the initial attitude toward the experience colors the entire experience and greatly affects the content that arises in it and the possibility of fulfilling the therapeutic and developmental potential embedded in the psychedelic experience. Indeed, in reports from subjects in experiments from the late 1950s that were mentioned earlier, enormous gaps were found: subjects who took LSD as part of studies with a medical nature and were prepared for threatening experiences with psychotic potential reported more on difficult and anxiety-provoking experiences, while subjects who took LSD as part of studies with a psychotherapeutic character, with early calming preparation and a therapeutic intention, described a positive and life-changing experience (Hartogsohn, 2017). It is difficult to explain the effect of the initial attitude, but it may stem partly from the suggestive nature of the psychedelic experience, which causes it to begin even before the substance itself enters the body. Thus, the more prepared and clear the person is about what they would like to receive from the psychedelic experience, the greater the chances of fulfilling the therapeutic potential that exists within it.

Another component of the set is the timing when the person chooses to experiment with a psychedelic substance, and particularly the question of whether they are in a crisis period. In crisis situations, the tendency to search for magical solutions and shortcuts increases, which may increase the risk of misuse of consciousness-altering substances to avoid emotional contact. The use of consciousness-altering substances can be a kind of “spiritual bypass” (Welwood, 1984), that is, to serve as a way of escaping from oneself, from the pain that one carries and finds difficult to give space to, and from the feelings one finds difficult to experience. Alternatively, during a more stable period, such use can allow a person to deepen into themselves and their emotional world, to explore the patterns and mechanisms that characterize them, and to work with unconscious contents that exist within them. The ability of the person to connect with their inner world in its various layers is important in the experience with psychedelic substances in order to turn the experience into a meaningful experience from a mental and spiritual perspective, and also to reduce the risk of mental crises. Therefore, when choosing to embark on a consciousness-altering journey, it is important to take into account traumatic events with potential, such as the death of a close person, a difficult separation, dealing with dismissal, and so on, and even to avoid using consciousness-altering substances during periods of such challenges or similar ones.

The set and setting principle is especially important since the use of consciousness-altering substances involves the cancellation of defenses and an intense flooding of consciousness with contents from the unconscious. In Bion’s terms (1962), during the psychedelic experience, the contact barrier that establishes the boundary between the conscious and unconscious is erased, so that threatening and anxiety-provoking contents from the unconscious become accessible and present, and a kind of window of opportunity opens allowing contact with them. In fact, even in the days following an experience with a consciousness-altering substance, there is usually a high sensitivity and greater openness to the world, as it takes time for defenses to return to their normal strength. This characteristic of the psychedelic experience makes it so dangerous, but it also contains part of its enormous potential. Therefore, in anticipation of the significant reduction in the power of defense mechanisms, much attention must be paid to alternative factors that will regulate the expected contents to erupt and reduce the intensity of anxiety.

Defense mechanisms are an important and vital part of our mental capacity as human beings, and they have developed to allow us to regulate ourselves in the face of threats, particularly threats that originate from within the psyche, like various needs and desires. Due to the fear of the mental mechanism from the destructive potential embedded in difficult-to-digest mental contents, contact with them is avoided. The more difficult these contents are to digest, the stronger the defense activated to protect the survival of the psyche. However, many times avoidance of contact continues even when contents that threatened mental stability in the past no longer pose the same threat, since the person has developed and is capable of bearing contents that were experienced in the past as impossible. In these cases, defenses become fixed and inhibit mental development. The use of consciousness-altering substances therefore provides a real opportunity for acceptance and coping with non-adaptive patterns, traumas that produce repetitions, and anxieties that inhibit mental development.

According to Bion (1962), in all of us there exists a psychotic part of the personality, which finds it difficult to bear feelings and tries to expel them outside, to deny them. This is a radical idea of Bion, who proposes a conception of mental health as being bound up with the recognition that madness exists in all of us. According to this conception, in each one of us there exist beta elements that were not digested during life and continue to exist somewhere in the expanses of the unconscious. As described earlier, there are cases where the emptying mechanism becomes dominant, and then the psychotic part of the personality occupies a much larger place than the non-psychotic part, since the capacity for “emotional thinking” of the internal reality does not develop. However, according to Bion, in all of us there is a constant struggle between the non-psychotic part and the psychotic part, that is, between parts within us that want to connect with reality and parts that deny it. The balance between them is determined according to the ability to bear those unbearable feelings, that is, according to the degree of emotional maturity of the person and according to their capacity for containment.

One can think of the psychedelic experience as one that awakens from their slumber beta elements that were not digested during life and which continue to exist somewhere in the expanses of the unconscious. Many times it invites a direct, sharp, and threatening encounter with the psychotic parts in our psyche. Moreover, the use of consciousness-altering substances is often accompanied by an experience of dismantling of meaning, emptying of all sense, and lack of understanding of reality as it is – an experience that can be likened to staying within a world of beta elements, a kind of dark and foggy forest where no matter where the person moves, they still feel they are in the same place. In such a situation, the person wanders in a world that is dream-like, with no order and coherence, and where things are emptied of their everyday meaning. This is a regressive experience, a primary infantile experience where things are as they are, without meaning. This is an experience that can be terrifying beyond compare, challenging and nightmarish. The danger is that the encounter will be so powerful and disintegrating that the person will not be able to bear at all the anxiety and dread in connection to the psychotic part within them. But alongside the danger, given the right setting conditions and appropriate mental work to prepare the set, this could be an experience of being in an intriguing and deep space that allows expansion of consciousness and wonder-filled observation of things as they are. In such cases, the flooding of beta elements could allow their transformation into alpha elements.

This mental work is involved, in my view, first and foremost in the very recognition of the existence of these parts in everyone, and their acceptance as yet another part in the psyche, similar to any other part. Alongside aspects of the setting (which will be described later), the very familiarity of a person with the madness in their psyche may contribute to the mental capacities that help maintain sanity in the face of the encounter with that madness and serve as an anchor within the stormy psychedelic experience. The ability to dwell in the disintegrated states and to bear them as temporary, to experience them with curiosity, openness, and acceptance and not with anxiety and repulsion, has significant developmental potential. In essence, what is possible here is a process of disassembly for the sake of reassembly, giving renewed meaning to unconscious parts through internal movement of something that was once built from alpha elements, lost its meaning and returned to beta elements, and again to other alpha elements, connected a bit more. In this context, I am reminded of a sentence I heard from a patient – “thank you for the courage to break into pieces in order to reconnect to something a little more whole”. I hope Bion would agree with such a sentence.

The containment capacity required when using consciousness-altering substances can also be described as the ability to bear difficult feelings and give them space. In the article “Fear of Breakdown,” Winnicott (1963) also speaks about the need to experience the feeling in its full intensity, to experience the breakdown that it was not possible to bear because there was no one to bear it, in order to rise in a more whole way. Similarly, Emotionally Focused Therapy is based, among other things, on the belief that when a feeling is given space in a full way, a kind of magic will happen that will lead to a strong experience of healing and mending.

The therapeutic potential embedded in the psychedelic experience is rooted in my view precisely in this ability – the ability to give space to every feeling that arises, without struggle or repulsion.

It’s important to clarify that the psychedelic experience doesn’t include only difficult feelings, but also powerful positive experiences. For instance, experiences of infinite harmony, immense gratitude to loved ones and the world, amazement and wonder at the wisdom and beauty that exist in the petals of a flower, feeling love and connection to all living creatures wherever they are. Often a positive experience is described where the inner world becomes one with the outer world. These can be transformative experiences that stay with the person for years after the experience, but they too must be contained and digested, and it must be understood how to integrate them into everyday reality that is not always harmonious and awe-inspiring. It is clear and obvious that negative feelings are difficult to bear, but also those that are “positive” might be such, since emotional intensity is emotional intensity even when it is positive. The ability to give space to feelings of any kind is part of the mental set that allows contact with oneself.

Setting and the Psychedelic Experience

The psychedelic experience is characterized by extreme sensitivity to tactile, auditory, visual, etc., stimuli, such that stimuli that might have been imperceptible in another state can be experienced as powerful and overwhelming. Because of this, reality may be experienced as intrusive and inappropriate, and cause great distress. Because of this, an important component of the setting principle when using consciousness-altering substances is attention to the influence of the physical environment. In designing the environment where the substance is taken, every detail is important. Indeed, in recent years it has become customary to establish “safe zones” at music festivals, with the assumption that a calming, safe, and enveloping environment is a basic condition for helping people experiencing emotional flooding when using psychedelic substances. For a similar reason, in studies where consciousness-altering substances are used that are now being conducted in hospitals around the world, it is customary to design the treatment room as a living room-like room, with a comfortable sofa for lying down, calming images, walls in soft colors, a vase with flowers, and pleasant music in the background.

An environment optimally suited for an optimal psychedelic experience is a sterile space, where the stimuli present in it have the potential to support a healing process. The more the environment is safe and stable, clean of disturbing stimuli and not overwhelming, the more the “noise” is reduced and the person is able to give more space to the experience itself and succeed in coping with the complex emotional intensities that may arise. One can assume that if K. (mentioned in the paper) had taken the substance in a safer environment, his first experience would not have been colored in such difficult shades.

Designing a “good enough” environment for users of consciousness-altering substances is intended to provide a response to the physical and mental needs of the person. In Winnicott’s terms (1971), one can describe the purpose of this aspect of the setting as creating an experience of holding and protection from disruptions coming from the external world. In his modesty, wisdom, and gentleness, Winnicott illuminates with the help of his concepts many important parts of infantile experiences, many of which seem to come to life under the use of consciousness-altering substances.

Winnicott speaks about the infancy period and the crucial importance of the caretaking figure (usually the mother) in the infant’s life. This is one of the significant jumps he makes in relation to Klein’s theory, which refers indeed to the importance of relationships and connection, but emphasizes mainly the internalized relationships. According to him, the mother needs to position herself in a stance he called a “good enough mother,” one who is attentive to the needs of the infant and manages to separate her needs from his needs. Such positioning is meant to preserve the “continuity of being” (going on being) of the infant, a state where the infant is free from external disturbances and feels in a fusion with existence. This experience also occurs through holding, a concept referring to the care of the environment for the totality of the physical and mental needs of the infant, which at this early period overlap to some extent. In essence, holding is all the actions the mother does in order to prevent penetrations of reality into the mental space of the infant, disruptions that cut off his being (Perlov, 2011). These disruptions, called impingements, can be destructive to the infant’s ability to create internal continuity, to create relationships of trust, and to succeed in connecting with himself.

When the mother fails to attune to the needs of the infant over time, a defensive mental structure of a false self may develop in him, oriented mainly outward and neglecting authentic needs. Conversely, when the infant feels held and secure, this enables the emergence of the true self, which is characterized among other things by creativity, authenticity, and playfulness (Winnicott, 1960). Additionally, Winnicott speaks about the role of regression within the therapeutic process and the possibility for patients who experienced early injuries to return to them in a protected and safe space in order to heal something in those early wounds in the psyche. He speaks about the need for regression in patients whom classical analysis cannot provide an answer to their needs because the injury is earlier.

In my understanding, the patients to whom he refers are those with borderline or psychotic personality organization (Kernberg, 1984). The psychedelic experience, on the other hand, creates a regressive state regardless of the person’s personality structure, one that can be dangerous to mental health or one that will serve as fertile ground for working on primary contents. It is a process with disintegrative potential, and for this reason, I believe that being in a safe setting is critical to how the experience can be experienced.

One of the important aspects of maternal holding is its physical aspect, which involves gentle and soft touch during care of the infant. Indeed, Margaret Little (2005), a famous patient of Winnicott, described the great significance of the physical touch to her hand and head in the holding experience she received from him as a patient. The need for touch also connects to the assumption that traumatic past experiences are imprinted in the body, and therefore in attentive, protective, and beneficial touch lies an opportunity for meaningful therapeutic work that allows processing of primary physical experiences. Similarly, even during controlled use of consciousness-altering substances, gentle and soft physical touch is often required.

Touch is of course a complex and delicate subject within the therapeutic space, especially in these days when we are exposed to shocking cases of abuse of power and trust relationships within the therapeutic space. In the classical psychotherapeutic setting, there is no place for physical touch but only for emotional touch, through words and feelings. However, many therapeutic fields use physical work as part of the healing process, including body-oriented psychotherapy, acupuncture, shiatsu, reflexology, therapeutic massage, and more. In any case, as much as touch is involved in treatment, it is of course necessary to agree and clarify in advance the boundaries and maintain them strictly, and to dedicate much attention to the subject and conduct an open and clear conversation before any touch. The importance of consent and conversation is great, all the more so in a situation where the defenses are loosened and the person is exposed and sensitive beyond measure. This is one of the reasons why in most studies being conducted today around the world with consciousness-altering substances, two therapists are present, a man and a woman, in order to allow touch that will not be perceived as threatening or with a sexual connotation. Also, the presence of two therapists in the room reduces the chance of misuse of the situation. Additionally, the treatments in these studies are filmed throughout the entire treatment to provide additional protection for the patient.

Another component of the setting principle when using consciousness-altering substances is the people accompanying the person taking the substance. An optimal psychedelic experience occurs in the company of people in whom trust can be placed, with preference for people who have already had experience with the substance in the past and who have the ability to support in situations where the person will not be able to support themselves. Ideally, the use of a consciousness-altering substance will be done in an almost ritualistic environment, where there is a guide or shaman who leads the ceremony. As in therapy, the relationship with the guide, the degree of trust placed in them, the degree of security felt from them – all of these profoundly influence the nature of the psychedelic experience. The guide does not have to have therapeutic training, but they must have experience working with altered states of consciousness. One can also speak about the role of guides or ceremony leaders in terms of holding.

Another aspect of the human encounter relates also to the high sensitivity that characterizes the experience of using consciousness-altering substances, since people’s emotions in the environment are also experienced with particularly strong intensity, and any emotional dissonance is experienced more acutely. One can surmise that as part of the regressive state there is also higher sensitivity to unconscious communication processes of projective identification (Bion, 1962). When the human environment responds with anxiety, distress, and helplessness, this state is likely to penetrate into the person under the influence of psychedelic substances, color their experience, and snowball as a negative and dark spiral. Familiarity of the guide with consciousness-altering substances and experience working with them contribute to their ability to be in a calm, containing, and holding position, which will in turn resonate into the emotional experience of the person under the influence of the substance.

Yet another aspect of the human environment relates to the position of the guide. For example, in the training of the Multidisciplinary Association for Psychedelic Studies (MAPS), the assumption is emphasized that the psyche has a healing power of its own, and that it needs the right space to realize and heal – just as the body knows how to heal from a crisis, but needs a cast that will fix the movement. According to this assumption, the guide should position themselves in a stance that does not know what is good for the person taking the psychedelic substance, but rather creates a space in which the mental process takes place and in which the “inner healing intelligence” can come to expression.

From a psychodynamic perspective, one can think of this stance as that of a “good enough mother” who is facing the infant with loving presence and empathic attunement to his needs, creating for him a space where he feels protected and safe, paying attention to him and to his needs, and allowing him to connect to himself and his being (Winnicott, 1971). Like in therapy, also during use of consciousness-altering substances, a good enough environment with therapeutic potential is an environment that allows the person to be in a transitional experience, in a potential space – that intermediate realm between imagination and reality, between the inner world and the outer, where the person can express their subjectivity while encountering the objective reality, without collapsing into one of them. The space of potential is a protected space where one can experience, play, explore, create, be creative, touch, build worlds and play with them – worlds that in fact were always there. A psychedelic experience that allows dwelling in such a potential space is a significant part of the potential inherent in the use of consciousness-altering substances, especially when it becomes possible afterwards to bring the ability to dwell in it to the everyday world.

Bion’s ideas that were presented earlier can also contribute to understanding the importance of the setting principle when using consciousness-altering substances. As mentioned, Bion claimed that in the personality of all of us there exists a psychotic part, and I added that the psychedelic experience is often accompanied by many direct and painful encounters with these parts. Following this, one can see the setting as a framework that allows bearing the encounter with the psychotic parts without collapsing into them, similar to the idea presented by Ehrlich (2006) in his lecture on the psychoanalytic framework (setting) and its importance for the therapeutic process. In the therapeutic field, the term “setting” is so common that it seems self-evident that in order to allow contact with internal experiences, external reality (therapist and patient in a room, defined time for meeting, known frequency in advance) is required, and that the characteristics of the framework carry within them certain qualities.

Following Bleger, Ehrlich suggested that the framework is a space which holds in an unconscious manner the psychotic and regressive parts of the patient, parts that are there even when the patient is not in a relationship with them: “The framework is like a phantom limb, that even when it is no longer there – is experienced as if it is there. The framework always constitutes a phantom, or the ghost world of the patient, which is the earliest and most undiagnosable internal organization” (p. 7).

In this Bionian spirit, one can think of the interaction between the environment where the consciousness-altering substances are taken and the person taking them as container-contained relations. While the discussion of set emphasized the ability of the person to be a mental container for themselves, here the focus is on the great importance that the environment has as a container. According to Bion, in the therapeutic relationship the therapist serves as a container for the beta elements that the patient brings to the therapy room (Bion, 1971). Similarly, the guides and the space composing the setting of taking consciousness-altering substances need to succeed in coping with the emotional intensities that arise in the person during the psychedelic experience – with the destructiveness and the drives, with the pain and rage, with the dread and helplessness – and transform them. Such a setting can serve as an alpha function that enables “emotional digestion” of the intense experience, or as a container that bears what cannot be borne. Such a setting can contribute to the chances that the psychedelic experience will be less traumatic and more growing and developing.

The conceptualization of Bion thus also contributes to understanding the importance of the setting when using consciousness-altering substances. One can see that there is a certain difference between the two approaches: the concept of “holding”, coined by Winnicott, refers to the role of the mother to protect the infant from the external reality and allow him the continuity of being. In his view, a good environment is the central component in the possibility of healthy mental development. In contrast, the concept of “containment” that Bion coined refers to the protection of the mother over the infant in the face of an internal attack of destructive drives (Perlov, 2011). Symington and Symington (2000) describe the difference in these words:

Bion’s concept differs in three ways: the container is internal while ‘holding’ or ‘holding environment’ are external or located in the transition stage between the internal and external; the container is non-sensory, while the holding environment is mainly sensory; the container together with the contained – active. This activity can be integrative or destructive, while the holding environment is positive and encouraging growth. (p. 69; emphasis mine, L.S.).

According to Bion, then, the interaction between the inside and the outside – between the drive intensities of the infant and the containment abilities of the mother – is a key factor in the possibility of development or stuckness. Because of this, many times even an “excellent” container will not survive the drive intensities.

Despite the differences between them, both from Winnicott’s ideas and from Bion’s ideas emerges the great importance of a human environment capable of containing the emotional experience, bearing the intensities that sometimes feel impossible to bear. Accordingly, during the use of consciousness-altering substances a beneficial and loving presence is required, free of judgment for any experience that the person is in, which helps the person to feel protected and safe and to receive a response to what they need as much as possible.

Personal Disclosure

The attitude of the therapeutic world to personal disclosure by therapists is complex and convoluted. Its history is intertwined as a common thread in the history of psychological treatment – from the days of Freud and the principle of abstinence to the intersubjective and relational approaches of our time, which hold that the therapist’s subjectivity passes to the patient in any case in many ways, overt and covert, conscious and unconscious. During the writing of the paper, I found myself busy with the question of personal disclosure regarding the use of consciousness-altering substances, and throughout the way I checked with myself how much I want and am willing to disclose. The very writing on the subject is in fact a disclosure of part of my subjectivity, but in this part I will share even more directly in part of an experience I underwent in my first ayahuasca ceremony. I believe that through this description I can express part of the importance of set and setting and present the possibility for therapeutic work with consciousness-altering substances and the place of the set and setting principle within it.

Ayahuasca is a liquid extract of two plants that grow in the Amazon rainforests. A certain method of cooking these two plants brings about, among other things, the secretion of dimethyltryptamine (DMT) – a strong psychedelic substance. The use of ayahuasca is usually done in a ceremonial environment (and not at a party or for pleasure purposes) because of the great intensity of the substance, which usually leads to introspection and deep internal processes. The effect of the substance on those taking it is varied, and therefore the personal experience I will describe is one of countless possibilities, since ultimately each user encounters themselves, their conscious and unconscious parts. Accordingly, the subjective experience described here is not intended to encourage use of these substances or to recommend them.

Set: I am in my thirties, after quite a few years of personal work that included long-term psychodynamic therapy and close to ten years of regular practice of Vipassana meditation. Cautiously, one can say that I am familiar with a not insignificant part of the conscious and unconscious contents that occupy and activate me. My life is in a stable state. Beyond that, I am conducting preparation for the ceremony, including two days of staying with myself, extensive writing about the process I think I expect to go through, and of course prior conversation about it with those close to me. The central intention that I formulate for myself is work on my trust in myself and in the world.

Setting: I travel for a week to Europe to a close friend at whose place I stay in the days before and after the retreat where the ceremonies take place, in a country where ayahuasca is legally permitted for use. I arrive for the last two days of a five-night retreat and join two ceremonies; in the first about twenty people participate, and in the second about ten people. The ceremony is led by two guides who were trained for the process, and they are responsible for accompaniment and support of the participants, playing music, and caring for any other need that arises. The process includes a personal preparation conversation with each participant, a group conversation of preparation before the ceremony, the ceremony itself where one or two cups of the substance are drunk, and the next day a group conversation where each person who wants shares in the experience they underwent and with the help of the guides performs integration of the experience with the intentions with which they came and with life in general.

So, the first night arrives and it is… how to say… disintegrating. About half an hour after drinking the first cup I begin to feel the effect, feel my consciousness stretching toward infinity along with the sounds of the music. I am frightened by the intensity of the experience, feel that I am losing control and try to calm down and remind myself that I trust and am ready for whatever comes. This doesn’t work so well for me. I go on and enter a state of anxiety, which intensifies as the effect of the ayahuasca becomes more present in my consciousness. I go on and lose mental structures that I can hold onto – try to remember those close to me and can’t understand who they are, say to myself “Lior, relax and breathe”, and then hear a voice answering ‘but who is Lior?’. I am lost, confused, yearning for the feeling to stop, found in a helplessness that envelops me in 360 degrees. The thought that passes through my head is that I will end my days hospitalized in a closed ward – a place that I know well from my work. I stay in this limbo for some time, apparently not long but one that is experienced as eternity. Then I remember an object I received from a close person with experience with consciousness-altering substances to serve as a kind of amulet in case I encounter distress, I grasp it and calm down. Slowly I manage to remember who I am, but feel terrified by the intensity of the dismantling to which I arrived so quickly. I am busy mainly with coping with the disintegrating anxiety and with ruminative thoughts of relentless self-criticism about my difficulty in trusting and letting go. This is not working so well for me. I go on and enter a state of anxiety, which intensifies as the effect of the ayahuasca becomes more present in my consciousness. I go on and lose mental structures in which I can hold onto – try to remember those close to me and can’t understand who they are, say to myself “Lior, relax and breathe”, and then hear a voice answering ‘but who is Lior?’. I am lost, confused, longing for the feeling to stop, found in a helplessness that envelops me in 360 degrees. The thought that passes through my head is that I will end my days hospitalized in a closed ward – a place that I know well from my work. I dwell in this limbo for some time, apparently not long but such that is experienced as eternity. Then I remember an object I received from a person close to me with experience with consciousness-altering substances to serve as a kind of amulet in case I encounter distress; I grasp it and calm down. Slowly I manage to remember who I am, but feel terrified by the intensity of the dismantling to which I arrived so quickly. I am busy mainly with coping with the disintegrating anxiety and with ruminative thoughts of relentless self-criticism about my difficulty in trusting and letting go. This is how I pass the hours until the end of the ceremony, moving between moments of distress and moments of catching my breath. In the middle, I hear an invitation for the second cup and see everyone except me approaching to drink, thinking to myself “how are they capable?”. The ceremony ends around three in the morning, with the integration conversation beginning at ten in the morning, after breakfast.

By this time I have already returned to myself, and I spend the night with very little sleep, trying to digest and process the powerful experience that to this day I find difficult to describe in words, understanding that I touched on madness but also feeling that my thought process has returned to itself and that I have a need to understand more what I experienced. When morning arrives I meet an American guy, who tells me how throughout the night he experienced a pleasant experience of passing between the streets of his childhood, floating above memories and from time to time diving inward into a memory, seeing it from the side and continuing onward. I am amazed by the gap between our experiences, longing to understand what I went through.

In the integration conversation I am one of the first to share, and within about two minutes I find myself crying bitter tears, trying to describe what I experienced. And all this in English. I speak about the loss of control I experienced, about the intensities of disintegration, about the feeling of failure and worthlessness that I feel. From there, through guiding questions I arrive at speaking about my relationship with myself and about the enormous gap between my ability to be soft and loving toward others and the great rigidity in relation to myself, a gap that connects to a relationship with a significant figure in my life. I tell about my response to anxiety during the night, about the difficulty in asking for help and relying on the fact that they will be able to help me, about my impatience toward myself and about the familiar and ingrained harsh self-criticism. I receive, among other things, reflections about my great sensitivity, about the vulnerability that accompanies it, and about the role of the rational in defense of emotion – creating explanations for primary emotional experiences in order to bring meaning to the world.

Looking back at this part of the experience, it appears that the primary anxiety intensities I encountered were so overwhelming that my capacity for self-containment shattered into pieces. I found myself flooded with feelings with a disintegrative quality, strongly experiencing the fear of breakdown (Winnicott, 1963) and the breakdown itself simultaneously – a kind of tsunami that swept me away and caused me to drown in it. I returned to a state of total lack of meaning, experienced the world as composed of beta elements devoid of meaning, and failed to hold onto any bit of understanding or meaning. In fact, I met the psychotic part in me in all its intensity. In this state, what saved me was a transitional object (Winnicott, 1953) that I held onto. From a developmental perspective, the transitional object belongs indeed to a later stage relative to the stage to which I regressed, but it managed to help me slowly restore the experience of self that I had worked to connect throughout all my years of life. Additionally, the setting had a very significant part in the process: the protected environment, the accompanying music, the possibility to ask for help (which indeed did not materialize, but was possible), as well as sharing in the experience I had, processing it and receiving professional feedback close to the experience, were a central holding factor and served as signposts in my ability to understand what I went through and connect it to mental processes familiar to me from the past. In retrospect, I look at the integration process that occurred after the ceremony as no less powerful than the night itself. In the entire process I underwent a deep therapeutic process that touched on points that I recognize from my mental work throughout the years, but in a more exposed, open, and uncompromising manner. The contents were indeed familiar, but the depth of emotional understanding and the completely unmediated and so alive experience illustrated for me the internal dynamics in a more pronounced way, in a way that I could not miss.

I decide to continue in the process of working on trust and to drink also on the next night, with an intention of softness and acceptance for myself and for whatever comes. I spend the rest of the day in a few conversations with people around me and mainly with myself, preparing and repeating to myself the mantra “softness and acceptance”.

The second night arrives, and I move between excitement and anxiety. I drink the first cup, remind myself to be soft and to accept whatever comes, and take a breath. The first two hours pass in relative ease and with pleasant sensations; I feel that the sounds of the music caress and envelop me, surrender to the experience, feel secure and serene in intensities that I do not recall. The guide of the ceremony invites us to drink a second cup, and I choose to drink. A few minutes after drinking the second cup I begin to feel symptoms of familiar anxiety. I push them away and remind myself – “softness and acceptance”. These sensations come and go for several minutes, and each time I avoid them, until I gather courage and say to myself – let’s give this space.

At that moment, I am thrown into a powerful visual and emotional experience, finding myself in front of an enormous hall of judges who surround me from all sides. I experience myself as small and insecure, like a child who got lost in an amusement park. I begin to hear voices from all directions – “you are not worthy”, “don’t delude yourself”, “you are not special”, “you don’t have the ability to deal with what you are experiencing”, “this thing will not help you to be a therapist or a better person”, “you are worthless” – and many more judgmental voices. I listen to them, breathe deeply, try not to contract, look them in the eyes and say to them gently: “Thank you. Thank you for doing your job. I understand that you are trying to protect me, to ensure that I don’t get hurt. Even if I do get hurt, I will know how to cope. You are invited to continue to come, but I don’t promise to let you in. That will already be my choice whether to believe you or not.”

From there, I begin to experience the most powerful experience I had experienced until then in my life, and which I have almost no way to describe. I connect to the ancient wisdom of existence, to creation, to the force of life, to divinity. I move for hours in an hyper-realistic way between magnificent realms and heavenly beings, experiencing visual and sensory visions of spectacular beauty, full of colors and life. But the significant thing for me is the emotional experience that I feel – I strongly feel infinite acceptance, perfect harmony, endless gratitude, deep serenity, and a feeling of powerful connection to myself and to the world. I feel that I received an invitation that says – “Come. All of us, including you, are part of creation. Let’s celebrate this together”. And so I move in dimensions without time and space, floating on an ultra-sensory mattress, surrounded by a reality that is ultra-realistic and feeling lucky for my very existence.

This was a life-changing experience, one that since then has been with me even when I don’t remember it. Without a shadow of a doubt, what I experienced was not a hallucination or illusion, but a reality in layers that consciousness is not capable of grasping in a normal state of consciousness. When I think of this part of the experience, I surmise that the encounter with the visual hall of judges was in fact a direct encounter with my super-ego. I was attacked by the critical and judgmental voices that exist in me, those I heard from outside and those I made myself hear throughout the years. The ability in those moments to be present in the face of the voices without fighting them, without resistance or judgment, allowed me to dissolve for several hours this mechanism and to experience new layers in the internal and external reality that were not accessible to me until then. Of course I have been rigid with myself many times since then, but this experience has imprinted within me a real emotional quality that is present. This quality was indeed existent in me before, and therefore apparently I succeeded in finding it within me during the experience, but usually it was swallowed up within that same super-ego hall. Today I try to continue to nurture and nourish this quality every day – a quality that is compassionate, accepting, loving and gentle. It is much more accessible to me, and for this I am grateful with all my heart to myself, to ayahuasca, and to the journey I underwent in those 48 hours, which I hope I succeeded in conveying a small fraction of it.

A Few Words in Conclusion

In this paper I proposed psychodynamic perspectives on the set and setting principle in the psychedelic world. For the purpose of the discussion I separated between set and setting, but of course the separation is artificial and in reality they are intertwined with each other: they are not separate but complementary. One can think of set and setting as scales whose function is to balance between the inside and the outside in order to prevent loss of balance, such that in situations where the mental structure does not succeed in bearing the emotional experience, the environment can assist and hold the situation, and vice versa. Balance between them may help to derive the best from the psychedelic experience.

In the paper I tried to reflect the many faces and the complexity of using consciousness-altering substances, the dangers and the therapeutic potential embedded in them, but I am aware that the subject is not easy to digest. When it comes to medications, we are accustomed that they have more or less a similar effect on all of us. However, in the case of consciousness-altering substances, the nature of the experience is influenced by a complex interaction between the mental structure, the emotional capacities, the timing, the preparation, and many more factors (Pollan, 2020). This complexity can arouse schizoid-paranoid mechanisms of splitting, which will dismiss the subject with statements like “it’s dangerous”, “it can only harm and destroy”, or “it’s the most significant thing I experienced in my life and everyone needs to experience this”. Thus, the discourse surrounding consciousness-altering substances is colored many times in black and white, even though there is nothing more colorful than it. In this paper I proceeded from the assumption that it is impossible to ignore the renaissance of psychedelic substances in the therapeutic domain, and I proposed that precisely in order to contribute to the reduction of the dangers inherent in the use of these substances, it is important to take into account that in reality people use them in various ways, many of which are not sufficiently protected. In my view, it is important to look at the subject with a settled and responsible gaze – with curiosity about the potential embedded in these substances, together with alertness to the dangers inherent in premature, not held, and without readiness use.

This is informational, not medical advice.

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