Therapy in the psychedelic underground
An interview with author Rachel Harris
By David Cameron
Painting by Helena Cameron
“What we do is more esoteric, still hidden, more internal, intuitive,” says an experienced psychedelic guide in Rachel Harris’s latest book, Swimming in the Sacred: Wisdom from the Psychedelic Underground. “We would need to be underground even if [psychedelics] become legal as a medical treatment.”
This is a startling admission from an experienced psychedelic guide working in a field where ketamine therapy has gone mainstream and substances like psilocybin and MDMA may very well become FDA approved within the decade. But this sentiment captures the spirit of Harris’s argument for the therapeutic potential of psychedelics. For Harris, a psychologist with both a clinical and research background, it is vital that we do not lose touch with the sacred provenance of these plant medicines—or “entheogens”—as they become more widely accepted by the medical world. Those who have worked as underground guides for decades have a wealth of collective wisdom that can greatly benefit new practitioners in this field.
Of course, many therapists—and psychoanalysts in particular—resist a purely pharmacological approach to mental health. The traditional setting for talk psychotherapy, however, is a couch in a climate-controlled office, not a ceremony in the jungles of Peru. Nevertheless, some clinicians have always been drawn to a more shamanic view of healing.
As for Harris, her psychological and therapeutic worldview was formed by the alternative “academia” of the late 60s, which flourished in fledgling communities like the Esalen Institute in Big Sur, California, where she studied in a residential program shortly after graduating college and later became a resident. After getting her PhD she worked for 35 years in private practice and spent a decade in social science research at the University of Miami Miller School of Medicine, where she received a three-year NIH New Investigators Award. Then, in 2005, an ayahuasca ceremony in Costa Rica transformed her and set her on a journey to understand the therapeutic potential of this particular plant medicine. This led to a three-year research project with psychologist Lee Gurel, resulting in a 2012 paper in the Journal of Psychoactive Drugs. In 2017 she published her book Listening to Ayahuasca: New Hope for Depression, Addiction, PTSD, and Anxiety, and in 2023 published Swimming in the Sacred: Wisdom from the Psychedelic Underground, where she explores the therapeutic use of psychedelics through the perspectives of a group of women “elders.”
Harris and I spoke about the dynamic of cultivating a relationship with the spirits of these plants, and how psychedelics can heal attachment issues through a “conversion” experience.
What makes psychedelics so therapeutically effective?
Psychedelics give us a shift in perspective. They provide a different way of looking at something.
I have a dear friend who is a Zurich-trained Jungian analyst, and for the last seven years he’s been training with a shaman in Peru. He brings people down to Peru for ayahuasca ceremonies. Often when they are having group discussions, processing everything that happened during their ayahuasca journeys, the shaman will sit in and listen, and as people are talking about their personal histories and their feelings, the shaman will often fall asleep. The attendees are insulted—understandably. They think, He doesn’t care. But the truth is that their personal histories aren’t relevant to how he works. He works in a completely different way.
This is probably horrifying to most analysts. Now, when I am acting as a therapist, I’m all about the personal story. Therapy as we know it is based on Freud. But I’ve come to learn that there is another way of healing that is completely different. And that is the entheogenic, shamanic way.
It’s hard to describe it. I can talk around the edges of it, but I don’t really know how it works. Nor does my Jungian friend. Whatever is happening works outside our Western concept of reality. At times, honestly, it just seems miraculous. I mean, traumas seem to disappear, and they don’t come back. Now from a clinical-therapeutic point of view, that makes no sense. But I can’t help thinking of William James, and the importance he places on “conversion experience.” That’s the closest description I have of the shift that happens. People experience an outright conversion.
A similar thing happens with near-death experiences. If you read about them, people come back from them completely different. They change their lives. It’s a conversion experience.
Rachel Harris, PhD, has been a private practice therapist, researcher, and author. Photo by Mary Fennell.
In your latest book, Swimming in the Sacred, you interview about a dozen women throughout the US who have been underground psychedelic guides for decades, some since the 60s. How did you access this community?
My earlier book Listening to Ayahuasca opened the door to this community. This group of women elders has such a strict code of silence. But one of the women I knew felt that I was someone who could be trusted and would understand. Since the book was published, they‘re less secretive. One of them even has been working on a federally funded research study.
The climate has changed so rapidly in the last 10 years. Is that making it easier to be public?
They’re not as scared as in the 60s, which is when most of these women started off. They still want to be private. But they are finding ways to come out a little bit. In some ways I’m their peer. I was in some of the same cultural counterculture situations. I was at Esalen Institute in the late 60s for many years, back when it’s main purpose was in-depth psychological and spiritual work. It was an extraordinary place to be at the time. The leaders of humanistic psychology and transpersonal psychology really grew out of it. One of the women, who is now in her 90s and who trained with [psychedelic therapy pioneer] Leo Zeff, was actually at Esalen the same time that I was there, and we recognized each other.
If they’re secretive, how do people who want a psychedelic guide find them?
Well, there’s the old saying: When you’re ready, the teacher appears. It’s that sort of thing. It’s very mysterious how these things happen, but it’s always in the process of building relationships.
I’ve heard many people say they’ve felt “drawn” to psychedelics.
Now we’re in Jungian territory. I’d be curious what the Freudian analysts do with that experience of “inner knowing” or “inner recognition.” This is not something we talk about a lot in Western culture, but I talk in depth with so many people about how this sense of “being drawn” guides lifetime choices. I’ve often wondered how I got to Esalen in 1968. I was on the East Coast. There was very little information about it. No Google! I was drawn. It was an inner recognition that this is what I’m hungry for, this is what I need.
Has your interest in spirituality and psychedelics made you a bit of an “odd man out” within the psychological community?
A bit. Because my PhD is in research, I feel that those years at Esalen were my clinical initiation. At the time there was no graduate program that even had this kind of orientation. I was way out of sync with the clinical community because Esalen was so far ahead of itself.
I eventually worked in private practice in Coconut Grove in Miami, Florida, and in Princeton, New Jersey. I also worked in research at University of Miami Miller School of Medicine. Because I had been at Esalen I attracted people who were different, people who’d had unusual experiences. I’ll never forget this one guy who came to me who had just had surgery and had a psychotic reaction to the anesthesia. He found his way to me because I was not going to tell him he needed to be hospitalized and drugged. I had a way of working with a wider range of consciousness than other therapists, and it was safer to come in and tell me these kinds of stories.
When I was 13 years old I was at a church retreat. The minister leading the retreat read a poem that tried to capture what it means to live in eternity. As I sat there listening to the poem, something happened to me that I’ve never been able to fully describe. All I can say is that it was a joy and an ecstasy that was so otherworldly that it terrified me. I felt it so viscerally I thought it might kill me. Nothing in my adult life—no joy or pleasure—has ever come close to that experience. It sealed my fate that I could never be an atheist. It is slightly embarrassing, but I have since seen the actual poem, and it’s very corny and juvenile.
That doesn’t matter. The details don’t matter. It changes you forever.
To your point, doing psychedelics has brought me back. Psychedelics have helped me understand the dynamics of that experience.
That’s what you’re following. You’re following that young boy.
Yes.
And I just want to defend the author of that corny poem. It could be their best expression of a similar experience. You might have really caught their experience. These things happen at retreats legitimately. Conversion is a real thing. And it’s alive in you today.
Now the psychedelics are another way to follow that experience.
Yeah. Something opens up inside. It’s of a different realm.
You talk in your book about using psychedelics as a practice for death and dying.
Yes, and this is what the studies at New York University with terminal cancer patients have found.
Our culture doesn’t have a place for entheogens. Other cultures, especially some Indigenous cultures, do. I believe we need to become students of these medicines, and hopefully part of what we learn is wisdom. And one approach is to be a student of death and dying. What does dying look like? How do we do it? What does it mean? We need to learn how to die. When you lose your ego on an entheogen journey, it is a kind of death—one you come back from.
Part of what entheogens teach us is how to let go. You reach a point on a trip where you are overwhelmed, and if you resist, you have a bad trip. So there’s this letting go, this trusting the process. And I think that’s a very similar teaching for how to die.
This is a different way of knowing.
The women that you interviewed for this book work underground. How are these kinds of practices regulated, if at all?
The women I interviewed had a lot of supervision and training, and they continued to meet in what therapeutically would be called a “peer supervision group.” To give you an example, one woman told me how she had guided a journey and she used a medicine that she had not experienced herself. This was against the rules. She was reprimanded by peer supervision and told she couldn’t lead any journeys for a year. That’s a serious consequence.
So they have checks and balances and oversight, but it’s informal. These women have therapists they refer to, they have pharmacological experts in this area. They use 18-page questionnaires asking about medical history. They confer with doctors. They talk with each other. When a young person comes up to me and says, “I’m an underground guide,” the first thing I ask is, “How do you screen medically?”
What about adverse reactions?
Sometimes that happens. It’s a very small percentage, but some people are harmed. And I get some phone calls from people who have not recovered, and it’s heartbreaking.
The most frequent one is what the DSM V calls depersonalization. Life suddenly doesn’t feel real or meaningful. A person thinks, “I’m not myself.” Everything is disembodied, disconnected. Someone can feel dissociated for weeks and months and years. There’s no pill for it. It’s rare, but we have to be able to recognize it and diagnose it when it happens. Willoughby Britton at Brown University studies this in the context of meditation retreats. The meditation teacher Shinzen Young calls it “enlightenment’s evil twin.”
Psychedelics are not totally a free ride. There is some risk. It’s still small, but it’s there. I want to acknowledge it because it’s part of the whole picture, and so I don’t want it to become the shadow that nobody talks about.
For me, personally, my first ayahuasca trip was profound and transformative and healing. My second ayahuasca journey was very difficult. There were issues of set and setting—the size of the group, the training of the shaman—that contributed, but I was caught in a negative loop and had a bad trip. It took me many months to fully regain myself.
Courtesy New World Library
How many ceremonies ago was that?
Well, that was the second one in 2005, so that was a long time ago. I have continued, even though I’m a terrible journeyer with ayahuasca. It’s really hard for me. I mean, the shaman I work with regularly, he teases me. He says, “I can’t believe you come back.”
Here’s another story: I have a dear friend, and I once told him that he must never do psychedelics. He simply wasn’t healthy enough. So what does he do? He goes off to Brazil and he finds an authentic iboga master and does ibogaine in a ceremony. Ibogaine is one of the toughest of all the medicines. It goes on for more than 24 hours. And it’s wonderful for him. In the last few years he goes to Brazil three or four times for this. He describes how the medicine is opening him up to love.
And that’s what happens. It’s as if you’re a child being rocked in the arms of love. I mean, it’s sort of a cosmic love that you’re just drenched in. And that’s what is healing. That doesn’t happen in a therapy office.
If you just had a few minutes to talk to a psychoanalyst colleague about psychedelics, what would you say? What’s your elevator pitch?
Attachment. Psychedelics address issues of attachment. There is a quote from one of the subjects from an NYU study on this who said, “I’m an atheist, but I felt that I was held in the loving arms of God. But I’m still an atheist.” This is a real New Yorker speaking. There is evidence that this overwhelming experience of love heals attachment traumas, that it soaks back into early attachment difficulties and heals.
This may sound crazy to an analyst, but it’s about our relationship to these plant medicines. From an Indigenous point of view, it’s not a drug; it’s a plant teacher, a plant spirit. And so there’s a relationship there. For many it’s a safe haven.
From an analytic or a Western point of view, this would be fantasy. But working with these medicines, you have to leave the Western worldview and enter into more of an Indigenous worldview that allows for a relationship with the spirit of a plant. To have a relationship with that unseen spirit, that’s a huge leap for an analyst.
So it’s really about attachment. It is all about relationship. Recently, watching my grandson, I see so clearly how these first five years are where attachment really gets established.
What do you think about studies at the Johns Hopkins Center for Psychedelic and Consciousness Research where they give someone the synthetic form of psilocybin, so it’s in a pill, but yet they do it ritualistically, almost like a sacrament?
That’s a medical approach. It doesn’t quite have the holistic approach that an Indigenous worldview has.
These relationships are healing. When you look at the attachment literature, if you miss the boat as an infant and a child in your childhood, if you have crappy parents or whatever, you can shift from an anxious or avoidant attachment category to a secure one through positive and secure relationships. That can be a life partner, even a therapist. I had a client once who would sometimes call me just to hear my voicemail greeting. That’s a request for an attachment experience. My recording on the phone was enough to reassure them.
The therapist has to be solid enough to provide that secure foundation for the client going through a high-stress traumatic time. So it is the presence, and that comes from that therapist’s inner capacity. It’s not just saying the right thing. It’s the therapist’s inner capacity to hold you during that time and to do it in a secure, safe way in your best interest. And therapists cross boundaries all the time, or don’t have that inner capacity to do that or know that’s needed.
Just like the therapeutic world, the psychedelic world has a big problem with boundary crossing, ethics, and so forth. It permeates the psychedelic world, and it’s present in all the professions.
One very positive element to the world of psychoanalysis is that for an analyst, part of their training is their own analysis, and that’s terribly important. And they really deserve a lot of credit for that because for most nonpsychoanalytic therapists, there’s no requirement to have your own therapy. People ask me all the time, how do I find a good therapist? I say that they should ask every potential therapist, “Have you had therapy yourself?”
We don’t really know how these plant medicines work. But keep in mind we also don’t know how many pharmaceuticals work. And what’s fascinating to me is there’s a quality in the healing that’s really distinct from a therapeutic process. Often there is a huge leap involved. That doesn’t happen in a therapist’s office. You get an aha moment or something like that, and then there’s a working through. It’s a process that goes on. God knows an analyst will understand that. But there’s a healing that can happen in, say, an ayahuasca ceremony that follows a different process. A friend of mine, the Jungian analyst who is also training as a shaman, has talked about his own healing of a childhood trauma. According to him, he didn’t work through it or make peace with it—it disappeared.
This is at the core of healing with plant medicines.
Published August 2025