Back from the Abyss: Psychiatry in Stories | Psychotherapy, Trauma, and Psychedelics
Jul 31, 2026 · 31 min · 12 segments
This is the first of a two part summer special with Laura Mae Northrup, who was first featured in the original BFTA summer special back in 2022. In this first episode, in an excerpt from her wonderful…
And she wrote and asked, "How many psychedelic sessions are too many, especially when clients don't seem to be doing the integration work? Where I work, MDMA is for PTSD, psilocybin is for depression, but increasingly, we're having clients do two sessions of one, one of the other.
How do we ensure that clients get what they need but not necessarily what they want?" First off, I would refer you to an episode I did in March of 2023 called Ketamine versus MDMA versus Psilocybin.
Some highlights from this, I think it's more helpful to think of psychedelics in a safety harm reduction algorithm rather than linking them with specific diagnoses.
If we're talking psychiatric safety, ketamine is the safest, followed by psilocybin, followed by MDMA in third place.
And if we're talking medical safety, psilocybin is safest, followed by ketamine, followed by MDMA in a distant third place.
And when you add in overall efficacy for various psychiatric presentations, ketamine is the clear winner.
It's the place to start with most psychiatric patients, and then psilocybin comes next, and MDMA is in third place.
How often should you use these compounds in treatment? I like to think of psychedelic treatments as fertilizer or compost in the garden of you.
Too much fertilizer can be a waste of time and money and effort, and can even poison the garden if the dosing frequency is too high.
To give some general guidelines, I think ketamine shouldn't be dosed more than once or twice a week during the acute treatment phase and every few weeks to months for maintenance treatment.
More frequent dosing can lead to loss of efficacy, tolerance, dependence, and addiction.
Psilocybin is probably safe and effective as frequently as every month or two, but MDMA, in contrast, has a much lower safety index and probably shouldn't be used more than quarterly or, say, three or four times a year.
And she wrote and asked, "How many psychedelic sessions are too many, especially when clients don't seem to be doing the integration work? Where I work, MDMA is for PTSD, psilocybin is for depression, but increasingly, we're having clients do two sessions of one, one of the other.
How do we ensure that clients get what they need but not necessarily what they want?" First off, I would refer you to an episode I did in March of 2023 called Ketamine versus MDMA versus Psilocybin.
Some highlights from this, I think it's more helpful to think of psychedelics in a safety harm reduction algorithm rather than linking them with specific diagnoses.
If we're talking psychiatric safety, ketamine is the safest, followed by psilocybin, followed by MDMA in third place.
And if we're talking medical safety, psilocybin is safest, followed by ketamine, followed by MDMA in a distant third place.
And when you add in overall efficacy for various psychiatric presentations, ketamine is the clear winner.
It's the place to start with most psychiatric patients, and then psilocybin comes next, and MDMA is in third place.
How often should you use these compounds in treatment? I like to think of psychedelic treatments as fertilizer or compost in the garden of you.
Too much fertilizer can be a waste of time and money and effort, and can even poison the garden if the dosing frequency is too high.
To give some general guidelines, I think ketamine shouldn't be dosed more than once or twice a week during the acute treatment phase and every few weeks to months for maintenance treatment.
More frequent dosing can lead to loss of efficacy, tolerance, dependence, and addiction.
Psilocybin is probably safe and effective as frequently as every month or two, but MDMA, in contrast, has a much lower safety index and probably shouldn't be used more than quarterly or, say, three or four times a year.
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