On emotional intensity, therapeutic responsibility, and the quieter work of healing.
A few years ago, a friend of mine took part in a psychedelic session with no therapeutic preparation beforehand, no therapist present, and no integration afterward. When the experience turned difficult and he became agitated, he was left on a street to find his own way home. It took him months to recover.
He came to mind again recently while I was reading a Forbes article about TOMS founder Blake Mycoskie and his evolving understanding of psychedelic-assisted therapy. What caught my attention was the distinction between having a powerful experience and engaging in a therapeutic process, and I've found myself thinking about it well beyond psychedelics.
As a trauma therapist, I'm drawn to approaches that help people reach experiences they haven't been able to process. I also know that reaching something difficult and being able to work through it are two different things. In our enthusiasm for what a treatment might make possible, that difference is easy to lose.
When Intensity Looks Like Progress
We tend to associate change with moments that feel significant. Someone remembers something they haven't thought about in years, or begins crying after a lifetime of holding it in. These moments can be meaningful, and sometimes they become real turning points in therapy.
But I've grown cautious about treating the intensity of an experience as a measure of how much it helped. An emotional release can bring relief without changing what contributed to someone's distress in the first place. And an experience that looks dramatic from the outside can leave a person more overwhelmed than they were before it began.
Emotional expression can be an important part of healing. I just think we need to pay as much attention to what surrounds it, and to what comes after.
What Makes an Experience Therapeutic?
In trauma work, we pay close attention to what a person can tolerate without becoming overwhelmed. That doesn't mean steering around painful material. Much of therapy involves approaching things that have been frightening or hard to understand, and how we approach them matters a great deal.
Helping someone encounter something difficult is different from pushing them into an experience they aren't prepared to navigate. The difference lies in preparation, in consent, and in a relationship attuned enough to notice when someone needs to slow down or stop.
I see this in my own sessions. Someone begins describing an experience and something changes: their breathing goes shallow, or they look away and lose their train of thought. Sometimes we keep going, carefully. Sometimes we decide it's enough for today, and that decision is part of the work too. For people who have spent years being pushed past their limits, discovering that they can choose not to go further can matter as much as going there.
The Responsibility of Opening Something Up
My friend's experience raises a question that reaches beyond psychedelics: what responsibility do we take on when we invite someone into an experience that may leave them emotionally vulnerable?
Retreats, workshops, and intensive personal-growth programs often encourage people to confront painful memories or push past what they describe as psychological barriers. Some participants find these experiences meaningful. Others leave carrying feelings they don't know how to manage.
I'm not suggesting every emotionally significant experience needs a therapist. People are changed by relationships, art, spirituality, and ordinary life all the time. But when an experience is deliberately designed to bring up difficult psychological material, especially when it's offered as healing, the responsibility changes. Someone needs to be ready to notice when a person becomes frightened or disoriented, to recognize when an experience is turning harmful, and to stay involved after the workshop ends and the person goes home. Planning for those moments is part of what it means to care for someone who has trusted us with their vulnerability.
What Happens the Next Morning
The language of healing tends to focus on the moment something changes, the breakthrough or the release. I'm often more curious about the following morning.
A person can leave an intense experience feeling deeply connected to themselves and come home to the same strained marriage and the same family tensions. Or they may have opened up memories and emotions that now feel hard to contain. The experience can be meaningful and still leave them with work they weren't expecting.
In psychedelic-assisted therapy, this is one reason integration receives so much attention, though researchers are still studying which forms of support work best and for whom. I think the same principle applies to other therapeutic work. I'm interested in what becomes possible in the life a person returns to, and that often takes time to show. That kind of change is usually built through repetition: returning to something difficult with enough support to experience it a little differently each time, until there may be no single moment to point to at all.
Beyond the Experience
I remain interested in what psychedelic-assisted therapy may offer, particularly for people living with significant psychological distress, and I'm following the research with real hope. But I'd like to see the growing enthusiasm matched by equal attention to the care surrounding these approaches, and I'd ask the same of any approach that promises profound emotional change. Whether something powerful happened matters less than how the person is doing afterward.
My friend did eventually recover. I don't know whether that session could have helped him under different circumstances. What stays with me is how vulnerable he became, and how little support he had when he needed it most.
Opening something up is not the same as helping someone work through what emerges.
Further Reading
Toms Founder Pledged $100 Million To Psychedelics. Now He Says The Trip Isn’t The Treatment (Forbes, 2026). The article that prompted this post: Blake Mycoskie on why the therapy around his psychedelic experience mattered more than the experience itself.
Not a Standalone Treatment: Considerations for Psychedelic-Assisted Therapy (Brain and Behavior, 2026). A review of why ongoing care, including work with a person’s existing therapist, matters before and after psychedelic sessions.
Extended Difficulties Following the Use of Psychedelic Drugs (PLOS One, 2023). A study of people who struggled for weeks, months, or longer after a psychedelic experience, and what those difficulties looked like.
The Varieties of Contemplative Experience (PLOS One, 2017). Research on difficult experiences during and after meditation retreats, showing that these questions reach beyond psychedelics.
Optimal Levels of Emotional Arousal in Experiential Therapy of Depression (Journal of Consulting and Clinical Psychology, 2010). A study examining how different levels of emotional arousal during experiential psychotherapy relate to treatment outcomes, suggesting that greater emotional intensity isn’t always associated with greater improvement.
Emotion in Psychotherapy: A Practice-Friendly Research Review (Journal of Clinical Psychology, 2006). An overview of how emotion contributes to change in therapy, including the role of regulation and reflection alongside emotional expression.
