Presence, Somatics & Integration: The Therapist's Role in Psychedelic-Assisted Psychotherapy

One of the questions I get asked most often — by therapists new to this work and by people curious about it from the outside — is some version of: what do you actually do during a psychedelic session? What does the therapist's role look like when a client is in an altered state, when the inner healing intelligence is running the show, when the usual tools of talk therapy don't quite apply?

I had a chance to answer that question directly in a recent conversation with Chad Franzen of Rise25, who flipped the script and interviewed me. What came out of it was one of the clearest articulations I've given of how I actually work — what I do, what I deliberately don't do, and why the clinical choices that might seem passive from the outside are among the most active and consequential ones I make.

It's the Whole Process, Not Just the Session

The most important thing to understand about psychedelic-assisted psychotherapy is that the medicine session is not the treatment. The treatment is the preparation, the medicine session, and the integration — all three, as a unified process. What I do in the medicine session is significantly different from what I do in a traditional therapy session. But what I do in preparation looks, initially, a lot like it.

Preparation is grounded in a real developmental history — understanding who this person is, how their sense of self has been formed, what relational experiences have held up a mirror that showed them who they are. In psychodynamic terms, we're looking at the internalized self-representation. I do three to five preparation sessions before we ever go into medicine together. I'm looking at the whole person, building a real case conceptualization, and I'm also teaching — skills for navigating the experience, an introduction to the trauma response, the beginnings of somatic awareness. And above all else, I'm building safety. The client needs to feel genuinely understood by me. That's the foundation everything else rests on.

What I'm Actually Doing in the Medicine Session

During the medicine session itself, the work looks and feels quite different. I'm not doing interpretation. I'm not making meaning. I'm not connecting what's emerging to something from their developmental history — even when I can see the connection clearly, even when it seems obvious. That work has its place in integration. In the session, I'm tracking where the inner healing intelligence wants to go, and I'm asking questions that deepen rather than direct.

Things like: What are you noticing? Where are you right now? Are you feeling drawn toward or away from that? What do you notice on the inside when that comes up? That last one is particularly important — it brings the body into the experience rather than staying in the narrative. We're in active curiosity together. We're not solving anything.

One of the things that's also really different in this work is the quality of physical and relational presence. I'm sitting right next to the client. I'm highly aware of the energy between us. Touch on an arm is not uncommon. The proximity, the energetic and physical closeness — these breed emotional connection in a way that sitting across from someone in a traditional therapy setting simply doesn't replicate. That relational container is part of what makes the work possible.

Why I Don't Make the Meaning

When I make meaning, I'm leading. I'm taking the client's experience and filtering it through my hypothesis about what it means. Even if that hypothesis is accurate, even if the connection is real, imposing it in the middle of a session can trigger defenses to come back online. It can narrow the field of what the client is able to notice and explore. It moves us from the present moment into the cognitive. And the cognitive is not where the most important work happens.

Insight is overrated. I say that provocatively, but I mean it. The big aha moment — the realization of why we do what we do — doesn't do as much for us as we tend to think. What we're looking for in a psychedelic session is something closer to a direct experience: a more unguarded, less defended version of what's actually there. A loose association that goes somewhere unexpected. A sensation that opens into something deeper. Those things can't happen if I'm doing the driving.

Meaning-making comes later. Integration is where connections get named, where the session gets woven into the larger arc of the person's life. There's plenty of time for that. We just don't need to manufacture it in the session itself.

Suspend the Need to Know

One of the phrases I come back to constantly — in trainings, with clients, and honestly in my own life — is suspend the need to know. As therapists, we are trained toward understanding, toward formulation, toward having something useful to offer. That urge is deeply baked in. And in this work, it's something we have to actively work against during the session itself.

Not knowing is not a failure. It's actually the appropriate stance. Each person is the expert on themselves. I am, in essence, a professional question-asker. And the real answers come from within the person, not from me.

Why Somatics Matter Here

I'm a follower of the somatic tradition, which came into my practice more fully about 15 years ago. Bessel van der Kolk, Babette Rothschild, somatic experiencing, sensorimotor psychotherapy — these approaches share a fundamental insight: the body holds the knowledge. Trauma isn't just a story we tell about the past. It's a pattern that lives in the nervous system, in the way the body holds itself, in the sensations that arise when certain triggers are present.

Connecting to the body in a psychedelic session is a way to bypass meaning-making and access something more direct. I open every session by grounding the client's body into the mat or the chair — drawing attention, one area at a time, from thought to sensation. Pausing. Letting it soak in. It sets the tone for the entire session: we're here in the body, in the present moment, noticing what's actually here.

Teaching Body Awareness to People Who Don't Trust Their Bodies

For many people — especially those with trauma histories — connecting to the body doesn't initially feel safe. When someone says they don't get the mindfulness stuff and shifts uncomfortably as they say it, I don't move past that. The more disconnected someone is, the more gently and externally I begin. I'll have someone rub their hands together, notice their fingers, feel where their back touches the chair.

What somatic work is not is asking "What do you feel in your body?" and waiting. That's too broad for most people. Real somatic work involves menuing — offering possibilities, helping people develop vocabulary and awareness of different areas and layers of sensation. Building tolerance and familiarity gradually. It sounds simple. The layers are anything but.

State vs. Content

One of the most important things clients gain from this work is a shift from focusing on content to developing awareness of state. People come in expecting to deal with the content of their lives — a relationship, a job, a recurring problem. What they actually get — when the work goes well — is a more nuanced relationship with their own state: the quality of their emotions, the texture of their thoughts, the sensations present in their bodies at any given moment.

State shapes perception. When we can develop awareness of our state and gradually begin to shift it, we have a tool that applies to everything, not just the things we identified as problems in prep.

Learning to Feel Okay With Feeling Okay

One of the most interesting things I've come to believe about psychedelic sessions is that they increase what's clinically called positive affect tolerance. My colleague Katie Asthma put it beautifully: can we feel safe feeling good?

If your nervous system has been in chronic hypervigilance — shaped by trauma, relational wounding, a world that's felt consistently unsafe — that state can become so constant that the absence of threat itself feels threatening. Calm feels wrong. Ease feels like something bad is about to happen.

Psychedelic sessions can create a window where the system softens. Where the body begins to learn that feeling okay is not dangerous. I call it: notice well-being, tolerate well-being, deepen into it. Over time, well-being can become more the norm. That's a big piece of trauma recovery — and relevant for most of us, trauma or not.

Spirituality: Curiosity Over Certainty

Spiritual experiences can and do emerge in psychedelic sessions. There's no guarantee, and no expectation should be set. But it happens, and therapists need to be ready to receive it without pathologizing it or projecting their own framework onto it.

In many cultures and ancient wisdom traditions, embodiment and spirituality are inseparable — connecting to the self is connecting to spirit, to source, to oneness. I've been thinking about this a lot since my conversation with Dr. Rohini Kanniganti, who speaks beautifully about embodiment as a doorway to the sacred.

When spiritual experiences emerge in sessions, the clinical response is the same as with anything else: soft authority, genuine curiosity, body-based anchoring. I've got you. Let's be curious. What's coming up? What if you just let this settle? No need to figure it out.

What This Approach Makes Possible

When you bring together careful preparation, genuine somatic tracking, sustained curiosity, and a therapist who is truly present and not leading — what becomes possible is quite profound. At its core, I believe this work is very deep attachment work. The experience of feeling genuinely held, genuinely understood, genuinely safe with another person — in an altered state, when the defenses are down — is something qualitatively different from what's possible in traditional talk therapy. It can reach things that years of conversation sometimes can't.

Self-compassion deepens. The capacity to hold both fear and safety simultaneously grows. And clients begin to see themselves differently — not just through the stories they tell, but through the direct experience of their own nervous system, their own resilience.

One of the lenses I use for this is what I call parallel process. The way a client enters every stage of this work — how they call me, how they come into the first session, how they drop into the medicine, how they come out — is all data. Behavioral, emotional, and relational pattern made visible. In psychedelic-assisted psychotherapy, those patterns get intensified in a way that gives both of us a unique and powerful lens for understanding what's actually happening and what's possible.

That, to me, is what this work is for.

With care,
Dr. Sandy Newes