Psychedelic-assisted psychotherapy often focuses on trauma—how we process it, understand it, and move through it. That work matters deeply. But in my conversation with Marcela Ot’alora (who I honor and appreciate as a wise elder in this field), another question began to take shape, one that feels just as essential:
Can we help people learn how to feel okay? And might it be that increased capacity to feel “Ok, when things are OK” is just as important of an outcome as symptom reduction?
Marcela is one of the pioneers of MDMA-assisted psychotherapy. For decades, she has helped shape this field through research, training, and clinical work. But what stood out most in this conversation was not just the depth of her experience—it was her wisdom about attunement, embodiment, and the profoundly relational nature of healing.
Marcela shared that her path into this work began through her own lived experience. After carrying trauma, she encountered MDMA-assisted therapy and, for the first time, connected with a part of herself that was not organized around that trauma.
Her history didn’t disappear. But her relationship to it shifted.
That distinction feels so important. Healing is not always about getting rid of what happened. More often, it’s about no longer being overtaken by it. It’s about having more space, more choice, and more access to connection. Feeling safe.
She also named something I think many clinicians—and many clients—will recognize: sometimes it’s not just pain that’s hard to face. Sometimes it’s wellness.
To say, “I’m actually doing really well,” can feel surprisingly vulnerable when suffering has been the most familiar state for a long time. And it can be unsafe at first,
That insight really stayed with me.
In psychedelic work, we often orient toward breakthrough, catharsis, and deep processing. And those experiences can be incredibly meaningful. But there is another task that feels just as important: helping people notice and stay with moments of “okayness.”
Not as avoidance. Not as bypassing. But as part of integration. And finding safety,
What happens when someone recognizes that, in this moment, they are safe? That their body has settled? That the light coming through the window is simply… there, and nothing is wrong right now?
For many people, that state is unfamiliar, even disorienting. Learning to feel okay—to stay with it, to trust it—may itself be a core part of healing.
Attunement is a word we use often, but it can be surprisingly difficult to define. Marcela spoke about it as something relational, subtle, and not easily grasped.
She referenced Thomas Hübl’s phrase: presence is integrated history.
That idea carries so much. Our ability to attune is shaped, in part, by how much of our own history we’ve metabolized. The more aware we are of what is integrated within us—and what is not—the more available we can be to someone else.
When we are frozen, defensive, or overly self-conscious, attunement narrows. When we are grounded and open, something else becomes possible. We can actually be with another person.
Not analyzing them. Not trying to fix them. Just being with them.
That, to me, is one of the most profound clinical skills we can develop.
This conversation kept circling back to something simple and true: as psychedelic practitioners, we have to do our own work.
It’s not enough to know protocols or techniques. We also have to know ourselves.
What gets activated in us?
Where does fear live?
What remains unintegrated?
What happens inside us when someone else is afraid, grieving, or opening?
Marcela made an important distinction here. Authenticity doesn’t mean bringing our personal material into the room in an uncontained or unprocessed way. It means being present, self-aware, and responsible for how we show up.
Participants deserve the best of us. That includes our skill, our steadiness, and our honesty.
Marcela also spoke about MDMA and psilocybin in a way that felt both clear and clinically useful.
With MDMA, there is often a shared relational field. Therapist and participant may feel, at times, like they are exploring the material together.
With psilocybin, the experience can be more internally oriented. The therapist’s role shifts toward holding, witnessing, and staying steady alongside whatever unfolds.
That distinction matters. These medicines are not interchangeable—and neither are the relational stances they invite. And, could it be possible that a day may come when we have the option to refer clients to any of the above, based on their needs and goals>
Marcela also touched on something the field is only beginning to explore more openly: that different psilocybin strains may carry different qualities and evoke different felt experiences. As this work evolves, so does our responsibility to understand and respond to that complexity.
I was especially moved by how Marcela spoke about spirituality—not as something separate from life, but as something woven into it.
She offered a question that I’ve continued to reflect on:
“What feels like praying to you?”
I love that question because it opens rather than defines. It invites people into relationship with whatever brings them meaning, reverence, stillness, or connection.
For one person, that may be time in nature. For another, silence. For another, being with loved ones, creating, or simply being present.
In psychedelic therapy, these moments are not peripheral. They are often central to the healing process.
Toward the end of our conversation, Marcela said something that felt like a quiet anchor for all of this work: “we need to respond when the body leans in.”
That feels essential.
In a field that can sometimes become overly cognitive, this brings us back to what matters most. The body holds wisdom. Attunement is embodied. Healing happens in relationship.
Our work is not only to interpret experience, but to meet it.
Psychedelic-assisted psychotherapy is not just about the medicine. It’s about presence, ethics, embodiment, and care.
And sometimes, healing begins not with a dramatic breakthrough, but with something much quieter:
for this moment, I am okay.
Thank you so much for reading and listening! Healing is done in community and I appreciate your support!
With care – Dr. Sandy Newes
