{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T14:56:55Z","timestamp":1781621815849,"version":"3.54.5"},"reference-count":83,"publisher":"Guilford Publications","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychodynamic Psychiatry"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>Recent clinical trials have suggested the safety and efficacy of psychedelic therapy for treatment-resistant depression, posttraumatic stress disorder, addiction, and end-of-life distress. While neurobiological mechanisms such as 5-HT2A receptor activation, increased neural entropy, and default mode network modulation have been well-characterized, significantly less attention has been given to the emergence of unconscious material within psychedelic states. This article introduces a psychodynamically informed framework for understanding and working with such material in clinical contexts. Drawing on psychoanalytic theory, we explore how psychedelic compounds may facilitate access to preverbal, dissociated, and developmentally embedded psychic content, often expressed through somatic experience, symbolic imagery, and unconstrained affect. Using the four standard phases of psychedelic screening, preparation, psychedelic treatment session, and follow-up or integration, we present a structured psychodynamic lens, integrating conceptual theory with illustrative clinical vignettes. These fictional composites, informed by publicly funded clinical research programs, highlight how unspoken experience, affective intensity, and shifts in psychic structure may unfold within the psychedelic experience. We argue that consideration of unconscious communication, symbolic processes, and defensive functioning can foster greater clinical depth. This article advances the position that psychoanalytic models, though underrepresented in current psychedelic research, offer valuable tools for conceptualizing mechanisms of change beyond symptom reduction. As psychedelic treatments approach regulatory approval and broader clinical use, such perspectives may play an important role in future research, training, supervision, and individualized care models.<\/jats:p>","DOI":"10.1521\/pdps.2026.54.2.338","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T14:44:12Z","timestamp":1781621052000},"page":"338-372","source":"Crossref","is-referenced-by-count":0,"title":["Psychodynamic Perspectives on Psychedelic States and Treatment Contexts: A Conceptual and Clinical Introduction"],"prefix":"10.1521","volume":"54","author":[{"given":"Nadav Liam","family":"Modlin","sequence":"first","affiliation":[{"name":"Compass Pathways, London, United Kingdom; Sunstone Therapies, United Kingdom; King\u2019s College London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zsofia","family":"Elek","sequence":"additional","affiliation":[{"name":"Compass Pathways, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Maggio","sequence":"additional","affiliation":[{"name":"The Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London; South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manish","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Sunstone Therapies, Rockville, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Lepow","sequence":"additional","affiliation":[{"name":"Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Rucker","sequence":"additional","affiliation":[{"name":"The Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London; South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Stubley","sequence":"additional","affiliation":[{"name":"The Tavistock Trauma Service, The Tavistock and Portman NHS Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Guss","sequence":"additional","affiliation":[{"name":"New York University Grossman School of Medicine, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"377","reference":[{"issue":"6","key":"ref1","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1001\/jamapsychiatry.2023.4685","volume":"81","author":"Aaronson S. 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Diagnostic and statistical manual of mental disorders: DSM-IV. American Psychiatric Association."},{"key":"ref6","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1007\/7854_2017_474","volume":"36","author":"Barrett F. S.","year":"2018","journal-title":"Current Topics in Behavioral Neurosciences"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.paid.2017.06.004","volume":"117","author":"Barrett F. S.","year":"2017","journal-title":"Personality and Individual Differences"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"824077","DOI":"10.3389\/fpsyg.2022.824077","volume":"13","author":"Bathje G. J.","year":"2022","journal-title":"Frontiers in Psychology"},{"key":"ref9","volume-title":"Learning from experience.","author":"Bion W. R.","year":"1962"},{"key":"ref10","volume-title":"Elements of psychoanalysis.","author":"Bion W. R.","year":"1963"},{"issue":"3","key":"ref11","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1177\/0269881114565144","volume":"29","author":"Bogenschutz M. P.","year":"2015","journal-title":"Journal of Psychopharmacology"},{"issue":"2","key":"ref12","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/00005053-197002000-00003","volume":"150","author":"Bowen W. T.","year":"1970","journal-title":"Journal of Nervous and Mental Disease"},{"key":"ref13","first-page":"637","volume-title":"Dissociation and the dissociative disorders: DSM-V and beyond","author":"Bromberg P. M.","year":"2009"},{"issue":"1","key":"ref14","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/S2215-0366(24)00203-7","volume":"12","author":"Butlen-Ducuing F.","year":"2025","journal-title":"The Lancet Psychiatry"},{"issue":"7","key":"ref15","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1176\/appi.ajp.2018.17060720","volume":"175","author":"Canuso C. M.","year":"2018","journal-title":"American Journal of Psychiatry"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.neuropharm.2018.03.010","volume":"142","author":"Carhart-Harris R. L.","year":"2018","journal-title":"Neuropharmacology"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"887255","DOI":"10.3389\/fpsyg.2022.887255","volume":"13","author":"Cavarra M.","year":"2022","journal-title":"Frontiers in Psychology"},{"issue":"4","key":"ref18","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1177\/0269881120967878","volume":"35","author":"Davis A. K.","year":"2021","journal-title":"Journal of Psychopharmacology"},{"issue":"5","key":"ref19","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1523\/JNEUROSCI.1659-20.2020","volume":"41","author":"De Gregorio D.","year":"2021","journal-title":"Journal of Neuroscience"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"724606","DOI":"10.3389\/fpsyt.2021.724606","volume":"12","author":"De Vos C. M.","year":"2021","journal-title":"Frontiers in Psychiatry"},{"issue":"1","key":"ref21","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1038\/s41398-021-01706-y","volume":"11","author":"Doss M. K.","year":"2021","journal-title":"Translational Psychiatry"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Earleywine, M., Low, F., Lau, C. & De Leo, J. (2022). Integration in psychedelic-assisted treatments: Recurring themes in current providers\u2019 definitions, challenges, and concerns. 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W.","year":"1980"},{"issue":"11","key":"ref47","doi-asserted-by":"crossref","first-page":"3170","DOI":"10.1016\/j.celrep.2018.05.022","volume":"23","author":"Ly C.","year":"2018","journal-title":"Cell Reports"},{"issue":"4","key":"ref48","first-page":"456","volume":"13","author":"Maggio C.","year":"2023","journal-title":"Journal of Psychology and Psychotherapy"},{"key":"ref49","doi-asserted-by":"crossref","first-page":"103938","DOI":"10.1016\/j.nsa.2024.103938","volume":"3","author":"McCulloch D. E.","year":"2024","journal-title":"Neuroscience Applied"},{"issue":"3","key":"ref50","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1176\/appi.focus.23021011","volume":"21","author":"Mitchell J. M.","year":"2023","journal-title":"Focus"},{"issue":"10","key":"ref51","doi-asserted-by":"crossref","first-page":"2473","DOI":"10.1038\/s41591-023-02565-4","volume":"29","author":"Mitchell J. M.","year":"2023","journal-title":"Nature Medicine"},{"key":"ref52","doi-asserted-by":"crossref","first-page":"109","DOI":"10.2147\/NDT.S432537","volume":"20","author":"Modlin N. L.","year":"2024","journal-title":"Neuropsychiatric Disease and Treatment"},{"key":"ref53","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jad.2023.01.077","volume":"326","author":"Modlin N. L.","year":"2023","journal-title":"Journal of Affective Disorders"},{"issue":"3","key":"ref54","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1111\/bjp.12852","volume":"39","author":"Modlin N. L.","year":"2023","journal-title":"British Journal of Psychotherapy"},{"issue":"11","key":"ref55","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.4088\/JCP.v67n1110","volume":"67","author":"Moreno F. A.","year":"2006","journal-title":"Journal of Clinical Psychiatry"},{"issue":"9","key":"ref56","first-page":"100725","volume":"6","author":"M\u00fcller F.","year":"2025","journal-title":"Med (New York, N.Y.)"},{"issue":"7966","key":"ref57","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1038\/s41586-023-06204-3","volume":"618","author":"Nardou R.","year":"2023","journal-title":"Nature"},{"issue":"2","key":"ref58","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1124\/pr.115.011478","volume":"68","author":"Nichols D. E.","year":"2016","journal-title":"Pharmacological Reviews"},{"issue":"4","key":"ref59","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1080\/21674086.1997.11927546","volume":"66","author":"Ogden T. H.","year":"1997","journal-title":"Psychoanalytic Quarterly"},{"issue":"1","key":"ref60","doi-asserted-by":"crossref","first-page":"24480","DOI":"10.1038\/s41598-024-74810-w","volume":"14","author":"Olami A.","year":"2024","journal-title":"Scientific Reports"},{"key":"ref61","doi-asserted-by":"crossref","first-page":"1020505","DOI":"10.3389\/fpsyt.2022.1020505","volume":"13","author":"Passie T.","year":"2022","journal-title":"Frontiers in Psychiatry"},{"issue":"8","key":"ref62","doi-asserted-by":"crossref","first-page":"1947","DOI":"10.1038\/s41591-023-02455-9","volume":"29","author":"Peck S. K.","year":"2023","journal-title":"Nature Medicine"},{"issue":"12","key":"ref63","volume":"46","author":"Phillips A.","year":"2024","journal-title":"London Review of Books"},{"issue":"6","key":"ref64","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1176\/appi.ajp.2019.19020172","volume":"176","author":"Popova V.","year":"2019","journal-title":"American Journal of Psychiatry"},{"issue":"3","key":"ref65","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1089\/psymed.2024.0026","volume":"3","author":"Richard J.","year":"2025","journal-title":"Psychedelic Medicine (New Rochelle, N.Y.)"},{"issue":"15","key":"ref66","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1001\/jama.2025.13481","volume":"334","author":"Robison R.","year":"2025","journal-title":"JAMA"},{"issue":"9","key":"ref67","doi-asserted-by":"crossref","first-page":"10761087","DOI":"10.1177\/0269881119855974","volume":"33","author":"Roseman L.","year":"2019","journal-title":"Journal of Psychopharmacology"},{"key":"ref68","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.neuropharm.2017.12.040","volume":"142","author":"Rucker J. J.","year":"2018","journal-title":"Neuropharmacology"},{"issue":"419","key":"ref69","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1192\/bjp.100.419.491","volume":"100","author":"Sandison R. A.","year":"1954","journal-title":"Journal of Mental Science"},{"key":"ref70","first-page":"43","volume":"3","author":"Sandler J.","year":"1976","journal-title":"International Journal of Psychoanalysis"},{"key":"ref71","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.genhosppsych.2025.12.021","volume":"99","author":"Schettino J. R.","year":"2026","journal-title":"General Hospital Psychiatry"},{"issue":"3","key":"ref72","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1080\/00754179808414823","volume":"24","author":"Segal H.","year":"1998","journal-title":"Journal of Child Psychotherapy"},{"issue":"2","key":"ref73","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1021\/acsptsci.0c00169","volume":"4","author":"Stauffer C. 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