On Bringing The Flowers: 5 Principles for Group Psilocybin-Assisted Therapy

By: Benjamin Lewis, M.D.

I’d like to close with some examples from some of our group psilocybin studies that highlight some of these principles in concert.  

A Case with Frontline Healthcare Workers 
In our study of group psilocybin-assisted therapy for frontline healthcare workers, we noticed a repeated pattern across cohorts in response to a particular track on the playlist, the kirtan song “Baba Hanuman” by Krishna Das. This track consistently stood out in participants’ experiences and recollections as a significant turning point in the experience. We had taken to playing this track again at the opening of the first integration session, held two days after the dosing day. We took this pretty seriously: opening the session in complete silence, candles lit, flowers arranged, evening sun coming in through the windows in a darkened space, the room pregnant with the signature of the ineffable and the mysterious. We were following the through-line here after all: bringing the heart-centered core of the experience itself into the integration process.  

Softly at first, the harmonium. Krishna Das’ searching baritone, a meandering flute. With a crescendo, the tabla joins in, and the bass.  (At this point there were generally tears starting to come down, among participants and therapists both.)  I surreptitiously increase the volume two clicks, controlling the speaker with my iPhone. A chorus of voices joins in and the tempo and intensity pick up: everyone is really feeling it now. I feel a deep sense of pride in our work: we’ve really done it.  

It was precisely at this point in our final cohort that my Spotify account was suddenly commandeered by my 7-year-old daughter at home, who was now playing the Moana soundtrack. It is hard to overstate the sense of disruption and surprise here: reverie broken, all eyes in the room leaping open.  What is going on here? Who is in charge? What is this violation of sacred space? The jarring transition was characterized initially by alarm, perhaps a sense of disappointment, a breaking of the spell. But this gave way to laughter: laughter not just towards the surprise of it, but to a strange kind of perfection to be found there. This event became a useful reference point for the group’s process of integration: how do you carry forward the profundity and clarity of your psychedelic experience into the mundane day-to-day aspects of living? What is it like to relax your expectations on the world, adhering to your designs? 

Now, going forward, I will of course continue to put forward full conscious and deliberate effort to get ‘Baba Hanuman’ right (or whatever its equivalent is). The music is part of bringing the flowers. But the fun always comes in sideways in an unexpected fashion.

A Case with Patients with Depression Associated with Cancer Diagnosis
In our study of group psilocybin-assisted therapy for patients dealing with depression associated with a cancer diagnosis(2), one of our participants was a woman with terminal cancer who had a young son. As we approached the dosing day, she shared a story with the group in one of our preparatory sessions. She had been explaining her cancer diagnosis to her son, framing this in terms of her body’s normal cells fighting off the malignant, bad cells: a battle reflected at the cellular level as well as the day-to-day level of her navigating care and treatments. At the time of her telling, her son interrupted her to say, “No, mom. It is not about good cells and bad cells. It is about oneness. Oneness in a good way.”  This became a central theme for her throughout her process in the trial: a marker of sorts that tagged certain elements of her experience with psilocybin, a deep nondual experience, but also a marker that was already present in her life before any of this: nothing new or magical. Just her own life. 

Also here: the wisdom that our children carry. A sensibility that, perhaps, we all have and then learn to lose as we enter adulthood. 

Looking even closer: perhaps you can also find doubt here about this situation, uncertainty. Where did this kid come up with this? What kind of emulation is at play here? Where does the wisdom here reside or come from? At the heart of these questions, there is a child carrying a terrible burden, showing up with wisdom somehow ahead of himself, ahead of his years, and maybe even ahead of his understanding or embodying it. All of that feels present to me, and all of it is also ‘oneness in a good way.’
This person became very close to another participant in the trial, whom she got to know during the study process, and then went on to be close friends with. This other participant was present with her through her end of life, caretaking, helping her family. Her own healing process involved opening up to this tremendous suffering of someone else and being present with it. These are hard things to measure with a Hamilton Depression Rating Scale, or a Mystical Experience Questionnaire.  

I also stayed in touch with this participant as she moved into her dying process. A year to the day after her dosing session in the trial, she sent me this photo (below) of the flower she had been given during the study, now dessicated and desaturated. I visited her with my young daughter, Junie, then 6. There is no simple summary here. No clean story about psilocybin and existential distress. No wrapping it up with a bow in terms of a ‘better way to die.’ There was palpable suffering, pain, tears, and fear in her and in her family. There was also humor, grace, acceptance, and love.  What else does the mantra ‘all is welcome’ point to if not this? Who is this mantra for? We visited her again in the hospital on the day she died. I played a song I had written for her on my banjo. She was marginally aware at this point. In explaining the song “Oneness in a Good Way”(4) to the others gathered, I burst into tears. My daughter rushed over to hug me.  

The future of psychedelic medicine will be shaped not only by the outcomes of Phase 3 trials, the rigor of our statistical methods, or the commercialization landscape, but also by how we – as clinicians and researchers – choose to show up in the work itself. The principles I have outlined here – the parallel process, the not-knowing, grounding, fun, and flowers – are not formal protocol elements, nor are they meant to be definitive. These principles are reminders. They are invitations to hold our work with sincerity, curiosity, and humility, while keeping in view the people and the suffering that brought us to this field in the first place. If psychedelic medicine does have transformative potential, perhaps it lies less in any specific compound, or receptor subtype, or market valuation, but more in how these experiences support conditions for connection, meaning, and care. In the end, perhaps psychedelic medicine is not about manufacturing something special or extraordinary, but about learning how to bring the flowers in the midst of our ordinary lives.