Responsible ceremonial medicine: science, ethics and professional framework
Over the past two decades, scientific research has produced a fundamental shift in understanding the therapeutic potential of classic psychedelic compounds. What the ancestral traditions of Mesoamerica, the Amazon, and other cultures have used as tools for healing and knowledge for centuries is being validated, with important nuances, by clinical trials at the world's most rigorous institutions.
To date, over 134 clinical trials with psilocybin have been registered on ClinicalTrials.gov spanning 54 potential indications (Norring & Spigarelli, 2024). Results in major depression and treatment-resistant depression have been published in the New England Journal of Medicine (Goodwin et al., 2022; Carhart-Harris et al., 2021), in JAMA (Raison et al., 2023), and in JAMA Psychiatry (Davis et al., 2021). Evidence with ayahuasca, while more limited in controlled trials, shows equally promising results in depression (Palhano-Fontes et al., 2019) and has generated a growing body of longitudinal research (Camargos et al., 2026).
But the same research that confirms the therapeutic potential of these substances reveals something equally important: outcomes depend radically on the context in which they are administered. Without psychological screening, therapeutic preparation, professional accompaniment, and post-experience integration, risks consistently outweigh benefits. This article examines the available evidence, the safety protocols that research has established, and the ethical considerations that every professional and every person interested in this modality must understand.
The current state of the evidence
Psilocybin research has advanced more rapidly than any other classic psychedelic. The trial by Goodwin et al. (2022), published in the New England Journal of Medicine, evaluated a single dose of psilocybin in 233 participants with treatment-resistant depression in a multicenter randomized controlled design. The 25 mg dose showed significant reductions on the MADRS depression scale at three weeks, though effects tended to diminish at 12 weeks, signaling the need for more robust follow-up protocols.
Davis et al. (2021) reported in JAMA Psychiatry that two psilocybin sessions with psychotherapeutic support produced significant and rapid reductions in depressive symptoms, with a 71% response rate at four weeks. Raison et al. (2023) confirmed these findings in a placebo-controlled trial published in JAMA, with a 69% response rate at 48 hours post-administration, comparable to response rates observed with ketamine.
Neurobiological mechanisms: Recent research has identified specific mechanisms that may explain the therapeutic effects. Moliner et al. (2023) demonstrated in Nature Neuroscience that psychedelics promote neuronal plasticity by directly binding to the TrkB receptor of BDNF (brain-derived neurotrophic factor). Morales-García et al. (2020) documented that DMT, the active component of ayahuasca, regulates adult neurogenesis both in vitro and in vivo. These findings suggest that therapeutic effects are not merely experiential but involve structural neurobiological changes.
Regarding ayahuasca, Palhano-Fontes et al. (2019) conducted the first randomized placebo-controlled trial in treatment-resistant depression, published in Psychological Medicine, demonstrating rapid antidepressant effects maintained during the 7-day follow-up period. More recently, Camargos et al. (2026) published a longitudinal study with 280 adults assessed at 6 time points over 180 days, showing sustained reductions in depressive symptoms, with the most pronounced improvements emerging within the first two weeks post-intervention.
It is essential, however, to contextualize these results. Norring and Spigarelli (2024) identified that of the 134 registered trials, only 28 have been completed and a mere 9 have posted results. Fifty percent of trials with start dates in the last three years lack double-blind design, which limits the interpretability of findings. The FDA has granted breakthrough therapy designation to psilocybin, but to date no marketing approval exists. These data demand informed optimism, not uncritical enthusiasm.
Why the professional framework determines outcomes
One of the most consistent findings in the literature is that therapeutic outcomes with psychedelics depend critically on the administration context. The concept of set and setting, formalized by Leary, Metzner, and Alpert (1964) and empirically validated by decades of subsequent research, establishes that the participant's psychological disposition (set) and the physical and relational environment (setting) are therapeutic variables as important as the substance itself.
The clinical trials with the best outcomes share a three-phase protocol that has become the reference standard: preparation (clinical evaluation, psychoeducation, establishment of therapeutic alliance), experience (administration in a controlled environment with continuous professional accompaniment), and integration (subsequent sessions to process the experience and translate it into concrete change). The absence of any of these phases significantly compromises outcomes (Horton et al., 2021).
The evidence on safety: The systematic review by Freitas et al. (2025), analyzing 24 articles on psilocybin-assisted psychotherapy safety, found that the most common adverse events during and after sessions include transient blood pressure elevation, headache, nausea, and anxiety. Suicidal ideation was observed infrequently and primarily in participants with prior history. No deaths were attributed to psilocybin in any of the studies reviewed. The authors conclude that safety is generally supported but that standardization in adverse event definition, measurement, and reporting is needed.
Pre-experience psychological screening is perhaps the most critical component and the one most frequently omitted in non-professional settings. Johnson, Richards, and Griffiths (2008) established safety guidelines that include exclusion of individuals with personal or family history of psychotic disorders, evaluation of medication interactions (particularly with selective serotonin reuptake inhibitors and other serotonergic agents), and assessment of sufficient psychological stability to sustain a high-intensity emotional experience.
As a licensed clinical psychologist and graduate of the Vital Program in the United States, a specialized training program in psychedelic-assisted therapy, I have observed that the difference between a transformative experience and a potentially harmful one almost always resides in the quality of the professional framework. The substance amplifies what it encounters. If it finds a solid therapeutic container, it amplifies the possibility of healing. If it finds a structural void, it amplifies vulnerability.
Ethical and cultural considerations
Any serious discussion of ceremonial medicine must address the ethical dimension. Psychedelic plants are not Western pharmaceutical innovations. They are tools of healing and knowledge that belong to Indigenous traditions with centuries of structured practice. The expansion of Western interest in these substances generates legitimate tensions related to cultural appropriation, knowledge extraction, and the commercialization of the sacred.
The ethical position I find coherent is one of respectful dialogue that acknowledges the origin of these practices without pretending to replicate traditions that do not belong to us. In my clinical practice, I work "inspired by" the wisdom of these traditions and "in dialogue with" the cosmological frameworks that sustain them, but I do not present myself as a practitioner of any specific Indigenous tradition. The framework is psychotherapeutic, informed by contemporary clinical research, with genuine reverence for the cultures of origin.
The traditions that lent us these tools did not conceive of them as isolated molecules to be administered in a laboratory. They conceived of them as relationships: between the person, the plant, the community, and the sacred. Modern science is rediscovering, in its own vocabulary, what that relational understanding always knew: that context is the medicine as much as the substance.
Another fundamental ethical aspect is transparency about the limits of the evidence. The research is promising but preliminary. Phase 3 trials are underway but incomplete. The populations studied are relatively small and often homogeneous. An ethical professional presents the data as they are, not as marketing would wish them to be.
The three-phase model in clinical practice
At Dynamis, the three-phase model is implemented with a level of structure that reflects both clinical evidence and accumulated experience in ceremonial work.
Preparation phase. This includes a comprehensive psychological evaluation, clinical interview, medical and medication history review, and preparatory work that may include personality mapping with the Enneagram to identify participant-specific patterns of resistance and vulnerability. Prior sessions at Healing Studio establish the therapeutic alliance and prepare both psychological and somatic ground. The admission process can result in a recommendation not to participate if the evaluation indicates clinical contraindications.
Experience phase. The Maloca at Dynamis was designed as a ceremonial space with specific architectural intention. The team includes professionals with clinical training and ceremonial experience. The safety protocol includes continuous monitoring, medical intervention capacity if required, and a participant-to-facilitator ratio that allows individualized accompaniment.
Integration phase. This is perhaps the most determining phase and the one most frequently neglected in non-professional settings. Post-experience integration sessions are where the experience is translated into understanding and understanding into change. Without integration, even the most profound experiences can dissipate without producing lasting transformation. Integration work includes individual sessions, somatic work, and a personalized continuity plan.
Who it's for and who it's not
Clinical honesty requires clarity about contraindications. Ceremonial medicine is not appropriate for individuals with active psychotic disorders or personal history of psychosis, individuals with certain uncontrolled cardiovascular conditions, individuals taking selective serotonin reuptake inhibitors (SSRIs) or other serotonergic agents without a medically supervised discontinuation period, or individuals without genuine disposition for the therapeutic work the experience requires.
The profiles that clinical evidence and accumulated experience suggest benefit most include individuals in therapeutic processes who seek to deepen their work, individuals with depression resistant to conventional treatments, individuals navigating existential crises or complicated grief, and mental health professionals seeking direct experience to inform their clinical practice.
Saying "this is not for you at this time" is an act of clinical care, not an arbitrary restriction. Part of what distinguishes a professional framework from an improvised one is the capacity to evaluate and, when appropriate, decline.
Final reflection
Ceremonial medicine is not an alternative to psychotherapy. It is an extraordinary tool within a therapeutic process. The current research is sufficiently robust to justify informed optimism, but not to support promises of universal cure. Psychedelic compounds open neuroplastic and experiential windows that, within an adequate professional framework, can catalyze transformation processes that conventional therapy rarely achieves. Outside that framework, the same compounds can generate destabilizing experiences without therapeutic benefit.
The relevant question is not "does it work?" but "does it work for this person, at this time, with this accompaniment, within this framework?" The answer to that question requires clinical evaluation, not marketing.
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Frequently asked questions
What is a plant medicine retreat?
It is an immersive experience using plant-based psychedelic compounds within a therapeutic and ceremonial context. In a professional framework like Dynamis, it includes prior psychological evaluation, therapeutic preparation, the ceremonial experience itself, and subsequent integration sessions. Duration, substance type, and protocol vary by program.
Is ceremonial medicine legal in Costa Rica?
The legal framework varies by specific substance and jurisdiction. In Costa Rica, certain ceremonial practices operate within legal frameworks that permit use in specific contexts. It is the participant's responsibility to be informed about the legal status of any substance in their country of origin. Dynamis operates within the Costa Rican legal framework and provides clear information about this aspect during the admission process.
How do I know if I'm a candidate for a ceremonial experience?
Through a clinical evaluation. The admission process includes a psychological interview, medical and medication history review, psychological stability assessment, and discussion of expectations and intentions. Not all individuals are candidates, and that is part of the program's ethical commitment. You can request an initial consultation through contact.
What differentiates a professional retreat from a tourist one?
Rigorous psychological screening, structured therapeutic preparation, facilitators with certified clinical training in psychedelic-assisted therapy, medical safety protocols, adequate participant-to-facilitator ratio, post-experience integration sessions, and the capacity to decline participants when evaluation indicates contraindications. Dynamis is directed by a licensed psychologist with specific training from the Vital Program (USA) in psychedelic-assisted therapy.
Do I need prior experience with plant medicine?
No. Prior therapeutic preparation is part of the program and is designed for both first-time participants and those who have previous contact with these substances. What is necessary is genuine disposition for the therapeutic work and honesty in the evaluation process. Check the events calendar for upcoming available dates.
References
Camargos, L., de Faria Júnior, G., Lourenço, L., & de Araújo Filho, G. (2026). The therapeutic potential of ayahuasca in depression, generalized anxiety, and substance use disorders: Modulation of the depressive burden in a longitudinal study. Frontiers in Psychiatry.
Carhart-Harris, R. L., Giribaldi, B., Watts, R., Baker-Jones, M., Murphy-Beiner, A., Murphy, R., ... & Nutt, D. J. (2021). Trial of psilocybin versus escitalopram for depression. New England Journal of Medicine, 384(15), 1402-1411.
Davis, A. K., Barrett, F. S., May, D. G., Cosimano, M. P., Sepeda, N. D., Johnson, M. W., ... & Griffiths, R. R. (2021). Effects of psilocybin-assisted therapy on major depressive disorder: A randomized clinical trial. JAMA Psychiatry, 78(5), 481-489.
Freitas, R. R., Gotsis, E. S., Gallo, A. T., Fitzgibbon, B. M., Bailey, N. W., & Fitzgerald, P. B. (2025). The safety of psilocybin-assisted psychotherapy: A systematic review. Australian & New Zealand Journal of Psychiatry, 59(2), 128-151.
Goodwin, G. M., Aaronson, S. T., Alvarez, O., Arden, P. C., Baker, A., Bennett, J. C., ... & Malievskaia, E. (2022). Single-dose psilocybin for a treatment-resistant episode of major depression. New England Journal of Medicine, 387(18), 1637-1648.
Griffiths, R. R., Johnson, M. W., Carducci, M. A., Umbricht, A., Richards, W. A., Richards, B. D., ... & Klinedinst, M. A. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer. Journal of Psychopharmacology, 30(12), 1181-1197.
Horton, D. M., Morrison, B., & Schmidt, J. (2021). Systematized review of psychotherapeutic components of psilocybin-assisted psychotherapy. American Journal of Psychotherapy, 74(4), 140-149.
Johnson, M. W., Richards, W. A., & Griffiths, R. R. (2008). Human hallucinogen research: Guidelines for safety. Journal of Psychopharmacology, 22(6), 603-620.
Leary, T., Metzner, R., & Alpert, R. (1964). The psychedelic experience: A manual based on the Tibetan Book of the Dead. University Books.
Moliner, R., Girych, M., Brunello, C. A., Kovaleva, V., Biojone, C., Enkavi, G., ... & Bhatt, D. K. (2023). Psychedelics promote plasticity by directly binding to BDNF receptor TrkB. Nature Neuroscience, 26, 1032-1041.
Morales-García, J. A., Calleja-Conde, J., López-Moreno, J. A., Alonso-Gil, S., Sanz-SanCristobal, M., Riba, J., & Pérez-Castillo, A. (2020). N,N-dimethyltryptamine compound found in the hallucinogenic tea ayahuasca, regulates adult neurogenesis in vitro and in vivo. Translational Psychiatry, 10, 331.
Norring, S. A., & Spigarelli, M. G. (2024). The promise of therapeutic psilocybin: An evaluation of the 134 clinical trials, 54 potential indications, and 0 marketing approvals on ClinicalTrials.gov. Drug Design, Development and Therapy, 18, 1143-1151.
Palhano-Fontes, F., Barreto, D., Onias, H., Andrade, K. C., Novaes, M. M., Pessoa, J. A., ... & Araújo, D. B. (2019). Rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression: A randomized placebo-controlled trial. Psychological Medicine, 49(4), 655-663.
Raison, C. L., Sanacora, G., Woolley, J., Heinzerling, K., Dunlop, B. W., Brown, R. T., ... & Griffiths, R. R. (2023). Single-dose psilocybin treatment for major depressive disorder: A randomized clinical trial. JAMA, 330(9), 843-853.
