Naranjo's MDA, harmaline and ibogaine therapy (historical)

1. Introduction

Version followed: Naranjo's own published accounts that are available in full: the MDA study with Shulgin and Sargent (1967) and Naranjo's 1987 paper on harmala alkaloids and imagery, plus secondary summaries of his harmaline (1967) and ibogaine work. The Healing Journey is the primary book. First edition: Pantheon, New York, dated 1973 by Erowid and 1974 by Wikipedia and the archive.org catalogue; Naranjo's own 1987 paper cites it as 1975, and Goodreads lists a paperback "first published 1975" [uncertain: first-edition year]. Second edition: MAPS, 2023 per buecher.de, subtitled Pioneering Approaches to Psychedelic Therapy, ISBN 978-0-9798622-8-1, with an endorsement by Stanislav Grof [source: MAPS store; buecher.de]. From publisher and catalogue pages and reader reviews: the book has five chapters, an opening essay (previously published) and one chapter each on MDA, MMDA, harmaline and ibogaine, which Naranjo groups as "emotion-enhancers" and "fantasy-enhancers"; it is built from his session notes and his patients' journal accounts [source: LibraryThing work page and review; OPEN Foundation; Naranjo 1987]. No legitimate full text or preview of the chapters is available, so this guide does not report their session-level detail, and anything that would depend on it is marked [uncertain]. [source: Erowid book page; Wikipedia; archive.org record; buecher.de; MAPS store; LibraryThing; Goodreads]

HISTORICAL — NOT FOR USE. This entry describes a historical drug-assisted psychotherapy as history. It gives no doses, routes, schedules or administration details, and nothing here should be read as a protocol. MDA, harmaline and ibogaine are not approved medicines for psychotherapy; this guide covers what a clinician today does with the knowledge (recognising claims, assessing and supporting clients), not how to run sessions.

What it was. Claudio Naranjo (1932–2019), a Chilean psychiatrist later associated with Berkeley, Esalen, Gestalt therapy (named by Fritz Perls as one of his successors) and the SAT Institute, experimented during the 1960s with four substances other than the classical psychedelics: the amphetamine derivatives MDA and MMDA, harmaline (a harmala alkaloid, linked by Naranjo to the Amazonian brew yagé/ayahuasca after a 1962 field trip to Putumayo, Colombia) and ibogaine. He began this work after returning to Chile from that trip, presented some of it at the 1967 San Francisco Ethnopharmacologic Search for Psychoactive Drugs conference, and gathered it in The Healing Journey. [source: Wikipedia; Erowid Naranjo vault; OPEN Foundation; Passie 2018] Erowid's biography says he befriended Leo Zeff, Stanislav Grof, Michael Harner and others in the early 1960s, and the MAPS author note places him in Zeff's psychedelic therapy group in 1965–66 [source: Erowid vault; MAPS store]. A 2016 Chilean profile reports that he worked with the University of Chile's Centre for Studies in Medical Anthropology (CEAM, founded 1959 by Franz Hoffmann), used the yagé he brought back in experimental sessions with patients at the university's psychiatric clinic (who reported vivid, conscious reveries), and dedicated The Healing Journey to Hoffmann [source: The Clinic 2016, in Spanish, paraphrased].

Core idea of how change happens (as Naranjo framed it). Naranjo separated these substances from LSD and psilocybin as two classes: "emotion-enhancers" (MDA, MMDA) that were thought to heighten feeling, empathy and self-insight without perceptual distortion, and "fantasy-enhancers" (harmaline, ibogaine) that were thought to release vivid, daydream-like imagery without loss of awareness. The therapeutic idea was that heightened access to feelings, memories and symbolic imagery inside a supportive relationship could bring unresolved conflicts into awareness so they could be worked through. The book's catalogue description puts their value to psychotherapy as "facilitating access to otherwise unconscious processes, feelings, or thoughts"; it describes MDA and MMDA as enhancing feeling, sharpening attention and improving fluency of association and communication, and harmaline and ibogaine as producing vivid dream-like sequences contemplated with eyes closed while the person stays in contact with the surroundings [source: LibraryThing]. For ibogaine, a later review summarises his view as enhanced retrieval of personal memories and fantasies helping patients resolve unresolved conflicts. [source: OPEN Foundation; MAPS store; Naranjo, Shulgin & Sargent 1967; Naranjo 1987; Brown 2013]

2. Framework

This is not a phased therapy with a manual. No published phase model, standard number of sessions, or criteria for moving between phases is available for Naranjo's MDA, MMDA, harmaline or ibogaine work [uncertain]. Catalogue and review pages show that the book is organised by substance, not by phase, and is built from session notes and patients' journals [source: LibraryThing]; whether its chapters describe a set sequence of sessions per patient is unknown [uncertain]. What the available sources do describe, in general terms:

Historical frame (described as history, not for use)

Selection and preparation. In the MDA study the eight participants were healthy volunteers, not patients, and all had previously taken LSD under comparable conditions. Each was interviewed beforehand about life history and interest in the research, and was told the drug might produce hallucinogen-like effects. [source: Naranjo, Shulgin & Sargent 1967]
Session format. Six MDA sessions: four with single participants and two with married couples. Each was closely observed throughout the drug effect, with a sympathetic observer available; otherwise the session was largely unstructured. [source: Naranjo, Shulgin & Sargent 1967]
Within-session structure (MDA). Periodic structured checks (looking at objects, own hands, a mirror, other people) to test for perceptual change; periods of eyes-closed attention to imagery, feelings and body sensations; the rest of the time relaxing and spending the time as the participant wished. [source: Naranjo, Shulgin & Sargent 1967]
Harmaline and yagé sessions. About 30 volunteers; subjects typically lay down, eyes closed, passive and withdrawn, with little wish to move or talk, absorbed in imagery [source: Keeper of the Trout, summarising Naranjo 1967; Naranjo 1987]. Separately, a Chilean profile reports experimental yagé sessions with patients at the University of Chile psychiatric clinic, with Naranjo in an observer role [source: The Clinic 2016].
MMDA and ibogaine. The book gives each a chapter of its own [source: LibraryThing]. Ibogaine was used as an adjunct to psychiatric treatment in the 1960s; Naranjo obtained a French patent for its psychotherapeutic use in 1969 [source: Brown 2013]. Reader reviews say the book's patients included people with chronic anxiety and depression, and one reviewer found his in-session style more directive than current practice [uncertain: secondary, unverified; Goodreads reader reviews]. No published session structure for either drug is available [uncertain].
Afterwards. In the MDA study, two participants had temporary amnesia for parts of the session that was largely recovered a few days later with the therapist's help, so follow-up contact was part of the work. [source: Naranjo, Shulgin & Sargent 1967]
Later related practice (MDMA, not in this entry's title). In the late 1970s–1980s Naranjo used MDMA mainly as an "opener" in groups of 12–16 people with ongoing relationships, after individual interviews and a preparatory group session, followed by an integrative session. [source: Passie 2018] This is included only because clinicians may hear it cited alongside his MDA work.

Why practice stopped. The sources used do not give Naranjo's own reason [uncertain]. Documented contributing facts: ibogaine possession became illegal in the US in 1967 and it was placed in Schedule I in 1970 [source: Brown 2013]; MDA was likewise placed under strict national and international control (see below); Leo Zeff reportedly found that MDA's toxicity had caused medical complications and deaths [source: Passie 2018]; a 2016 Chilean profile says the purely observational, theoretical character of his yagé experiments disillusioned him and turned him toward psychotherapy and mystical exploration [source: The Clinic 2016]; after his son's death in 1970 Naranjo undertook a six-month retreat under Oscar Ichazo, which he regarded as the start of his spiritual and contemplative life, and his later work centred on meditation, Gestalt, the Enneagram/Protoanalysis and SAT [source: Erowid vault; Wikipedia; uncertain: secondary]. The link between these facts and the end of the drug work is [synthesis].

Legal and regulatory status (as of the sources' dates). MDA: Schedule I in the US, Class A in the UK, and in Schedule I of the UN 1971 Convention on Psychotropic Substances; also prohibited in Canada (Schedule I), Australia (S9), Germany (Anlage I, authorised scientific use only) and across the EU [uncertain: secondary, unverified; Wikipedia "3,4-Methylenedioxyamphetamine", accessed October 2026]. Harmaline and harmine: uncontrolled federally in the US (supplement, food and drug law still applies); controlled in France since 3 May 2005; Schedule 9 in Australia; harmaline and harmalol in Schedule III in Canada [source: Erowid harmala legal status page, last modified 2015, which states it is not a legal authority]. UK and UN status of harmaline: [uncertain]. Ibogaine: Schedule I in the US since 1970; illegal in Australia, Belgium, Denmark, France, Sweden and Switzerland; unregulated in most other nations; a non-approved prescription medicine in New Zealand from 2010 [source: Brown 2013, current to 2013]; UK status [uncertain]. MMDA: status [uncertain]. None of the four is an approved medicine for psychotherapy in these jurisdictions. Laws change; check current national schedules before advising anyone.

Framework for a clinician today [synthesis]. One to three assessment and integration sessions, inside ordinary psychotherapy, when a client (a) took part in historical or underground sessions with these substances, (b) cites Naranjo or The Healing Journey to justify a practice they are considering or have been offered, or (c) plans to use ibogaine or ayahuasca-type preparations outside a regulated setting. Goals: safety assessment and medical referral; harm-reduction education in general terms; integration of whatever material emerged; and, where relevant, support after harm. Move on to ordinary treatment planning once safety is addressed and the experience has been made sense of.

3. Guiding principles

Principles Naranjo's opened work states or shows (historical)

Distinguish substance classes by their psychological profile. Feeling-enhancers versus fantasy-enhancers, both distinct from LSD-type drugs; practical meaning then: the kind of material expected (emotion and relationship versus imagery) shaped how the session was used. [source: OPEN Foundation; Naranjo 1987]
Constant attendance. The MDA paper advised that someone stay with the person throughout; practical meaning: never leave a person alone in an altered state. [source: Naranjo, Shulgin & Sargent 1967]
Sympathetic, largely non-directive presence. The observer was available to discuss personal concerns, otherwise the session was unstructured; practical meaning: follow the person's material rather than imposing an agenda. [source: Naranjo, Shulgin & Sargent 1967]
Inward first, then outward. In his later MDMA groups he asked people to focus inward before reaching out to others; practical meaning: let insight form before interpersonal work. [source: Passie 2018]
Spontaneity balanced with non-interference; minimal intervention. He intervened little except in preparation, retrospective sharing and feedback. [source: Passie 2018]
Verbal interaction over sensory isolation (for the interpersonal drugs). He preferred talking to the blindfold-and-headphones model used with LSD. [source: Passie 2018]
Integrate afterwards. A follow-up integrative session; help recovering forgotten material. [source: Passie 2018; Naranjo, Shulgin & Sargent 1967]
Read imagery symbolically. He treated recurrent harmaline imagery (snakes, felines, birds of prey, death) as spontaneous symbolisation of the drug state, and linked it to kundalini; this is Naranjo's own interpretation, which he himself called metaphorical and partly incomplete, and which other researchers did not confirm. [source: Naranjo 1987]

Principles for the clinician today [synthesis]

Not for use. Treat this as history; practical meaning: never facilitate, source, dose or supervise use of these substances.
Harm reduction, not facilitation. Practical meaning: assess, educate in general terms, plan safety and refer; do not help someone obtain or take a drug.
Medical risk is medical business. Practical meaning: any plan involving ibogaine, MDA or harmala preparations triggers referral to a physician; you do not assess cardiac or drug-interaction risk yourself.
Historical claims are not evidence of safety. Practical meaning: small, uncontrolled 1960s case series (eight volunteers; about thirty volunteers) do not establish efficacy or safety.
The client's meaning, not the theory's. Practical meaning: work with imagery as the client's material; present kundalini, archetypal or shamanic readings as one tradition's or author's view, never as fact.
Non-judgemental curiosity. Practical meaning: clients disclose more, and more safely, when they do not expect a lecture.
Respect cultural authority. Practical meaning: Indigenous ayahuasca/yagé use belongs to its communities; refer and respect, do not describe or recreate ceremony.

4. Intervention inventory

The inventory has two parts. Part A describes the historical procedures that the available sources document, as history and not for use: the steps say what was done, without doses or administration details, so a clinician can recognise them. Part B gives what a clinician does today with this knowledge, all [synthesis] unless cited. The detailed procedures in the chapters of The Healing Journey are not reported here, so Part A may be incomplete, especially for MMDA and ibogaine, where no published session procedure is available [uncertain].

Part A — Historical procedures (not for use)

A1. Pre-session life-history interview and expectation setting (MDA study)

Purpose: Get to know the participant and their reasons for taking part, and tell them what the drug might do. [source: Naranjo, Shulgin & Sargent 1967]
Steps (as described): Volunteers who had previously had LSD under comparable conditions were interviewed about their life histories and their interest in the research. They were then told the drug might produce effects like a hallucinogen's.
Example language: Not reported; none attributed.
Watch for (historical lesson) [synthesis]: The screening was a research interview, not the medical and psychiatric screening that modern regulated trials publish. A client who describes "screening" in an informal setting may mean only a conversation.

A2. Constant attendance by a sympathetic observer

Purpose: Keep the person safe and available to talk, and observe the drug's effects. [source: Naranjo, Shulgin & Sargent 1967]
Steps (as described): The observer stayed with the participant for the whole period of drug effect. They were available if the person wanted to discuss personal or symptom concerns, and otherwise left the session largely unstructured. The authors explicitly advised constant attendance during psychotherapy sessions.
Example language: Not reported.
Watch for: The paper reported temporary amnesia in two participants, which was one reason given for constant attendance.

A3. Structured perceptual checks (MDA study)

Purpose: A research assessment of whether the drug altered perception, not a therapeutic technique. [source: Naranjo, Shulgin & Sargent 1967]
Steps (as described): At intervals, participants were asked to look at objects, their own hands, a mirror and other people, and to report any change.
Example language: Not reported.
Finding: No hallucinations, perceptual distortions or eyes-closed imagery were reported with MDA. Pupil dilation was the only consistent physical sign.

A4. Eyes-closed inward attention (MDA study)

Purpose: Let feelings, imagery and body sensations come into awareness. [source: Naranjo, Shulgin & Sargent 1967]
Steps (as described): At times participants were asked to close their eyes and attend to imagery, feelings and body sensations. The rest of the time they were encouraged to relax and spend the time as they wished.
Reported experience: Intensified feeling, improved self-insight, heightened empathy and aesthetic enjoyment. Waves of euphoria alternated with depression or guilt, mostly about the person's own life and personality. Seven of eight participants described music as "three-dimensional". One participant spent much of the session writing his life history.

A5. Conjoint sessions for couples (MDA study)

Purpose: To see how the state affected a relationship. [source: Naranjo, Shulgin & Sargent 1967]
Steps (as described): Two of the six sessions were held with married couples, who discussed their shared difficulties during the session.
Reported: Better communication and mutual acceptance. These were reports from a small uncontrolled sample.

A6. Post-session recall work

Purpose: Recover parts of the session the person could not remember. [source: Naranjo, Shulgin & Sargent 1967]
Steps (as described): In the days after the session, the therapist helped the participant reconstruct what had happened. The amnesic material was largely recovered.
Watch for [synthesis]: Material "recovered" after an altered state is reconstructed memory. Treat it as the client's narrative, not as verified fact.

A7. Recumbent eyes-closed imagery sessions (harmaline)

Purpose: Release vivid symbolic imagery (the "fantasy-enhancer" use). [source: Keeper of the Trout, summarising Naranjo 1967; Naranjo 1987]
Steps (as described): About 30 volunteers who had no expectations of the effects. Subjects typically lay down, relaxed, with eyes closed, and contemplated the imagery. They showed little wish to move, talk or communicate.
Reported experience: Vivid, brightly coloured imagery seen with eyes closed and long dream-like sequences; images were more realistic than with mescaline, and the surroundings were essentially unchanged. Typical themes were snakes, big cats, birds of prey and images of death and killing. Many subjects felt certain scenes had really happened, with themselves as a disembodied observer. Religious and philosophical concerns were frequent. Naranjo reported that neurotic symptoms improved in 8 of the 30. This is secondhand and the outcome was not systematically measured [uncertain].
Watch for (documented adverse effects): Nausea in 18 of 30, sometimes with intense vomiting. Tingling then numbness, head pressure, chest discomfort, dizziness, malaise, and buzzing sounds in over half. [source: Keeper of the Trout]

A8. Symbolic interpretation of imagery

Purpose: Find meaning in recurrent imagery. [source: Naranjo 1987]
Steps (as described): Naranjo read the recurrent animal and death imagery as a spontaneous symbol of the drug state. He combined the reptile, feline, bird and fish features into the dragon as its emblem. Drawing on reports of shamans' advice, he proposed that the healing worked through what he called kundalini activation, linked to waves of muscle tone, inner guidance and healing.
Status: These are Naranjo's interpretive views. He called the kundalini account metaphorical and his earlier dragon reading incomplete, and other researchers did not confirm his imagery observations. They are not established mechanisms.

A9. Ibogaine-assisted memory and fantasy work

Purpose: Retrieve personal memories and fantasies to resolve unresolved conflicts. [source: Brown 2013]
Steps: No published step-by-step account is available [uncertain]. The book has an ibogaine chapter built from session notes and patients' journals; its catalogue description characterises the experience as vivid dream-like sequences contemplated with eyes closed while the person stays in contact with the surroundings [source: LibraryThing]. Ibogaine was used as an adjunct to psychiatric treatment in the 1960s, and Naranjo held a 1969 French patent for its psychotherapeutic use [source: Brown 2013]. The sources used give no number of patients or outcome data [uncertain].
Watch for (modern evidence on ibogaine generally): Sudden deaths, at least 19 between 1990 and 2008 in later treatment settings, not Naranjo's. Also cardiac risk factors, QT prolongation and bradycardia. [source: Brown 2013]

A10. Group sessions with interpersonal preparation and integration (later MDMA work, for recognition only)

Purpose: Naranjo used the drug as an "opener" that also helped later therapeutic work, aiming at trust and empathy in groups. [source: Passie 2018]
Steps (as described, in general terms): He worked with groups of 12–16 people who had ongoing relationships. He interviewed members he had not met before and held a preparatory group session. During the session he asked people to focus inward before reaching out, and intervened little. Retrospective sharing and group feedback followed, then an integrative session. He preferred verbal interaction to blindfold and headphones.
Naranjo's framing: He described the state as a temporary "artificial sanity" that lowers defences. These are his words as reported by Passie.
Note on dates (checked against guide 042): Erowid says Naranjo befriended Leo Zeff in the early 1960s, and the MAPS author note places him in Zeff's psychedelic therapy group in 1965–66, saying these meetings led to his contributing harmaline, MDMA and ibogaine [source: Erowid vault; MAPS store]. The 1960s acquaintance fits guide 042's dates for Zeff (introduced to LSD in 1961). The MDMA part does not: guide 042, following Passie 2018, has Shulgin first giving Zeff MDMA in 1977, so "MDMA" in the MAPS note for 1965–66 is probably an error for MDA [synthesis]. An earlier reading that Passie dates their acquaintance only "from the 1970s" was not re-checked [uncertain].

A11. Written session accounts (session notes and patients' journals)

Purpose: Record what happened and the patient's own account, as material for interpretation. The book is built from this material [source: LibraryThing].
Steps (as described): Naranjo kept session notes, and patients wrote journal accounts of their experiences; the book reproduces long passages of these alongside his interpretations [source: LibraryThing review]. When and how patients wrote them is not described in the sources used [uncertain].
Example language: Not reported; none attributed.
Watch for / today [synthesis]: A client's own written account is useful integration material (see B4); treat it as their narrative, not a record of fact. Before keeping a written account of an illegal session in clinical records, discuss confidentiality and legal exposure with the client.

A12. Directive, Gestalt-influenced guidance within sessions (as reviewers report)

Purpose: Not stated in the sources used [uncertain].
Steps (as reported, secondary): Reader reviews describe Naranjo's in-session style as more directive than current practice and as reflecting the 1970s Gestalt approach. One reviewer objected to a "conversion session" late in the book and to demeaning language about some patients' visions [uncertain: secondary, unverified; Goodreads reader reviews]. The specific techniques are not described in the sources used [uncertain].
Example language: Not reported; none attributed.
Watch for / today [synthesis]: Directive reframing of a person's experience while they are in a highly suggestible altered state, especially pushing toward a conversion-type experience, carries strong suggestion and power-imbalance risks. Treat any present-day facilitator who does this as a red flag (see B1 and B5).

Part B — What a clinician does today [synthesis throughout unless cited]

B1. Recognising and appraising historical claims

Purpose: Respond when a client, colleague, retreat or website cites Naranjo or The Healing Journey as backing for a practice.
Steps: (1) Ask what exactly is claimed and who is offering what. (2) Place the claim in context. The opened evidence is an uncontrolled study of eight healthy volunteers for MDA and roughly thirty volunteers for harmaline, with secondhand outcome reports [source: Naranjo, Shulgin & Sargent 1967; Keeper of the Trout]. (3) Note that the substances' legal status rules out legitimate outpatient use in many jurisdictions (for ibogaine see Section 2). (4) Separate the historical psychotherapy ideas, such as a sympathetic presence, inward attention and integration, from the drug use itself. (5) Point to regulated trials as the only legitimate route to drug-assisted therapy.
Example language (illustrative): "Naranjo did write about this in the sixties, mostly from small groups of volunteers. That's interesting history, but it doesn't tell us this is safe for you now. Can we look at what's actually being offered?"
Watch for: Marketing that uses "pioneer" lineage, "fantasy-enhancer" or "emotion-enhancer" language, or a Gestalt or Enneagram pedigree to imply safety. Look for an absence of medical screening.

B2. Assessment of a client who took part in such sessions

Purpose: Understand what happened and whether there is lasting harm or unfinished material.
Steps: (1) Ask when and where, who ran the sessions, whether the client was alone or in a group, and whether they gave informed consent. (2) Ask about the physical course, including any collapse, cardiac symptoms or vomiting, and whether there was medical follow-up. (3) Ask about the psychological course: memory gaps, "recovered" memories, frightening imagery, persisting perceptual changes, mood or sleep changes, and any psychotic or manic symptoms. (4) Ask about relational or boundary problems, such as pressure, touch or sexual contact, financial demands, or group dependence. (5) Run standard suicide and self-harm risk assessment where indicated. (6) Ask for a medical review if any physical symptoms continue.
Example language (illustrative): "I'm not here to judge the choice. I'd like to understand what the sessions were like, what you remember, and anything that's stayed with you since."
Watch for: Shame or secrecy, and missing memory for parts of the sessions (temporary amnesia was documented with MDA [source: Naranjo, Shulgin & Sargent 1967]). Also watch for persisting distress tied to imagery.

B3. Harm-reduction conversation for a client planning use outside regulated settings

Purpose: Reduce risk without facilitating illegal use.
Steps: (1) State your role clearly: you won't help obtain or use the drug, but you will help them think through safety. (2) Explain the documented risks in general terms. For ibogaine these are sudden deaths, cardiac rhythm problems (QT prolongation, bradycardia) and cardiac disease as a risk factor [source: Brown 2013]. For MDA, toxicity has been linked to medical complications and deaths [source: Passie 2018]. For harmala preparations, marked nausea and vomiting and other physical effects have been reported [source: Keeper of the Trout]. (3) Say that interactions with prescribed and other drugs can be dangerous, and that a physician or pharmacist must review all medicines, without going into the specifics yourself. (4) Urge a medical assessment, including of the heart, before any decision. (5) Draw up a safety plan: who knows where they are, how emergency help would be reached, and a plan for a crisis. (6) Discuss legal risk. (7) Offer alternatives, such as regulated trials, evidence-based treatment for the problem they want to address, and addiction services where relevant.
Example language (illustrative): "I can't help you get or use it, and I'm worried about the heart risks with ibogaine. What I can do is make sure you've had a proper medical check and that we've thought through what happens if something goes wrong."
Watch for: Plans that involve stopping prescribed medication on someone else's advice, being alone, being far from emergency care, or using it to self-treat addiction.

B4. Integration of imagery-rich experiences

Purpose: Help a client make use of vivid imagery (animals, death, "real" scenes) without overvaluing or pathologising it.
Steps: (1) Let the client tell the experience in their own order. (2) Ask what each image felt like and what it brings to mind in their current life. (3) Treat "it really happened" experiences as meaningful experiences, not as evidence of events. (4) Link any insights to concrete changes the client wants. (5) If the client uses kundalini, shamanic or archetypal frames, explore them respectfully as their framework or that author's (Naranjo held that...), not as fact.
Example language (illustrative): "The snake keeps coming back in how you tell this. What did it feel like, and where in your life now does that feeling show up?"
How you know it's working: Less preoccupation with the experience, insights put into practice, and stable sleep and mood.

B5. Support after harm or exploitation

Purpose: Help clients who were harmed in historical or present-day unregulated sessions.
Steps: (1) Stabilise first, with grounding, sleep and medical review. (2) Use trauma-informed, phase-based care if there are trauma symptoms. (3) Consider psychiatric referral for persisting perceptual, psychotic or manic symptoms. (4) Explain reporting options for professional misconduct or crime, such as licensing boards and the police, and respect the client's choice unless mandatory reporting applies. (5) Address any group dependence or a damaged trust in therapy.
Example language (illustrative): "What happened in that group wasn't your fault. We'll go at your pace, and you decide what, if anything, gets reported."

B6. Referral to regulated research or care

Purpose: Steer interest toward legal, monitored options.
Steps: (1) Find ethics-approved clinical trials, for example through trial registries. (2) Explain that trials publish eligibility criteria and medical and psychiatric screening, and that medical staff handle monitoring. (3) Help the client prepare questions for the trial team. (4) Offer to continue psychotherapy alongside, if the trial allows.

5. Handling problems

Problems the historical sources record (described as history, not for use)

Temporary amnesia for parts of a session (MDA). Then: constant attendance was advised, and the therapist helped the person recall the material in the days afterwards [source: Naranjo, Shulgin & Sargent 1967]. Today [synthesis]: when a client reports gaps, ask gently about safety and boundaries during the missing time, and do not press for reconstruction. See B2 and B5.
Mood swings within the session (MDA). Waves of euphoria alternated with depression or guilt [source: Naranjo, Shulgin & Sargent 1967]. Today [synthesis]: in integration, separate lasting insight from passing guilt states, and screen for low mood that persists.
Physical distress (harmaline). Nausea and sometimes intense vomiting, numbness, chest discomfort, dizziness and noise sensitivity [source: Keeper of the Trout]. Today [synthesis]: any chest symptoms, fainting or continuing physical symptoms after use need medical assessment. This is not a matter for psychotherapy.
Passivity and withdrawal (harmaline). Subjects had little wish to talk or communicate [source: Keeper of the Trout]. This made it hard to intervene verbally during the state [synthesis].
Cardiac risk and deaths (ibogaine, later settings). At least 19 deaths between 1990 and 2008, plus QT prolongation and bradycardia [source: Brown 2013]. Today [synthesis]: treat any plan to use ibogaine as a medical safety issue. Refer, and draw up a safety plan (B3).
MDA toxicity. Zeff reportedly found it caused medical complications and deaths [source: Passie 2018]. Today [synthesis]: correct any belief that MDA is a "gentle" therapeutic drug.

Problems in today's clinical work [synthesis unless cited]

Client asks you to facilitate, sit for, or recommend a source or amount. Decline clearly and warmly. Explain the legal, ethical and safety reasons, and offer harm-reduction and integration support instead. Document the conversation. (illustrative) "That's not something I can do, but I don't want you going into it without a safety plan. Can we work on that?"
Rupture after you decline. Name the disagreement, affirm that the client chooses their own goals, and keep the door open. Repair works through explaining your role, not through giving in.
Client idealises Naranjo, a lineage or a facilitator. Explore what the person or idea offers them, such as belonging, meaning or hope, and help them check the claims against current evidence (B1). Avoid ridicule.
Persistent distressing imagery, derealisation or perceptual changes. Use grounding and sleep hygiene, and refer for psychiatric and medical assessment if symptoms persist or include psychotic or manic features.
Spiritual crisis framed as kundalini or shamanic calling. Respect the framework as the client's or the tradition's own, without endorsing it as fact. Assess safety and functioning; if they are impaired, treat the symptoms whatever the framing.
Stuck integration (client keeps retelling the experience without change). Move from content to present-day meaning and behavioural commitments (B4). Set a time limit on integration work.
Non-adherence to medical referral. Use motivational interviewing to explore ambivalence, restate the specific risks in general terms, and document your advice.
Suicide or self-harm risk. Use standard structured risk assessment and safety planning. Counsel on lethal means where relevant (safe storage and removal of means), and escalate according to local protocol.
Disclosure of abuse or misconduct by a facilitator or therapist. Follow mandatory reporting rules, where they apply, for children or vulnerable adults. For other cases, inform the client of options such as licensing boards and the police and support their decision. Consult your professional body.
Indigenous ceremonial use (ayahuasca/yagé). Do not describe or advise on ceremony. Cultural and religious authority lies with the communities concerned. Support the client's own integration, and focus on general medical safety and interactions.
Clinician's own enthusiasm or curiosity. Keep this role separate from any personal interest, and use supervision. Never blur integration support into facilitation.

Sources

Pages consulted:

Books and papers cited through the pages above [uncertain on content]:

Naranjo, C. (1973/1974). The Healing Journey: New Approaches to Consciousness. New York: Pantheon. 2nd ed. (2023), The Healing Journey: Pioneering Approaches to Psychedelic Therapy, MAPS, ISBN 978-0-9798622-8-1. [primary; five chapters per LibraryThing; chapter content not used]
Naranjo, C. (1967). Psychological aspects of the yagé experience in an experimental setting. In Efron, D. H. (ed.), Ethnopharmacologic Search for Psychoactive Drugs. [cited via Keeper of the Trout]
Naranjo, C. (1969). Paper on fantasy-enhancing drugs. [cited in Brown 2013] Naranjo, C. (2001). Experiences with the interpersonal psychedelics. In Ecstasy: The Complete Guide. [listed in Erowid bibliography]

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