Psychedelic-Assisted Therapy, EMDR, and Beyond: Real Talk on Mental Health Modalities
Welcome back to PsyberSpace. I'm your host, Leslie Poston. And today, we're kicking off season three of the podcast, talking about something I get asked about pretty frequently, therapy. But we're not just answering the question, should I go to therapy? We're also going a little deeper and talking about the fact that therapy isn't one size fits all.
Leslie Poston:Different modalities work for different people and different issues. And finding the right match between you, the therapeutic approach, and the therapist matters just as much as just going to therapy. Now, full disclosure: I'm an applied psychologist. Clinical psychology isn't my main research focus, so I've done a lot of research and reached out to a number of my colleagues that work in clinical practice to get this episode just right for you. We're going to cover different therapeutic modalities, talk about who they work for and who they don't, discuss how to vet a therapist, and importantly, how to fire your therapist if their modality or technique isn't working.
Leslie Poston:We're also going to talk about an aspect of therapy that doesn't get discussed enough, in my opinion. Whose knowledge counts in mental health? And how many Western approaches are actually just repackaging what indigenous, black, and other marginalized communities have always known about healing? This episode is a little longer than usual we've got a lot of ground to cover. So let's dive right in.
Leslie Poston:Before we get into specific modalities, let's set some context. Western psychology has a habit of discovering things that indigenous black and other marginalized communities have known forever. Body based healing? Indigenous practices have centered that for millennia. Plant medicine?
Leslie Poston:That's indigenous knowledge being extracted and commodified. Understanding intergenerational trauma? Scholars in non Western cultures around the world have been talking about historical trauma and its transmission through our bodies and communities long before it became a trending topic in psychology journals. I want you to get to know some names as we move through this episode, to help you balance your Western knowledge with cross cultural information. Resma Menakem, who wrote My Grandmother's Hands, is essential reading on racialized trauma stored in the body.
Leslie Poston:Doctor. Thema Bryant, current president of the American Psychological Association, is doing vital work on culture and trauma. Maria Yellow Horse Braveheart is doing vital work on historical trauma. Doctor. Jametta Nicole Barlow is doing vital work on black women's mental health and why cultural mistrust of medical systems exists for very good reasons.
Leslie Poston:Doctor. Jennifer Mullen is doing work on decolonizing therapy, and Doctor. Kenneth Hardy is doing vital work on racial trauma and therapeutic spaces. These aren't just names to drop these are people whose work should fundamentally shape how we understand mental health. Another consideration is that not everything needs to be pathologized.
Leslie Poston:Sometimes what looks like symptoms are actually healthy responses to oppressive systems. Depression in response to systemic racism isn't a personal failing it's a reasonable response to unreasonable circumstances. Anxiety in a transphobic world isn't irrational it's adaptive. We have to be careful not to medicalize what is actually resistance or survival. Also, healing doesn't only happen in individual therapy rooms with credentialed providers.
Leslie Poston:Sometimes the most healing thing you can do isn't therapy, it's mutual aid. Community organizing, healing circles, collective action, or addressing the material conditions that are causing harm in the first place. Traditional practices like talking circles, ceremonies, land based healing these are all legitimate forms of healing that deserve recognition as well. Okay. With that foundation, let's move on to talk about specific modalities.
Leslie Poston:I'm going to walk through several different therapeutic approaches. For each one, I'll tell you what it targets, who it tends to work well for, and who it might not suit. Remember, none of these are universal solutions. This is all about finding what works for you. If we're talking about a modality you're familiar with, just fast forward to the next one.
Leslie Poston:I'll put timestamps in the show notes for you to make that easy. Let's start with CBT, or Cognitive Behavioral Therapy, because it's probably the most well known and most commonly covered by insurance, which is part of why it's so widespread. CBT targets thought patterns and behaviors. The basic premise is that our thoughts influence our feelings and our behaviors, and by identifying and changing unhelpful thought patterns, we can change how we feel and how we act. It works well for things like anxiety disorders, depression with clear cognitive distortions, panic disorders, and specific phobias.
Leslie Poston:If you're someone who likes structure, homework assignments, and a relatively short term approach with clear goals, CBT might be a good fit. However, CBT is often a terrible fit for autistic individuals. CBT assumes that the person's thoughts are the problem, that they're distorted and need to be fixed. But for autistic folks, their thoughts are often completely logical and it's their circumstances that are invalidating, because the current world just wasn't built for the way autistic brains work. Telling an autistic person their thoughts are distorted when they're actually seeing their situation clearly is gaslighting.
Leslie Poston:It can increase masking, increase shame, and make their lives worse. Similarly, CBT often doesn't work well for people with ADHD. The homework component requires the very executive function that ADHD brains struggle with, and when you can't complete the homework to fix yourself, it just becomes one more thing to feel shame about. The structure that helps some people becomes a setup for failure for others. CBT also tends to be less effective for complex trauma.
Leslie Poston:It can feel superficial, like it's rushing past necessary emotional processing to get to fixing thoughts. For people who need to process deep wounds, CBT can feel like putting a band aid on a bullet wound. Now there are third wave CBT approaches like acceptance and commitment therapy and dialectical behavior therapy that address some of these limitations, but standard CBT just know what you're getting into. For more on neurodivergent affirming therapy, check out the work of Doctor. Devin Price and Doctor.
Leslie Poston:Nick Walker. Speaking of dialectical behavior therapy, or DBT, I wanted to talk about it separately because it's a little different than standard CBT. DBT was originally developed by Marsha Linehan for borderline personality disorder, and it targets emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness. It's more skills based than insight based. It works well for emotional dysregulation, suicidality, and situations where someone needs concrete practical tools to manage intense feelings.
Leslie Poston:Some people with ADHD find it helpful because the skills are structured and specific. It usually involves both individual therapy and a skills group, which some people really benefit from. However, DBT is primarily about stabilization It's not really designed to process deep trauma. It's great for building a foundation so you can eventually do that work. But if you need to process trauma, and you're stable enough to do so, DBT alone might not be sufficient.
Leslie Poston:Also, not everyone wants to do group therapy, and that is a core component of DBT. Psychodynamic and psychoanalytic therapy is the name of the lie on a couch and talk about your childhood therapy stereotype. Although modern psychodynamic therapy usually doesn't look quite like that anymore. Psychodynamic therapy targets unconscious patterns, how past relationships shape your present, and deep self understanding. It's exploratory, rather than directive.
Leslie Poston:The relationship you build between you and your therapist is considered part of the work. It works well for people who are introspective, who want to understand themselves deeply rather than just reduce symptoms and those who have patterns in relationships or life that they want to explore. If you have surface level stability but deeper dissatisfaction, or if you keep repeating the same life patterns that harm you, this might resonate. It doesn't work as well for acute crisis. This isn't the approach if you're in immediate danger or need rapid symptom relief.
Leslie Poston:It's also usually longer term and can be expensive, so practical constraints matter. And if you find open ended exploration frustrating rather than illuminating, this modality might not be for you. That brings us to EMDR, or eye movement desensitization and reprocessing, which is specifically designed for trauma. It uses bilateral stimulation while you process your traumatic memories. Usually this is in the form of eye movements, but sometimes it can involve tapping or sounds.
Leslie Poston:The theory is that trauma gets stuck and how it's stored in the brain, and bilateral stimulation helps you reprocess it. It works really well for PTSD, particularly single incident trauma. So if you've been in a car accident, experienced an assault, or witnessed something traumatic, EMDR has strong evidence for helping with that. It's also good for people who struggle to verbalize their trauma or who've talked about it extensively in traditional talk therapy without relief. But you need adequate stabilization first.
Leslie Poston:If you're in active crisis, if you don't have good coping skills yet, if you're dealing with complex ongoing trauma without support, EMDR might be too much too fast. You need a good foundation before you can do this kind of processing. Some people also just don't gel well with the protocol. It's quite structured, which doesn't work for everyone. But for what it's designed for, PTSD, the evidence for success is strong.
Leslie Poston:For those of you who didn't choose to fast forward to a specific modality you were curious about, we've got three modalities left to cover. Note that we also have our main website, where we upload many of the studies we use for these episodes to help you avoid AI slop and fake research. You can check that out at psyberspace.com, where you'll see our research repository and episode list grow daily as we add to it. Now let's talk about therapy modalities centered around the way emotional trauma impacts your body and your nervous system. This includes therapy modalities like somatic experiencing, sensory motor psychotherapy, and other body centered therapies.
Leslie Poston:The premise is that trauma lives not just in our minds, but in our bodies in tension patterns and how we breathe in, in illnesses or in our nervous system's general state. This therapy works really well for people who are disconnected from their bodies, for trauma survivors where talk therapy hasn't been enough, and for people who struggle with verbalization of what they're feeling. Interestingly, a lot of autistic individuals report that somatic approaches feel more validating than CBT because they're not being told their perceptions are wrong. They're being helped to regulate their nervous system in a world that's genuinely overwhelming. These approaches are also important for understanding racialized trauma.
Leslie Poston:This is where I want to re recommend Resma Menakem's My Grandmother's Hands, which I mentioned at the start of the episode, instead of the well known Bessel Vander Kolk's The Body Keeps the Score. Vander Kolk's work has been influential, but he's also been credibly accused of professional misconduct and creating hostile work environments, particularly toward women. Menachem's book is both more ethical to recommend and more insightful about how historical and racialized trauma gets stored in bodies across generations. Somatic approaches acknowledge what Western psychology is just catching up to, that you can't think your way out of trauma that's stored in your body, and that healing has to include the body. These approaches are less effective if you specifically need cognitive restructuring or if you're very uncomfortable with body awareness work.
Leslie Poston:And you need a skilled practitioner. This isn't something that you can just DIY. This next modality requires some nuance because there's so much hype about it right now. Psychedelic assisted therapy uses substances like psilocybin, MDMA, or ketamine combined with preparation and integration therapy. This isn't just taking some drugs.
Leslie Poston:It's a structured therapeutic protocol that centers your mental health and physical safety. The current evidence shows promise for treatment resistant depression with psilocybin, and for PTSD with MDMA though we should note that the FDA recently declined to approve MDMA assisted therapy, citing concerns with the clinical trials. Ketamine is already legal for off label use and has different effects than psilocybin or MDMA. There's also research on how these substances help end of life anxiety. This is an emerging field.
Leslie Poston:The research is quite promising, but is not yet conclusive. Many people have found success with this modality, but the hype right now is outpacing both the evidence and the legal structure in various states across The United States, and you need to be aware of that as you explore this as a possibility for you. This modality might work well for people who haven't responded to other treatments, who need significant shifts in perspective, or who are dealing with existential questions. But it requires a skilled, ethical facilitator, and that matters enormously. There are serious contraindications.
Leslie Poston:If you have a personal or family history of psychosis, certain heart conditions, or you're on many of the psychiatric medications, this therapy could potentially be dangerous for you, and you should get advice on that before you start. Both the environment for the therapy and your mindset going in are crucial. And integration therapy afterward is just as important as the experience itself. Access is also very limited right now. You're looking at clinical trials, certain specialty clinics, or in the case of ketamine, which is more available, but again, works differently than psilocybin or MDMA, an appropriately monitored facility.
Leslie Poston:There's also the part that doesn't get discussed enough. Again, these are indigenous medicines. Psilocybin comes from Mazatak traditions in Mexico. Ayahuasca is from Amazonian peoples. Peyote is sacred to Native American practices.
Leslie Poston:These aren't chemicals that Western science invented or discovered. They're medicines that have been used ceremonially and therapeutically by indigenous communities for generation. Right now, there are also serious ethical issues around extraction and commodification. White researchers and wealthy clinics are profiting from indigenous knowledge, while those communities often lack access to any type of basic health care. People are being charged thousands of dollars for experiences with medicines that were removed from the cultures that developed them.
Leslie Poston:If we're going to talk about psychedelic assisted therapy ethically, we have to ask ourselves: are indigenous communities being consulted? Are they benefiting? Is traditional knowledge being credited and compensated? Francois Bourzat's work attempts to bridge this more ethically, but it's still a huge problem in the field. So yes, this might be a great tool for your needs, but approach it with your eyes open about both the evidence base and the ethics.
Leslie Poston:The last thing I want to mention isn't usually listed as therapy in the clinical sense, but it is therapeutic, and that's community based healing. Mutual aid networks, healing circles, community organizing, traditional practices like talking circles, ceremony, land based healing. These are all legitimate forms of healing that happen outside of individual therapy rooms. For many people, especially those from marginalized communities, this kind of collective healing is more accessible, more culturally relevant, or more effective than individual therapy alone. Healing happens in relationship and community, not just in fifty minute sessions.
Leslie Poston:Sometimes the most therapeutic thing you can do isn't to process your feelings about injustice. It's to organize with others to change the conditions creating the injustice. You'll notice perhaps that I didn't include online or app based solutions like BetterHelp, Cerebral, Regain, or similar in my recommendations. I'll first say that if that is the only way you can access therapy, it is a valid method of therapy, and you should do so. I rarely recommend it as a first recourse, however, due to a variety of challenges, from data breaches all the way out to underpaid therapists.
Leslie Poston:Before choosing an app, if that's how you can access therapy, please do extra due diligence on their data safety practices, how they have handled any past breaches and how they're preparing for future breaches, whether or not they use AI, how they pay the therapists that are in their network, and how they vet the therapists that are in their network. And just proceed with some caution, but definitely seek the help you need. So with all of these options, how do you figure out what's right for you? First, think about what you're dealing with. Specific symptoms like panic attacks might respond well to CBT.
Leslie Poston:Complex trauma might need somatic work or EMDR. Emotional dysregulation might benefit from DBT. Relational patterns you want to understand might call for psychodynamic work. And sometimes you need different modalities at different times. Maybe DBT to stabilize and then EMDR to process trauma.
Leslie Poston:Consider your learning style. Do you like structure and homework, or does that stress you out? Do you process things verbally, or do you need to work through your body? Are you introspective, or does too much self reflection spiral you? Think about your nervous system.
Leslie Poston:Are you in crisis and need stabilization first? Are you stable enough to dive right into processing? Do you need help regulating before you can do anything else? And be real about your practical constraints. What does your insurance cover if you choose to go through insurance?
Leslie Poston:And know that insurance often only covers certain modalities, which can create serious access issues. Know what's available in your area and what you can afford. What language do you need? What cultural specificity matters for your healing? Do you want a therapist who consults AI, or do you want to make sure AI doesn't go anywhere near your medical records?
Leslie Poston:The key insight here is that what works isn't universal. It's about what works for you and your body with your brain in your specific circumstances right now. And right now might change six months from now, and that's fine. So be prepared to try different approaches. That's not failure.
Leslie Poston:You're just gathering information. Now that you've got a sense of what kind of therapeutic approach might help, you need to find an actual therapist. And this is the part that can be most challenging because a great modality with the wrong therapist doesn't work, and the right therapist using the wrong approach doesn't work either. So before your first session, do some homework. Check their credentials.
Leslie Poston:Are they licensed, and what are they licensed as? LCSW, LPC, psychologist, psychiatrist. All of those mean different things. Do they have specific training in the modalities they claim to practice? Be wary of coaches or unlicensed people claiming clinical expertise.
Leslie Poston:Look at their profile on a site like Psychology Today, Therapy Den, Open Path Collective, or on their own website. Do they make specific statements about populations they serve? Do they list your identities or issues explicitly? Then, and this is important, don't be shy about asking them direct questions in a phone consultation. Good therapists expect this.
Leslie Poston:Questions like, are you comfortable working with LGBTQ plus clients? Do you have experience working with neurodivergent adults? What's your approach to clients with my issue? How do you understand systemic racism or colonization's impact on mental health? Have you done your own work on your biases and your privilege?
Leslie Poston:Can we talk briefly about your politics and value system so I can determine how they might impact our work together? If a therapist gets defensive about these questions, that's information for you too. In your initial sessions, you're assessing several other things. Safety. Do they affirm your identities without you having to fight for it?
Leslie Poston:Do they understand intersectionality that you're not just one identity, but a whole person with multiple experiences of privilege and marginalization? If you're LGBTQ plus, do they assume they know your experience, or do they ask you about it respectfully? If you're a person of color, here's a distinction that matters, cultural competence versus cultural humility. Be wary of therapists who claim competence in your culture like they've mastered it. If you're in an area where you can't get to a therapist who shares your culture, look for therapists who approach it with humility and a willingness to learn about your specific experience.
Leslie Poston:You shouldn't have to educate them or risk harm for their learning curve, but someone who knows they don't know everything is better than someone who thinks they're already an expert. Assess their actual competence. Do they explain their approach clearly to you? Can they tell you why they're suggesting specific techniques for your situation? Do they stay current with research?
Leslie Poston:Are they willing to say, I don't know, or refer you elsewhere if you need something outside their expertise? Evaluate their boundaries. Are they clear about their session structure, fees, and cancellation policies? Do they maintain professional boundaries, not oversharing their own stuff and not trying to be your friend? Do they respect your pace and your consent throughout the process?
Leslie Poston:Looking again at politics and therapy, you don't need to have identical politics with your therapist, but you do need them to respect your fundamental dignity and your reality. If your existence is political, for example, if you're LGBTQ plus, if you're advocating for disability rights, if you're invested in racial justice, you're needing a therapist who doesn't debate your humanity. Red flags are therapists who play devil's advocate about your marginalization. Therapists who claim color blindness or say I don't do politics when you're discussing systemic issues that directly affect you. Therapists who make you defend your right to exist or to be treated with basic respect.
Leslie Poston:And here's something that doesn't get said enough. If you're black, indigenous, or from another marginalized community, being cautious about therapists, especially white therapists, isn't paranoia. It's informed by history, medical racism, the Tuskegee experiments, forced sterilization, Indian boarding schools, forced institutionalization, pathologizing of resistance and survival strategies. Cultural mistrust of medical systems exists for good reason. You're not obligated to give someone the benefit of the doubt or to be the teacher or the test case.
Leslie Poston:Doctor. Jamita Nicole Barlow's work on this is essential. Also, trust your gut. Do you feel heard, or do you leave sessions feeling worse, confused, or like you're performing for them? Your body often knows before your mind catches up.
Leslie Poston:Some clear red flags, therapists who refuse to answer direct questions about their approach or experience, boundary violations like contacting you inappropriately outside of sessions, self disclosure that serves them instead of you, defensiveness when you raise concerns, pathologizing your identity or your cultural practices, promising rapid cures or guarantees, pushing you faster than you're ready, or making you feel responsible for their feelings. If you see any of these happen, it's time to leave. Which brings us to firing your therapist, because sometimes you need to, and you should know how. When should you consider leaving? If you feel consistently worse after sessions, and I mean genuinely worse, not the productive discomfort of hard work.
Leslie Poston:If there's no progress after three to six months, depending on what you're working on, if they violate boundaries or ethics or if you don't feel safe being honest with them, if they're not competent in what you need and won't refer you out, if your needs have changed and they can't adapt, or if you just have a gut feeling that something's wrong, you should trust that. Now here's an important caveat. Some therapy is uncomfortable. Trauma work is so hard. Confronting patterns is hard and sitting with difficult feelings is so hard.
Leslie Poston:So how do you know the difference between productive discomfort and harmful therapy? Productive discomfort leads to eventual relief or insight, and you feel like you are supported throughout. You might cry or be challenged, but you don't feel unsafe, and you don't feel diminished. Harmful therapy creates shame, confusion, destabilization without adequate support. Growth can be uncomfortable, but you shouldn't feel like you're drowning.
Leslie Poston:So how do you actually fire a therapist? You have options. You can do this over email or message, and you don't need a final session if you don't want one. There are so many ways to write this, but let me give you one example. You could say, I've decided to end our therapy relationship.
Leslie Poston:I appreciate the work we've done together, but I've realized I need a different approach. I won't be scheduling additional sessions. Please send me any final paperwork, and let me know the process for getting my records. Key points. You don't owe them a detailed explanation.
Leslie Poston:You can give one if you want to. If it's unsafe or they've been harmful, you can simply stop scheduling and send them a brief message. You have a legal right to your records. If they respond defensively or try to talk you out of it, you don't need to engage further. If you do want a final session, you can change that message to say, I've realized this approach isn't the right fit for me, and I'd like this to be our last session with a date.
Leslie Poston:Some therapists will use that as an opportunity to explore your decision, but you can decline that. You can also use it to practice advocating for yourself or to ask for referrals to other modalities. A good therapist will respect your decision. If they make you feel guilty, that just confirms that you're making the right choice. Alright, let's bring this home.
Leslie Poston:Therapy is a tool, not a moral imperative. It should serve you. The right approach, plus the right therapist, plus the right timing all matters. You have permission to try multiple therapists and multiple approaches. Changing therapists isn't failure, it's taking your own healing seriously.
Leslie Poston:And sometimes healing happens outside therapy rooms entirely, in your community, through action and connection. If you're looking for therapists, try Psychology Today or TherapyDin where you can search by specialty, identity, and insurance. Try Open Path Collective if you need more affordable options like therapists who work on a sliding scale. Try therapy for black girls and inclusive therapists for identity specific directories. Also, the National Queer and Trans Therapist of Color Network.
Leslie Poston:Your local mutual aid networks might also have resources. Your healing matters. You deserve approaches and practitioners that actually help you. And trust yourself. You're the expert on your own experience.
Leslie Poston:Thanks for listening to PsyberSpace. I'm so excited to start season three. We have got so many great things in store for you. Thanks again for listening. I'm your host, Leslie Poston, signing off.
Leslie Poston:If this episode was helpful, share it with someone who might need to hear it. And until next time, as always, stay curious and take care of yourselves and each other.
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