When Music Sits in the Chair: The Hidden Therapist Guiding Psychedelic Healing
A dim room. A low chord blooms. Shoulders drop. Breath slows. Words thin out, and the music seems to sit beside you. In psychedelic therapy, music often acts like a co-therapist, guiding throughout the journey, stirring emotions, holding presence, and helping people return.
Indigenous traditions have placed music at the center of healing for thousands of years. Icaros in Amazonian ayahuasca ceremonies, peyote chants in Native American Church rituals, and Mazatec mushroom veladas weave song and medicine together as inseparable practices (Jerotić, Vuust, & Kringelbach, 2023). This article focuses on Western clinical research and practice while honoring those roots.
Neurodivergent note: Many neurodivergent people use repetitive pattern/sensory-seeking, or audio-stimming behaviors, or even silence, as ways to regulate our nervous systems. Throughout this article, you will see examples of how these strategies connect with music in psychedelic therapy, as well as how facilitators can incorporate them. I go into much greater detail about accommodations and strategies in my new book, Neurodivergent Psychedelic Healing: A Trauma-Informed Approach to Facilitation.
Why Music Matters in Psychedelic States
When psychedelics shift the brain’s filters, sound can move from background to foreground. A single tone may feel like a touch, a melody like memory itself. Research shows that psychedelics loosen top-down control, the brain’s usual way of filtering and organizing information, and make room for bottom-up input. Bottom-up processing refers to the direct flow of raw sensory data into conscious awareness. In a psychedelic state, sound and music can shape experience flow more strongly (Carhart-Harris & Friston, 2019). Music has typically been central to the process.
Mendel Kaelen’s neuroimaging work revealed that under LSD, the brain devotes more resources to processing tone color, the felt texture of sound beyond pitch or volume (Kaelen et al., 2018). Tone color is also how humans read emotion in voices, which helps explain why participants describe music during sessions as a presence that feels alive, listening, or even carrying them. In clinical interviews, people often said they felt “held” by the music, which led Kaelen to describe it as a kind of hidden therapist in the room.
Other studies link music with mystical states, memory reconnection, and imagery. For many, the soundscape opens doors to deep autobiographical material and supports emotional release (Griffiths et al., 2006; Richards, 2015). Structured playlists in research trials reflect this power, placing music as the primary external stimulus once the medicine begins, particularly as many clients are encouraged to wear eye shades and the facilitator’s non-directive role is limited to gentle check-ins about needs rather than questions or interpretations of the client’s experience.
Facilitator Tip: Name music’s role as a guide during consent and preparation. Offer clear opt-outs and controls such as access to volume knobs, skip functions, or non-verbal cues for silence.
Neurodivergent note: This heightened sensitivity can work in two directions. Sensitivity to tone color, rhythm, and volume can amplify under psychedelics. For some, this creates a sense of anchoring safety, meaning that the predictability or familiarity of certain sounds can serve as a steady point of orientation. In a state where perception feels amplified or unfamiliar, these cues provide the nervous system with something consistent to hold onto, helping the client feel secure enough to continue exploring. For others, any sounds can be overwhelming. Preparation and collaboration help align the music with personal sensory and trauma needs.
From Past to Present: A Short Lineage
Leuner and the Psycholytic Movement
In the 1950s and 60s, Hanscarl Leuner developed psycholytic therapy in Europe (Passie, Guss, & Krähenmann, 2022). Psycholytic literally means “mind-loosening.” It referred to the use of repeated, lower to medium doses of psychedelics within a course of psychotherapy, rather than a single high-dose session. Music played a central role in this method, helping evoke memories, lower defenses, and support emotional release. For Leuner, music served as a catalyst that helped clients access material that was otherwise locked away.
Pahnke and Sacred Sound
In 1962, Walter Pahnke conducted the Good Friday Experiment, pairing psilocybin with sacred music in a chapel (Doblin, 1991). Organ and choral works deepened the mystical states of theological students. Decades later, research confirmed that such peak experiences often predicted lasting therapeutic benefit (Griffiths et al., 2006). This line of research also led to the development of the Mystical Experience Questionnaire, which has been widely used to measure these states and link them to long-term therapeutic outcomes (Barrett, Johnson, & Griffiths, 2015).
Bonny and Grof’s Structured Arcs
At the Maryland Psychiatric Research Center, music therapist Helen Bonny and psychiatrist Stanislav Grof worked side by side. Bonny designed carefully sequenced programs that later grew into Guided Imagery and Music (Bonny & Pahnke, 1972; Messell et al., 2022); it became a structured method for music therapists where (sober) clients listened to curated classical and archetypal pieces while describing the imagery, emotions, and memories that arose. The therapist supported the process by gently guiding the client's attention, helping them explore the symbols and feelings that the music evoked. Grof mapped archetypal arcs, noting how stages of opening, confrontation, transcendence, and return could be mirrored in musical form (Grof, 1980). He also connected recurring musical-emotional themes with the Basic Perinatal Matrices, each stage of birth resonating with specific tones and intensities. Together, they created a model where music offered steady support and may align with the client’s inner shifts.
Richards and the Contemporary Arc
Bill Richards extended this work into psilocybin research at Johns Hopkins. His playlists followed session phases, featuring gentle music for the opening, powerful works at the peak, and calming pieces for the return (Richards, 2015). His influence remains visible in today’s clinical protocols as a clear arc of “gentle → stirring → soothing.” These playlists are now widely available online and often used in research and informal settings. However, they may not be a good fit for everyone. For some clients, the cultural associations, classical music focus, or lack of collaboration in their design can feel mismatched or destabilizing. This highlights the importance of tailoring music choices to each person rather than relying on a universal template.
Roquet and Confrontation Through Sound
Salvador Roquet is a fascinating figure in psychedelic history, and well chronicled in The Ketamine Papers (Wolfson & Hartelius, 2016), as he was the first to administer ketamine to people to improve their mental health during his carefully orchestrated all-night group psychedelic healing journeys in Mexico City during the 1960s and 70s. In a method called psychosynthesis, he combined psychedelics with sensory overload, including strobe lights, provocative film, and music that included abrupt swings between sacred chants and jarring military marches. His method was intended to overwhelm and force clients to confront their shadows, activating repressed material so it could be processed through various medicines, including mescaline, psilocybin, ketamine, MDA, and LSD, which some participants reported transformation and healing.
His therapeutic use of music (and film) was highly directive and intended to evoke strong, specific reactions of disgust, fear, anger, and sadness. For many, such coercive intensity removed informed choice and could overwhelm rather than support their nervous systems (Wright & Ross, 2021). Today, his work is remembered as both pioneering and ethically fraught, often cited as a cautionary example of how music and sensory tools can cross from guidance into control.
Kaelen and Adaptive Soundscapes
At Imperial College London, Mendel Kaelen found that psychedelics heighten sensitivity to timbre and emotional tone, often opening autobiographical memory (Kaelen et al., 2018). Participants frequently described feeling guided and supported by the music. Building on this, Kaelen founded Wavepaths, which develops adaptive, generative music software that adapts to the client’s emotional and physiological state in real-time. The music shifts according to the desired experience, and it can also change course if a person becomes overwhelmed and needs the music to adjust its tone throughout the journey.
Facilitator Tip: Focus on creating playlists that follow emotional arcs, inviting a range of feeling states rather than adhering to rigid musical genres. Collaborate with your client to determine their sonic triggers and glimmers.
Voices, Words, and Directionality
Mendel Kaelen emphasized how different forms of sound shape the therapeutic process. In their research and clinical reflections, participants described instrumental music as providing them with more space to project their inner world into the soundscape. Wordless vocals were sometimes welcomed as adding a human presence without directing the story too strongly. Lyrics, by contrast, bring in narrative and cognitive anchors, which he suggested using sparingly and usually later in the session, when the client is grounding (Kaelen, 2022).
He also distinguished three ways music can act in a session: inviting, accompanying, or steering. Some pieces invite the client into an experience, others accompany, while some tracks can steer forcefully. He cautioned against overly cinematic tracks that impose an emotional script, urging facilitators to match each track’s level of directionality to their intention, such as whether the music should invite, accompany, or steer. Matching track choice to that purpose can help maintain an intentional and supportive atmosphere.
Facilitator Tip: If you use an emotionally evocative or stirring piece, consider following it with something sparse to allow meaning to form in the spaciousness.
Trauma-Informed Neurodivergent Accommodations
Planning for music in a session with neurodivergent people works best when it is simple, collaborative, and sensitive to trauma histories. A trauma-informed approach can include inviting clients to shape the playlist and informing them beforehand what to expect so that they can give informed consent. This collaboration can help build the therapeutic alliance early by building trust, agency, and a sense of safety through predictability and structure, which will likely be welcomed by many neurodivergent clients. However, other clients may prefer novelty and choose not to preview or collaborate on the music.
Below are practical ways to collaborate on music selection with sensory and trauma awareness in mind:
Easy controls: Keep a volume knob, skip/pause button, or EQ setting nearby so the client can adjust the sound quickly without needing to ask.
Delivery options: For variable sensory needs, offer private headphones, shared speakers, or (if possible) bone-conduction/vibroacoustic tools.
Structure: Steady and predictable pieces of music can support orientation; carefully chosen novel tracks may open space for discovery when the person feels ready.
Sensory safety: Check for sensitive frequencies, misophonia triggers, or instruments or genres associated with challenging experiences.
Stimming-friendly: Welcome requests for looping a regulating track and invite clients to move with the music to release energy and stay regulated.
Silence as an option: Agree on a clear nonverbal signal to switch to silence or natural sounds whenever grounding is needed.
Trauma-informed choice: explore whether certain vocal qualities or instruments might connect to painful or healing memories, and decide together how to use or avoid them.
Mini Checklist: Musical Qualities Across Psychedelic Phases
(adapted from Bonny & Pahnke, 1972)
1. Opening / Pre-Onset (0–1.5 hrs)
Qualities: welcoming, familiar, melodic, pleasant, neutral
Function: support relaxation, trust, and orientation; ease into an altered state
Examples: gentle acoustic or light classical, simple melodic lines, songs with a reassuring tone
2. Onset → Build to Peak (1–3 hrs)
Qualities: flowing, rhythmic, emotionally warm, supportive
Function: encourage surrender as sensations deepen; balance anticipation and calm
Examples: adagio movements (Vivaldi, Brahms), smooth crescendos, clear rhythm
3. Confrontation / Ego Dissolution / Peak (3–4.5 hrs)
Qualities: intense, dissonant or vast, emotionally stirring, sacred or archetypal
Function: amplify emotion, invite catharsis or transcendence; guide through resistance
Examples: Beethoven Symphony No. 5, Faure Requiem, Barber Adagio for Strings
4. Return / Re-Entry (4.5–7 hrs)
Qualities: grounding, soft, lyrical, reflective, integrative
Function: reorient and consolidate insight; soothe the nervous system
Examples: Brahms Violin Concerto (Adagio), Rachmaninoff Symphony No. 2 (Adagio), Copland Appalachian Spring
5. Afterglow / Reunion (7–12 hrs)
Qualities: familiar, gentle, personally meaningful
Function: bridge inner experience with external world; invite conversation and embodiment
Examples: patient-chosen music, family or cultural favorites, or silence interludes
More planning playlists for specific journey phases will be explored in future articles.
Closing
The chord fades. Breath steadies. The chair beside you is empty again, yet something in you has changed. For facilitators and clients alike, this moment reflects how music can be more than a background. It can be a companion, a mirror, or a steadying presence.
Facilitator Reflection:
What would it mean to let the music be a partner in healing, shaped with care and collaboration, rather than just a playlist?
References
Barrett, F., Johnson, M., & Griffiths, R. (2015). Validation of the revised mystical experience questionnaire in experimental sessions with psilocybin. Journal of Psychopharmacology, 29(11). https://doi.org/10.1177/0269881115609019
Bonny, H., & Pahnke, N. (1972). The use of music in psychedelic (LSD) psychotherapy. Journal of Music Therapy, 9(2), 64–87. https://doi.org/10.1093/jmt/9.2.64
Carhart-Harris, R. L., & Friston, K. J. (2019). REBUS and the anarchic brain: Toward a unified model of the brain action of psychedelics. Pharmacological Reviews, 71(3), 316–344. https://doi.org/10.1124/pr.118.017160
Doblin, R. (1991). Pahnke’s “good friday experiment”: A long-term follow-up and methodological critique. The Journal of Transpersonal Psychology, 23(1), 1–28. https://www.atpweb.org/jtparchive/trps-23-91-01-001.pdf
Grof, S. (2008). LSD Psychotherapy (4th edition). Multidisciplinary Association for Psychedelic Studies. https://maps.org/product/lsd-psychotherapy/
Griffiths, R. R., Richards, W. A., McCann, U., & Jesse, R. (2006). Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance. Psychopharmacology, 187, 268–283. https://doi.org/10.1007/s00213-006-0457-5
Jerotić, K., Vuust, P., & Kringelbach, M. L. (2023). Psychedelia: The interplay of music and psychedelics. Annals of the New York Academy of Sciences, 1531(1), 12–28. https://doi.org/10.1111/nyas.15082
Kaelen, M. (2022). Music for psychedelic therapy: Mendel Kaelen, founder and CEO of Wavepaths. Human 3 with Brom and Sam Podcast. Episode 33. https://tinyurl.com/4h9jk8p6
Kaelen, M., Giribaldi, B., Raine, J., Evans, L., Timmerman, C., Rodriguez, N., Roseman, L., Feilding, A., Nutt, D., & Carhart-Harris, R. (2018). The hidden therapist: Evidence for a central role of music in psychedelic therapy. Psychopharmacology, 235, 505–519. https://doi.org/10.1007/s00213-017-4820-5
Messell, C., Summer, L., Bonde, L. O., Beck, B. D., & Stenbæk, D. S. (2022). Music programming for psilocybin-assisted therapy: Guided imagery and music-informed perspectives. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.873455
Passie, T., Guss, J., Krähenmann, R. (2022). Lower-dose psycholytic therapy: A neglected approach. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyt.2022.1020505
Richards, W. A. (2015). Sacred knowledge: Psychedelics and religious experiences. Columbia University Press. https://tinyurl.com/Sacred-Knowledge
Wolfson, P., & Hartelius, G. (Eds.). (2016). The Ketamine Papers: Science, Therapy, and Transformation. Multidisciplinary Association for Psychedelic Studies. https://maps.org/product/the-ketamine-papers/
Wright, I, & Ross, L. (2021). “Bad Hug.” Power Trip. Cover Story Podcast, New York Magazine. https://www.thecut.com/2021/12/cover-story-podcast-bad-hug.html