Author: Kathleen Zachary

By Kathleen Zachary, MSW, LCSW, NMCF. Last updated October 2026.

Kathleen Zachary is a licensed psychotherapist, a co-owner of Numia Healing Center and its Director of Research, and she holds Colorado’s clinical facilitator license. Many of the people she works with come to Numia carrying depression. We asked her four questions: what those people bring into preparation, what the session day tends to be like and how she holds a hard moment, what integration focuses on afterward, and who she tells “not now.” Her answers are below, in her words. After them, a short note from us on what the research does and does not show.

As a psychotherapist, I don’t approach every journey the same way. Someone coming to me with depression needs different preparation and integration than someone working with addiction, trauma, grief, or a major life transition. My training and more than 20 years of clinical experience help me tailor the entire arc of the experience, from the first preparation session through integration, around what depression has taken from a person’s life and what may be asking to emerge.

What people tend to bring into preparation

By the time someone reaches me for psilocybin work, they’ve often been carrying depression for a long time. Many have done years of therapy, tried medications, read the books, listened to the podcasts, and worked incredibly hard to feel better. What I often encounter is exhaustion. They’re tired of trying and tired of wondering why nothing seems to create lasting change.

Hopelessness is often present from the very beginning. Sometimes it sounds like, “I don’t think anything will work for me.” I don’t try to talk people out of that experience or convince them to be hopeful. Usually hopelessness makes sense in the context of what they’ve lived through. We make room for it, and we listen to what it’s trying to communicate.

Many people also arrive caught in deeply ingrained thought loops. There can be a constant stream of self-criticism, self-doubt, or questioning what is wrong with them. I don’t see those patterns as something to fight against. More often, I see them as protective strategies that developed for a reason. In preparation, we get curious about them. We begin exploring what they may be protecting, and we get to know the hopeful parts of a person as well as the parts that feel skeptical, fearful, or discouraged.

One of my goals in preparation is to help people reconnect with a sense of agency. Depression can leave someone feeling as though life is happening to them and their choices no longer matter. From the beginning, I want them to have an active voice in the process. They set their intentions. We talk about how they want support if there is discomfort. Together, we create a foundation of safety, trust, and body awareness so they have reliable ways to return to the present moment when things feel intense.

What the session day is often like, and how I hold a hard moment

Many people living with depression have become accustomed to feeling numb. They’ve spent years behind a kind of emotional flatness. On the session day, that can begin to shift.

Sometimes emotions that have been held back for years start to move. Grief, sadness, anger, longing, tenderness, or tears that haven’t found expression may come forward. Some people encounter moments of relief, connection, gratitude, or renewed perspective. Others spend some of the journey working with difficult feelings. I try not to predict what someone’s experience will look like. Each person’s process unfolds in its own way.

My role is not to direct the experience or push it toward a particular outcome. My role is to stay present and be a compassionate support.

The support I offer during the session is something we discuss ahead of time in preparation. We talk about what helps someone feel supported, grounded, and safe, and what they would like from me if they encounter a difficult moment. Whether it’s a grounding breath, a supportive presence, a reminder that they are not alone, or an offer of touch when appropriate and agreed upon, these supports are established beforehand so they feel familiar and supportive rather than disruptive to the experience.

When a hard moment arrives, I focus on helping someone feel accompanied rather than alone. I may offer a hand, invite a grounding breath, or simply remind them that I’m right there with them. Often the most healing thing is not fixing the discomfort but creating enough safety for someone to stay connected to it without becoming overwhelmed by it.

I gently encourage people to move toward what feels difficult rather than immediately away from it, while honoring their own pace and capacity. The body often knows the way before the mind does, so I pay close attention to what is happening somatically as well as emotionally. Again and again, I find that compassion, steadiness, and trust are more important than any therapeutic technique.

What integration tends to focus on afterward

For me, integration is where the experience becomes part of a person’s life.

We spend time making sense of what emerged, whether that comes as emotions, memories, images, insights, or something harder to put into words. Rather than rushing to explain everything, we stay curious. Sometimes understanding unfolds gradually.

One thing that often comes into focus is just how much of a person’s life has been organized around surviving depression. People begin to recognize how much energy has gone into bracing for the next low, managing symptoms, staying guarded, or simply trying to make it through the day. That realization can open a conversation about what they may want to reclaim.

Integration often involves recognizing depressive patterns more clearly and more quickly. People become increasingly familiar with the thoughts, beliefs, and protective strategies that have shaped their experience for years. When those patterns return, and they often do, we treat that as information rather than a setback. Together, we explore what may have activated them, how much space they took up, and what helped the person reconnect with themselves and the people and practices that support them.

We also talk about neuroplasticity and the brain’s capacity for change. While the session itself may create opportunities for new perspectives, integration is where those perspectives are strengthened through reflection, relationships, and daily practice. In many ways, integration is the process of helping new patterns become more familiar than the old ones. As people become more aware of long-standing depressive loops, they often learn to recognize them sooner, respond with greater intention, and lessen the influence those patterns have on their daily lives.

The goal is not to never struggle again. The goal is to develop a different relationship with the struggle. Over time, people may discover greater awareness, more choice in how they respond, and a stronger ability to return to themselves when old patterns inevitably reappear.

Who I tell “not now,” and why

There are times when my answer is not “yes,” but “not now.”

I do not move forward when someone is in acute crisis, including active suicidal thinking or a recent suicide attempt. In those situations, stabilization and support need to come first.

I also proceed very carefully with anyone who has a personal or strong family history of bipolar I disorder or psychosis, and with people taking certain medications, including lithium, where safety concerns require additional evaluation. If someone is in the middle of a medication change, I coordinate closely with their prescribing clinician before considering next steps.

There are also times when I encourage someone to wait because they don’t yet have enough support around them. Preparation and integration are not side notes to this work. They are essential parts of it. I want people to have the resources, relationships, and stability they need to make use of whatever emerges.

In my experience, “not now” is rarely the same as “never.” More often, it is a conversation about timing, readiness, and safety. It’s a decision we make together, with care for the whole person and not just the journey itself.

What the research does and does not show

Four randomized trials have tested one or two psilocybin sessions with psychological support in adults with major depressive disorder. Davis and colleagues at Johns Hopkins randomized 27 adults with major depressive disorder who were not taking antidepressants to two sessions, either right away or after an eight-week wait; among the 24 who completed, 71 percent met the response criterion on a clinician-rated scale four weeks after the sessions and 54 percent were in remission (Davis et al., JAMA Psychiatry, 2021). Carhart-Harris and colleagues at Imperial College London compared two full-dose psilocybin sessions with six weeks of daily escitalopram in 59 adults with moderate to severe depression; on the primary self-report measure the two groups did not differ significantly at six weeks, and the secondary outcomes that favored psilocybin were not corrected for multiple comparisons (Carhart-Harris et al., New England Journal of Medicine, 2021). Goodwin and colleagues gave a single full, lower or very low control dose to 233 adults whose depression had not improved with earlier medication; the full-dose group’s depression scores fell more than the control group’s at three weeks, the lower-dose group’s did not, and suicidal ideation or behavior or self-injury occurred in every dose group (Goodwin et al., New England Journal of Medicine, 2022). Raison and colleagues compared one full dose with niacin in 104 adults with major depressive disorder; six weeks later the psilocybin group’s clinician-rated score had fallen 19.1 points against 6.8 for niacin, 41.7 percent of the psilocybin group had a sustained response against 11.4 percent, and the difference in sustained remission was not statistically significant (Raison et al., JAMA, 2023).

These are small to mid-sized trials measured in weeks, not years. Every one of them screened out people with a personal or family history of psychosis or bipolar I disorder and people with a recent serious suicide attempt, which is the same line Kathleen draws above, and most participants were off antidepressants at the time. A response means a lower score on a symptom scale at a checkpoint; some people did not respond, and in the largest trial, adverse events of some kind were recorded in 77 percent of participants (Goodwin et al. 2022). We make no prediction about your session.

Our page on how we screen and how a hard moment is held describes how those risks are handled at Numia, how to prepare for a psilocybin session covers the grounding breath and phrase Kathleen refers to, and the science behind psilocybin therapy covers the neuroplasticity research she talks about in integration.

Common questions

Sources

1. Davis AK, et al. JAMA Psychiatry. 2021;78(5):481-489. https://pubmed.ncbi.nlm.nih.gov/33146667/
2. Carhart-Harris R, et al. New England Journal of Medicine. 2021;384(15):1402-1411. https://pubmed.ncbi.nlm.nih.gov/33852780/
3. Goodwin GM, et al. New England Journal of Medicine. 2022;387(18):1637-1648. https://pubmed.ncbi.nlm.nih.gov/36322843/
4. Raison CL, et al. JAMA. 2023;330(9):843-853. https://pubmed.ncbi.nlm.nih.gov/37651119/
5. Trial registrations: NCT03181529, NCT03429075, NCT03775200 and NCT03866174

Whenever you are ready

If depression is part of what brings you here and you are wondering whether a psilocybin session fits your life, we would be glad to talk. Book a free 15-minute consultation. It is a conversation, and there is nothing to decide on the call.

About the author

Kathleen Zachary, MSW, LCSW, NMCF, ACS, is a licensed psychotherapist, a co-owner of Numia Healing Center and its Director of Research, and holds Colorado’s clinical facilitator license. She has more than 20 years of clinical experience, holds a Master of Social Work from Indiana University and a Bachelor of Science in Psychology from Xavier University, and completed a psychedelic-assisted therapy fellowship through the Integrative Psychiatry Institute and MAPS. She is an Approved Clinical Supervisor and works with complex trauma, depression, anxiety, couples and family dynamics, grief, and life transitions.