What Nine Perfect Strangers Can Teach Us About Psychedelic Therapy

In what may be television’s first “psychedelic soap opera,” Hulu’s Nine Perfect Strangers puts psychedelic mental health treatment in the spotlight. Thousands watched as Masha, a luxury retreat owner played by Nicole Kidman, extolled the healing power of psychedelics to her guests. 

“This protocol can cure addiction. It can treat mental illness. It can treat PTSD, schizophrenia, dementia. It can make you eat better, sleep better, fuck better, and it has the capacity to change the world,” Masha declares. 

Masha’s statement could have been a strong public endorsement for psychedelic-assisted therapies, especially at a time when mental illnesses are on the rise. At least series director Johnathan Levine hoped that would be the case. However, the possible ethical violations and misinformation that pile up as the show goes on, with Masha taking increasing measures to “heal” her guests, including dosing them with psilocybin without their consent, are troubling to some practitioners of psychedelic therapy. 

“We can look to psychedelic history to know that nothing in the show is completely fabricated. They just cherry picked the worst practices,” says Dee Dee Goldpaugh, a psychedelic integration therapist whose private practice focuses on survivors of sexual abuse and who works in the ketamine assisted psychotherapy program at the Woodstock Therapy Center in New York. “I hope people do not walk away from the show thinking that those are acceptable things to happen in a psychedelic-assisted therapy context.”

While the show may have inaccuracies and shouldn’t be confused with reality, it does bring the conversation a little bit further into the mainstream, says Dr. Julie Holland, an author and psychiatrist specializing in psychopharmacology with a private practice in New York City. 

“What’s important is that it is a springboard for serious talk and self-education,” says Holland. 

Psychedelic Retreats

The psychedelic community isn’t immune to unethical therapists or guru figures like Masha who abuse their power by crossing the personal boundaries of their clients and staff or by taking advantage of those who are seeking treatment to improve their mental well-being. As in all industries, some observe there is also a shadow side to wellness.

With the exception of the medical use of ketamine, which is not a classic psychedelic but a dissociative, psychedelics remain illegal under federal law in the U.S., but are becoming accessible for therapeutic use in some states such as Oregon. A person can legally seek experiences with psychedelics by joining a psychedelic church where they are legally sanctioned, or through participating as a subject in clinical trials, which often requires a medical diagnosis.

While major efforts to advance drug policy are underway nationwide, most people seeking psychedelic therapy today have to opt for “underground” therapists or expensive luxury retreat centers in countries where the substances are legal. 

“A good retreat will collect a lot of information from you before they take your money to make sure that you’re an appropriate fit for the experience,” says Holland. “And there should be basic screening, education, and preparation prior to going there. It’s also important you receive integration and supportive follow-up after, which is key to a successful retreat.” 

Not every psychedelic wellness retreat is a personalized boutique experience like Strangers’ Tranquillum House. Many vary in length, substance used, and framework. Retreats based in indigenous traditions of ceremonial psychedelic use, have become popular with Westerners in recent years. Goldpaugh points out that there are many people, including indigenous shamans, who can offer genuine healing spaces that are not trained in the western paradigm.

However, Rachel Harris, psychologist, researcher and author of Listening to Ayahuasca, warns that there are additional ethical questions to ask when attending shaman-led retreats. 

“How many people are attending? Large groups rarely receive an optimal amount of individual support, which can indicate that the retreat is about profit and not healing,” says Harris. “Who owns and runs the retreat? Because they’re often not run by the healers. How is the shaman treated and what rules are imposed on him or her? Sometimes they aren’t allowed to speak to guests or are silenced outside of ceremony, and that should not be supported.” 

Though Goldpaugh doesn’t believe that every person who has a space in psychedelic healing must be a trained therapist, they do think a good healer or well run retreat center will have an awareness of boundaries and community accountability so people aren’t harmed.

Psychedelic Guides, Boundaries, and Expectations

Nicole Kidman told Good Morning America, “If someone said to me, ‘Come give yourself to me for ten days and I will heal you,’ I’d be like, ‘I’m in.’ I would definitely check into Tranquillum House.”

Kidman may have just been promoting the show, but her statement reflects how Nine Perfect Strangers misrepresents the process of psychedelic healing.

“The show implies you attend this retreat for ten days and your problems are solved, and that creates false expectations for the audience when it comes to this work,” says Leslie (not her real name), an underground psychedelic therapist with forty years experience who studied under Stanislav Grof. “For the majority of people, the process of using psychedelics for healing is like opening Pandora’s box. You are opening up to the unknown, to a potentially long journey, and it’s a blessed journey that has the possibility of incredible outcomes, but there is no quick fix.” 

Even if the treatment happens to catalyze a dramatic healing in one session, the results don’t justify the abusive behavior that guides like Masha might use to get those results, warns Goldpaugh. 

“What I’ve learned working with survivors of sexual trauma is vulnerable people are often put in situations where they’re told this is for your good, this is for your benefit, this is going to help you. It can send extremely confusing messages. They may even feel helped in the short term. Until much later, when they can put together the pieces of how those situations were traumatic because of the abuses of power,” says Goldpaugh. 

An ethical and experienced guide will not abandon a participant or leave the premises during a psychedelic session, adds Leslie. They will also set clear physical boundaries and should never touch a client without permission. She points out that many people have trauma around touch and intimacy, and Masha’s abuse of power in this arena is an egregious transgression, not only with her guests, but also in her relationships with her staff. 

“Informed consent is foundational to psychedelic therapy because trust is foundational. Some therapists deserve that trust and some don’t, but that consent and trust protects both the participant and the therapist, legally and emotionally,” says Leslie.

Jayne Gumpel, a therapist who owns Relationship Resources, works with Woodstock Therapy Center, and also trains integration therapists at Fluence, echoes this. “The lack of consent that happens at Tranquillum House wouldn’t happen in real life. You also don’t do forensic work on your participants without their knowledge. You include them in it because that’s where the gold is: Helping them find their intentions and connect to why they want to have the experience,” she says. 

Microdosing, Macrodosing, and Set and Setting

Strangers does manage to get a few things right about psychedelic therapy, and perhaps this is where Levine’s research for the show shines through: MDMA is used effectively in couples therapy, psilocybin is microdosed for mental health, shared psychosis is rare but can happen, and connection with nature is important during a psychedelic experience. 

But there is one glaring inaccuracy: the microdosing protocol Masha claims to use isn’t technically microdosing. 

There are different protocols for microdosing set forth by Paul Stamets and James Fadiman, but both involve taking small, sub-perceptual doses of LSD or psilocybin for a few days and then resting for a few days. Leslie explains that, in contrast to Nine Perfect Strangers, microdosing does not involve hallucinations, and it would never involve increasing a dose daily for ten consecutive days. Holland adds that withdrawal isn’t a side-effect of following a microdosing regimen, like the show implies, while tolerance is. She also warns that there are risks to regularly dosing like the guests in Strangers, including the possibility of cardiac issues related to taking sertogenic medicines like LSD. 

“There are risks to balance with the benefits of these sorts of treatments,” says Holland. 

Many challenging trips and medical emergencies can be avoided by practicing the basic tenets of psychedelic therapy. For someone who isn’t experienced in psychedelics, and is considering it, says Goldpaugh, the chances of having a distressing experience are greatly reduced when they feel prepared and safe before they engage in the experience. 

Guests of Tranquillum House are not able to prepare for the experience due to Masha’s unethical choices. Some, like Carmel (Regina Hall) and Heather Marconi (Asher Keddie), are even sedated and isolated in the middle of their psychedelic experience, which, Holland points out, wouldn’t typically happen in a retreat setting.

“Connecting to intense emotions provides a real potential for healing. Squashing those experiences down the way Masha does by strapping somebody to a table, sedating them, or locking them in a room can be very damaging. Interrupting a difficult experience with sedation while initially may seem beneficial, could potentially leave the participant in unresolved psychological states,” says Leslie. “A therapist that reacts out of fear the way Masha does is usually not experienced, hasn’t been trained in those situations, or hasn’t dealt with their own personal trauma or issues.”

Goldpaugh adds that when someone is having a distressing experience, a facilitator is trained to help the person through the difficult experience rather than try to bring them down. 

It is also worth noting, says Leslie, that sometimes a person’s experience can look distressing to someone on the outside, but inside, that person might be in a state of spiritual emergence rather than a state of emergency.

“I think these medicines can and do unlock the potential in people to heal from loss and trauma, if guided properly, if the set and setting is optimal, and the preparatory and integration sessions are there,” says Gumpel. 

Strangers was Hulu’s most-watched series when it premiered, but despite the abundant misinformation, Holland believes that it has little chance of derailing psychedelic treatments. 

“The data are compelling, and the FDA knows this,” says Holland. “The point now is just to prepare people and educate people. Between the anti-inflammatory activity of these medicines and the ability to be a transdiagnostic treatment that can help a lot of different people, I’m not worried about a little bit of misinformation or fiction.”