Indigenous Voices in Psychedelic Therapy: Experiential Learnings from a Community-Based Group Psychedelic Therapy Program

Manson and colleagues situate this work within the broader context of colonial harms, structural racism, and the mismatch between many current biomedical models of care and Indigenous Ways of Knowing. The introduction notes high levels of trauma and health inequities among Indigenous people in British Columbia (reported as 3.3% of the population but 14.7% of overdose deaths in 2020, with Indigenous women disproportionately affected), and highlights calls to centre Indigenous healing practices from Canadian and international policy bodies. The authors argue that contemporary psychedelic therapy models frequently lack culturally safe community engagement and alignment with Indigenous epistemologies. This paper reports on a pilot, community-based evaluation of a group psychedelic therapy programme co-created between Roots to Thrive (RTT) and the Snuneymuxw First Nation. The project aimed to assess cultural safety and perceived effectiveness of a 12-week RTT group model augmented by three ketamine sessions for Indigenous participants, and to document experiential learnings that could inform programme adaptation, reconciliation, and future Indigenous-led work in psychedelic-assisted healing.

The project was undertaken as a collaborative partnership between RTT and Snuneymuxw First Nation, formalised by a memorandum of understanding that prioritised Indigenous applicants and mutual stewardship of knowledge. The cohort evaluated here consisted of a small relationally recruited pilot: eight participants formed a discrete Indigenous small group within cohort five, and two Elders also participated in mixed groups; ten Indigenous people contributed to the qualitative dataset. The authors emphasise that these voices are not pan-Indigenous and reflect specific relational and community contexts. RTT's intervention was a 12-week programme comprising weekly two-hour virtual sessions and three in-person group ketamine sessions occurring after weeks four, six, and eight. Ketamine was administered intramuscularly at 1.0–1.5 mg/kg per sit, with support from facilitators including at least one registered nurse and at least one energy medicine practitioner. Core psychedelic-assisted therapy elements were used during sits (individual pads, weighted blankets, eye shades, curated music). Integration sessions were delivered virtually 24–48 hours after each ketamine session. Participants were recruited through community networks and underwent RTT's eligibility screening for physical and psychological safety relevant to ketamine use. Consent for participation in RTT surveys was obtained at intake, and separate consent was obtained for interviews about the partnership and pilot. The project was treated as quality improvement within an established treatment programme and fell under an exemption granted through Vancouver Island University (VIU). Data collection combined an anonymous survey and recorded exit interviews conducted two to four months after programme completion. Transcription and initial theme development were performed by fourth-year nursing practicum students using a basic qualitative approach aligned with Merriam's framework. Two graduate students refined coding as triangulation. Thematic analysis proceeded iteratively until no new themes emerged (data saturation). A collaborative team including facilitators, participants, students, and external researchers produced the data summary, which was member-checked by participants and shared with community stakeholders.

The results are presented as thematic findings derived from interviews and anonymous feedback provided by ten Indigenous contributors. The authors intentionally omitted sociodemographic statistics to preserve anonymity. Participants described a range of motivations for engaging with RTT and ketamine therapy, most commonly addressing personal and intergenerational trauma and seeking respite from chronic stress and survival-oriented identities. Reported barriers included distrust of non-Indigenous systems and staff, fear of re-triggering trauma, concerns about sobriety, and time and energy constraints. A core theme was reconnection to culture and spirit: several participants described renewed engagement with cultural practices (for example, mountain baths and forest time) and spiritual experiences during ketamine sessions, including encounters with ancestors. Some programme practices were experienced as culturally congruent, while others felt awkward or misaligned early on; for instance, the empathic practice termed 'compassionate witnessing' was welcomed by many but some preferred silence or alternative language such as 'loving listening.' Participants emphasised the value of placing narrative to the side at times, noting shifts from ruminative storytelling toward somatic awareness and the sentiment that 'you're not your story.' The multidisciplinary, non-judgemental team approach and continuity of care were repeatedly identified as important contributors to safety and healing. Participants noted facilitators' consistency, compassion, follow-up after intense sessions, and willingness to acknowledge and repair conflict; a formal resolution circle led by the Elder was described as a turning point in rebuilding trust. Small-group dynamics were highly valued for relational healing and for the sense of belonging; several participants stated the Indigenous-only group composition fostered immediate trust and ongoing connections. Participants reported meaningful therapeutic effects attributed to the ketamine sessions: somatic release of trauma, a 'softening' or cushioning effect that allowed engagement with painful material, reconnection to self, and reduced arousal such as decreased nocturnal fear. Reports included enhanced capacity to face trauma, faster emotional recovery, and an overall increase in trust (one participant contrasted earlier 'blind trust' with later 'informed trust'). Side effects and anticipatory fears were also noted: nausea was experienced variably (as unpleasant, as a purging sign, and as a trigger for those in recovery), and insufficient pre-session information increased fear for some. Participants appreciated inclusion of traditional plant medicines and the presence of spiritual elements, and many described the partnership between RTT and Snuneymuxw as respectful and mutually beneficial. Suggested programme improvements focused on strengthening Indigenous presence in staffing and leadership (including community-recognised Elders), more integrated spirituality in the large-group curriculum, trauma-informed intake procedures (plain language, minimized reading), clearer and multiple avenues for ketamine education, choice around group composition (Indigenous-only vs mixed), and increased accessibility through funding, transportation, and tailored groups for specific needs (for example, survivors of residential schools, youth, LGBTQ2S+).

Manson and colleagues interpret their findings as indicating that RTT provided a distinctive opportunity for deep healing among this group of Indigenous participants. They identify a constellation of factors that appear to have supported beneficial outcomes: participants' prior engagement with healing practices, robust social and physical supports, staff who have undertaken personal healing work and model cultural humility, and a programme structure that intentionally incorporates Indigenous perspectives. The authors emphasise the centrality of the ketamine experience for fostering trust and permitting participants to 'surrender' protective patterns, with self-reported outcomes consistent with disidentification from a traumatised self and reconnection to a more integrated sense of self. Spirituality is framed as a critical component of effectiveness: participants reported that spiritual practices, Elder involvement, somatic and energy-healing techniques, and the presence of traditional plant medicines complemented the psychedelic experience and Indigenous ways of knowing. Acknowledging complexity, the paper stresses that this work exists within ongoing colonial harms and that authentic intercultural partnership is challenging and requires careful stewardship. The authors note that the sample is not pan-Indigenous and therefore findings are context-specific. Their recommended path forward centres on long-term commitments to reconciliation: formalising Indigenous engagement structures, equitable compensation for Elders and knowledge holders, Indigenous-led research and training, destigmatisation of psychedelics as medicine, transparent decision-making, and clear protocols for knowledge stewardship. They encourage non-Indigenous partners to build intercultural partnerships founded on humility and authentic relationships, framing this approach as foundational to transformative healing and reciprocity.