Clinical Observations on the Role of Microdosing in Psychotherapy

Introduction

Over the past several years, psychedelics have moved from the fringes of alternative culture into serious scientific inquiry. As a clinical psychologist working primarily within a cognitive-behavioral framework, my goal has always been straightforward: to help people move toward greater happiness and psychological well-being.

My introduction to psychedelic-assisted psychotherapy began in 2021, during the height of the COVID-19 pandemic. I was not actively searching for a new direction in my practice, but I consider myself fortunate that this path emerged when it did.

Today, a significant portion of my patients either currently microdose or have done so in the past. This clinical exposure has provided a unique vantage point for observing how microdosing interacts with psychotherapy and how subtle internal shifts can translate into meaningful, lasting change.

Who I Work With: A Wide Range of Clinical Presentations

Approximately 30 percent of my caseload involves individuals who are microdosing. These patients present with a broad range of concerns, including:

• Combat veterans with PTSD

• First responders with PTSD

• Survivors of childhood trauma

• Individuals with depression or anxiety

• Patients who have not responded to SSRI treatment

• Those navigating major life transitions

• Individuals recovering from narcissistic relationships

• Patients managing chronic or terminal illness

While their experiences differ, the shared thread is a search for relief, insight, and improved emotional functioning.

What Is Microdosing—and Why Does It Matter?

Microdosing generally involves taking one-tenth to one-twentieth of a typical psychedelic dose. The intent is not to induce a traditional psychedelic experience, but rather to support subtle, functional changes that complement daily life and therapeutic work.

Most patients microdose twice per week once an appropriate individual dose has been established. The changes they report are often modest in magnitude, yet meaningful in their cumulative impact.

Clinical Insights and Reflections

1. One Size Does Not Fit All

Despite growing enthusiasm around psychedelics, no single therapeutic model has emerged as universally effective. My clinical foundation is firmly rooted in cognitive-behavioral therapy, with a strong emphasis on behavior and measurable change.

In the Midwest—particularly here in the “Show Me State”—patients often respond well to approaches that are practical, structured, and grounded. A CBT framework integrates naturally with psychedelic work, and many individuals who pursue this path already have experience with CBT-based treatment.

I sometimes describe this work as psychological rehabilitation, a phrase that resonates with patients seeking clear steps and tangible progress.

2. “Everything Changes and Nothing Changes”

One of my early microdosing patients summarized the experience succinctly:

“Everything changes, and nothing changes.”

Patients often expect dramatic transformations. In reality, the shifts associated with microdosing are frequently subtle—sometimes so subtle they go unnoticed until explored during integration sessions. Much of the work involves helping patients recognize what has shifted, even quietly.

3. First the Euphoria—Then the Work

Some patients report feeling better after their initial microdoses. When this occurs, I intentionally redirect attention away from “the medicine” and toward changes they are already making in their behavior and thinking.

The purpose of microdosing is not sustained euphoria. Rather, it is to create enough cognitive flexibility for individuals to consider new thoughts, new behaviors, and new possibilities. In this sense, psychotherapy assisted by psychedelics may be a more accurate description than psychedelic-assisted psychotherapy.

4. The Disappearance of Negative Self-Talk

One of the most consistent—and often overlooked—changes is the reduction of chronic negative internal dialogue. Many patients fail to notice its absence until it is explicitly highlighted.

This observation informs a key integration strategy. Instead of asking what patients notice, I ask what they no longer notice. As internal noise diminishes, behavioral change often becomes easier and more congruent with a healthier internal environment.

5. Insights Can Bring Both Relief and Distress

Microdosing frequently accelerates insight, making psychotherapy more efficient. However, insight does not always equate to happiness. New awareness can surface unresolved wounds or long-standing patterns.

At times, patients question whether microdosing is still beneficial when difficult material arises. In many cases, it may simply be revealing what had previously remained obscured.

6. Emotional Flatness From SSRIs vs. Genuine Happiness

A substantial number of patients seek support while tapering or discontinuing long-term SSRI use. Many describe feeling emotionally flat—not deeply depressed, but not fully alive either. SSRIs can function as an emotional splint, dampening both distress and joy.

As some patients taper SSRIs while maintaining an appropriate microdose, they often report:

• greater emotional range

• increased capacity for joy

• improved sexual functioning

The return of positive emotion is often as noticeable as the reduction of depressive symptoms.

7. Psychological Safety and Comfort

For individuals apprehensive about a full psychedelic experience, microdosing provides a psychologically safer entry point. Initial anxiety frequently gives way to curiosity after early experiences.

Microdosing often serves as a bridge—helping patients recognize that change can be tolerable, manageable, and at times even welcome.

8. Sometimes a Small Change Makes a Big Difference

This phrase has long been the guiding philosophy of Quantum Behavioral, and microdosing aligns with it well. Earlier in my career, I believed that only profound psychedelic experiences could produce profound change. Clinical experience has challenged that assumption.

A microdose—small by design—can facilitate meaningful shifts in behavior, cognition, and self-perception.

Conclusion: Moving Toward Better Tools and New Paradigms

These observations reflect consistent clinical patterns rather than isolated anecdotes. Psychedelic research faces a unique methodological challenge, as traditional placebo-controlled designs struggle in contexts where blinding is inherently difficult.

New therapeutic approaches require new measurement tools. While placebo effects may contribute, my clinical experience suggests that something more is occurring—something subtle, and potentially measurable once appropriate instruments are developed.

Microdosing, when thoughtfully integrated with psychotherapy, appears capable of facilitating genuine change. Until research methods evolve further, it is premature to attribute outcomes entirely to placebo or entirely to pharmacology. The truth likely exists somewhere in between.

Call to Action

If you are interested in exploring whether microdosing or psychedelic-assisted psychotherapy may support your therapeutic goals, I invite you to contact Quantum Behavioral, LLC. Together, we can determine whether this approach is appropriate for your needs and develop a plan focused on real, sustainable change.