Psychedelic-assisted psychotherapy can be transformative by dissolving the ego boundary, which normally acts as a defense mechanism regulating the significance objects hold for the self. This ego dissolution uncouples midline cortical structures and deactivates defenses that mitigate the threat of losing loved objects, allowing dreamlike primary process imagery, regression to earlier object relations, and feelings of love and connectivity. The noetic quality of the psychedelic state arises from recognizing that experiences without character defenses feel more genuine. The process supports Freud's oceanic mode of relating to the world, better suited for finding meaning, alongside the narrower ego feeling suited for survival. An analogy to Fonagy's mentalization model suggests that psychedelic-assisted psychotherapy enables transformative self-acceptance by seeing oneself through another's eyes.
People who undergo MDMA- and psychedelic-assisted psychotherapy often adopt new beliefs about themselves and the world, and these changes are linked to mystical-type experiences during drug sessions. This paper argues that the sense of authenticity accompanying these belief changes arises from a simultaneous feeling of knowing and being known. The medications reduce defensive barriers, enabling the subject to share powerful feelings intersubjectively with the therapist or internalized others. The author draws on concepts such as existential feeling, ipseity, the True Self, transitional phenomena, implicit relational knowing, and predictive processing to propose a transitional space model for working through dissociated experience.