The Relational Model vs. the Sitter Model in Psychedelic-Assisted Therapy

Issue 37 - Read Time: 3 minutes 35 seconds

Psychedelic-assisted therapy can follow different frameworks, each with distinct roles and effects on the healing process.

Two primary approaches are the sitter model and the relational model. While both provide support, they operate in fundamentally different ways, leading to different therapeutic outcomes.

Distinguishing the Two Models

The sitter model is a passive approach. The role of the sitter is to hold space, ensuring safety and providing a non-directive presence. This model prioritizes a neutral stance, allowing the individual to have their own experience without external influence.

While it offers a sense of containment, it does not actively engage in reshaping deep-seated relational patterns.

In contrast, the relational model takes an active role in the therapeutic process.

This approach is rooted in the understanding that relationships are the foundation of healing—especially at the level of the autonomic nervous system (ANS).

The relational model does not merely provide safety; it repairs attachment wounds in real-time by engaging the client in an interactive, co-regulated experience.

Why Relationships Are Essential at the ANS Level

The human nervous system is wired for connection. At a fundamental level, if a person’s ANS does not feel safe in relationships, that insecurity permeates all aspects of their psychological and physiological well-being.

No amount of cognitive insight can override an embedded bodily fear of relational abandonment or rejection.

Psychedelics provide a unique opportunity to interrupt habitual patterns of relating.

By quieting the default mode network (DMN)—the part of the brain responsible for self-referential thinking and habitual pattern-making—these medicines create a window where new relational experiences can take root.

In this state, the nervous system is more receptive to corrective emotional experiences that can alter attachment dynamics at their core.

Mechanisms of Change: Strategic Pressurization and Prediction Errors

A core feature of the relational model is strategic pressurization—the intentional activation of a person’s relational wounds within a safe and responsive environment.

This involves bringing to the surface deep-seated fears and expectations around connection, abandonment, and unworthiness. Once activated, these wounds can be rewired through relational presence.

One way this occurs is through prediction errors. The nervous system operates on predictive models shaped by past experiences.

If a person has been conditioned to expect rejection, their body and mind prepare for it automatically.

However, when the therapist remains present, attuned, and engaged in moments where the client anticipates abandonment, the system encounters a mismatch—a prediction error.

This unexpected relational safety forces the nervous system to update its model of relationships, leading to deep, embodied healing.

A Practical Example: Healing a Childhood Trauma

Imagine a client, under the influence of psychedelic medicine, revisits a childhood trauma where they were alone, terrified, and convinced they were unlovable. In their past, there was no comforting presence—only isolation.

As the client re-enters this memory, with their default mode networked turned off by the psychedelic, their nervous system expects the same outcome: abandonment.

But this time, the therapist is there. Attuned to the client's emotional and physiological cues, the therapist offers grounding, reassurance, and connection.

The client's nervous system, initially primed for rejection, now experiences a radical shift—they are no longer alone.

This direct contradiction to their past experience initiates a fundamental recalibration of their attachment system.

With repeated reinforcement, these new relational patterns become encoded in the nervous system, altering the client’s baseline capacity for connection, trust, and intimacy in everyday life.

Why This Can Only Be Done Through the Relational Model

The sitter model, while providing safety, does not actively intervene in the relational healing process.

Without co-regulation and engagement, the opportunity for deep nervous system-level transformation is lost.

The relational model is essential because healing does not happen in isolation—it happens in connection.

This model reaffirms what research in attachment theory and interpersonal neurobiology has long suggested: the most profound healing occurs not just within ourselves, but between ourselves and others. 

Psychedelic medicine, when combined with a relational, attuned therapeutic approach, provides one of the most powerful pathways for deep, lasting transformation.

Reflection and Next Steps

As you reflect on these ideas, consider this question: How do your past relational experiences shape the way you connect with others today?

If you're curious to explore these concepts further or experience the power of relational psychedelic work, reach out to learn more about our approach. Let’s continue the conversation—healing happens in connection.

Need More Support?

If you feel like you want some extra support here are some ways Attunement and I can help you:

1. Individual therapy or coaching with a provider at our clinic (in-person or virtual)

2. How to Feel Your Feelings 12-week course (online offering)

3. May 1-5 Attuned Being Desert Intensive (In-person - San Rafael Swell - Central Utah)

Thank you!

I love that you are interested in exploring yourself in the pursuit of growth and expansion. 

And I love that you are diving deeper into the unconscious patterns that limit our capacity as a species to transcend this paradigm. 

You are becoming the change you want to see in the world and that is incredibly inspiring!

Thank you for allowing me to be a part of your journey ✨✨

With Love,

Christian

Raise your consciousness - change the world.

Exploring the human condition — breaking down the blockages that limit our capacity to give and receive love.