Now Therapists Have to Figure Out Astrology, Tarot and Psychedelics

Patients are confronting psychotherapists with a fresh pile of really useful challenges.

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CreditCreditPhilip Wrigglesworth

Jonathan Kaplan, a clinical psychologist in New York, recently noticed that more and more of his clients are referring to Mercury being in retrograde.

“I’m not familiar with cosmic cycles,” he said. (Instead, his specialty is cognitive behavioral therapy.) “Nor do I try to be, but I want to understand what that means to a person and how that influences their understanding of the world.”

Now he, like many other therapists, is learning something new, to better communicate with patients.

Alternative treatments, rituals and metaphysical organizing principles loom large in popular culture. Astrology and tarot cards have permeated apps and social media. Sound baths and other forms of “energy medicine” appear not only in “healing centers,” but also in hospitals.

“A lot of things in psychology were once considered edgy and alternative,” said Charlynn Ruan, a clinical psychologist and the founder of Thrive Psychology Group in California, who said she is learning about different alternative treatments and approaches. “I’m not teaching it, but I’m not saying you can’t bring this into the room. That would be disempowering and arrogant.”

People are putting their trust — and their money — into these practices, which they view as pathways to enlightenment. The wellness market, which encompasses fitness, skin care, travel and nutrition, was valued at $4.2 trillion in 2017, according to the Global Wellness Institute.

That same year, a Pew Research Center survey reported that roughly half of Americans had dabbled in alternative medicine. As states continue to legalize recreational and medical marijuana, and hallucinogens gain credibility in the scientific community, the number is likely to grow.

What does that mean for therapists, the old standbys of self-knowledge and personal growth? Well, they’re hearing about some of these New Age treatments from patients, and it may have a lot to do with where they work.

In Los Angeles — likely the wellness capital of the world — plant medicine, shamans, astrology, reiki and sound baths come up frequently in sessions.

“In L.A., you’ve always said, ‘My therapist says’ — that’s not a weird thing to say,” said Kristie Holmes, a therapist with Thrive in Beverly Hills, Calif. “But now name-dropping a shaman is normal.”

In New York and Chicago, it’s ayahuasca, tarot readings, astrology and mediums. In Austin, Tex.: crystals, ayahuasca and mediums. In D.C. … well … it’s a little more along the straight and narrow.

According to many therapists who spoke to The New York Times, the patients bringing up these approaches in general tend to skew female, younger and more affluent, though many practitioners reported patients of all ages expressing interest.

When these topics do emerge, mental health professionals often see them as ripe for exploration.

“Am I looking up what a person’s sign is?” Dr. Ruan said. “No.” But she has scoured research journals for studies on ayahuasca and watched documentaries on kambo, a secretion from Amazonian tree frogs touted for its healing powers. She has connected with hypnotherapists and somatic healers when clients have raved about them, to better understand what they do, though she doesn’t refer patients to such practitioners.

In fact, one psychic, whom Dr. Ruan has not met, has made several referrals to her.

Occasionally, her open-mindedness has led to breakthroughs. She recalled a patient who played an hour-and-a-half-long recording of her psychic reading over the course of two sessions. “We listened to it together, and we talked about it,” Dr. Ruan said. “For her, it was really an opening and brought up grief about a lost loved one.”

In Chicago, Nicolle Osequeda, a therapist and the clinical director of Lincoln Park Therapy Group, said that some of her patients who have lost loved ones are seeking out mediums to feel a connection. She also hears from clients who have seen intuitive healers and done reiki.

“I don’t find them to be competing things,” Ms. Osequeda said. “I do very different things than a reiki practitioner does.” In general, she supports the use of any safe methods that her patients find helpful.

What may be useful as a metaphor for discussion — and how willing a therapist may be — could seem surprising.

“A client of mine went to a medium, and it ended up bringing up a past trauma for her that she had blocked out, a horrible event,” said William Schroeder, a counselor and co-owner of Just Mind in Austin.

Mr. Schroeder is perhaps unusually willing to go the extra mile to understand patients. “I had a client who talked about Dungeons & Dragons a lot, and so I went to a game and learned more about it,” he said.

In the corner of Anthony Freire’s otherwise nondescript Manhattan office sits a bronze bowl he bought on Etsy, etched with a swirling poem and piled with silver “angel cards.” Mr. Freire, a psychotherapist and the clinical director at the Soho Center for Mental Health Counseling, uses them in his practice.

Printed on the cards are abstract words, like “peace,” “respect” and “forgiveness.” At the end of each session, patients can pluck a card from the bowl and describe its meaning in the context of the appointment.

“It was a gag at first,” Mr. Freire said, noting that he bought the cards after seeing a therapist use them in a Vice Media show. “Then it was like, ‘Wait, this really works.’”

But more often it’s the clients who raise these ideas.

“There are times when there are feelings that come out of nowhere, and I don’t know how to describe them,” said Abby Mahler, a 25-year-old in Los Angeles. During those moments in therapy sessions, she has found herself talking about tarot, as well as internet memes, to communicate.

Ms. Mahler said her therapists have realized that “when I bring up tarot or a meme, it’s because I don’t have the verbal ability to describe what I need to and this is just a tool to do it.”

Tiana Clark, a 35-year-old in Nashville, has gone to therapy on and off for the past two decades. She became interested in crystals, online tarot readings and astrology apps like Co-star this year, after experiencing burnout and extreme anxiety.

“You’re breaking down your thought patterns and behavior patterns in therapy, and that’s kind of what you do in astrology,” she said. “If something seems applicable, like if I read something on Co-star, I feel comfortable peppering in those details as I’m walking through certain traumas.”

In the future, Ms. Clark said she may not need a therapist who “understands the healing power of crystals.” But for now, it feels right.

There are plenty of reasons mental health professionals cite for why they don’t use or encourage these treatments and behaviors.

Some patients, Dr. Holmes said, turn to alternative methods as a means of getting a quick solution to their problems. She estimated that half of her patients have come to traditional therapy after alternative practices didn’t work.

“I had an older woman in her 60s and after two sessions with me, she was like, ‘This is just not going to be fast enough for me,’” Dr. Holmes said.

The patient consulted a shaman and did “energy work” to help deal with her chronic condition, but she didn’t see results. “You can’t energy that away,” Dr. Holmes said.

She also sometimes finds the distinctions confusing. “I was Googling Webster’s definition of ‘shaman,’ because I was like, ‘Is this all the same thing or is it different?’” Dr. Holmes said. “A shaman sounded like a life coach sounded like a reiki person.”

And while the American Psychological Association doesn’t have an official stance on alternative practices, it maintains an evidence-based practice policy, said Lynn Bufka, the associate executive director for practice, research and policy at the organization.

Some alternative interventions, like meditation, have significantly more scientific backing than, say, crystals, Dr. Bufka said. For alternative practices with more spiritual components, she noted that cultural sensitivity is also important.

In cases where there is little credible research or information on a method, Dr. Bufka said that the clinician should discuss why that particular practice is meaningful to the client. “Is there something that they’re not getting from their psychotherapy or other care that they hope that they will get from this?” she said.

It all comes from a place of concern for the patient’s well-being and a sense of social-scientific responsibility.

“This is my line: ‘I don’t have an opinion on things I can’t measure, and unless I think it’s being harmful to you, I’m going to trust your wisdom and your intelligence to make good decisions about whether this is a benefit to your life,’” Dr. Ruan said.

Dr. Kaplan, in New York, put it another way: “If someone is pursuing psychological evidence-based therapy while meditating with crystals while Mercury is in retrograde, I’m fine with that.”

Sanam Yar writes about youth culture and social media for The New York Times. She is based in New York. @sanam_yar

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