Ego Strength Assessment for Facilitators

Ego Strength Assessment Tool for Psychedelic Preparation

Background and explanation of terms/research that supports the use of this tool

Ego strength refers to a person’s ability to maintain a coherent and resilient sense of self while navigating inner conflict, external stress, and emotional intensity. In Jungian psychology, the ego is not something to eliminate, but rather the conscious center of identity—a necessary structure that mediates between the unconscious, the body, and the external world. A strong ego allows for flexibility, self-reflection, reality testing, and integration of complex experiences.

In many New Age and psychedelic circles, however, “ego” is often misunderstood or reduced to meaning arrogance, narcissism, or grandiosity—traits more accurately described as inflated ego states or defenses. This conflation can lead to the mistaken belief that any dissolution of the ego is inherently healing, when in fact, ego weakness or fragmentation can leave someone highly vulnerable to dysregulation, depersonalization, or psychosis.

In psychedelic work, ego strength is vital. These substances often dissolve the usual boundaries of self, exposing deep unconscious material. Without sufficient ego development, this can result in emotional flooding or long-term destabilization. Assessing ego strength helps facilitators ensure that a client has the internal structure and self-awareness needed to tolerate and integrate often chaotic, transpersonal experiences.

The reseearch to back up the necessity of such an assessment:

From a recent study: (https://doi.org/10.1038/s41380-024-02800-5):

-Lifetime incidence of psychedelic-induced psychosis is estimated at ~0.002% in the general population, but ~0.6% in clinical trial.

-In studies that included individuals with a history of schizophrenia, up to 3.8% developed prolonged psychosis

-Of those, 13.1% later developed schizophrenia

So while I deeply respect Dr. Richards and others leading the clinical trials, this data shows that even in controlled, “safe” clinical settings, adverse events still occur—and at higher rates than in the general population.

There are multiple ways to interpret this:

-Smaller sample sizes in clinical trials can inflate incidence rates

-Better reporting and clinical oversight may catch symptoms that go unreported in broader population studies

-But importantly, many of these trials recruit individuals with pre-existing mental health conditions, which may increase vulnerability—and suggest that current screening protocols may not be sufficient

This is exactly why my research focuses on understanding this phenomenon: so we can better assess risk and improve best practices moving forward.

Despite my admiration for pioneers like Richards, I do not believe the clinical trials—particularly those using a rigid medical model—are being conducted in the most effective or ethical way. I worry that programs like those at Hopkins may ultimately fail under regulatory scrutiny. We’re already seeing hesitancy from the FDA around MDMA, and in some ways, that caution might be justified.

At the same time, this does not mean criminalization is the answer. If anything, it highlights the extreme need for legalization and decriminalization—paired with education and harm reduction and truly ethical frameworks. People have the right to explore their own consciousness, even at personal risk. Human agency, when supported by informed consent and harm reduction, must remain central in this unfolding psychedelic renaissance. But within this, people should be aware of the risks involved, and the psychedelic movement has been entrenched with nothing but toxic positiivity for sometime. The "there are no bad trips" people are like termites, eating our foundations away at the core.

We are still in the early stages of understanding the intersection between psychedelics and mental health. Anyone using psychedelics today for therapeutic purposes is, in many ways, acting as their own test subject, navigating unpredictable terrain with limited guidance. There is no one-size-fits-all protocol—nor will there be anytime soon.

So, what if someone "fails" this assessment then what? We're talking about the person who’s already spent years in the traditional biomedical model, exhausted every option, and still feels stuck… only to take this assessment and land in the “defer” category? What then? Likely not psychedelics—at least not in higher doses, and not right away.

But this doesn’t mean there’s nowhere to go. In fact, it may point to the right next step: deep preparation. Not more of the same therapy that’s already failed to help, but practices that work more subtly, somatically, and soulfully. I would suggest modalities like vipassana meditation (shown to help defrag the Default Mode Network), EMDR, Somatic Experiencing, Brainspotting, intensive yin yoga, kundalini practice, dreamwork, or even microdosing under a Fadiman-style protocol. If talk therapy has run its course, consider working with a trained, ethical, and well-vetted coach grounded in integrative or depth-oriented approaches. Explore active imagination. Rebuild trust with the unconscious. Psychedelics are powerful—but they are not the only portal.

Sources the substantiate the use of metrics such as this:

Aday, J. S., Mitzkovitz, C. M., Bloesch, E. K., Davoli, C. C., & Davis, A. K. (2020). Long-term effects of psychedelic drugs: A systematic review. Neuroscience & Biobehavioral Reviews, 113, 179–189. https://doi.org/10.1016/j.neubiorev.2020.03.017

Bremler, R., Katati, N., Shergill, P., et al. (2023). Case analysis of long-term negative psychological responses to psychedelics. Scientific Reports, 13, 15998. https://doi.org/10.1038/s41598-023-41145-x

Elfrink, S., & Bergin, L. (2025). Psychedelic iatrogenic structural dissociation: An exploratory hypothesis on dissociative risks in psychedelic use. Frontiers in Psychology, 16. https://doi.org/10.3389/fpsyg.2025.1528253

Frecska, E. (2007). Therapeutic guidelines: Dangers and contra-indications in therapeutic applications of hallucinogens. https://doi.org/10.13140/RG.2.1.2364.8888

Johnson, M. W., Hendricks, P. S., Barrett, F. S., & Griffiths, R. R. (2019). Classic psychedelics: An integrative review of epidemiology, therapeutics, mystical experience, and brain network function. Pharmacology & Therapeutics, 197, 83–102. https://doi.org/10.1016/j.pharmthera.2018.11.010

Krediet, E., Bostoen, T., Breeksema, J., van Schagen, A., Passie, T., & Vermetten, E. (2020). Reviewing the potential of psychedelics for the treatment of PTSD. International Journal of Neuropsychopharmacology, 23(6), 385–400. https://doi.org/10.1093/ijnp/pyaa018

Sabé, M., Sulstarova, A., Glangetas, A., et al. (2025). Reconsidering evidence for psychedelic-induced psychosis: An overview of reviews, a systematic review, and meta-analysis of human studies. Molecular Psychiatry, 30, 1223–1255. https://doi.org/10.1038/s41380-024-02800-5

Yildirim, B., Sahin, S. S., Gee, A., Jauhar, S., Rucker, J., Salgado-Pineda, P., Pomarol-Clotet, E., & McKenna, P. (2024). Adverse psychiatric effects of psychedelic drugs: A systematic review of case reports. Psychological Medicine, 54(15), 1–13. https://doi.org/10.1017/S0033291724002496

the assessment

This non-clinical assessment is designed to help psychedelic facilitators evaluate a client's ego strength across key domains of psychological resilience and emotional maturity. Each domain contains two reflection questions. Clients should answer as honestly as possible. Facilitators can use the accompanying scoring guide to interpret the responses.

Section 1: Self-Reflection (Client-Completed)

Clients rate each statement using the scale: 0 = Never, 1 = Rarely, 2 = Sometimes, 3 = Often, 4 = Always.

·      - I can remain calm even when I’m deeply upset.

·      - I can tell the difference between my emotions and objective reality.

·      - I’m open to feedback, even when it challenges me.

·      - I have bounced back from emotional setbacks before.

·      - I know who I am, even when things fall apart.

·      - I can sit with painful or confusing thoughts without needing to escape.

·      - I reflect on my choices and grow from them.

·      - I seek help when I need support.

·      - I trust myself to make good decisions.

Total Score: Add all items (maximum = 36).

Interpretation:

Green Zone: 28–36 – Likely ready

Yellow Zone: 18–27 – Recommend preparation

Red Zone: <18 – Defer psychedelic work

Section 2: Open-Ended Prompts

Ask one or more of these questions and listen for responses indicating readiness:

Resilience

·      - Can you share a time when you faced a significant challenge? What helped you get through it?

·      - When life knocks you down, what helps you get back up?

Adaptability

·      - How do you typically respond to sudden change or uncertainty?

·      - Can you share a moment when things didn't go as planned—and how you adapted?

Coping & Emotion Regulation

·      - What do you usually do when you're feeling overwhelmed, anxious, or angry?

·      - How do you care for yourself in difficult emotional states?

Self-Efficacy

·      - Can you describe a time when you believed in yourself—even in the face of doubt?

·      - How do you approach goals that feel intimidating or unclear?

Relationships & Support Systems

·      - Who do you turn to when you're struggling? What do those relationships feel like?

·      - Have you ever experienced support that helped you through something hard?

Problem-Solving Capacity

·      - When you're faced with a complex decision or problem, how do you break it down?

·      - What's your process for choosing between difficult options?

Purpose & Meaning

·      - What gives your life direction or purpose right now?

·      - When things feel hard, what values or inner beliefs help guide you?

Self-Reflection & Insight

·      - How do you reflect on past experiences—especially painful or confusing ones?

·      - What have you learned about yourself in the last few years?

Gratitude & Emotional Resourcefulness

·      - What are you grateful for, even amidst struggle?

·      - Can you recall a moment where expressing gratitude shifted your emotional state?

Sense of Achievement & Integration

·      - Tell me about something you've accomplished that you're proud of. Why does it matter to you?

·      - How do you celebrate your growth and recognize your progress?

Look for themes of resilience, self-awareness, support systems, and grounded expectations.

Scoring Guide:

After reviewing the client's responses, rate each domain on a scale from 1 to 5:

1 – Severely underdeveloped or missing

2 – Limited capacity, with inconsistent insight or coping

3 – Moderate development, functional under normal conditions

4 – Well-developed, stable and resourceful

5 – Highly developed, reflective, adaptive, and integrated

Total possible score: 50

Interpretation:

40–50: Strong ego structure, high readiness

30–39: Moderately strong, some support recommended

20–29: Needs preparatory work before high-dose work

Below 20: High risk, consider deferring psychedelic work

Section 3: Facilitator Observations (Post-Conversation)

Rate each trait below on a scale from 1 (Low) to 5 (High), based on your interaction with the client.

• Emotional regulation- Insight into their own behavior-

• Resilience in the face of challenge-

• Openness to feedback-

• Presence/groundedness-

• Reality testing (can distinguish inner from outer)-

• Flexibility (not rigid or black/white)-

• Sense of purpose or meaning-

• Social support system strength

Scoring Guide: Total possible score: 45 (9 items x max score of 5)

Interpretation:

• Green Zone (36–45): High overall ego strength and readiness for psychedelic work.

• Yellow Zone (24–35): Moderate ego strength. Some traits may need further support or development.

• Red Zone (Below 24): Low ego strength. Recommend deferral and additional preparation or support before engaging in psychedelic work.

 

Final Summary: Synthesizing Scores and Intuition

This Ego Strength Assessment Tool is designed to support facilitators in evaluating psychological readiness for psychedelic work, not to replace human judgment. While numeric scores provide a helpful framework, they should always be interpreted within the broader context of the client’s lived experience and the facilitator’s own intuitive understanding.

Let’s say a client receives the following:

• Section 1 (Client Self-Reflection): 40 – High self-reported resilience and insight

• Section 2 (Facilitator Interview Scoring): 35 – Moderately strong responses with areas for reflection

• Section 3 (Facilitator Observations): 32 – Functional ego structure with some traits still maturing

These scores indicate a client with overall good ego strength, likely capable of navigating a psychedelic experience with the right preparation. However, numerical data alone doesn’t fully capture nuance, risk, or subtle warning signs. This is where the facilitator’s presence, discernment, and inner clarity are essential.

Ask yourself:

• Did I feel safe and grounded in their presence?

• Do they seem willing and able to face difficult material without avoidance?

• Do they exhibit humility, openness, and a willingness to learn?

• Do I sense a strong enough anchor in their psyche to return from expanded states of consciousness?

Facilitators must lean into their own inner compass—that quiet knowing that emerges when we hold space with curiosity, compassion, and deep listening. Psychedelic facilitation isn’t just technical—it is relational, intuitive, and energetic. Sometimes a high score doesn’t mean readiness, and a lower score doesn’t always mean “no.” Readiness lives in the total field—between data, dialogue, and your direct experience of the person.

Ultimately, this tool is here to empower you to make informed, embodied, and ethical choices—on behalf of the client’s safety and their highest potential for transformation.