Dear editor

I read with great interest the recent review by Lewis (Reference Lewis2026), which highlights the critical role of spiritual well-being assessment in psychedelic-assisted therapy (PAT) among palliative care populations. The author emphasizes that individuals facing life-limiting illness frequently experience depression, anxiety, and demoralization, and that spiritual well-being represents a core therapeutic outcome.

The identification of validated measures such as FACIT-Sp-12 and NIH-HEALS represents an important advancement in assessing meaning, connection, and existential adaptation in palliative care. These findings provide important implications for contemporary counseling frameworks that emphasize meaning reconstruction and narrative integration.

Recent developments in existential counseling highlight the importance of meaning-making and existential acceptance in psychological adaptation to serious illness (Vos et al. Reference Vos, Craig and Cooper2015; Breitbart et al. Reference Breitbart2018). Meaning-centered therapeutic approaches have demonstrated effectiveness in improving spiritual well-being, reducing demoralization, and strengthening psychological resilience among palliative care patients (Breitbart et al. Reference Breitbart2018). PAT appears to facilitate similar mechanisms. Clinical trials have shown that psilocybin-assisted therapy produces rapid and sustained reductions in depression, anxiety, and existential distress, with therapeutic benefits mediated by spiritual and meaning-related experiences (Griffiths et al. Reference Griffiths2016; Ross et al. Reference Ross2016). Lewis (Reference Lewis2026) similarly emphasizes that PAT promotes spiritual healing, acceptance, and multidimensional psychological integration.

From a postmodern counseling perspective, narrative reconstruction represents a key mechanism in psychological healing. Narrative and constructivist counseling approaches emphasize that individuals continuously reconstruct meaning and identity in response to life challenges (Neimeyer Reference Neimeyer2019). PAT has been shown to facilitate experiences of connectedness, transcendence, and identity reorganization, which may support adaptive narrative reconstruction in individuals facing mortality (Belser et al. Reference Belser2017; Watts et al. Reference Watts2017). These experiences may allow individuals to reinterpret illness and suffering within broader existential and relational frameworks, enhancing spiritual well-being and psychological integration.

Furthermore, contemporary counseling research emphasizes the importance of relational and therapeutic factors in facilitating existential adaptation and psychological healing (Norcross and Lambert Reference Norcross and Lambert2019). Lewis (Reference Lewis2026) highlights the importance of interdisciplinary spiritual care and therapeutic support in PAT.

These findings align with counseling principles emphasizing therapeutic presence, empathic engagement, and meaning-centered dialogue as key mechanisms supporting spiritual and psychological well-being.

Integrating existential and postmodern counseling perspectives into psychedelic-assisted palliative care may enhance therapeutic effectiveness by supporting meaning reconstruction, identity integration, and spiritual adaptation. Future research may benefit from explicitly incorporating counseling-based frameworks into PAT protocols to strengthen holistic psychological and spiritual care for individuals facing life-limiting illness.

Thank you for the opportunity to contribute to this important discussion.