With the internationalization of ayahuasca and reports of its positive effects on mental health, the interest in its therapeutic potential is increasing. Additionally, the different uses of ayahuasca may elicit wide-ranging psychological and emotional experiences. Therefore, the therapeutic use of ayahuasca can—and should—be appreciated from a psychotherapeutic point of view. This approach follows, but only to a certain extent, the already established paradigm of psychedelic-assisted psychotherapy. The effects of ayahuasca include bodily, emotional, and experiential changes to the experience of self and world, both during its acute effect and in the days after, and several of them may be related to its psychotherapeutic effect. In this chapter, the association of ayahuasca and psychotherapy will be discussed through the review of existent literature, the authors’ professional experience, and remarks about possible new paths in this field. Some points discussed here include: the role of the experience for the individual, suffering and challenging experiences with the brew, ayahuasca visions, the generation of content to be used in psychotherapy, the mediation of a “plant third party,” integration processes, and the encounter of ayahuasca with well-established psychotherapeutic schools.