Being conscious during the trip is an essential part of the healing process. In fact, healing comes from the realization of what consciousness really is, that death is not the end, how my little self is just a stubborn part of a larger infinite consciousness that is the Universe thinking itself into existence, etc. You 'remember' what you really are and that's liberating.

One theory that I subscribe to is that the drug increases the brain's neuroplasticity, allowing for new pathways to be created between sometimes unrelated parts of the brain.

Being conscious allows one to guide (but not control heh) this process, where the user can pick a subject to think about and immerse oneself into a audiovisual/emotional/cognitive hallucinatory experience that follows related to that subject. Inevitably the most pressing issues of one's life will surface, allowing the user to examine them from all these different angles - accept, forgive, love and heal.