If I tell people I work with smell (not perfume), the word that comes back at me, almost every time, is aromatherapy. There is usually a particular nod that comes with it, warm, slightly knowing, sometimes dismissive. Lavender for sleep, peppermint for focus. A diffuser in the corner of a spa doing its quiet work on your cortisol. People file what I do into that drawer because it's the only drawer they have.
I have argued before that it is the wrong drawer, not because aromatherapy is fake, but because it is answering a different question than the one I am interested in. Aromatherapy asks what does this smell do to you? The work I care about asks something closer to what happens when you actually pay attention to what you are smelling? The difference between the two is huge.
First, let's be fair to aromatherapy
It would be easy and lazy to wave aromatherapy away as nonsense, so let me not do that. The honest evidence picture is more interesting than either the true-believer or the debunker version.
Ancient history aside, when researchers have gone looking for clinical efficacy (does inhaling this oil treat this condition) the results are mostly thin. A large Australian government evidence review concluded there was no clear evidence demonstrating that aromatherapy is effective as a medical treatment, and that conclusion has held up reasonably well across subsequent work. There are narrow exceptions where short-term symptomatic benefit shows up. Some signals for anxiety, nausea, and pain relief, particularly in palliative and hospice settings, but the studies are small, heterogeneous, hard to blind (you can tell when a room smells of lavender), and rarely controlled well enough to separate the molecule's effect from relaxation, attention, expectation, and the simple fact that someone is caring for you.
So the careful statement is: aromatherapy as a treatment for disease has weak and inconsistent evidence, with a few modest short-term exceptions, mostly in comfort care. Notice the frame it lives inside: a substance, administered, to produce an outcome in a passive recipient. It is a pharmacological model with a nicer smell. The person is a body that the oil acts upon.
The thing aromatherapy skips: you
In the aromatherapy frame, attention is irrelevant. The oil is supposed to work regardless whether you are thinking about it or scrolling your phone.
But smell, of all the senses, is the one that barely functions on autopilot. It habituates fast, within minutes a constant smell fades to nothing, which is why you stop noticing your own home and a stranger smells it instantly. It's bound up with breath, so the way you sniff changes what you get. And it's notoriously hard to name. Most people, handed a familiar smell with no label, can identify only a fraction of what they would swear they know. Cucumber is one of the most evil things I could give at the blind smelling exercise because it is so well recognized when I actually say what it is. Smell is the sense most dependent on what you bring to it. The same molecule is a different experience depending on attention, context, expectation, memory, and mood. Look up the parmesan and vomit study for the most striking example.
Which means the interesting variable was never really the oil. It was the meeting between a person and a smell, and most of the time, in most lives, that meeting never actually happens. "We move through a world of scent we have trained ourselves not to notice."
Olfactory engagement is just: making that meeting happen on purpose.
What engagement actually looks like
In practice, the work has very little in common with handing someone lavender and telling them it's calming. In a lot of ways it's the opposite. A few things I hold as non-negotiable, and why:
Agency is absolute. I don't tell anyone what they are smelling, or what it should do, or whether they should like it. The moment I say "this is relaxing," I have contaminated the experience and replaced their response with mine. The whole value is in their contact with it, including their dislike, their confusion, their "this smells like my grandfather's garage and I don't know why." This is information about them, not a malfunction.
Smell first, name after. We are so verbal that naming arrives like a guillotine. The instant you decide a smell is "vanilla," you stop perceiving it and start perceiving the word. So I withhold the label, sometimes for a long time, and ask people to stay in the un-named space where the smell is still doing something they can't yet categorize. This is the part that maps onto the actual neuroscience: the emotional, associative response genuinely does arrive before, and partly independent of, the identifying machinery. I am just protecting that gap instead of papering over it.
Push, and bet on human range. The aromatherapy palette is relentlessly pleasant: clean, soothing, marketable. But people are not fragile, and the most alive moments come from smells that are strange, ambivalent, even faintly repellent. I would rather offer something that provokes a real reaction than something engineered to produce calm. And oftentimes, when I mention having dozens of different types of stinks, I am asked to prepare the scent strips. Disgust on demand is fascinating.
Semantic freedom is the target. This is the one that confuses people most. In a regular session, I am not trying to regulate anyone toward a serene baseline (unless that has been explicitly requested). We all try to arrive at something, be it surprise, memory, disagreement, or whatever the live unpredictable thing that happens when a person genuinely encounters something. A session that goes exactly to plan has usually failed. A diffuser's job is to make a room consistent. My job is closer to the opposite.
Why this is not just a nicer spa
Smell is wired unusually close to emotion and memory. I am sick of the mantra, but the olfactory bulb projects almost directly into the parts of the brain that handle feeling and recollection, a structural intimacy that is confirmed, not just assumed, in recent human brain-imaging work. That's why losing smell is so destabilizing, and why olfactory loss is now recognized as something that often precedes and accompanies neurodegenerative and psychiatric conditions, an early signal worth taking seriously rather than a minor inconvenience.
The clinical adjacents to the work are real. Olfactory training, systematic, repeated, attentive exposure to a set of odors, does have evidence behind it for recovering smell after viral loss, though the results are variable and it's no guaranteed cure. Crucially, what makes training work is not a magic oil. It is the attention: the deliberate, repeated act of paying attention to smell appears to drive measurable change in the system. The active ingredient is engagement itself.
I don't run a clinic and I don't make medical claims. But that finding is, in a way, the whole thesis underneath my practice: the value is not in the substance acting on a passive body, but in the person showing up to the encounter. Aromatherapy is built around the molecule. Everything I find interesting is built around the meeting.
The actual distinction
Aromatherapy treats smell as a delivery system. It is a way to get a compound into a person to produce an effect, ideally without bothering them. Olfactory engagement treats smell as an occasion - a reason and a structure for a person to make contact with something, including parts of themselves they lost track of.
One asks the smell to do the work. The other asks you to.
The point is to be acted upon, soothed, managed, returned to baseline. The point, at least the point I care about, is the exact opposite: to be woken up, briefly, into a sense most of us have agreed to stop using. To stand in front of something ordinary and strange and let it be strange. To smell first, and name later, and notice what happened in between.
You don't need me, or an oil, to start. You need about thirty seconds and the decision to actually pay attention to the next thing you smell, instead of letting it pass through you like all the rest.
References:
Aromatherapy efficacy
The core "no clear evidence" finding comes from the Australian Government's National Health and Medical Research Council evidence evaluation. One of the findings from the 2015 Review was that there was no clear scientific evidence that aromatherapy was effective. The protocol updating that work:
Bensoussan A, et al. "Effectiveness of aromatherapy for prevention or treatment of disease, medical or preclinical conditions, and injury: protocol for a systematic review and meta-analysis." Systematic Reviews, 2022; 11:148. PubMed Central
For the narrow short-term symptomatic signal in palliative/hospice care:
Sharma M, et al. "Essential oils for clinical aromatherapy: A comprehensive review." Journal of Ethnopharmacology, 2024
The VA evidence map:
"Aromatherapy and Essential Oils: A Map of the Evidence." U.S. Department of Veterans Affairs, Health Services Research & Development, Evidence Synthesis Program.
"Efficacy of Essential Oils in Relieving Cancer Pain: A Systematic Review and Meta-Analysis." Pharmaceuticals / PMC10138439, 2023
This review demonstrated significant efficacy of essential oils in reducing the intensity of cancer-associated pain, while highlighting the need for earlier, more homogeneous, and appropriately designed clinical trials.
Olfactory training
The foundational meta-analysis:
Pekala K, Chandra RK, Turner JH. "Efficacy of olfactory training in patients with olfactory loss: a systematic review and meta-analysis." International Forum of Allergy & Rhinology, 2016; 6(3):299–307
Frames smell loss as a challenging clinical problem with few proven therapeutic options, with early results suggesting olfactory training may be effective across dysfunction of multiple etiologies.
On the variability and the "not a universal solution" caveat:
Pieniak M, et al. "Classical Olfactory Training for Smell Restoration: A Systematic Review." 2025 (PubMed 40103490)
Concludes it is promising but should not be seen as a universal solution for anosmia, given the variability of results.
The thirteen-year review that connects training to the limbic projections and to neurodegeneration:
Pieniak M, Oleszkiewicz A, Avaro V, Calegari F, Hummel T. "Olfactory training – Thirteen years of research reviewed." Neuroscience & Biobehavioral Reviews, 2022; 141:104853.
This is the source for both the limbic-projection point and the statement that olfactory loss accompanies and precedes psychiatric and neurodegenerative diseases.
Webster KE, O'Byrne L, MacKeith S, Philpott C, Hopkins C, Burton MJ. "Interventions for the prevention of persistent post-COVID-19 olfactory dysfunction." Cochrane Database of Systematic Reviews, 2022; 9:CD013877
