Written by Hannah Dresdner, LCSW
In a quickly evolving world of therapeutic modalities and therapy speak, psychedelic psychotherapy has a tendency to stick out. Psychedelics are making the comeback of the century in the western world. From their villainization and criminalization beginning in the 1970’s to their uprising as healing agents 50 years later. The narrative is shifting towards psychedelics as effective treatments. Over a decade of research has shown that psychedelic assisted therapy for PTSD and trauma can be effective. This great news for people suffering with symptoms that have been labeled ‘treatment resistant’. This shift comes at a time when individuals are struggling to make use of the tools at hand. Fresh out of a three year pandemic, re-integrating into a world that may or may not make any sense anymore, individuals are seeking connection, meaning making and solutions to issues and challenges outside of the conventional medicine and pharmaceutical industries. And so enters something new; or something really, really, ancient.
Brief History of Psychedelics
Psychedelics have been used for millennia, dating back 7,000 to 9,000 years ago. There is evidence of different psychedelic substances including mushrooms and cacti that have been found in historical relics throughout time. These substances have been, and continue to be, used by indigenous groups in healing rites and rituals. They were first “discovered” in the western world in 1496 on Christopher Colmbus’ journey when native Tiano peoples of the Dominican Republic/Haiti were observed ceremonially consuming Cahoa/Yopo, a shrub that contains DMT (dimethyltryptamine), a strong psychedelic found in plants. Later, western explorers and conquistadors encountered the Aztec people engaging with their native medicines, peyote and psilocybin mushrooms, Brazilians with ayahuasca and the people of present day Gabon and Congo using iboga root. The native ancestors of these groups continue to utilize these substances to this day.
LSD
Nearly 450 years after the western world first stumbled upon psychedelic substances, scientist Albert Hoffman self administered 250 mg of LSD after synthesizing it, kicking off the first round of modern psychedelic research in 1943. By the late 1940’s psychiatrists began exploring the potential of psychedelics within the field primarily using LSD for depression and alcoholism. By 1952 many psychiatrists were integrating psychedelic medicine into their practices; between 1960 and 1964 Stanslof Groff provided more than 4,000 LSD-assisted psychotherapy sessions.
At that time there were no regulations on these substances and practitioners and scientists had free reign to use them as they saw fit. Eventually LSD made its way into popular culture and shortly thereafter bans on psychedelic use became more prevalent. In 1971 Nixon launched his “War on Drugs” campaign, increasing the size and presence of federal drug control agencies and mandatory sentences. This push led to complete prohibition of entheogens as well as any research that was being conducted with these substances. Along with these policy shifts came a mountain of anti-drug rhetoric leaning on intensely hyperbolized caricatures of psychedelic drug use, touting potentially deadly results. This propaganda has had a lasting impact, stimulating fear and uncertainty around these substances that is still present today.
Multidisciplinary Association for Psychedelic Sciences (MAPS)
The Multidisciplinary Association for Psychedelic Sciences (MAPS) has been patiently waiting in the background since 1986. Spearheaded by Rick Doblin, PH.D., MAPS has worked relentlessly to end the prohibition on psychedelics by focusing efforts on policy reform and research. In 2004 MAPS began its first trials of MDMA assisted psychotherapy for PTSD. Two years later Johns Hopkins published the results that captured the mystical experiences associated with psilocybin; at the 14 month follow-up, volunteers reported this experience was among the most “personally meaningful, and spiritually significant” of their lives. A 2008 study found that 80% of individuals that underwent psychedelic assisted therapy for PTSD no longer met criteria for PTSD following MDMA assisted therapy. Hence, the renaissance has begun, yielding many more scientific studies as well as advocates speaking up for the place of psychedelics in the field of mental health care.
Current State of Psychedelic Medicine
Currently substances such as psilocybin (magic mushrooms), LSD, ectasy (Molly, MDMA) and marijuana are on the U.S. Drug Enforcement Agency’s (DEA) Schedule 1. According to the DEA, these “drugs <have> no currently accepted medical use and a high potential for abuse.” To remove a substance from Schedule 1 there needs to be a body of research supporting safe medical uses. Many obstacles, such as powerful interests, exist to getting the funding or approval for this research. Even though some psychedelic substances hold great therapeutic benefit its’ placement on Schedule 1 presents many challenges. These challenges limit their use in treatment for those that are suffering and not responding to conventional treatment.
Ketamine
Ketamine, which has been historically used as an anesthetic, is an exception. It’s placement on Schedule III allows licensed medical professionals to prescribe it. Ketamine, for some people, can be psychedelic in nature and it has the potential of offering mystical, healing experiences. The research on its’ efficacy is based on the therapeutic integration component, facilitated by a trained professional. Yet there are ketamine clinics offering IV infusions of the medication sprouting up all over the U.S.
Some of these clinics have a therapeutic component built into their model. However the majority have a prescribing doctor and nurses who simply administer the medicine. While this approach can still produce beneficial results, it can be quite difficult to manage the rapid transformation and life shifts that may ensue without the assistance of an informed and trained therapist, counselor, or guide. As the field continues to evolve we hope ketamine clinics will add therapists into their model to provide guidance and integration of the experience.
Psilocybin
Less widespread is the legalization of psilocybin (‘magic mushrooms’) for therapeutic use. Recently only Oregon and Colorado passed legislation creating the possibility of therapeutically assisted use of magic mushrooms. Despite the potentially long road to legality for most states, training institutes and universities are beginning to offer Psychedelic Assisted Psychotherapy training. These trainings certify clinicians as ketamine assisted therapists, as well as teaching them on best practices for MDMA and Psilocybin in anticipation of their eventual legalization.
Importance of Set and Setting
Despite the amplification of positive research relating to psychedelic medicine it is important to note that these medicines are no panacea. They are incredibly helpful tools to be used on one’s healing journey, fostering a sense of internal awareness and creating the possibility of tending to the root causes of issues in a new way. But, there is still work to be done, both prior to engaging in medicine work as well as after the journey outside of the psychedelic space, Set and setting are two critical aspects of preparing for a safe and profound experience.
‘Set’
‘Set’ refers to the mental state of the participant upon entering the medicine space. Psychedelic medicines are nonspecific amplifiers; this means they magnify whatever emotions or feelings the participant comes in with. For example, if a participant comes in with an anxious mental set, i.e. holding fears relating to the medicine, their experience within the medicine space will likely enhance these sensations, leading to a potentially darker, more challenging experience. In order to ensure a positive and productive experience it is important to work with a qualified professional in preparation sessions prior to embarking on such a journey. The objective of preparation sessions are similar to that of a regular therapeutic intake; gathering the patient’s history (personal and psychedelic), building therapeutic rapport, working through biases and fears and creating clear intentions for the psychedelic session.
Creating safety with, and for, the person who will be experiencing a psychedelic journey is critical. The psychedelic space is even more vulnerable for participants than traditional talk therapy. In this space, the patient is entrusting their safety to the sitter while they release into an altered state of consciousness. It is possible during these sessions, depending on the medicine, that feelings may be felt and expressed more dramatically; sensations may be enhanced and/or intense; associations may possibly be made between the therapist and the client’s personal life (transference); and potentially nonsensical comments, statements, and feedback could be spewed about.
Grounded Presence
It is vitally important to have a grounded, non judgemental, trauma informed presence in the room! A figure who can stay calm and grounded in the wake of intense emotional episodes. Someone who can navigate the possibility of transference if it arises. Beyond the clinical skills, it is important the recipient feels trust in their therapist/sitter in order to be able to fully release into the experience without concern for the external world. A trained professional will emphasize the significance of building therapeutic rapport on the front end. This will ensure the client is fully aware that all their needs will be taken care of during the session itself. The role of the ‘sitter’ is critically important; they provide a calm, grounding presence to reassure and comfort should the experience become intense or challenging.
Setting
Setting refers to the physical setting of the experience. Many individuals have reported difficult experiences with hallucinogens when engaging with them at concerts, events or just generally the wrong circumstances. The intention of psychedelic assisted therapy is to remove any unnecessary environmental variables to create a warm and comforting space, minimizing any sense of uncertainty, unpredictability or external interruptions.
During a medicine session clients will typically undergo their experience with eye shades and headphones. The eye shades provide the participant with the opportunity to tune out external distractions and journey inside of themselves. Typically specific playlists are selected that incorporate a variety of music from classical to soundscapes and include natural sounds and indigenous instruments. Music plays a key role in these journeys, lubricating the experience and engaging a familiar sense to help the participant dive deeper into themselves and the journey.
Please consider set and setting when planning to engage with psychedelics recreationally or in a therapeutic setting. Set & setting is a helpful framework to gauge whether a psychedelic experience is in alignment with your intentions and desired outcome. These experiences have immense healing potential. They also hold some risk of traumatizing or re-traumatizing the journeyer. Having a psychedelic experience with a safe, competent sitter help minimize risk.
Ceremony & Indigenous Reciprocity
Psychedelic medicines are ancient and highly energetic. They open up the user to mystical experiences as well as a new understanding of reality. In a world focused on clinical trials and evidence based modalities, psychedelics are different. Psychdelics can offer something far beyond our intellectual understanding of mind and body. It is critical to hold these plant or synthetically derived medicines with an immense amount of reverence and respect. Including an element of ceremony in the medicine space can be an important part of the session. Creating space to honor the substance and its’ wisdom can have a positive impact on the journey.
Acknowledging the roots and the lineage of these substances shows respect for those who have worked with these substances for millenia. Indigenous reciprocity is a crucial theme amongst what promises to be a multibillion dollar industry. Acknowleding Indigenous Reciprocity appropriates ancient healing practices is respectful. Giving back to the communities from which these mystical medicines originate is reverence in action.It incorporates a need to tend to ecological wellbeing. Indigenous reciprocity seeks to find balance between these communities and current businesses profiting off of their rituals.. The Indigenous Initiative of the Americas (IRI) is working alongside some of the key players in the developing psychedelic field. The IRI would like to uplift and support the communities from which these medicines came. It is paramount to give a voice to indigenous wisdom and contributions to this field as it evolves.
Are psychedelics right for you?
Consider these questions before psychedelic assisted therapy
- Are you willing to invest time into talking with professionals and preparing for the experience? Education and preparation are key to receive therapeutic benefit from psychedelics. MAPS is a great place to start for learning about the fundamentals, clinical research and harm reduction.
- Has a licensed health professional suggested exploring Ketamine for ‘treatment resistant’ PTSD or depression? Psychedelics, whether experienced in a clinic with or without therapy assistance is not a substitution for longer term talk therapy. However, psychedelic assisted therapy can bring awareness and new perspective which can then be turned into a transformative experience with a therapist. Ketamine treatment, either at home or in a clinic, with or without therapy assistance, is currently very popular. Consider ketamine may not work for everyone and research has not be done to show the benefits are sustainable. We recommend putting expectations aside and receive psychedelic assisted therapy for PTSD with a trained professional to achieve the best possible outcome. Learn more about Mona’s approach to ketamine assisted therapy.
Consider these questions before plant-based psychedelics
- A friend has a source for mushrooms and you are curious to try them. As we mentioned above, ‘set’ and ‘setting’ are paramount to your safety. Again, these experiences need serious consideration. While they have immense healing potential, they equally hold risk. Some some, psychedelics can traumatize or re-traumatize the journeyer. If you still want to do them please make sure you are accompanied by a grounded, competent, sober ‘sitter’. Also ‘set’ the appropriate intentions, expectations and reverence for the medicine.
- You are planning to engage with psychedelic medicines in a ceremonial retreat space. It is important to do your due diligence when vetting ceremonies that fall within the psychedelic tourism space. Considering asking: 1) how many people will in the group; 2)how many attendants will be present; 3) is there an intake or interview process; 4) how do they manage the difference experiences of individuals.
Planning to travel for a psychedelic experience?
Travelling for a psychedelic experience? Please consider the buffer time between the medicine portion of the retreat, and when you plan to head back home. It can take days to weeks to integrate big experiences. Sometimes individuals report feeling more sensitive to their surroundings and/or a desire to spend more time with themselves. It is best to build time into your itinerary to take space before returning to life. Going straight from a medicine retreat back to work or family life may be jarring. Also important is to set up appropriate integration practices after the experience. This may be attending integration groups or seeking out a therapist who is open to aiding in the integration process.
