Last updated on 18th March 2019
"The real voyage of discovery consists not in seeking new landscapes, but in having new eyes." Marcel Proust
"There isn't any formula or method. You learn to love by loving - by paying attention and doing what one thereby discovers has to be done." Aldous Huxley
This is the eighth in a series of blog posts about psychedelics. The earlier posts are "Recent psychedelic research: an introduction", "Their use in psychotherapy (1st post)", "Their use in psychotherapy (2nd post)", "How do they work?", "What are the risks?", "Their use in the general population" and "Recent psychedelic research: Re-mining personal experience".
Over the last couple of months I have rather immersed myself in trying to understand where we have got to in our knowledge of the potential benefits & costs of psychedelics. I have looked at close to 200 research papers and many websites & books. I have also tried to integrate this information with decades of experience as a medical doctor & psychotherapist. So where from here? I would like to move forward in four overlapping areas: 1.) Contributing to the conversation. 2.) Helping therapists organise. 3.) Be skilful at helping with psychedelic experiences. 4.) Learn from all of this personally. So to expand a bit on these four areas.
1.) Contributing to the conversation: I think as a society we're currently reviewing how we see psychedelics. There's a gradually increasing appreciation that they can potentially contribute to good in our society ... relieving suffering and increasing our understanding of the brain & consciousness. Think globally, act locally. I've had many conversations with others over this last couple of months about psychedelics. There have been a wide variety of reactions, from interest to dismissal, from well-informed discussion to almost complete ignorance. Some of the most knee-jerk dismissal has come from those with the least knowledge. Supporting the spread of more accurate information seems obviously worthwhile. I can do this in small ways through conversations with friends, family & colleagues ... and I can tweet, blog, scoop.it, write & lecture.
2.) Helping therapists organise: More & more health professionals are becoming aware that psychedelics can be useful therapeutically. I intend to contribute to this educational process by continuing to stay abreast of emerging research in this area and passing the knowledge on through tweets, blog posts, scoop.it, and possibly lectures. I have been asked to write an article on psychedelics & psychotherapy for COSCA (Scotland's professional body for counselling & psychotherapy). Here's what I'm sending them "Psychedelic-enhanced psychotherapy: time for a Scottish special interest group?" ... so a health professionals group is on the cards. I'll also offer to lecture for the Scottish branch of BABCP (British Association for Behavioural & Cognitive Psychotherapies) and for other counselling/psychotherapy trainings/groups. I'll explore helping to start a BABCP Special Interest Group on Psychedelics & Psychotherapy, as well as organising/contributing to a possible Symposium or other event at a national BABCP conference.
3.) Become skilful at helping with psychedelic experiences: There are at least three ways of helping people use psychedelic experiences that I can see at the moment. In the Netherlands it is legal to take psilocybin in the form of truffles - a possibly rather unappetising compact mass of hardened fungal mycelium. There are some apparently well-managed psychedelic retreats available, run - for example - by the UK Psychedelic Society and the organisation Synthesis. There are also Dutch sitter services, where experienced 'specialists' trip sit to provide increased safety & support. I am in the process of checking out these options to get a better sense of what they involve. I plan to support clients who are interested ... before they take part, then via Skype while they're in the Netherlands, and then to integrate the experience afterwards. A second potential option for the future is to cooperate with others to organise a psychedelic retreat in the Netherlands myself.
Thirdly there are many people who have taken and will be taking psychedelics illegally as well as legally (current legislation is a bit of an illogical mess). Extrapolating from research papers like "Epidemiology of hallucinogen use in the US" and "Over 30 million psychedelic users in the United States" produce very approximate back-of-a-packet figures of around a million people in the UK who have taken a psychedelic in the last year, and roughly around 100,000 last year users here in Scotland. These are approximate calculations, and people take psychedelics for different reasons - but for quite a high proportion 'personal exploration' and 'spiritual growth' will figure high - see, for example, the small recent research paper "Motivational structure of ayahuasca drinkers in social networks" with its conclusion (in the studied population) that "Self-exploration and spiritual purposes appear to be the main reasons for drinking ayahuasca." This illustrates that offering a service to help people make sense of & integrate psychedelic experience might be helpful. This is exactly what MAPS - the Multidisciplinary Association for Psychedelic Studies - has attempted to respond to with their published Psychedelic Integration List stating "Millions of people have had a psychedelic experience at some point in their life. Without support it can be challenging to understand and integrate these experiences. The Psychedelic Integration List is a resource of individuals and organizations in the mental health field who help people integrate past psychedelic experiences." Sounds as though it might be worth joining.
4.) Learn from all of this personally: As I wrote in the post "Recent psychedelic research: re-mining personal experience", I took a dozen or so LSD trips back in the late 60's and early 70's. Does this make me more qualified or less qualified to write about & try to help people use psychedelics to relieve suffering & to learn more about consciousness? Am I a raving ex-hippie whose opinions clearly can't be trusted, or does my personal experience make me better able to understand & help with the challenges of using these substances therapeutically? And should I be updating my psychedelic experience to re-connect more strongly to what it's like in very practical terms, for example to use legal Dutch psilocybin truffles. Elizabeth Nielson & Jeffrey Guss wrote an excellent recent paper "The influence of therapists’ first-hand experience with psychedelics on psychedelic-assisted psychotherapy research and therapist training". They're highly qualified to do so ... they write "Both authors are presently therapists in the ongoing psilocybin-assisted treatment of alcohol dependence trial at New York University School of Medicine (NYUSoM). JG was a therapist in the now-completed trial of psilocybin-assisted treatment of cancer anxiety, also at NYUSoM (Ross et al., 2016). Additionally, he ran the psychedelic therapy training program for the 16 therapists who worked in the cancer anxiety trial, ... Both authors have participated in the Multidisciplinary Association for Psychedelic Studies (MAPS)-sponsored 3,4,-methylenedioxymethamphetamine (MDMA)-assisted therapist training program and have served as therapists with the MAPS-sponsored trials of MDMA-assisted treatment of PTSD at NYUSoM."
Wow ... in the current fairly limited psychedelic research environment, you don't get much more qualified than this. They acknowledge "Psychedelic therapists and researchers who work in this field have previously been questioned regarding their own use of psychedelics, with the concern that direct experience might compromise their objectivities regarding their research, or that the absence of direct experience might compromise their effectiveness, even their validity, as therapists." Meanwhile they point out "Clinical research on psychedelic-assisted psychotherapy is rapidly advancing in the USA, with two drugs, psilocybin and MDMA, progressing through a structure of FDA-approved trials on a trajectory toward Drug Enforcement Agency rescheduling for therapeutic use ... Currently, there is no empirical research on personal use of psychedelics by current academic researchers and clinicians; its influence is undocumented, unknown, and undertheorized. This paper explores ... the rationale for opening an academic discussion and program of research to investigate the role of personal use ... We argue that scientific exploration of the influence of therapists’ first-hand experience of psychedelics on psychedelic-assisted therapy outcomes is feasible, timely, and necessary for the future of clinical research." And they underline this important point, saying "We propose that this should now be an askable and researchable question, and as such it should be moved from theoretical debate to a subject of formal inquiry."
I think these are very good points. For the moment I take the provisional position that using psychedelics to strengthen psychotherapy benefits is more akin to prescribing & helping someone integrate a major new experience (a sort of inverse PTSD intervention), rather than trying to boost therapy effectiveness by prescribing a drug that the client will now take on a daily basis to alter their brain biochemistry. Although there is still debate over the benefits to their clients of therapists having personal experience of being psychotherapy clients themselves - for example, see Jane Edwards' thoughtful recent paper "Counseling and psychology student experiences of personal therapy: a critical interpretive synthesis" - there seems more agreement that teaching experiences like mindfulness does demand personal experience/expertise on the part of the teacher. Even here though, hard data is scarce ... and I think it's worth bearing in mind that the much more extensive research on what makes a psychotherapist/counsellor more or less effective pretty overwhelmingly highlights that interpersonal/general therapist qualities are more important than their expertise in specific therapies - see "Some counsellors & psychotherapists are more effective than others".
I believe we'll find this with psychedelic-assisted psychotherapy too ... that a degree of personal experience with psychedelics for the therapist helps somewhat in them being more helpful, but interpersonal factors will be found to be even more important. Having years of experience playing top flight football doesn't automatically mean that one will be a great football trainer or manager ... but one would expect that the great trainer or manager would have had some actual experience playing the game. So probably 'yes' to therapist personal experience, and 'no' this isn't likely to be the most important factor in distinguishing more & less helpful psychedelic-assisted psychotherapists. Rather than wait several years to find out what future research might tell us about this issue, for the moment I suggest it is sensible & compassionate for trainee psychedelic-assisted psychotherapists to arrange to have a fairly broad range of personal psychedelic experiences ... particularly with the substances & in the environments where their clients are likely to have these experiences.