With the resurgence of research along with clinical trials showing promise for the treatment of anxiety, depression and PTSD as well as substance use disorders, psychedelics are back in the mainstream. Documentaries and books are coming out on topics ranging from mushroom cultivation to microdosing for productivity.
Yet, even as popularity has grown over the past several years, psychedelics remain schedule 1 and a federally illegal drug, aside from off label use of Ketamine. While some states and counties across the country have voted to decriminalize or even legalize and develop protocols for treatment, access and legality remains highly controlled.
WHAT IS A PSYCHEDELIC?
To better understand what psychedelic assisted therapy is and why it is believed to be effective, it may first be helpful to understand how psychedelics work. According to the National Institutesof Health, “Hallucinogens (psychedelics) are a diverse group of drugs that alter a person’s awareness oftheir surroundings as well as their own thoughts and feelings.”
If this definition sounds somewhat confusing it is likely because, unlike other drugs, psychedelics do not directly impact the user in a way alcohol or caffeine might, by depressing or exciting the nervous system. Psychedelics, rather act, as Dr. Stanislav Grof, one of the pioneers of psychedelic assisted therapy, put it, “Non-specific amplifiers of consciousness..” Effectively, psychedelics can bring forth deeply hidden material.
POTENTIAL
It is because of this potential to elicit transformative, even mystical experiences, that psychedelics are being reconsidered for use in a therapeutic context. However, experiences elicited by these substances remain highly variable, ranging from intense transcendent states to extremely challenging and even terrifying confrontations. Given the potential for such varied and intense experiences, it is not surprising that respect and responsibility are primary concerns throughout the process, guiding current (arguably historical) approaches.
WHAT IS PAT?
Psychedelic Assisted Therapy (PAT) then, is the use of a psychedelic substance, (typically LSD, Psilocybin or MDMA) during structured sessions to elicit transformative and insightful experiences of connection and healing. Most therapy within psychedelic assisted therapy is not actually conducted when the client is under the influence of a substance, rather much of the work is done preparing the client for the experience, being present and supportive during the psychedelic session and working to integrate the experience in follow-up sessions.
SET AND SETTING
Perhaps the most important component of psychedelic use (historical, indigenous and therapeutic) is an emphasis on set and setting. As early as the late 1950’s the concept of set and setting had been recognized as fundamental to how the experience unfolds. Because these substances are amplifiers of consciousness, researchers began to recognize the role of context (setting) and mind(set) when observing outcomes. Developing a process in which set and setting are primary concerns is a significant way of promoting connection and healing during sessions. Additionally, the process of screening, preparation, guidance and integration accounts for set and setting in nearly every facet.
(Mind)Set: Everything related to the internal state of the individual, personality, preparation, intentions, mood, expectations, fears and wishes, cultural influence and background.
Setting (Context): Anything related to the environment during the experience, including comfort, sounds, smells, lighting, music choice. An environment free from distractions and interruptions.
Screening:
Screening for any underlying (mental) health conditions is an important concern, as individuals with a family history of bipolar or psychosis may be excluded on the basis of potential adverse outcomes.
Preparation:
Preparation is essential for developing a mind(set) of openness and acceptance going into the experience. Additionally, establishing a trusting relationship with the therapist is necessary as the session unfolds. Clarifying intentions prior to the session helps guide the participant, acting as an anchor, further cultivating the mindset for a therapeutic experience. Larger themes of meaning and purpose are often explored; engaging with the experience rather than avoiding difficult material.
Guidance:
After several preparation sessions the client is ready for the psychedelic session. During much of the session the client is reclined, wearing eye shades and headphones, monitored by a facilitator or guide (typically 2). Sessions vary in length but are often 6 or more hours long. Carefully selected music fosters an internal unfolding of the experience. As the session progresses, the therapist typically has limited involvement, allowing the client to be present with any material that arises. Acting as a supportive, empathic guide often means being attuned to any changes and offering assistance as needed.
Integration:
Follow up sessions are focused on integration, exploring the content and challenges of the experience. Integration is fundamental to carrying the experience into daily life, interpreting and exploring meaning for the client. Exploring ways to continue to connect the experience with daily routine and having some form of community support are increasingly seen as important to integration.
SO WHAT?
As psychedelics are amplifiers of (un)conscious material, often bringing to the surface and fostering insight into past experiences, subtle elements of the session, such as lighting or minor interruptions can dramatically impact the experience. Highlighting the necessity of set and setting is perhaps the best way of ensuring responsible and respectful use, thereby fostering a transformative experience.
Based on current clinical trials as well as greater influence and acceptance within wider cultures it is likely that treatment with MDMA and Psilocybin will have FDA approval within the next five years or less. With proper guidance and qualified practitioners, psychedelic assisted therapy may be able to offer additional options for those struggling with mental health symptoms.
For more information on education, clinical trials and progress towards federal legalization go to: https://maps.org/
Andrew Raz, LMHCA, NCC.
Mental Health Therapist
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