Psychedelics are no longer the taboo they once were. They’ve become a topic for dinner-table conversation. What was once considered a stigmatized icon of sixties counterculture has entered the mainstream as a therapeutic treatment for mental health.
Study after study has shown that substances such as LSD, psilocybin, and MDMA provide relief for people suffering from a host of disorders. But because psychedelics are still largely illegal people are taking it upon themselves to self-medicate. Experimentation is not isolated to clients either.
Many therapists are also trying psychedelics on their own—or in groups (you may be one of them)—to learn why so much attention is being given to these substances after so many years of disapproval. There is a mad rush to understand, both in scientific and mental health communities. Once curiosity is let out of the bag it’s near impossible to stuff it back in.
Therapists have clients visiting them who are reporting either an interest in psychedelics or reporting a good or bad experience. In this article we want to educate therapists as to how to respond to clients in these three situations:
- Clients are interested in having an experience and need to be educated for harm reduction.
- Clients have had a “good” experience and need help finding meaning and to integrate the experience into their lives.
- Clients have had a “bad” experience and need help resolving the trauma, finding meaning, and education to reduce future harms.
How did this psychedelic revolution happen?
Author and journalist Michael Pollan published How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence in 2018, and it hit The New York Times nonfiction Best Seller list for the year. In it, Pollan discusses the history of psychedelic treatments, details his own experiences with psychedelic substances, and shares ongoing research exploring psychedelic-assisted treatments for PTSD, depression, and a host of other mental health issues.
While there have been efforts, prior to Pollan’s book release, to alter the cultural perception of psychedelics since they were made illegal, Pollan’s book helped turn those rumblings into a national discussion.
For now, most psychedelics remain the purview of researchers in clinical environments—they’re a long way from receiving FDA-approval for medical treatments. As far as the rest of the population is concerned psilocybin, LSD, MDMA, DMT, and their ilk remain illegal. But that hasn’t stopped a homegrown movement.
What should you, as a therapist, know about the burgeoning use of psychedelics?
A Very Brief Overview of Psychedelics
A complete history of psychedelics needs its own textbook. So, we’ll stick with what’s happening today, and what you should know as a therapist.
Currently, there are a handful of organizations running clinical trials to study how psychedelics may be used as a therapeutic aid, including the Multidisciplinary Association for Psychedelic Studies (MAPS) as well as the John Hopkins Psychedelic Research Unit, among others. While research has increased in recent years due to a shift in cultural attitudes, studies have been ongoing since the fifties.
And what has recent research uncovered?
Psychedelics have had an enormously positive impact in helping alleviate an array of disorders. They’ve been used to treat PTSD, anxiety, addiction (psilocybin has helped smokers quit cigarettes, permanently), depression, and cluster headaches. And that’s only a sliver of the potential psychedelics pose.
Studies are ongoing. There is a small army of researchers working to discover the full potential of various substances.
What is a “psychedelic”?
It’s important to understand what exactly is being referred to with the word “psychedelics”. Well, some of the substances currently being studied for therapeutic purposes include:
- LSD (Lysergic acid diethylamide)
- Psilocybin (aka Magic Mushrooms)
- DMT (a chemical substance found in many plants and animals)
- Ayahuasca (a brew also known as yagé from the Banisteriopsis caapi vine )
- Ketamine (previously used as an anesthetic)
- Cannabis (Medical Marijuana)
- MDMA (commonly known as Ecstasy or E)
There is no strict one-to-one correlation between a particular psychedelic and its application to a particular disorder, as of yet. MDMA has shown promise as a treatment for PTSD and other traumas, and both ketamine and cannabis have also been effective in trauma treatment, as well.
Yes. Psychedelics are physiologically safe. At least one study concluded that psychedelics are non-addictive, do not cause brain damage, and do not lead to mental health problems. In his book, Drugs Without the Hot Air, Professor David Nutt, speaking of LSD and psilocybin, writes:
“It’s virtually impossible to die from an overdose of them; they cause no physical harm; and if anything they are anti-addictive, as they cause a sudden tolerance which means that if you immediately take another dose it will probably have very little effect.”
He goes on to state that while physiological harm is virtually unheard of, psychedelics in the wrong hands can cause psychological harm.
If someone were to unknowingly ingest psilocybin—as a topping on their pizza, let’s say—they might think they were losing their mind. Mitigating psychological harm is a matter of being informed and working with knowledgeable people.
Dispelling Urban Myths
There are urban myths surrounding psychedelics that are worth dispelling to have a reasonable conversation. A classic relates a hapless hippie who took LSD and believed he could fly, jumping out of a window while flapping his illusory wings. The apocryphal story is the Reefer Madness of psychedelics. There is no evidence that this event took place, though it has been circulated by word of mouth for decades.
And the above story is just one piece of a junkyard of stories that’s been used to fearmonger rather than inform. People are far more prone to injure themselves and others under our legal form of self-medication, alcohol.
What is the Psychedelic Experience Like?
The most difficult question to answer is “What is the psychedelic experience like?” Language tends to fail the desire to describe what happens. Though books like Aldous Huxley’s The Doors of Perception have made the attempt. What we can say with a degree of certainty is many people self-report their psychedelic journey as being one of the most profound experiences of their lives:
“Psychedelic experiences are notoriously hard to render in words; to try is necessarily to do violence to what has been seen and felt, which is in some fundamental way pre- or post-linguistic or, as students of mysticism say, ineffable. Emotions arrive in all their newborn nakedness, unprotected from the harsh light of scrutiny and, especially, the pitiless glare of irony. Platitudes that wouldn’t seem out of place on a Hallmark card flow with the force of revealed truth.” -Michael Pollan, How to Change Your Mind
“It’s a very salutary thing to realize that the rather dull universe in which most of us spend most of our time is not the only universe there is. I think it’s healthy that people should have this experience.” -Aldous Huxley, The Doors of Perception
“Taking LSD was a profound experience, one of the most important things in my life.” -Steve Jobs from Steve Jobs, Walter Isaacson
While no single quote will perfectly summarize the experience we hope the above conveys the profundity some people have felt.
Legality of Psychedelics
Almost all psychedelics are labeled as Schedule 1 dangerous substances, which means the federal government recognizes no accepted medical use for them. That includes cannabis, heroin, LSD, peyote, ecstasy, psilocybin and quaaludes, among others. The current labeling places psychedelic substances in the same category as heroin and quaaludes.
Today, psychedelics are only legally consumed in clinical research trials (or if you’re a member of the Native American Church). However, psilocybin mushrooms are decriminalized in Denver, Colorado, which may be the first signal of a legal shift on at least the local level. That does not mean mushrooms are legal for consumption but that law enforcement treats their possession as a low-priority for enforcement.
However, the FDA has granted Breakthrough Therapy designation to MDMA-assisted psychotherapy. It is a signal that the federal government is paying attention to the flood of research, as well as the diligent work of nonprofits, researchers, and institutions, that have pushed for a shift in perception.
With that little background, we can now delve into how psychedelics may help your clients.
What do I do if my client wants to have a psychedelic experience?
You can’t stop a client from experimenting with a substance no matter how much you may try to persuade them. The eternal truth is that people will do what they want to do. That doesn’t mean you shouldn’t try to advise your client if you feel its against their best interest.
It’s ultimately up to you to decide how much you’re willing to talk about psychedelics with your client.
If you want to engage your client then start by asking them what their intentions are. Why are they interested in psychedelics?
- Have they heard about psychedelic research as an aid to therapy?
- Are they seeking a spiritual experience?
- Are they curious about the experience itself because of the rise in popularity of psychedelics?
Help them introspect to discover what it is that’s motivating them.
No matter what their answer the next step may be the most important. Encourage your client to educate themselves. (We’ve included a host of further resources at the end of this article.)
Psychedelic substances induce powerful, sometimes life-lasting experiences. Contrary to high-school movies and pop-culture they should not be viewed as party drugs—though they are certainly used in that way by some people. For clinical purposes, they’re best viewed as tools.
Some therapists have an ethical dilemma
Therapists who have clients with crippling depression, anxiety, trauma or relationship issues are torn about what to do. If they’ve done their research around how these substances can help, they may feel morally obligated to support their clients to find help, even if that means referring their clients to underground psychedelic guides.
If you’re in this situation, we get it. However, we also want to be clear that if you refer your clients to underground guides or other sources for illegal substances, you are putting your license at risk. We understand if your ethical commitments supersede legal considerations, however, we want to be clear that there is a legal and professional risk.
The benefit of your clients working with underground therapists/guides or being part of clinical trials is that someone is with the person undergoing the psychedelic experience. These people might be called sitters. They are there to anchor the experience, helping the person through any crisis that may arise—MAPS provides a thorough manual detailing the role of the sitter.
The sitter is someone who has had their own experience but remains sober to help the person, bringing compassion, understanding, and knowledge to the experience to foster growth.
Trained therapists also typically help a person reintegrate into their day-to-day life as powerful psychedelic experience often lingers in the days and weeks after the event. This is because unconscious materials often manifest themselves during the experience: thoughts, memories, and notions of the self that challenge who we think we are.
*The role of the sitter is the most important aspect of any psychedelic experience, whether it be used as an aid to therapy or spiritual growth or curiosity.
Every substance works under its own dosages. LSD is measured in micrograms (a single microgram is one-millionth of a gram), whereas a common dose of psilocybin may be anywhere between 1 and 5 grams. It’s important that the person understands the typical dosage of the particular substance they plan to ingest.
What makes up a psychedelic experience
There are three factors which heavily impact a psychedelic experience. And no two experiences are self-reported in exactly the same way, though some similarities exist. What determines a psychedelic experience is threefold…
- Set: refers to one’s mindset.
- Setting: the environment in which the experience takes place.
- Dosage: both the substance and the dosage of the substance.
Substance: each psychedelic also fosters its own experience, i.e. an LSD experience is often radically different from a DMT experience.
Before you advise your client to seek a substance you may suggest that they try more legal means.
You may want to advise your client not to dive into the world of psychedelic substances straightaway, particularly if you believe it’s not beneficial for them. There are legal alternative therapies in the same vein as psychedelic substances. These therapies also produce non-ordinary states of consciousness and can be therapeutic.
Breathwork is particularly popular. It’s easy to overlook breathwork as the equivalent of yoga. But, it can produce as positive, altering effects. Holotropic Breathwork was developed by Stanislav and Christina Grof, Stanislav Grof being a psychiatrist that studied LSD until they were made illegal in the 1960s.
In states where cannabis (marijuana) is legal, there are a number of cannabis-related clinics, typically used to treat PTSD. The same is true of ketamine, which has been used to alleviate both severe depression and PTSD.
Unlike anti-anxiety medications such as valium and Xanax, psychedelics are not intended as a lifelong treatment. Often, people take a psychedelic substance for a limited time (until they’ve recovered from a particular ailment) and stop. These are not ongoing treatments.
There is an often-shared quote from Alan Watts that illustrates this point: “When you get the message, hang up the phone. For psychedelic drugs are simply instruments, like microscopes, telescopes, and telephones. The biologist does not sit with eye permanently glued to the microscope, he goes away and works on what he has seen” (The Joyous Cosmology, Adventures in the Chemistry of Consciousness).
A smoker does not continue to take LSD after overcoming their addiction; a person who suffered from PTSD does not continue to ingest psilocybin mushrooms. After the experience, the former-sufferer lives their life.
What makes psychedelics psychedelic?
What binds each psychedelic substance under the category of “psychedelic” is their effect on conscious experience. The word “psychedelic” means “mind-manifesting.” It’s a helpful etymology to keep in mind.
Unfortunately, words—especially in this short space—are only capable of capturing the experience to a small degree. What occurs is a deconstruction of the ego: the systems which combine in the brain to create everyday (ordinary) conscious experience are disrupted or shifted. That may sound frightening. And it can be if the person is unprepared. However, the overwhelming number of people who report positive experiences as a result of psychedelics is evidence that a kind of mental vacation is a lifelong beneficial experience.
Your client already had a psychedelic experience and needs help.
For the sake of simplicity, we’re dividing the types of psychedelic experiences into two camps. (In truth, like a symphony, there may be, and often are, many highs and lows in a single experience). Unfortunately, without having direct experience with a psychedelic yourself you may find it difficult to relate to your client. However, what you can do, as with all therapies, is listen to your client while keeping an open mind, helping them talk through what they’ve undergone.
Numerous reports abound about positive psychedelic experiences. Clients may gush if they’ve had the experience recently. Or, they may be relating a memory of an experience which they believe had a meaningful impact on their life.
One word of caution, which really applies to the client, is that psychedelics often induce experiences of profound meaning. People tend to want to act on these experiences right away, such as, say, quitting a job. It’s important to emphasize that any person who has recently undergone a psychedelic experience should always take time to consider any momentous change in their day-to-day life, with all faculties of the mind, i.e. reason and emotion.
Even if your client’s experience was positive, a lot can be gained by helping them integrate the experience and meaning into their lives. This is something you can help them with.
But it’s all-too-easy to focus solely on the positive aspects of psychedelic experiences without pointing that there can be negative experiences as well.
Difficult psychedelic experiences are not talked about enough but do happen. Colloquially, they’re known as “bad” trips, although the nomenclature is changing, and many therapists and clinicians prefer to call them challenging trips. Why? Well, there is almost always something beneficial to be gained from the experience so long as there is a trained therapist helping the person talk through the lingering unconscious manifestations in the following days and weeks after the experience. Otherwise, the experience may linger as a deeply painful memory.
Challenging trips occur for a variety of reasons. In most circumstances, they’re a natural consequence of the psychedelic itself. Traumas buried in the person’s unconscious rise to the surface once the psychedelic has broken down the brain’s normal defense mechanisms. A challenging trip as a result of the substance is normal, and nothing to be ashamed of, but are one of the reasons why it’s important that someone undergoing an experience have someone to guide them.
It’s when external factors influence the experience that additional trauma is created instead of being relieved.
Poorly Trained or Unethical Underground Guides
Due to the underground nature of psychedelic-assisted therapy, negative experiences often occur due to a poor guide. Lack of certification and an enforced standard of behavior has created a motley economy of guides offering their services. Some are excellent, but as with anything, there are also those who taint the psychedelic-assisted therapy community. That may be the result of inexperience, their own unresolved trauma, a person prone to take advantage of their clients in a vulnerable state, or an inflated ego that believes it’s responsible for the effects of the medicine rather than the medicine itself.
Unfortunately, there are also guides who engage in unethical behaviors. Psychedelic experiences put people in a particularly vulnerable position. This enables them to face unconscious traumas, addictions, and behaviors with a proper guide. But they can also be taken advantage of by opportunistic charlatans. A wise soul said, “Many people who have an investment in control become teachers,” and these people shine in the underground therapy environment.
We don’t want to disparage those who have created safe environments to help people. There are many people doing excellent work. But it’s also important to be aware of those engaged in questionable practices. We’ll soon be publishing a post detailing what therapists and clients should know in regard to unethical underground therapists.
Due to the legality of psychedelics in the United States, some people travel to other countries such as Jamaica, the Netherlands, or one of several South America countries where some psychedelics are legal. Clinics have popped up in these countries like mushrooms after a rainstorm. As with poorly trained underground guides (detailed above), these clinics have both good and bad actors. It’s difficult to determine what you’re getting yourself into, alone.
Again, this is why education is paramount. Both clients and therapists need to be aware of what it is they’re signing up for and with who.
Psychedelic-assisted therapy may be the future
Counterculture’s association with psychedelics substances earned them a stigma but the tide is finally turning. While it’s unlikely the federal government will change its position on psychedelic substances in the short-term, people’s curiosity due to study-after-study has created an underground sensation that is unlikely to fade. Whether you support or discourage psychedelics, they are here, and they are near-impossible to ignore when there is a national conversation occurring daily regarding their place in mental health treatment.
While we haven’t been able to cover the entire galaxy of psychedelics, their research, and therapeutic applications, we hope this brief overview has been helpful. If you have any questions please leave a message in the comments and we’ll do our best to answer them.