Understanding Therapeutic Versus Recreational Use of Psychedelics
Experiences with recreational use of psychedelics can vary greatly, with some individuals having positive, enlightening experiences and others encountering panic, anxiety or intense, frightening visions or thoughts sometimes referred to as a “bad trip.” We believe that the potential of psychedelic assisted psychotherapy is enhanced in a carefully structured therapeutic environment. Psychedelic plants and medicines have a powerful impact on our central nervous system, particularly, in expanding our states of consciousness. Such expansion opens pathways of self-reflection and introspection, broadening perceptions and interpretations of our inner world, of the “reality” we navigate in our everyday lives, our relationships with others and our feelings toward nature and the world.
Negative effects of psychedelic use in Western cultures are more likely if they are used recreationally without enough regard for the participant's mental state and readiness or if the setting is chaotic or unpredictable. It is interesting to note that in Indigenous practices, such as Native American Peyote or Shipibo Ayahuasca ceremonies, plant medicines are not typically used recreationally but rather with great respect during carefully designed and ritualized ceremonies. As Western practitioners, we believe that the potential for transformative experiences is facilitated by the same reverence, which carefully crafted therapeutic contexts for psychedelic-assisted psychotherapy provides.
The lasting impact of the current psychedelics’ renaissance is owed in part, to the combination of psychotherapy and psychedelics that have been commonly utilized in clinical trials with MDMA and psilocybin. However, it is important to recognize that standard psychotherapy may not successfully support outcomes involving the intake of psychedelics. Instead, the “set and setting” model used in clinical trials provides the therapeutic context of psychedelic-assisted psychotherapy. Many components are necessary to successfully provide the supportive set and setting conducive to promoting a healing psychedelic experience. Such components are carefully fostered by trained psychedelic assisted therapists who are committed to ensuring both physical and psychological safety, while also maximizing the potential for meaning making and overall mental well-being of clients.
Essential therapeutic components of Psychedelic Assisted Psychotherapy
A good summary of both, the set and setting, and psychotherapy components that psychedelic assisted psychotherapy entails is provided in the Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder (Mithoefer, Michael C., Version 8.1, May 2017). The core components from this manual have provided a standardized approach for research-based psychedelic assisted therapy protocols and we have adapted and summarized them below for use in psychedelic assisted psychotherapy outside research protocols. They include,
Prioritizing the safety and wellbeing of clients. Trained therapists help maximize the benefits of the inner experience catalyzed by psychedelic medicines, while at the same time ensure that clients are safe and not perturbed or re-traumatized by internal conflicts that may arise. Therefore, it is essential that psychedelic assisted therapy is provided by qualified therapists with the appropriate training and experience in the field.
Careful attention to creating an appropriate set, setting, and support system during all sessions of psychedelic assisted psychotherapy including, preparation, psychedelic dosing, and follow up sessions. This requires investment in the development of therapeutic alliance and trust, prior to the engagement in psychedelic dosing sessions and over the course of therapy. It also requires the provision to clients of appropriate preparation and orientation to psychedelic assisted therapy. Therapists work with clients in advance, to identify tools such as music, focused bodywork, breathing, or other techniques to evoke and support meaningful emotional experiences while avoiding distraction or derailment.
The use of a nondirective approach to therapy based on empathetic rapport and empathetic presence to support clients’ own unfolding experiences and their healing process. This includes providing assurance and facilitation of the clients’ innate growth resources and inner capacity to heal scars from adverse experiences and hardships, as well as the wounds of trauma. Such innate capacity is known as “inner healing intelligence.”
Intervention management in the form of guidance or redirection, when appropriate, to facilitate the participant’s processing. Therapists are attuned to balancing their responsibilities as facilitators and as noninvasive empathic witnesses. In this regard, therapists assume the responsibility to support the processing of trauma rather than enable the avoidance of traumatic memories. Such support is provided with respect for protective mechanisms, which are referred to in different models of therapy as “resistance”, “defenses”, “protectors” etc. The therapists facilitate awareness of and curiosity about any apparent resistance that arises rather than commonly used attempts to overcome it. Therapists are also skilled in therapeutic techniques to address somatic manifestations of trauma that may arise. These may include one or more approaches such as nurturing touch, focused bodywork, breathing techniques, or other approaches to somatosensory processing.
The facilitation of Integration as an essential and ongoing process that stems from the inner experiences catalyzed by psychedelic-assisted sessions. Integration is key to identify the lessons gained in a non-ordinary state of consciousness, and most importantly, to facilitate their merger into regular and everyday life. It is also necessary to address any difficulties that may have arisen during and following psychedelic dosing sessions, in connection to history of trauma or adverse experiences. Such support requires a keen understanding of the nature of psychedelic effects as well as of the non-linear ways in which they catalyze and promote healing.
The key role of Integration in Psychedelic Assisted Psychotherapy
Traditional therapies have supported psychological well-being, and helped clients comprehend and address their emotions, thoughts, and behaviors. Yet, traditional therapies typically require a significant investment of time, financial and emotional resources to achieve long-lasting and/or impactful outcomes. In very limited cases, they may lead to transformational experiences like those seen in psychedelic assisted psychotherapy. However, the broad expansion of states of consciousness, ego dissociation, otherworldly and otherwise esoteric experiences are almost exclusively reached under the effect of a psychedelic substance, which are all evocative of meanings that escape the realm of the rational mind under regular states of consciousness. In fact, people with such experiences often state that they are ineffable and challenging to review and decant for meaning without the support of a trained clinician in psychedelic assisted therapy.
A trained therapist assists with the identification of insights from a psychedelic experience and the paths through which they can be brought to the conscious level. Integration is important in clarifying, exploring, and deepening the insights, imagery, and other unconscious material that emerge into one’s daily life in tangible ways. Such sources of “sacred knowledge,” as coined by William A. Richards (1940) that occur under states of “mystical consciousness ” from psychedelic medicines and substances, require stances of deep respect and appreciation, which could only be accomplished within a relational therapeutic context, and by well-trained clinicians who understand the importance of supporting ego integration. Therefore, integration sessions are intentional and necessary components of a well-organized and properly supported psychedelic assisted therapy experience.
It is natural for anyone exploring psychedelic assisted therapy to have questions or concerns about what will happen during and after psychedelic assisted treatment. At Aracari Healing, we offer Ketamine Assisted Psychotherapy, and we are invested to answer any questions people may have about the process. To help in this endeavor we are offering free talks on ketamine assisted therapy. Check the Livestream Events tab on our website for upcoming offerings.