Understanding the Role of Psychedelics in Therapy
This article is for people who are considering psychedelic medicine or who are wondering how to support those using it in their current therapy practice.
Most of us know or have heard about someone who has experienced psychedelic therapy in one iteration or another. Currently, reactions to the “Psychedelic Renaissance” in the therapeutic world seem to range from "Oh thank god, these are miracle tools” to “psychedelics are terrifying and keep them out of my therapy”. The average of these two extremes is somewhere around “I hear about psychedelic medicine but don’t really know if it helps or how it works, and I have no idea where to start.” So I am going to try to shed a little light on these three questions: What do psychedelic medicines do? How does this therapy process work? And, where do I start? Everyone will have their own interpretation of the experience and, just like all other forms of therapy, one cannot assume that psychedelics are of interest, or a good fit, for everybody. Education and a careful, mindful approach are necessary.
How do Psychedelic Medicines Help?
The easiest way to answer this is just to tell you what I have seen and experienced myself. So here are a few snapshots I can offer after working with a few clients who have done some psychedelic work in the past year. You’ll see that there is not necessarily a direct line between the “diagnosis” and the healing that occurs, but that it’s more accurate to say that psychedelics will bring up whatever needs to come up to facilitate the healing that’s necessary for growth.
Psychedelics are, in a broad sense, awareness-enhancing medicines. They work differently than psychiatric medications in that they do not just adjust how the brain chemistry functions; rather, they allow for adjustment of the mind to an expanded perception of life. As the stories show, depression, anxiety, PTSD and addiction are not just about chemical and neurological changes, they are also about the way in which experience, beliefs, and self-concept are related to.
“There is a wealth of information built into us … tucked away in the genetic material in every one of our cells … without some means of access, there is no way even to begin to guess at the extent and quality of what is there. The psychedelic drugs allow exploration of this interior world, and insights into its nature.” —Alexander Shulgin, chemist, researcher, synthesized MDMA, author of PIHKAL
A client I’d been working with had been on a medication for anxiety for several years. They were conflicted about it for some time, but had become resigned to staying on it as they felt the anxiety was too big to manage without the meds. They underwent a psychedelic medicine session to investigate some unrelated questions in their life, particularly about a relationship they were currently in and whether it was right for them. After this session, the client reported they’d experienced an intense sense of their partner being a source of very pure and inviting love for them, and were able to go forward with the knowledge that the challenges in this relationship were secondary to the unquestionable love that was at its core. They were then able to lean into the work that needed to be done in the relationship with the knowledge that the heart of it was good and felt (also unquestionably) supported by the universe, or God. Following this session, the client had an unexpected awareness that the anxiety medication was no longer necessary. They subsequently came off that medication, and use it sparingly as needed almost a year later. Their relationship is currently more vital and more satisfying. The interplay between the anxiety and the relationship is complex, and the layers there had not been reconcilable in several years of talk therapy. The client had a stronger sense after the psychedelic medicine that they could manage the anxiety on their own going forward, as if the “Self” was more present and capable now.
Another client received support in quitting smoking with a psychedelic session. This client’s intention going into the medicine session was to let go of the smoking attachment, and they were able to see deeper into this relationship in the psychedelic state. They reported they'd been brought into contact with the “root” of their relationship with this habit and got a deep clarity and catharsis in that session. Most interesting was the experience this client had when they were able to physically observe the craving from a bit of a distance (which is, in large part, how psychedelics work) which gave them space to understand the choice in the relationship that they had with smoking. When they did make the choice to smoke in that psychedelic state, rather than the relief they normally felt, they instead felt a heavy sadness that they could not separate from, and it was apparent in that moment that smoking was actually a way of keeping the sadness that their psyche had been afraid to let go of for decades, as it had been a protector of sorts. This client has not smoked since that session and has gained other bits of clarity as well as a result of releasing that attachment.
ADD / Self Esteem
Yet another client had for a long time been struggling with depression, ADD, and addictions. They had made a lot of progress in the recent few years but were still living in some routines that kept them in a workaholic-like state without clear direction, and had curiosity about going deeper into themselves. They underwent some psychedelic medicine experiences during which they were able to find space and value in being present without activity and distracted engagement. A series of questions they pondered in the sessions were around what they were looking for in being validated by others, what the constant internal argument and restlessness was really about. They were able to feel on a deep level that the source of approval or validation they had been seeking, was ultimately from themselves. Those drives of “doing it right” or “winning the argument” were ultimately less important than they believed, and the outside voices questioning all their decisions quieted down. This client found themself less in need of constant media input afterward, as well as a greater draw toward quiet time and more specific goals for themself. Their self-esteem has since improved, and they are experienced as more relaxed and creative by their family.
Phobias / Trauma
The last client I will share about is a strong example of the indirect line toward healing. A specific, life-limiting phobia brought this client into psychedelic therapy. As the client and the therapist were aware, their phobia was not a simple phobia, but was related to the client’s fears about some aspects of being in control. Layers of trauma underlie this panic for them. The client intended to address the specific phobia, but the psyche instead needed them to feel the inner wisdom and autonomy that they had lost long ago, as a result of parental and caregiver trauma and then spiritual abuse in a cult-like setting years later. The client underwent multiple psychedelic sessions, during which they were able to interact with their panic and anxiety from a bit of a distance (again, how psychedelics work, by giving space and detachment) and learned that the anxiety was not the threat they believed it to be. Learning to lean into the body’s experience of fear rather than run away from it gave them a sense of themselves in control. They were also intensely aware that the safety, knowledge and healing they had been taught to seek outside of themselves was right there within, which a part of them had known but was admonished in spiritual circles for practicing. This experience opened the door for them to start to trust themselves, to feel the control that was within, which allowed them to come back to the trauma layers with less fear. The phobia relaxed for a time, but still exists, which points to the cycles of healing that remain and the continued work that is required.
It could be helpful to state that, in summary, psychedelics are not a magic pill; instead, they allow us to get past some of the opaque layers of our beings that keep us from fully living in our healthy selves.
How Does the Psychedelic Therapy Process Work?
Today, the legal psychedelic landscape in the US only includes ketamine therapy, with psilocybin and other psychedelic substances currently legalized in Oregon and Colorado (as of November 2022) and decriminalized in various cities throughout the US. It’s forecasted that in the next few years, psilocybin will join ketamine in legal clinical therapy application. MDMA is also being vetted by the FDA currently and is likely to be approved for clinical use within the next year or two. Here in Illinois, there are a few medical clinics that provide ketamine therapy, and several psychedelic medicine-trained therapists who are educated in the preparation and integration process. Going into psychedelic work, we need to be aware of and accept that the difference between an unrealistic hope and a meaningful change in one’s life is how we prepare for and then integrate the experience of the medicine. They are powerful teachers and historic wisdom shows us clearly that the substance is only part of the medicine; that the real healing is the relationship we create between the subject, the medicine, and the guide.
There are a couple of different options for ketamine treatment, which include ketamine medicine only, which is similar to taking psychotropic medication only, and ketamine with therapy. The mode of treatment determines where the treatment is done – either in the therapy office, at home, or in a ketamine clinic. Ketamine clinics are medical locations that provide consultation, screening, ketamine delivery, and follow-up support.
The ketamine-only option is generally for clients who have tried psychiatric medications for depression and are not seeing an improvement. There will be an assessment for both a psychiatric and a medical screening, as ketamine is not suitable for certain medical and psychiatric conditions. Once the patient is cleared, ketamine delivery sessions are scheduled on-site, and consist of roughly two 60-to-90-minute sessions per week for two to three weeks, and then one session per week for follow-up weeks. These are usually IV drip sessions, wherein a nurse is present but not interacting with the client during the session. Often clients will be very relaxed or sleep through these sessions, and then will get a ride home afterward. The psychiatrist will check in with the client intermittently, but the therapy component is to be done with a separate therapist, either at that clinic or with their outside therapist, to process the changes experienced. Because ketamine therapy often involves some significant changes in insight and perception of self, the past, and worldview, it’s highly recommended that one has professional support throughout the process. If the drug itself is the only “medicine” applied, the mind will tend to fall back into the same patterns once the drug effects have worn off, and the treatment won’t have the lasting impact they were looking for. As the nature of the psychedelic experience tends to be hard to put into words, it’s helpful to talk through the experience so that the brain has a language with which to understand the insights so they can be put into one’s life going forward.
Ketamine with therapy can look a few ways as well. These are usually once-per-week sessions, for three hours, where the client is processing with a therapist while they are under the effects of the ketamine, on-site, and then integrating the experience after the sessions. This can be done with either a ketamine injection, or a ketamine lozenge. In clinics that are staffed with a psychiatrist or nurse, the ketamine is administered on-site. Another option, to be used with a therapist who is not in an office with an on-site prescriber, is for the client to consult with a virtual prescriber, (see links below). In this process, the ketamine lozenges are sent to the client at home, who can use them either at home or bring to their therapist’s office and undergo the ketamine session there. Each method has benefits and drawbacks, and the options should be discussed with the ketamine-trained provider.
A crucial component to this process is the integration of the experience. A therapist trained in psychedelic medicine, who optimally has had their own psychedelic experiences from which to understand the nature of the medicine, is likely to provide the best support and, therefore results.
Where Do I Start?
Here is a link to a local search for ketamine and integration services: https://healingmaps.com/region/chicago/ .
The following is a link to a clinic in Chicago that I have personally worked with that provides ketamine therapy on-site. They also do group integration work and have a community of support with whom to stay connected. https://sanahealingcollective.org/This is a local facility that provides both ketamine IV sessions and follow-up integration in Elgin: https://advancedpsychiatryofelgin.com/ketamine/Option for virtual prescription and support service (Mindbloom): https://www.mindbloom.com/.For any psychedelic service, it is recommended that one has an ongoing therapy relationship to process and integration support.
For support with the psychedelic process (without obtaining psychedelic medicine necessarily) https://psychedelic.support/network/?online=false&acceptingClients=true&profileType=practitioner&profileType=clinic&size=12®ion=IL&s=4&pc=falseOther psychedelics such as psilocybin are not currently offered in Illinois. Healing services in other states are available, but it is highly recommended that a local therapist who is familiar with the process and prepared to assist in integration is involved.
ResourcesHere is a very cool podcast by MAPS (Multidisciplinary Association for Psychedelic Studies)https://maps.org/news/maps-podcast/A few articles and studies of interest for further reading:https://www.scientificamerican.com/article/the-power-of-psychedelics/https://www.yalemedicine.org/news/ketamine-depressionhttps://www.outsideonline.com/outdoor-adventure/exploration-survival/psychedelics-research-paralysis-treatment-jim-harris/https://www.nytimes.com/2022/08/25/health/psilocybin-mushrooms-alcohol-addiction.htmlhttps://www.frontiersin.org/articles/10.3389/fpsyt.2021.727117/full
- Meghan Scully, LCSW, CADC 847-413-9700, ext. 338