Putting the Therapy in Psychedelic Therapy

The number of advocates for Psychedelic therapy (sometimes referred to as psychedelic-assisted psychotherapy, or (PAP)  is increasing, as it is seen as a solution to address challenging and disabling mental health conditions. We are making significant progress towards this approach being accepted and legally available in the UK.

Psychedelic clinics offer varying degrees of preparation and integration support, typically provided by the medical professionals conducting the psychedelic sessions, who may also recommend follow-up therapy. Preparation activities range from medical/psychological screening and discussing goals, to preparing for the experience itself. Integration involves ongoing psychotherapy to help process the psychedelic experience and integrate insights into daily life. Retreats often use similar non-clinical models.

The field of medical science has been extremely disappointing in addressing mental health issues. Antidepressants, once hailed as a miraculous solution during the early stages of Prozac, have shown effectiveness for a few individuals, provided temporary relief for some, and at best offered symptomatic relief for most.

Anti Depressants psychedelic assisted therapy

Despite the effort by NHS Talking Therapies to make counselling more accessible (in England), individuals struggle on long waiting lists or resort to private treatment as they are unable to receive timely help when needed.

What is Psychedelic therapy?

Psychedelic-assisted therapy is a unique blend of therapy and medication, presenting challenges for research due to this duality. While significant attention has been directed towards understanding the pharmacological mechanisms at play, there remains a noticeable lack of exploration into the specific role of psychotherapy in treatment and the optimal structure of such therapeutic interventions.

The quality of the therapeutic relationship and feeling safe, held are vital in psychedelic-assisted psychotherapy. The skill of the ‘therapist’ is to hold this space and provide that solid, containing space for the patient to undergo this intensive experience. It will be challenging as well and sessions will vary with individual experience.

In Clinical trials, one or two therapists will be readily by your side, guiding and prompting you through a session that will last up to eight hours.

Psychedelic therapy clinics and retreats offer different experiences with psychedelics. While psychedelic clinics are aimed at treating clinical mental health issues, retreats typically offer an immersive experience in a natural setting where these substances can be used for personal development. 

While the risk of overdose and addiction in psychedelics is low, no drug is without risk. Psilocybin and ketamine raise blood pressure and heart rate, so those with heart conditions, high blood pressure and arrhythmias are advised not to take them. Given that the drugs change brain activity, there may also be a risk they trigger a seizure in someone with epilepsy, or increase pressure in people who have suffered a traumatic brain injury. So when these drugs are used in a therapeutic context, it’s vital that practitioners have the right qualifications and access to the right training, to ensure they are used safely and effectively.

The significance of the therapy component in psychedelic-assisted therapy has been a matter of debate since the 1960s, when psychedelic drugs were initially explored for their medicinal potential. Some posit that the therapeutic value primarily stems from the therapy sessions, with the psychedelic substance merely enhancing the therapeutic journey. Conversely, others argue that the hallucinogenic experience may not be indispensable for realising the mental health benefits, as they attribute the positive outcomes directly to the drug.

Boundaries and Precautions

There is little evidence to back up how necessary or helpful accepted norms in psychedelic-assisted therapy are. Some could even be potentially harmful as one of the more problematic is the concept of “nurturing touch,” which can take the form of hand-holding and hugging. Another encouraged form of touch is “focused bodywork,” in which the therapist offers their body as a form of resistance the patient can push against. In traditional psychotherapy, touching a patient is considered controversial as both therapists and patients may have differing views on whether it is appropriate or acceptable.

The MAPS manual (A Manual for MDMA-Assisted Psychotherapy in the Treatment of Post traumatic Stress Disorder 2017 Update) for example, advises that “mindful use of touch can be an important catalyst to healing.” It elaborates: “Nurturing touch that occurs when the participant is deeply re-connecting with times in life when they needed and did not get it can provide an important corrective experience.” This was updated in 2019.

In order to establish clear and safe boundaries, it is important for therapists to prioritise non-touch methods of providing comfort. There is a concern that the unquestioning promotion of touch as a fundamental aspect of the P-AT healing process could result in an excessive reliance on touch, potentially undermining therapeutic interventions aimed at developing clients’ self-soothing abilities. Although brief non-sexual touch may offer relief during intense distress or offer nurturing support, it is crucial to acknowledge that it may also involve unknown risks. Therefore, it should be thoroughly researched, theorised, and debated before being widely adopted as a validated therapeutic technique.

Using breathwork as a preparation tool.

Breathwork can induce similar mental states to a psychedelic journey and can be used to simulate the effects.  Therefore, it the therapist has a experience of what people might go through, they may feel more confident and could be better prepared to support people and hold space.

Psychedelic-assisted therapy in a Group Setting

The use of psychedelics in group settings dates back centuries. connectedness may be a fundamental, underlying mechanism of therapeutic change, Aside from group therapy’s cost- and time-saving efficiencies, trends suggest that incorporating groups into psychedelic therapy might enhance both participant satisfaction and outcomes.

Some research suggests, group therapy is as effective as individual therapy, and more efficient.

Clinic or Retreat setting

Psychedelic retreats

Clinics may use decor to make the environment more relaxing and hospitable. Retreat centres on the other hand are comfortable and restorative spa like places. The ceremonies themselves on a retreat may include shamanic or spiritual practices and indigenous traditions to frame the experience that are not found in a clinical setting. Retreats typically involve a group setting

Psychedelic therapy – Conclusion

Psychedelic-assisted therapy combines elements of therapy and medication, making it a complex subject to study. While there is much emphasis on understanding the pharmacological effects of the drugs, the role of psychotherapy in treatment and the specific therapy approaches used deserve more attention and exploration.

Data surrounding the psychotherapy component of psychedelic-assisted therapy results in a lack of best practices, guidelines, and regulation around it.

The Australian Government is taking this very seriously and has set up a new training programme for doctors, nurses, pharmacists and psychotherapists in using psychedelics to treat mental disorders, In the UK, independent providers are filling the gap.

Online workshops focusing on orientation and integration in psychedelic use are becoming popular. Notably, Exeter University made an announcement during the sixth biennial international multidisciplinary ‘Breaking Convention’ conference on psychedelic consciousness in April this year. They revealed plans to launch an online postgraduate certificate in psychedelic studies, which will be offered by their faculty of Health and Life Sciences starting this September.

Currently, psychedelics are primarily intended to complement therapy rather than replace it. However, in order to ensure the safety and efficacy of this treatment approach, it will be crucial to have well-trained psychotherapists with specialised expertise to administer it. The pressing question is whether the counselling and psychotherapy professions are adequately prepared to respond swiftly and embrace this new treatment modality.

Author: PsyNurse

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