Psychedelic assisted therapy is not the same as psychedelic therapy. Most underground psychedelic retreats today offer psychedelic therapy which involves the administration of a psychedelic substance with the hope that insights will be gained that may benefit the user psychologically. Clients then leave the retreat and are left to your own devices. This can be risky as traumatic experiences or difficulties may have been brought up during the session without achieving full catharsis or resolution. Clients may be left in a more sensitive and vulnerable state and with no idea of how to make sense of your experiences.
Psychedelic assisted therapy puts emphasis on psychotherapy. It uses psychedelic medicines to help relax egoic defences and see things from new perspectives but these sessions are embedded in a greater body of therapeutic work. Using psychedelic medicines dramatically speeds up the psychotherapeutic process but the process is still paramount.
Before taking psychedelic medicines, a number of sessions are needed to first explore the client's issues and identify key problems contributing to that person's suffering. It is also a time to safely screen for any contraindications for psychedelic medicines, i.e. conditions that may be exacerbated by psychedelics. These sessions are also important to prepare the person for what to expect, develop a trust with their therapist and sitter, and learn techniques that help manage some of the anxiety that can arise during psychedelic sessions.
The psychedelic sessions themselves occur in a safe environment in the presence of experienced staff with whom the client has developed a rapport. The client must feel comfortable with the setting, the purity of the psychedelic they are taking, and the person who is sitting for them. They must also know that they will not be interrupted for the next 6 to 8 hours and have all that time to explore their psyche safely. The client does not have to talk while taking the psychedelic medicine, in fact it is often more beneficial if they maintain their focus inward and be present for what comes up rather than trying to externalise what they are experiencing as it happens. Users taking MDMA are more inclined to want to talk to their sitter than users taking psilocybin. Most trials involve two to three psychedelic sessions embedded in eight to twelve therapeutic sessions in total.
The psychotherapy sessions after the psychedelic sessions focus on integrating and making sense of the thoughts, images, memories, emotions, insights that arose under the influence of the psychedelic. This is a vital component of the therapy as it strenghtens the learnings that were had as well as helping to resolve some of the questions that remained. Psychedelic experiences can be very powerful and although great insights and clarity may be achieved, it can also sometimes lead to some confusion or disorientation on certain topics that were not possible to be fully explored during the session. It is a great relief to clients to have an experienced and trained professional with whom to discuss these concerns.
The most appropriate and beneficial form of psychotherapy is still being trialled. In 2017, Rosalind Watts published 'Patients’ Accounts of Increased “Connectedness” and “Acceptance” After Psilocybin for Treatment-Resistant Depression' in the Journal of Humanistic Psychology. Here, participants in psychedelic trials reported a common insight that denying their emotions was compounding their issues and accepting them and allowing them to flow greatly improved their mental health.
The following are quotes from these participants:
'There was a lot of sadness, really really deep sadness: the loss the grief, it was love and sadness together, and letting go, I could feel the grief and then let it go because holding onto it was hurting me, holding me back. It was a process of unblocking.' (P2)
'Excursions into grief, loneliness and rage, abandonment. Once I went into the anger it went ‘pouf’ and evaporated. I got the lesson that you need to go into the scary basement, once you get into it, there is no scary basement to go into [anymore]'. (P3)
'I took away from the experience that I used to get angry about having anxiety, now I think I can have the anxiety, I can just feel it and it will go, I don’t have to have the fear or run away.' (P2)
'I saw negative patterns in my life where if something bad happens, I used to just put it [to the back of my mind]. Afterwards, I allowed myself to experience everything - even if it is sadness. Now I know how to deal with my feelings rather than repress them.' (P7)
'I have felt a sense of acceptance; more acceptance of agony, boredom, loneliness, and also appreciation of the wonderful times. [A] willingness to try to accept the negative times.' (P5)
Because of these responses, Dr Watts decided that Acceptance and Commitment Therapy (ACT) would be the most beneficial psychotherapy in which to embed the psychedelic sessions. In ACT, clients learn to stop avoiding, denying, and struggling with their inner emotions and, instead, accept that these deeper feelings are appropriate responses to certain situations that should not prevent them from moving forward in their lives. With this understanding, clients begin to accept their hardships and commit to making necessary changes in their behaviour, regardless of what is going on in their lives and how they feel about it.
ACT was developed in the 1980s by psychologist Steven C. Hayes. The ideas that coalesced into ACT emerged from Hayes’s own experience of panic attacks. Eventually, he vowed that he would no longer run from himself—he would accept himself and his experiences.
"We as a culture seem to be dedicated to the idea that ‘negative’ human emotions need to be fixed, managed, or changed—not experienced as part of a whole life. We are treating our own lives as problems to be solved as if we can sort through our experiences for the ones we like and throw out the rest," Hayes writes. "Acceptance, mindfulness, and values are key psychological tools needed for that transformative shift."
ACT aims to develop and expand psychological flexibility. Psychological flexibility encompasses emotional openness and the ability to adapt your thoughts and behaviours to better align with your values and goals.
The six core processes that promote psychological flexibility are:
1. Acceptance
Acceptance involves acknowledging and embracing the full range of your thoughts and emotions rather than trying to avoid, deny, or alter them.
2. Cognitive Defusion
Cognitive defusion involves noticing our automatic thoughts, stepping back from them, observing them without judgement, and changing the way you react to distressing thoughts and feelings, which will mitigate their harmful effects.
3. Being Present
Being present involves being mindful in the present moment and observing your thoughts and feelings without judging them or trying to change them; experiencing events clearly and directly can help promote behavior change.
4. Self as Context
Self as context is an idea that expands the notion of self and identity; it purports that people are more than their thoughts, feelings, and experiences.
5. Values
Values encompass choosing personal values in different domains and striving to live according to those principles. This stands in contrast to actions driven by the desire to avoid distress or adhere to other people’s expectations.
6. Committed Action
Committed action involves taking concrete steps to incorporate changes that will align with your values and lead to positive change. This may involve goal setting, exposure to difficult thoughts or experiences, and skill development.
With ACT, the benefits of psychedelic experiences can be maximised and solidified, allowing for longer term psychological wellness. As research trials continue to hone this therapy to the psychedelic context, it is important that we begin training staff as psychedelic therapists in Ireland so that patients can gain access to a well organised, safe, and effective programme as soon as the medicines are medically licensed. It is vital that we do not neglect the T in PAT!
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