This article investigates the (history of) psychedelics use by therapists. It ends with three recommendations, 1) to better investigate historical therapist’ psychedelic use, 2) experiences of MAPS PTSD therapists, and 3) a new, more extensive study of the “relationship of direct experience to identity formation, therapeutic alliance, and clinical outcomes by giving a course of psilocybin-assisted psychotherapy to therapists who work with psilocybin as a part of their training and measuring these constructs empirically.”
Abstract
“Clinical research on psychedelic-assisted psychotherapy is rapidly advancing in the USA, with two drugs, psilocybin and MDMA, progressing through a structure of FDA-approved trials on a trajectory toward Drug Enforcement Agency rescheduling for therapeutic use. Researcher’s and clinician’s personal use of psychedelics was cited as a potential confound in psychedelic research studies conducted in the 1950s and 1960s, a concern which contributed to the cessation of this research for some 20 years. Currently, there is no empirical research on personal use of psychedelics by current academic researchers and clinicians; its influence is undocumented, unknown, and undertheorized. This paper explores the history of personal use of psychedelics by clinicians and researchers, the potential impact of personal use on psychedelic-assisted psychotherapy and research, and the rationale for opening an academic discussion and program of research to investigate the role of personal use. We propose that there are factors unique to psychedelic-assisted therapy such that training for it cannot neatly fit into the framework of modern psychopharmacology training, nor be fully analogous to psychotherapy training in contemporary psychological and psychiatric settings. We argue that scientific exploration of the influence of therapists’ first-hand experience of psychedelics on psychedelic-assisted therapy outcomes is feasible, timely, and necessary for the future of clinical research.”
Authors: Elizabeth M. Nielson & Jeffrey Guss
Notes
This paper goes into depth on the (possible) influence of (different) psychedelics use by therapists on the choice of treatment/trial they offer. The main question (somewhat answered) is if personal use has an/what effect on how a therapists designs a trial/treatment and how successful it is.
“The field of contemporary psychiatry currently maintains that the direct experience of a psychotropic medication is neither necessary nor detrimental in effectively treating patients with that medication. Unfortunately, this area has not been explored in the literature: as of June 2018, we were unable to locate a single study on the relationship between psychiatrists’ personal use of pharmaceutical substances, their prescribing practices with psychotropic medicines, and/or effects on patient outcomes.”
“Regardless of one’s position on the question of objectivity, we can confidently state that variation in therapists’ personal experience with LSD and psilocybin introduces a potential confound to research efforts to demonstrate the efficacy of psychedelic therapy in a rigorous way. The nature of this confound is, in fact, an unaddressed empirical question: no contemporary studies have systematically studied whether or how therapists’ first-hand experience with psychedelics affects clinical outcomes in psychedelic therapy.”
Currently, the only way for therapists to speak openly about their experience is when they have had an experience in the MAPS training protocol (MT-1) (or possible other training programs, but not recreational use).
Some problems with discussion personal use include the legal framework/situation and stigmata of hedonism.
The paper ends with three research proposals:
- First, a thorough analysis of the data collected on the Spring Grove research group’s provision of LSD to researchers and therapists between 1969 and 1974 is in order, as this may offer insight into the role of these experiences for therapist and researcher development at this point in history. EMN is currently undertaking this project with expected completion in 2018.
- Second, analysis of the experiences of the MAPS PTSD therapists who have received MDMA through the MT-1, or future, similar programs, should be conducted to explore the impact of this experience on therapist development and patient outcomes.
- Third, we suggest a study designed to answer research questions on the relationship of direct experience to identity formation, therapeutic alliance, and clinical outcomes by giving a course of psilocybin-assisted psychotherapy to therapists who work with psilocybin as a part of their training and measuring these constructs empirically.“
Summary
INTRODUCTION
Psychedelic researchers’ and therapists’ personal experience with psychedelic compounds was a controversial point, and the use of psychedelics in sanctioned research settings was disrupted by increasingly restrictive laws that emerged in the mid-1960s and culminated in the passage of the Controlled Substances Act of 1970.
Sanctioned research on psychedelics in humans was reinitiated in 1990 by Strassman (2001). This paper explores the history of personal experience with psychedelic compounds among researchers and psychotherapists, and the role of this experience in therapist preparation and training among contemporary therapist training programs.
BACKGROUND: WHAT IS PSYCHEDELIC-ASSISTED PSYCHOTHERAPY?
After the discovery of lysergic acid diethylamide (LSD) in 1943, the compound was made available to researchers and psychiatrists for use in psychotherapy and alcoholism treatment. However, after the above-ground clinical and research work came to a halt, underground work continued.
PSYCHEDELIC-ASSISTED PSYCHOTHERAPY AND PSYCHOLYTIC PSYCHOTHERAPY: DISTINCTION AND OVERLAP
Psychedelic-assisted psychotherapy involves the use of a psychedelic compound during 1 – 3 therapy sessions that are spaced several weeks apart. The sessions are structured to inform, shape, and interpret the psychedelic experience.
Psycholytic psychotherapy involves a lower dose of a psychedelic compound administered at regular intervals or with varying frequency during traditional psychotherapy sessions. The therapist employs active psychotherapeutic interventions while the patient is under the influence of the psychedelic compound.
Psychedelic-assisted psychotherapy is an approach presently being studied in the majority of large-scale research studies in academic settings. It differs from psychedelic sessions that have nonillness-related intentions, such as those undertaken for personal or spiritual growth.
The authors’ relationship to psychedelic therapy
The authors are psychedelic therapists and researchers who have participated in the Multidisciplinary Association for Psychedelic Studies (MAPS)-sponsored 3,4,-methylenedioxymethamphetamine (MDMA)-assisted therapist training program and who have served as therapists in the MAPS-sponsored trials of MDMA-assisted treatment of PTSD at New York University School of Medicine.
This paper grew out of discussions held during the design of a study on psychedelic compounds.
of psychedelic therapy
The choice of psychedelic compound for a research study varies considerably, depending on the feasibility of use, legal restrictions, neuroscience-based considerations, and cultural stigma associated with certain compounds. Additionally, the phenomenological effects of different drugs vary considerably, and these variations may guide the selection and development of an optimal psychotherapy platform.
Contemporary clinical research protocols vary in emphasis among variables such as pre- and post-treatment testing, psychotherapy, and integration sessions. This may reflect the beliefs and backgrounds of the researchers as well as the hypotheses of specific research projects.
Interest in psychedelic therapy rapidly grew after the discovery of LSD’s psychoactive properties in 1943. Some researchers and clinicians stressed the value of direct experience with a psychedelic compound in order to function successfully as a psychedelic researcher and psychedelic therapist.
Early US-based researcher/clinicians disclosed their personal use of LSD as a potentially relevant factor in their preparation to provide psychedelic therapy, and some writers speculated that their patients’ outcomes were negatively influenced by their attitudes toward the psychedelic experience.
Psychotherapy treatment outcomes are influenced by clinician-specific extra-pharmacological factors, such as personal experience in relationships with individuals of other racial or ethnic backgrounds, and personal resilience and competence. In psychedelic therapy, patient outcomes are influenced by staff’s behavior toward patients.
Contemporary psychiatry maintains that direct experience of psychotropic medications is neither necessary nor detrimental in effectively treating patients with those medications. However, no studies have examined the relationship between psychiatrists’ personal use of pharmaceutical substances and their prescribing practices with psychotropic medicines.
Researchers’ and clinicians’ first-hand experience with psychedelics could impact the objectivity and ethical conduct of their work, because contemporary psychopharmacologic research values scientific objectivity in which personal experience is irrelevant and excluded as a source of knowledge.
Regardless of one’s position on the question of objectivity, therapists’ first-hand experience with psychedelics introduces a potential confound to research efforts to demonstrate the efficacy of psychedelic therapy in a rigorous way. However, no contemporary studies have systematically studied this question.
Psychedelic experience as a part of psychedelic therapist training
Academic-based psychedelic therapists’ experience may span a continuum, from psychedelic naive to those who have extensive experience with a variety of compounds in diverse settings. However, the illicit nature of psychedelics makes it difficult to speak openly about their experiences.
The Maryland State Psychiatric Institute group and MAPS protocol known as MT-1 are the only programs in the USA that allow psychedelic therapists to take psychedelic medicines as part of their training.
Spring Grove Research Center
Researchers at the Spring Grove Research Center of the Maryland State Psychiatric Institute applied to FDA to allow therapists to undergo psychedelic-assisted therapy for training purposes. Over 100 mental health professionals took up to three high doses of LSD between 1969 and 1976. Participants in this study included clinical researchers, therapists working with non-psychedelic-related approaches, and crisis interventionists, in addition to psychedelic therapists in training. Follow-up data were collected but were never systematically analyzed and published.
MAPS’ MT-1
While prior experience with MDMA is not required for MDMA therapists, the ongoing trial of MDMA-assisted treatment of PTSD is designed to provide therapists in training with an opportunity to experience MDMA in a therapeutic setting, while collecting safety data in healthy volunteers.
THE IMPORTANCE OF PERSONAL EXPERIENCE WITH ONE’S THERAPEUTIC METHOD
Due to the protean nature of the psychedelic experience, the skillful psychedelic therapist needs to approach the patient with certain clinical positions in place, including a self-aware and non-judgmental attitude, a radical acceptance of highly emotional states and disordered thought, and a coherent stance regarding the relationship of this experience to integrative work.
Strassman (2001) encourages US investigators to consider implementing the practice in Europe to improve safety and allow for true informed consent. However, there is little academic research on the role of personal experience with psychedelics by psychedelic researchers and therapists.
Potential parallel #1: Training of healers who use psychedelics in religious/ritual settings
Shamans who work with psychedelic compounds for diagnosis and treatment of a variety of ailments in ceremonial settings often take high doses of ibogaine, while ceremony leaders and other participants take lower doses.
Ayahuasca, a traditional psychoactive tea made by indigenous Amazonian tribes, is ingested in a ritual context over a number of years to become an ayahuascero (ayahuasca shaman). Training institutes offer 6- and 10-week courses that include three ayahuasca ceremonies per week.
Although these examples could be used to train psychedelic therapists in academic settings, it remains unclear how shamanic principles and practices might relate to the practices of academic psychedelic therapists.
Potential parallel #2: Training for other psychotherapeutic interventions that evoke an alternative state of consciousness: Psychoanalysis and Mindfulness
Psychoanalysis and mindfulness-based interventions bear important similarities to psychedelic therapy. Both methods use an alternative state of consciousness to facilitate access to normally unavailable and inaccessible parts of the self. In each of these examples, the therapist creates conditions that lead to an alternative state of consciousness, but the training to provide psychedelic therapy cannot be fully analogous to training to provide psychoanalysis or mindfulness-based interventions.
The training analysis is a central part of psychoanalytic training, and mindfulness instructors must develop an ongoing meditation practice before being accepted for formal instructor training programs. No psychopharmacology researcher or psychiatric prescriber is either required or forbidden to have direct experience with any of the medications they study.
The training analysis of psychoanalytic training is used to evaluate the analytic candidate. Contemporary analytic training institutions have shifted away from this model to analysis by a nonreporting analyst.
The relevance of personal therapy for therapists in training has a long and interesting past. Although quantitative empirical research has failed to consistently show a direct relationship between such experience and improved patient outcomes, qualitative studies consistently demonstrate a nuanced and dynamic relationship between the therapist’s therapy and patient outcomes. Wheeler (1991) found that the more therapy a therapist had, the lower the quality of the alliance with their own patients.
Six contributions of personal therapy to clinical practice were summarized: improved emotional and mental functioning, more complete understanding of human relations, relief from intense emotional demands, and direct experience of therapy’s benefits.
Training programs for therapists working in research studies of psilocybin in the USA exclude discussion of previous experience with psychedelics. They receive training in specific skills they are asked to employ, followed by recorded and fidelity monitored pilot-participant therapy sessions.
The NYU Phase 2 Cancer Anxiety study offered guidance to therapists on how to respond to questions from participants regarding their own psychedelic use. However, the manual suggested that therapists may indirectly allude to personal experience, or make disclosures limited to the use of psychedelics in legal settings.
An alternative approach to answering a question is to explore the fantasies, hopes, and fears that lie beneath the participant’s question. However, present protocols for psychedelic therapy are short term.
The impact of sharing versus withholding such information on psychedelic therapy outcomes is also not systematically explored. However, it may seem intuitive that a participant would feel greater trust in a therapist who is experienced and comfortable with the terrain of psychedelic experiences.
An analytic candidate’s personal experience of psychoanalysis is a key component of training, just as a meditation teacher draws on personal experience to teach meditation. If psychedelic therapy is more akin to these examples than to a biologically conceptualized psychopharmacological treatment, open discussion cannot occur.
What makes therapists’ personal experience with psychedelics difficult to discuss
The use of psychedelic medicines for healing and personal growth in religious contexts and therapists’ personal experience with other therapies that employ alternative states of consciousness are standard practice in each of those fields. However, the legal status of psychedelic compounds currently being researched means that most therapists cannot use them.
Although current research on psychedelics in academic settings follows rigorous regulatory guidelines, the stigma of hedonism and dangerousness remains attached to psychedelic use. Today’s clinical researchers create distance from many of their predecessors and cultivate an image of cautious, respectable, conscientious, and sober scientists.
A Western worldview that privileges ordinary waking consciousness above all others may marginalize and devalue healing methods that involve ecstatic or highly aroused emotional/cognitive states. Psychedelic therapy questions the position that meaningful, profound change can occur only in sober consciousness.
What, when, and why? Issues for future research
Personal experience with psychedelics was a central role in the rise and fall of the first wave of psychedelic research. It is likely to have some influence on the second wave of psychedelic research.
The field of psychedelic therapy must stay focused on projects that will help realize its goal of rescheduling psilocybin and MDMA in the near future.
The role of psychedelic therapists’ personal use of psychedelics in training and professional development should be explored.
We suggest a study to explore the role of personal experience with psilocybin in therapeutic setting on therapist development. This study would require a substantial allocation of resources, but would provide evidence-based improvement in training methods.
We close by restating our empirical question: Does psychedelic therapists’ personal experience with psychedelics affect the outcomes of the patients they treat? Further research is needed to answer this question.
This manuscript was supported by the National Institute on Drug Abuse and was written by a postdoctoral fellow at NYU Rory Meyers College of Nursing.