The long & short of psychedelic-assisted therapy. Part 2 – Maximalists.

If you want to provide psychedelic-assisted therapy (PAT), you will need a protocol to follow.

What that protocol will look like, is currently a hot debate within the psychedelics field. Here is what the two sides have to say.

One side, the maximalists, argue that psychedelic-assisted therapy needs a lot of support. More than with any other medication, patients need to know what they are getting into. After treatment, integration encompasses more than just a debrief session.

Here are 4 of the arguments the maximalists put forth.

1. Participants need to be able to trust their therapist. Building a therapeutic alliance should be front & centre.

The minimalists’ dream of giving participants psychedelics after a brief introduction – or letting them take it at home.

But that is not what psychedelic-assisted ¡therapy! is about. The maximalists argue that building a therapeutic alliance (TA) is key to getting positive outcomes.

Roberta Murphy and colleagues recently showed that a stronger TA predicted rapport (prep), emotional-breakthrough and mystical experiences (session), and lowered depression scores (after). Conversely, those with a weaker TA before the second (of two) high-dose psilocybin PAT session predicted higher depression scores.

If psychedelics amplify the therapeutic process, it makes sense to build out that relationship beforehand – and for the therapist to be in the room during the session.

2. You want your therapist there during the session.

Screw the costs, without your therapist there, what is even a PAT session?

Matthew Johnson might have written, “reassurance has been sufficient to handle all cases of acute psychological distress that have arisen.” But what if that’s only the case because participants felt safe because their therapist – which whom a TA was built – was there.

A lot of PAT sessions involve hours of sitting next to a participant. Yet, there are times when there is interaction – will a monitor be able to have that conversation?

Stepping beyond the classical psychedelics – MDMA-AT involves a lot more interaction. The maximalists argue that a qualified therapist is necessary to make this work.

3. Participants need more – not less – integration.

Imagine your world being shaken up by an event you would describe as one of your top 5 life experiences – and then being sent home without much follow-up.

Observing what is happening outside of clinical trials, Rosalind Watts states, “after their brief taste of [a healing community], they found themselves back home treading the same old pavements.” Without proper integration, will participants get the message or fall back on old patterns?

Lea Mertens – whos involved with the MIND Foundation’s PAT study – argues that the amount of integration currently provided is not enough. “We need more psychotherapy around the psilocybin sessions in most patients, not all, but in most patients to actually induce change.”

In the smoking cessation trial mentioned yesterday, many got the message and permanently stopped smoking. Does this translate to chronic PTSD or depression (TRD), the maximalists argue it’s not so.

4. Safety is the most important factor. This is open-heart surgery – not applying a bandaid.

Underlying the 3 points above is one key factor, safety. If PAT is to become available, the maximalists want to do it right.

If not done properly, they fear PAT may wither down to just another ineffective drug treatment.

If done properly, it might be a cure for those walking around with trauma and depression for decades.

Recently the enthusiasm for PAT as a one-and-done cure has died down. The maximalists argue instead for an intensive treatment protocol where the drug session can serve as an amazing start – but without integration may leave someone back where they started.

This is just one side of the debate – see yesterday’s post & thoughtful discussion for the other side.

To see both perspectives in full – read my latest column for Lucid News.