Psychedelic therapists should first take the plunge themselves!

Gepubliceerd op 15 december 2022 om 20:30

In my previous blog, I used the metaphor of scuba diving to illustrate why it’s important for psychedelic guides to have ample personal experience with psychedelics before they take others on a journey. In this essay, I will argue that it’s equally important for therapists working with psychedelics, to be familiar with the terrain of altered states of consciousness. Studying the map does not suffice: therapists should actually visit the territory that they want to send their patients to. Not only does this contribute to the safe set and setting that they’re creating for their patients, before and during their journey, but it will also make patients feel better understood upon returning from the mysterious depths of a psychedelic state of consciousness. Therapists who are reluctant to take the leap themselves, miss out on a great opportunity to authentically connect with their patients from a place of personal experience. Although theoretical training will probably be enough to safely guide patients through their trip, I hypothesize that, if they were to leave the shallows of theory and take the plunge into the rich and deep waters of personal experience, this could deeply enrich the therapeutic relationship with their patients and thereby, significantly improve the therapy outcome. I would love to see this hypothesis be put through the test in a clinical trial.

          Like-minded readers will find this proposal obvious. Others might consider it food for thought. And there will be readers who find the thought of caregivers having to take psychedelics before being able to give psychedelic care, ridiculous. If you fall into the last category, I mean no offense and invite you to follow my reasoning, with an open mind.


But, I’m not taking anti-psychotics either...


One of the arguments most often used against doctors having to try their own psychedelic medicine, is that they don’t try any of the other medication they prescribe. As a psychiatrist, you probably don’t take antidepressants if you don’t need them, and you don’t sign yourself up for an electroshock treatment just to see what it’s like. However, the fundamental difference with psychedelic therapy is that you’re not just prescribing a substance with a psycho-pharmacological effect, but that you’re primarily delivering an experience. A very intense one, in which the patients’ mindset and the treatment setting greatly influence the outcome. It can be argued that all medical interventions, from swallowing a pill to undergoing open-heart surgery, are experiences that are to some extent influenced by patient expectations and the relationship with the caregiver.

          So, why should psychedelic caregivers have personal experience with the medicine, while we don’t require surgeons to be operated, nurses to be catheterized and psychiatrists to take anti-psychotics?

          Firstly, because taking a psychedelic substance provides an experience that is so different to how we normally perceive and interact with the world, that we don’t even have the vocabulary to describe it. While journeying, patients might not find the right words to describe what they need or to indicate if something is bothering them. It takes personal experience in this state of consciousness to become sensitive to a patient's needs and to know how to best guide them through possible challenging moments. And to understand just how vulnerable tripping people are and how easily their experience is affected by outside influences, including the content of the words you speak, but also your volume, tone and body language. Under the influence of a psychedelic, our senses become magnified and we can become incredibly sensitive to the world around us. Not only are people more sensitive and perceptive in an altered state, they are also highly suggestible – and this suggestibility starts even before the onset of the experience: the words and explanations that are used in the preparation phase are likely to become part of someone's mindset, one of the determining ingredients in the experience. This heightened sensitivity, suggestibility, and vulnerability present practical and ethical challenges that are more easily recognized when caregivers have personal experience with such states.


You don’t have to be sick to benefit from psychedelics


Another important characteristic that sets psychedelics apart from most regular medical interventions, is that you don’t have to be sick in order to benefit from a psychedelic experience. While it makes little sense to undergo electroshock therapy when there’s no indication for it, psychedelics potentially have something in store for everyone – provided that there are no contra-indications. Our brains are wired to interact with the molecules in psychoactive plants and fungi - cultures throughout the world and throughout history have explored the states of consciousness that result from these interactions. Not only in healing rituals, but also in the pursuit of (spiritual) knowledge, for personal growth and for the strengthening of social and community ties. In western underground use of psychedelics, hundred-thousands of healthy people have taken psychedelics to improve their well-being – or just to have a very interesting new experience.

          If you’re a therapist reluctant to take the plunge into the ocean of psychedelic consciousness, please note: just because you’re not a patient, it doesn’t mean that you cannot find your own treasures underneath the surface. How do you know if there’s nothing for you there, if you haven’t tried?


Enhancing a safe mindset and setting


Can a therapist without psychedelic experience keep a patient safe, while they’re under the influence of a psychedelic? With adequate training, yes. However, I also believe that patients can feel that much safer if at least one of their caregivers does have personal experience. And the degree to which a patient feels safe, influences the level of them being able to surrender to the experience, which in turn affects the quality of the experience. And a better quality of the psychedelic experience is likely to lead to better results. I see this principle at work in my own practice. My participants are not patients, but they also need to trust me in order to surrender to the journey. If they don’t feel complete trust in me as a guide, it is likely to affect their experience. Upon returning from – and sometimes even during – their journey, people often mention that they feel safe with me because on some level, I understand what they’re going through. Even though I don’t know the content of their experience, this doesn’t matter. To refer back to the diving metaphor: they know that I’ve also been in the ocean and that I’m familiar with the feeling of being and breathing underwater. I know from experience where the potential challenges are and how overwhelming the vastness of the ocean can feel. Knowing that their guide is an experienced diver, contributes to their mindset of feeling safe and enhances the safe setting.


Building bridges of shared experience


Personal experience with psychedelics not only contributes to safety, but also to the therapeutic relationship. These concepts already enforce each other in normal therapy and exponentially so in a psychedelic session, when the patients’ senses are enhanced and in which their expectations and impressions of their caregivers directly feed into the experience. I would argue that one of the crucial elements of the therapeutic relationship is feeling understood. And this is where it often goes wrong. During my decade's working-experience as a counselor in mental healthcare, clients frequently complained that they didn’t feel understood by their psychiatrist or doctor. It’s a theme that’s abundantly present in medical anthropological literature, not just about mental healthcare, but about medical care in general. There’s often a gap between a caregiver and the receiver of care – this gap can be created by a combination of factors: cultural differences, different world views, differences in professional status or socioeconomic environments. And a significant portion of this chasm is created by the difference in the lived embodied experience of the patient, who is suffering from a certain illness or symptoms, and the caregiver, who most often does not share this illness experience. Although such chasms in lived experience are inevitable and there’s usually no-one in particular to blame for their existence, some caregivers (sometimes even entire medical disciplines) are a lot more successful in building bridges than others. This is why medical anthropologists are sometimes hired by hospitals: they are trained to translate between the two sides of the gap and they can help construct bridges of understanding.

          Now, back to the situation of the psychedelic therapist. Imagine your patient returning from an intense psychedelic experience, that was at once confusing, fascinating, liberating, blissful and full of terror. They will struggle to put their experience into words because this is inherent to psychedelic experiences. There will inevitably be a gap in understanding each other, and this gap will add to the distance that already existed because your patient is suffering from a condition and you’re not. I believe that your personal experience with psychedelics can function as a sturdy bridge. A shared experience is a powerful ingredient in creating trust and a feeling of understanding. Whereas as a therapist, it’s not in your power to step into your patients’ world of suffering, you can enter the same waters that might house their healing experience.

          Even if you have been diving in another metaphorical sea, you will still share the indescribable experience of having been immersed in the water, breathing oxygen from a tank. You might have visited a beautiful coral reef in tropical waters while your patient made a night dive in the cold Dutch sea, but you will still be able to relate to their experience in a more authentic way. You’ve both made the leap into the unknown, into the depths of human consciousness, and your patient will feel a lot safer knowing that. By building the bridge of common experience, you can provide better support for your patient when they surface from the ocean’s depths.


Tune your instrument


I compare being guided by an inexperienced psychedelic therapist to receiving sexuality therapy from a virgin, or to learning how to dive from someone who can’t swim. They can give you well intended advice that might even be valuable, but when given the choice, you will probably choose someone who resonates with you from a level of personal experience, authenticity and motivation.

          Is personal experience always a prerequisite for being a good caregiver? No. There are plenty of situations where personal experience is not even an option. You can be a good gynecologist without having a uterus, a caring gerontologist when you haven’t even reached midlife yourself, and you can be a compassionate support for someone who’s dying, when you obviously have no personal experience with that particular human condition. However, the case with psychedelics is significantly different because there is the choice of immersing yourself in personal experience. Provided that there are no medical, psychological or legal contraindications, going on a psychedelic journey is a real possibility, that takes about the same time and resources as traveling abroad to a multi-day professional conference.

          As a therapist, you’re mainly your own instrument. Medication and diagnostic tools might be part of your toolkit, but in the end, the quality of the therapeutic relationship is one of the most important influencing factors regarding treatment success. I have argued that in the case of psychedelic therapy, caregivers’ personal experiences will strengthen this therapeutic relationship, by making patients feel more understood. It also contributes to patients’ feeling of safety, allowing them to surrender more to the psychedelic experience and thereby improving the quality of their experience. Therapists and other caregivers – at least in countries like the Netherlands – have legal options to tune their instrument to the frequencies of the psychedelic state of consciousness, so that they can resonate better with their (future) patients. I believe a well (a)tuned caregiver can make the difference between good psychedelic care and excellent, life transforming care.


Dear reluctant therapist,

I wonder: what’s stopping you from taking the plunge? I’m really curious and hereby invite you to a dialogue. If you want to share your perspective with me, please send me an email. I'd love to hear from you!