Psychotherapy Assisted By Psychedelic Medications

A recent trend in psychotherapy research is to add the effects of a psychedelic medication to a therapy session. The renewed interest in these medications ( psilocybin, LSD and MDMA)  is due to a number of factors: the cost and length of time psychotherapy alone can take, especially when dealing with issues such as substance addictions, end of life anxiety, post traumatic stress, isolation and depression; the high failure rate of some therapies to effect certain conditions; and the high safety rate of these medications compared to other psychiatric medications.  The combination of a long therapy session done under the influence of a psychedelic medication appears to be powerful in healing  the conditions described above. Currently, the only way to obtain this combination legally is to qualify for a clinical trial. You can find those by going to www.clinicaltrials.gov and entering the search terms most important to you. In Atlanta, there is currently one clinical trial ongoing at Emory University for a study of MDMA and the startle response. This study does not include therapy and only measures the effect on one PTSD symptom (easily startled).

All of these models emphasize the importance of proper preparation before the session and integration following the session. The only legal services that a licensed psychologist can provide at this time are preparation and integration services. Supplying medications and guiding therapy experiences while under the influence of the medication are not legal for a licensed psychologist to provide at this time. Although I am trained to provide these services there is currently no legal way for me to provide them except in a research setting in the US. Qualifying for a clinical trial is not easy and at this time may require that a volunteer relocate for a period of time. The sites closest to Atlanta are in Baltimore, New Orleans and New York. Another legal option for psilocybin guided experiences  is to attend a retreat in Amsterdam.

There are also a number of people who have become interested in shamanistic practices and religious ceremonies with plant medicines. Currently there is no scientific research showing the effectiveness of these ceremonies for clinical conditions. These ceremonies have been developed primarily as spiritual practices and any therapeutic value is coincidental and established via anecdote. This path to healing is varied, unpredictable and holds significant danger in certain clinical conditions. Group ceremonies can be large; the plants used cannot be controlled for strength of dosage; side effects are unpredictable and significant and the competence of the healer can be in question. Your friend may have had an awakening and no longer has the same problem but that in no way gives you information about what the impact on you would be. Retreat centers have opened up in Mexico, Costa Rica and throughout South America that offer these experiences.

The only legal medical psychedelic currently available is ketamine. Ketamine is an interesting substance that was originally developed as a battlefield anesthetic to be used on wounded soldiers for its ability to create paralysis and control pain while safely altering consciousness as it does not suppress respiration. The off label uses of ketamine include working with depression, trauma and other clinical states. The NIH method of using ketamine is to have a low dose IV drip once per week for about 6 weeks to help with depression and this treatment occurs in a medical facility. Other areas of the country have begun to explore the psychedelic effects of ketamine when given in a more therapeutic setting and accompanied with psychotherapy, using other delivery methods such as lozenges and injections. This kind of treatment is not yet available in Atlanta but is available on the West Coast and in New York. There are some promising data on ketamine used in this way but it can still be somewhat controversial and not always available.

The traditional psychedelic medicines of LSD, psilocybin and MDMA are still currently in the Schedule 1  drug category, meaning there is high potential for abuse and no known medical use. The FDA is now considering allowing the  compassionate use of MDMA for PTSD. At this time there are about 4,000 patients requesting this and next year about 50 will be allowed treatment. Clearly the data show that there is medical use for these drugs and that when used in a therapeutic setting and not a recreational setting the potential for abuse is much lower. The power is in the interaction between psychotherapy and the drug as the drug by itself does not have the same impact. Many people are confused by this and seem to believe the healing is in the drug alone. It is not the drug by itself that heals but the drug given within a certain context with safety, therapy, therapeutic setting , mindset, proper preparation  and integration that creates the therapeutic effect. I would be glad to assist you with preparation and integration work but please do not call my office asking for underground therapists and sources for these drugs as I cannot provide that. I hope this blog has clarified for you the current state of the science of psychedelic-assisted psychotherapy as it is an exciting area of treatment when we have not had new and effective short term treatments available in many years.