Psychedelic Psychotherapy Flashcards
The following is taken from these sources:
Yale Manual for Psilocybin-Assisted Therapy
of Depression
- http://uczesieact.pl/wp-content/uploads/2020/01/Yale-Psilocybin-Depression-Therapy-Manual_Oct-2019.pdf
A Manual for MDMA-assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder (from MAPS)
- https://maps.org/research-archive/mdma/MDMA-Assisted-Psychotherapy-Treatment-Manual-Version7-19Aug15-FINAL.pdf
Manual for Psychedelic Guides
- https://uploads-ssl.webflow.com/5f7390dfac8708fbb8e78a8c/5fb9cd63019a29942351bce5_Psychedelic-treatment-manual-jan-7-2019.pdf
Human Hallucinogen Research: Guidelines for Safety
- https://pubmed.ncbi.nlm.nih.gov/18593734/
What is psychedelic-assisted psychotherapy?
The use of psychedelic substances to facilitate - both on a biological and experiential level - a therapeutic relationship
Process involves multiple sessions including:
- Preparation = beginning with the establishment of a traditional therapeutic relationship and psychoeducation on the nature of the treatment
- Support = a supported psychedelic experience(s)
- Integration = debriefing/follow up sessions post treatment reflecting on the content of the experience
The preparation and integration phases differ between trials but there are core features:
- The need for all 3 stages
- Set and setting emphasis during support
- Maintenance of a strong therapeutic alliance
Generally speaking, what is necessary in the preparation phase?
Development of therapeutic rapport
Gather information about participant and history
Provide psychoeducation on the nature of the psychedelic experience and the therapeutic approach to be used
Practical considerations for the support phase:
- Expectation clarified
- Logistics (duration, use of music/make a playlist, eye masks, other things of comfort/support)
- Delineate acceptable boundaries of the interaction between therapist and participant during the session(s)
Generally speaking, what is the typical role of the therapist during the support phase?
Largely nondirective
- Participants encouraged to have an inward directed experience during dosing sessions
- Emotional support and encouragement to engage with difficult thoughts, sensations or memories
- Ensure safety and immediate needs met (e.g. water)
Generally speaking, what are the features of the integration phase?
Usually begins the day after the dosing session
Includes a thorough review of the participants experience during their dosing +/- application of therapeutic techniques (of a given modality) to reinforce particular aspects of the experience so that positive changes are encouraged to persist
What is ‘set’?
Mindset of the participant and intention of the individual prior to the experience
Beliefs, hopes, fears, traumas, personality, temperament; expectations and fantasies about the psychedelic experience
+/- Participants attitude toward the research setting, medication, therapists; expectations for relief of symptoms
What is ‘setting’?
Physical space and environment in which one has the psychedelic experience
Inhabitants (therapists/guides), music, artwork, safety equipment (incl. basic observations monitoring like HR, T)
What are some differing approaches to the types of psychotherapeutic support provided throughout psychedelic psychotherapy?
The main debate is between modality-specific vs. non-specific supportive approaches
Some studies utilise evidence based psychotherapies that have already been shown to work in certain conditions e.g. motivational interviewing for alcoholism, and simply adapt these to a psychedelic context
Others e.g. Carhart-Harris (2016) opt for some general core supportive principles e.g. safety, containment, clear guidelines etc
- Therapists here are known as sitters/guides/monitors
There are many reasons to opt for one or another:
- Research aims e.g. isolation of the therapeutic effects of the drug itself (as opposed to drug + therapy)
- Uncertainty as to the types of therapy to apply in given contexts, for different conditions
- Uncertainty as to whether the healing potential is contingent on ‘internally self-generated repair’ i.e. self-healing is a natural consequence of the use of these substances and the process should thus be minimally interfered with
More research will likely elucidate greater understanding, but is somewhat reminiscent of the dodo-bird verdict in the context of psychedelics
What things are required to prepare the physical setting?
Basics:
- Private, free from interruption, minimal external stimuli
- Comfortable, not overly clinical, places to sit and lie down, good ambient temperature, availability of blankets
- Nice items of interest/comfort e.g. fresh flowers, artwork, creative materials, warm colours, personal shrine with images of friends/family/meaningful objects etc
- Eye masks are useful, to facilitate inward exploration/contemplation
- Easily digested food and drinks of persons preference available should they desire to eat/drink; ensure adequate hydration during experience
- Availability of medical monitoring and resus if needed
Music:
- Goal to provide guidance and a sense of motion throughout session
- Music may be obtained online from existing protocols or in some instances chosen by patients
- Playlist may be crafted in a way to complement psychedelic experience; thinking about transitions between songs and periods of silence might be important too
- Headphones are ideal, may be linked up with external speakers to play same music quietly, to allow some connection with therapist
What is important when considering the relationship to therapist as part of setting?
Must commit adequate time - incl. prep/during/debrief/follow-up
Must agree boundaries regarding touch, including refraining from sexual advances, avoid harm to self, others and property
Must have at least one sitter in the room at all times (bar breaks for bathroom etc)
What exercises might be encouraged during the support phase?
‘Going in’
- Is going to be the key focus, hence use of eye mask and headphones
- Not attempting to control external world beyond what is making you seriously uncomfortable i.e. a song you are listening to is scaring you witless
- Being curious and open with kindness, to all the experiences as they unfold
Expressing oneself:
- Through any means that feel appropriate to them: vocally (laugh, cry, animal noises, chant etc); physically (dance, shake, spin, stretch etc); with creative media (paints, pencils etc)
- Without the need to explain to anyone
Breathing exercises:
- esp. breathe into the experience, or letting the breath ground you
Bodywork exercises:
- esp. exploring sensations, going with what the body wants to do, befriending your physical form, being encouraged to release pain
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What are some useful (non-directive) phrases to guide the support phase?
To start the session or when confronted with fear responses:
- e.g. “trust, let go, and be open” (W. A. Richards, 2015)
To expand on verbal discussion:
- e.g. “Would you like to say any more about that?”
To direct attention to non-verbal/indirect communication:
- e.g. “I just noticed your voice changed, what is going on for you right now?”
To invite the individual to focus inwards:
- e.g. “Would you be willing to experiment with being silent for a few minutes just to see what you might discover?”
- “Maybe it would be a good idea to put the eye mask and headphones back on and go back inside for a period of time to let the medicine help you with this?”
To explore bodily responses:
- e.g. “where do you feel that in your body?”
- “Why don’t you try just going with that energy for a little while”
- “You might want to try breathing into your experience right now”
- “I encourage you to be as present a possible with that feeling, feel it as fully as you can, and express it in any way that might come”
- “Any visions or bodily sensations associated with what you are saying?”
- “let those tears come” “its okay, you can let go”
To reassure:
- e.g. “you are in a safe space, what is happening now is part of the healing process”
- “remember your breathing”
- Asking if they want a pre-agreed nurturing touch e.g. hand or shoulder touch
