I remember the first time I heard the word psychedelics in a clinical setting. Over eight years ago, I was working in a community health clinic in Madison, WI when one of the addiction medicine physicians I had worked alongside of asked me a most unexpected question in between patients: “Are you in interested in working with psilocybin?” I couldn’t have heard him correctly, did he mean psilocybin, the active ingredient in magic mushrooms? “I’m sorry can you repeat that?” He said that he had been in contact with a local biotech organization that was interested in sponsoring a clinical trial through the University of Wisconsin-Madison to investigate the safety and feasibility of psilocybin in a therapeutic capacity. They needed a psychologist to assist with the psychological screening of research participants and serve as a facilitator to monitor safety and provide emotional support when participants take the psilocybin. My curiosity was piqued. I had no experience in this domain. I had only been on the end of treating individuals who had problematically used and misused illicit substances, I certainly would never have imagined my sanctioning the use of them.
With more education I learned that John’s Hopkins University and New York University were conducting a clinical trial examining psilocybin for anxiety and depression in terminal cancer patients that led to very promising results. Their research indicated that when psilocybin is administered in a supportive and controlled environment with trained therapeutic facilitators, people may be able to approach threatening existential issues in a way that occasions a deeply meaningful experience.
In 2017, the FDA granted breakthrough therapy designation for another schedule 1 psychoactive compound, MDMA (aka “ecstasy”) in combination with psychotherapy for Post-traumatic Stress Disorder. Two years later, the FDA granted breakthrough therapy designation for a phase 2 clinical trial examining the use of psilocybin for treatment of major depressive disorder. In between these two events came the release of Michael Pollan’s book in 2018: How to Change Your Mind which featured a highly respected journalist and writer exploring and experiencing psychedelics as a facilitator of psychological growth and transformation.
More recently there has been explicit endorsement from several prominent therapeutic giants such as Gabor Mate MD, Bessel Van Der Kolk MD, and Richard Schwartz PhD extoling the virtues of various psychedelic medicines and their profound therapeutic applications. Even Gwyneth Paltrow dipped her toe in the psychedelic waters by devoting the first episode of The Goop Lab to exploring the healing and potential impact of psychedelic assisted journeys. On an academic scale, psychedelic clinical research has been established and well-funded at several top universities across the country and the world to name just a few: John’s Hopkins, UCLA, Yale, Columbia, New York University, Imperial College London, and the aforementioned, University of Wisconsin. Then came the public trading of psychedelic companies on the stock market and a current valuation of the industry in the billions.
In the last year, psilocybin has been decriminalized in multiple cities and states in the US and approved for compassionate use for end of life distress in terminal cancer patients in Canada. Additionally, MAPS, the Multidisciplinary Association for Psychedelics, anticipates open access to MDMA-Assisted Psychotherapy by 2023.
I have had the opportunity to work in FDA and DEA approved clinical trial settings with MDMA and psilocybin (neither of which can legally be prescribed in Wisconsin) and also have been trained as a Ketamine Assisted Psychotherapist. Ketamine (not a classic psychedelic but has psychedelic properties dependent on dosage and route of administration) is a unique medicine in this space as it seems to be less celebrity and more workhorse in conversations about psychedelics. As this medicine is currently being prescribed off label for the treatment of many various health conditions ranging from PTSD, OCD, anxiety related disorders, depression, and chronic pain, it provides a unique window into the future of what may come when other psychedelics may be legalized for clinical use. Many providers are approaching Ketamine as an alternative to anti-depressant therapy or in more extreme cases an alternative to electroconvulsive therapy. In this regard, the purpose of ketamine is to provide a patient or client with a ketamine infusion occurring over 45 minutes to an hour. The subjective and/or psychedelic effects during the infusion are not the intended purpose of the treatment, but rather there is often strong adherence to an infusion protocol (often 6 sessions over 3-4 weeks) aimed to produce symptom relief.
Ketamine infusions are thought of by many as a sort of “reset” button for people. Many people may already be aware of ketamine infusion clinics and they are likely to proliferate considerably over the next several years. No doubt they can (and do) help many people, but others may not benefit (or even feel harmed) from this more pharmacologically focused treatment model.
My interest in Ketamine as a therapeutic intervention aligns closely with the training I received as an MDMA-Assisted Psychotherapist, in that the ketamine is administered in conjunction with psychotherapeutic support (i.e., “Ketamine Assisted Psychotherapy”). An incredibly critical aspect of the Ketamine session involves the mindset and environment (i.e., “set and setting”) in which it is administered. Thusly, a ketamine treatment experience should involve comprehensive screening, psychotherapy prior to the session to build rapport and prepare for the journey, exploration of a person’s history, and the development of intentions for the treatment. Following the ketamine session, the integration of the experience into a new narrative of self is critical to the growth process.
Approaching Ketamine sessions in this way is influenced largely by our focus on trauma work. The lens is biased towards exploring what type of healing work can occur when deeper self-access takes place in a supportive, non-judgmental container. So many people seek out therapy earnestly with the desire to evolve and grow and yet the reflexes of self-protection are so formidable that the felt changes occur at a glacial pace. I personally have encountered the frustration of expending considerable energy in therapy trying to reveal “my tells,” (things that will reflexively block me from opening up) only to leave the session feeling unseen and still stuck. Unfortunately, there are many people who have spent countless hours in therapeutic dialogue without significantly or ostensibly shifting the needle.
This is where the therapeutic use of a medicine like Ketamine can provide a gentle invitation to soften typical defenses and protective reflexes while expanding one’s access to difficult feelings and deeper insights. It is certainly not a “silver bullet” and holds certain risks, but it can provide many people with a greater range of options for self-exploration. When done in the setting of a supportive therapist many people can galvanize the healing opportunity to extend beyond their own exploration by inviting a more vulnerable, safe, and healing interpersonal connection.
In any big industry boom, there is darkness and light and the capitalization of the psychedelic world is no exception. What will this mean for the treatment of various mental health and medical illnesses several years from now? How can we better educate the public on the risks and benefits of riding the purported silver bullet of enlightenment? I think the key is to promote an active and ongoing dialogue that continues to clarify who is appropriate for this treatment, elaboration on the variation’s forms of administration, and deeper clarity surrounding the opportunities and implications of pursuing this path for healing. We also must not forget to honor the indigenous origins of this work and persistently search for the ongoing accommodations and adaptions required to respectfully suit the unique needs of the people being served.
Dr. Chantelle Thomas is Windrose Recovery’s Executive Clinical Director and a Clinical Psychologist specializing in addiction treatment, trauma, and health psychology. With her experience in trauma work, Dr. Thomas guides the clinical team in the comprehensive assessment and treatment of each guest. Dr. Thomas is also a certified biofeedback practitioner, providing clients with an added dimension of insight and discovery helping them better regulate and understand the psychological impact of stress and chronic trauma. Dr. Thomas began her career as the Program Director for a dual-diagnosis addiction and trauma treatment center in Malibu, California. After receiving her PhD in Clinical Psychology, she completed her internship and post-doctoral fellowship in Health and Rehabilitation Psychology at the University of Wisconsin School of Medicine and Mental Health. While there, she gained specialized expertise in medical-surgical consultation, trauma-informed therapy and chronic pain treatment. Through the University of Wisconsin’s School of Family Medicine, Dr. Thomas then joined Access Community Health Center as a Behavioral Health Consultant to primary care physicians where she innovated the development of a substance use disorder consultation clinic embedded within primary care. Her background in research-supported treatment modalities directly informs her ability to ensure the most effective interventions are incorporated into Windrose Recovery’s holistic programs.
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