The potential benefits of psychedelic therapy

The controversial use of psychedelics as an alternative method of psychology is advocated by some medical professionals, writes Gilchrist Clendinnen.

AFTER DECADES of being largely ignored, mainstream medicine appears to be taking an interest in the healing potential of psychedelics. This year, Saint Vincent’s Hospital is working on two trials using psilocybin, the active ingredient in magic mushrooms. The first is using psilocybin to treat anxiety in people in palliative care and the second will be working with people who have treatment-resistant depression.

While using psychedelics in therapy is still illegal in Australia outside of medical trials, a growing number of psychedelic therapists have chosen to offer these treatments in secret. Practising in Melbourne, “Doc” (not his real name) is one such therapist.

“I’ve never really had an issue with living in the grey zones when it comes to helping others,” he said when I questioned him about the risks of operating outside the law. Despite the difficulties of underground practice, he has no shortage of clients. Before COVID-19, there was a three to four-month waitlist for a psychedelic session with him.

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For Doc, the road to becoming a psychedelic therapist came from the benefits he has had from psychedelics personally:

“To this day, I think the overwhelming majority of my own healing has been in some ways linked to psychedelics.”

In terms of the people who are most affected by psychedelic therapy, somewhat counter-intuitively, Doc believes that it is those that have never used these substances before that are likely to have the largest benefit:

“If you’ve never done psychedelics, the square that you see the world through is often so much more rigid, so the impact can be so much more profound.”

Doc’s beliefs regarding who would most benefit from psychedelics mirror the findings of research in this area. In 2006, John Hopkins University released the first American study on the effects of psilocybin in nearly 40 years. Participants were given 30 milligrams of psilocybin and were asked to lie down and listen to classical music while wearing eyeshades.

The results of the study were remarkable. Of the mostly highly-educated participants who had never used psychedelics before, 67 per cent rated the experience as one of the top five most meaningful experiences in their life two months after the session. The idea that five hours under the influence of a drug could be as meaningful to people as “the birth of a first child or the death of a parent” sparked a flurry of renewed academic interest in psychedelics.

Since then, studies have shown impressive results using psychedelics in a range of different applications. In one study on patients with severe depression, multiple participants reported that one session with psychedelics had been more effective than years of mainstream depression treatments such as anti-depressants or cognitive behaviour therapy.

The purported effectiveness of psychedelics in some of these studies has interesting implications for how we think about mental health and recovery. Western medicine’s understanding of mental health is that treatment takes time and many people with mental illness are on antidepressants or in therapy for years. In contrast, psychedelic therapy usually only involves one or two sessions where psilocybin is taken, plus a couple of counselling sessions to build trust beforehand and debrief afterwards. Can one experience, however mind-bending, really make that much of a difference?

Sean O’Carroll, a psychotherapist involved in psilocybin trials and training programs for psychedelic therapists thinks that in the right circumstances it can:

“Part of what causes mental illness is a rigidity in not just thinking, but being. Psychedelics like psilocybin seem to temporarily loosen the iron-like grip that the conditioned mind has on the psyche.”

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I managed to get onto Sean after a few weeks of following up. His kids are home from school because of the second coronavirus lockdown and his work as a psychotherapist keeps him busy.

He told me:

The conscious mind acts as a kind of filter, keeping really troubling experiences and psychological material out of view. It also filters out positive aspects of oneself that have historically led to harmful, negative or hurtful experiences. When you introduce something like psilocybin, what seems to happen is that this filtering mechanism is interrupted, consciousness is loosened in some way and we gain access to these previously obscured experiences and aspects of self.

However, while Sean is a believer in the effectiveness of psilocybin and other psychedelics as healers, he also feels that there are serious risks with underground psychedelic therapy and the resulting lack of regulation or training standards.

His website offers information on the effects of psychedelics and, as a result, he often gets clients who have had some form of underground psychedelic psychotherapy and have become disturbed by their experiences:

They come in and essentially they’ve suffered a non-ordinary state trauma. Something’s happened in their psychedelic experience where they’ve come out of it with a sense of being haunted, or believing that an entity has taken up residence inside them, or with really concrete thinking, like I have to leave my partner. People can have various kinds of bad trips and become stuck or damaged by them.

I asked Sean if people could also be damaged by incompetent therapists without psychedelics, but he sees psychedelic therapy as categorically riskier:

If you think about why psychedelics are so healing for some people, it stems in part from the way in which aspects of their psychedelic experience settle in their being with a deep sense of knowing — what the psychologist William James referred to as the noetic quality of mystical states. The dark side of that is that when people have bad trips, their resultant negative beliefs can settle with that same deep sense of knowing in a way where it can’t be challenged by ordinary thinking. It’s a categorically different kind of damage that can be done.

It is for this reason that Sean does not offer psychedelic psychotherapy, as he believes that working underground, he would lack the resources necessary to guarantee that clients who had difficult experiences were traceable and well supported.

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Doc is less concerned by the potential of a psychedelic experience to turn negative, as he believes a skilled therapist is able to assist the client work through many of these issues.

To illustrate, he tells a story about a client of his who became distressed during one of his sessions:

He was convinced he was going to die and had to immediately go home, say goodbye to his family and prepare for death. We talked it through and the client came to realise that if he didn’t take immediate steps to change his lifestyle, dying was a real possibility. This was the underlying meaning of his message, beyond him only hearing ‘I’m going to die’. Having professional guidance and reflection during a psychedelic therapy session can make all the difference between an insightful, healing experience versus one that is traumatic.

While Doc is content to operate outside the law for now, he is hopeful that psychedelic therapy will become legal soon.

He points to the increasing pace of medical trials in the area and the fact that the not-for-profit Mind Medicine Australia is planning to offer a four-month course in psychedelic-assisted therapy next year:

“It looks like there is going to be a whole bunch of trained psychedelic therapists within the next 18 months and hopefully the industry should follow within the next six to nine months of that.”

Stephen Bright, a psychologist, researcher and academic with an interest in the use of MDMA to treat PTSD feels it might take a little longer.

When I asked him about his hopes regarding legalisation, he said:

“I think a little more realistic five to ten years. The optimist in me says five years.”

Sean O’Carroll also feels it may take a while for psychedelics to be legalised, but doesn’t necessarily think this is a bad thing as treatments in this area are still being developed:

“Psychedelic psychotherapy isn’t only about the psychedelics. Psychedelics have been around for a long time. The unknown quantity is the therapy and that will be the thing that will determine whether this is a boon for mental health or not. There’s a lot of work to be done working out what good psychedelic-assisted psychotherapy looks like.”

In the meantime, he is keen to point out that psychedelics aren’t the only way to heal through altered states of consciousness:

For mainstream mental health, psychedelics are this radically different and exotic thing, because they are so different to the normal treatments of talk-therapy and medication. But if you come from a background in transpersonal psychology or depth psychotherapy, psychedelics are seen as just one particularly powerful way of exploring and understanding the nature of consciousness. From this vantage point other non-ordinary states such as dreams, meditative and dance states can be similarly powerful — psychedelics are just one tool amongst many that can reveal to us that we are far more than our conscious ego.

When or if this tool will be legally available to therapists in Australia remains to be seen.