Discussion Psychedelic Medicine Has a Therapy Problem - Shared from the atlantic

[tryptakid]

Thought I would share an article from The Atlantic talking about the FDA's pushback on MDMA.

I've struggled a lot with psychedelic medicine. I'm a therapist, and I'm someone who has been profoundly impacted by mescaline and psilocybin for the better. I also don't know that I'm the right person to be guiding people through experiences, and am not sold on how psychedelics can neatly fit into the therapeutic relationship. There are numerous ways in which my role as a therapist diverges significantly from the role of curandera or shaman. Therapy has become so intertwined within the western medical paradigm that it's difficult to parse out how practitioners could/should ethically practice, and it is telling that interventions involving psychedelics still struggle to figure out how to implement psychotherapy into the admixture we're trying to create.

Frankly, at the risk of speaking out of turn, I feel like Rick Doblin and MAPS may benefit from brushing up on Ikarus a bit... head in the clouds isn't great for feet on the ground. I got a rambling email on Friday from MAPS discussing this 'devastating setback' and it was unclear to me what the setback even was, or how MAPS hoped to address this, what lessons they were learning, or how they were planning to move forward.

Do the fucking work guys, and lay off the drugs.

 

[Vastness]

MAPS unfortunately has quite a few black marks on it's credibility by now, as far as I recall...

I just started reading that article though and just this sentence caught my eye, about - "concern that participants knew whether they received the drug or the placebo"... umm... seems a kinda unreasonable concern tbh, obviously almost everyone is gonna twig pretty quickly whether or not they got MDMA or indeed, almost any other psychedelic, or placebo... no? In the context of psychedelic research, the usual rules about placebo control surely need to be applied differently, if not just abandoned altogether...

 

[tryptakid]

I

MAPS unfortunately has quite a few black marks on it's credibility by now, as far as I recall...

I just started reading that article though and just this sentence caught my eye, about - "concern that participants knew whether they received the drug or the placebo"... umm... seems a kinda unreasonable concern tbh, obviously almost everyone is gonna twig pretty quickly whether or not they got MDMA or indeed, almost any other psychedelic, or placebo... no? In the context of psychedelic research, the usual rules about placebo control surely need to be applied differently, if not just abandoned altogether...

I agree that the double blind is a tough bar with this stuff. How do you make someone feel something that doesn't interfere with mental status but still has a subjective effect. I want to say niacin has been used in the past but I can't remember specifically.

I guess in theory you would compare efficacy of folks ONLY given therapy like CBT via a manualized intervention and then compare to folks given both therapy AND MDMA. The problem is, the therapy part hasn't really been the priority.

I think that the bigger issue is that therapy is thrown around as if it's just a given, but hasn't been part of the conversation at all, and at times has actually been bad therapy (such as the sexual assault allegations).

This article in vox has a good overview of multiple converting things during the process and how it's almost become cult like with very vague safeguards in place.

 

[Vastness]

Thanks, I'll give that a read. Yeah... I really don't know much about MAPS at all on the kinda, granular level I guess, besides their general mission, but most of the stuff I've heard about them honestly paints a sad picture of a kinda stereotypical group of washed out hippies who did too much acid (excuse the vague prohibitionist slur, I just can't think of a better way to describe the situation) and now just think that psychedelic drugs in and of themselves are the solution to everything and all the other stuff is kinda unimportant... obviously what you just said only adds to that perception.

And I am aware obviously of the motive for dishonest or skewed reporting to discredit MAPS from multiple directions but I consider myself to have enough of a sense of when something is a blatantly dishonest "hit piece" and when there are genuine concerns... and really everything I've seen about MAPS' huge missteps has actually seemed quite balanced as far as the perspective on "the drug thing", while the actual events seem very difficult to skew in a direction that isn't a pretty serious moral crime.

I could be misremembering this but I think a while back someone died and MAPS actually tried to sue the family, based on, I have no clue what sketchy reasoning but, Jesus Christ, if anything they are actually doing some harm to public perception of psychedelic research and completely failing at their primary mission. I mean, I dunno if that's too harsh, there is psychedelic research happening, on the face of it that's a good thing, but if the research is marred by sexual assaults and deaths and general massive negligence swept under the rug then that's not a good thing and it would probably be better if this research just didn't happen until it can be conducted ethically by an organization that actually has their shit together.

 

[deficiT]

Thought I would share an article from The Atlantic talking about the FDA's pushback on MDMA.

I've struggled a lot with psychedelic medicine. I'm a therapist, and I'm someone who has been profoundly impacted by mescaline and psilocybin for the better. I also don't know that I'm the right person to be guiding people through experiences, and am not sold on how psychedelics can neatly fit into the therapeutic relationship. There are numerous ways in which my role as a therapist diverges significantly from the role of curandera or shaman. Therapy has become so intertwined within the western medical paradigm that it's difficult to parse out how practitioners could/should ethically practice, and it is telling that interventions involving psychedelics still struggle to figure out how to implement psychotherapy into the admixture we're trying to create.

Frankly, at the risk of speaking out of turn, I feel like Rick Doblin and MAPS may benefit from brushing up on Ikarus a bit... head in the clouds isn't great for feet on the ground. I got a rambling email on Friday from MAPS discussing this 'devastating setback' and it was unclear to me what the setback even was, or how MAPS hoped to address this, what lessons they were learning, or how they were planning to move forward.

Do the fucking work guys, and lay off the drugs.

Interesting article. It is pretty crazy the progress we've made at this point. If there weren't these issues with the studies, I think it would have been approved. Hopefully someone picks up the slack here and puts forward a good example for these medicines to be approved. MDMA and psychedelics have been looked at for therapy for their entire existence, I think it's inevitable for them to be used for that legally.

 

[tryptakid]

Interesting article. It is pretty crazy the progress we've made at this point. If there weren't these issues with the studies, I think it would have been approved. Hopefully someone picks up the slack here and puts forward a good example for these medicines to be approved. MDMA and psychedelics have been looked at for therapy for their entire existence, I think it's inevitable for them to be used for that legally.

I tend to agree though I have some reservations about some of the way in which we approach this particular issue:

1) Inherent cult of personality/therapy cult type dynamics emerging - We've seen this with Leary, sounds like Doblin may be falling into that mindset a bit. This article from Vox does a good job of highlighting some examples of how this may be playing out with Lykos and their associated therapists.

2) Drug focus versus therapy focus - When we rolled out SSRIs in the 90s, the idea was to use stuff like prozac as a short term-stabilizing medication so that people could then focus on the work that they felt unable to approach in talk therapy. By reducing the severity of depression symptoms, we could improve talk therapy engagement and work on authentic improvements in outcomes. Over time, pharma became enamored with the huge profits that a daily, chronic, psychiatric therapy provides, and psychiatric providers enjoyed the ease of billing to manage medications like prozac/paxil etc. From the early 1990s until now, there are people who have never stopped taking SSRIs, while prior to the 1990s, no one took SSRIs.

I worry about a similar pattern developing with psychedelics. We already see people chasing enlightenment through high dose psilocybin experiences (I see this a lot on /r/psychonaut) - When drug use gets adapted into a medical treatment, it's easy to start seeing negative effects as just part of the treatment, instead of as a reason to reconsider your relationship with them. The number of people I talk with who are medical cannabis patients but don't have an actual doctor involved in their 'treatment', who can't accurately define what they're actually being treated for using cannabis, or how even their cannabis 'treatment' is helping them, troubles me. Further, side effects like anxiety/paranoia/psychotic reactions can be misattributed to other stressors unrelated to the cannabis use. I worry a lot about what happens when we open those doors on a large scale in psychedelic medicine.

3) What if these tools are actually better suited for spiritual guides rather than western medicine psychotherapists? I'm much more comfortable seeing my roll as providing psychedelic integration, separate from your psychedelic experience while also informed about it and able to help collaborate on it. The thing is, that's much less profitable to Lykos or Compass or whomever is trying to get those sweet sweet pharma bucks from otherwise unpatentable drugs like MDMA and Psilocybin. They need to patent the intervention as the drugs have existed for far too long.

My view is that decriminalization of these drugs and promotion of psychedelic integration as a skill set within existing psychotherapy training programs would be preferred and more clinically responsible. Let people make the choice to find these things on their own, come up with a plan on how to use them outside of the clinic setting, and then talk about it during their therapy sessions before and after. If something goes wrong, it's not my license that has to be on the line as there's implicit consent in you making the choice to take them outside of our work together. I'm not responsible for a car crash you have going to a concert, if we happen to have talked about the concert in therapy the week before. I would be responsible if I were the one driving the car.

Thing is, integration is no more billable than existing models like CBT, DBT or any other standard of care that we already provide. For people like Doblin and his ilk who don't provide those services, they want the glory and the bank associated with patenting these drugs.

Capitalism baby...

 

[Mjäll]

I see all the therapist talk as whitewashing and ludditism by reference to an accepted therapeutic paradigm. Psychedelics don't require an external therapist. They require a sensible user.

People feel safer if they hear that these new (well...) freaky drug medicines are at least used "under supervision". That's an expression of materialist authoritarianism.

 

[-5MeoAmt-]

stereotypical group of washed out hippies who did too much acid

To many peoples' hearts have been ruined and become a tremendous endless source of hate when they should be filled with empathy and love.

You could perhaps read this. I would not call a United States Three Star General a washed out hippie who did too much acid.

https://www.politico.com/news/2024/08/05/congress-psychedelics-ptsd-bergman-00172463

"In July, veteran advocates installed a tombstone near the Capitol. They covered it in dog tags to represent veterans who'd died by suicide. "

 

[Flynnal]

T'was never about the drugs. T'was always about controlling people. Always. Always. Always.

 

[tryptakid]

I see all the therapist talk as whitewashing and ludditism by reference to an accepted therapeutic paradigm. Psychedelics don't require an external therapist. They require a sensible user.

People feel safer if they hear that these new (well...) freaky drug medicines are at least used "under supervision". That's an expression of materialist authoritarianism.

If you want to legalize for adult use, that's different than legalize and calling 'therapy'.

If you're going to call it a therapy, it needs to meet standards of evidence and ethics that are connected to pharmacotherapy and psychotherapy.

This was the path that MAPS chose to go down - connecting it with psychotherapy.

I am in support of sensible legal adult use, but wary of medicalization of this stuff.

 

[Mjäll]

If you want to legalize for adult use, that's different than legalize and calling 'therapy'.

If you're going to call it a therapy, it needs to meet standards of evidence and ethics that are connected to pharmacotherapy and psychotherapy.

This was the path that MAPS chose to go down - connecting it with psychotherapy.

I am in support of sensible legal adult use, but wary of medicalization of this stuff.

I think we're on the same page. Legalize for adult use without passing through medical authorization.

We can call it therapy if we feel it's therapeutic. No need for a government authorization. More power to the people and organic bottom-up creation of knowledge.

 

[Jnowhere]

I tend to agree though I have some reservations about some of the way in which we approach this particular issue:

1) Inherent cult of personality/therapy cult type dynamics emerging - We've seen this with Leary, sounds like Doblin may be falling into that mindset a bit. This article from Vox does a good job of highlighting some examples of how this may be playing out with Lykos and their associated therapists.

2) Drug focus versus therapy focus - When we rolled out SSRIs in the 90s, the idea was to use stuff like prozac as a short term-stabilizing medication so that people could then focus on the work that they felt unable to approach in talk therapy. By reducing the severity of depression symptoms, we could improve talk therapy engagement and work on authentic improvements in outcomes. Over time, pharma became enamored with the huge profits that a daily, chronic, psychiatric therapy provides, and psychiatric providers enjoyed the ease of billing to manage medications like prozac/paxil etc. From the early 1990s until now, there are people who have never stopped taking SSRIs, while prior to the 1990s, no one took SSRIs.

I worry about a similar pattern developing with psychedelics. We already see people chasing enlightenment through high dose psilocybin experiences (I see this a lot on /r/psychonaut) - When drug use gets adapted into a medical treatment, it's easy to start seeing negative effects as just part of the treatment, instead of as a reason to reconsider your relationship with them. The number of people I talk with who are medical cannabis patients but don't have an actual doctor involved in their 'treatment', who can't accurately define what they're actually being treated for using cannabis, or how even their cannabis 'treatment' is helping them, troubles me. Further, side effects like anxiety/paranoia/psychotic reactions can be misattributed to other stressors unrelated to the cannabis use. I worry a lot about what happens when we open those doors on a large scale in psychedelic medicine.

3) What if these tools are actually better suited for spiritual guides rather than western medicine psychotherapists? I'm much more comfortable seeing my roll as providing psychedelic integration, separate from your psychedelic experience while also informed about it and able to help collaborate on it. The thing is, that's much less profitable to Lykos or Compass or whomever is trying to get those sweet sweet pharma bucks from otherwise unpatentable drugs like MDMA and Psilocybin. They need to patent the intervention as the drugs have existed for far too long.

My view is that decriminalization of these drugs and promotion of psychedelic integration as a skill set within existing psychotherapy training programs would be preferred and more clinically responsible. Let people make the choice to find these things on their own, come up with a plan on how to use them outside of the clinic setting, and then talk about it during their therapy sessions before and after. If something goes wrong, it's not my license that has to be on the line as there's implicit consent in you making the choice to take them outside of our work together. I'm not responsible for a car crash you have going to a concert, if we happen to have talked about the concert in therapy the week before. I would be responsible if I were the one driving the car.

Thing is, integration is no more billable than existing models like CBT, DBT or any other standard of care that we already provide. For people like Doblin and his ilk who don't provide those services, they want the glory and the bank associated with patenting these drugs.

Capitalism baby...

I can't even image what the insurance costs would be. The Lawyers would have a field day suing every shrink who used psychedelic medications.

The costs would be astronomical because doctors in so many states would get sued left and right.

Have you gone to a therapist and had a bad reaction to psychedelics; call 1-800- Sue -Them; right now for your free no obligation consultation. We get no money till you get paid.

If doctors don't prescribe opiods hardly ever, what chance does do psychedelic medicines have?

 

[deficiT]

I can't even image what the insurance costs would be. The Lawyers would have a field day suing every shrink who used psychedelic medications.

The costs would be astronomical because doctors in so many states would get sued left and right.

Have you gone to a therapist and had a bad reaction to psychedelics; call 1-800- Sue -Them; right now for your free no obligation consultation. We get no money till you get paid.

If doctors don't prescribe opiods hardly ever, what chance does do psychedelic medicines have?

Well, while there are still plenty of challenges to navigate, the thing that differentiates psychedelics from opioids, is that they are not physically or mentally addictive, and don't cause overdoses.

Idk, I think the world is making some progress on this front slowly. I mean, even when I was growing up, which wasn't all that long ago, I never expected weed to be basically legal in many states. Drugs decriminalized in some areas, can buy psychedelics in some cities, etc.

Honestly it seems like general society is a little bit further along in progress than the healthcare system even.

 

[Jnowhere]

Well, while there are still plenty of challenges to navigate, the thing that differentiates psychedelics from opioids, is that they are not physically or mentally addictive, and don't cause overdoses.

Idk, I think the world is making some progress on this front slowly. I mean, even when I was growing up, which wasn't all that long ago, I never expected weed to be basically legal in many states. Drugs decriminalized in some areas, can buy psychedelics in some cities, etc.

Honestly it seems like general society is a little bit further along in progress than the healthcare system even.

Recreational drug use; while denying pain patients opiods, is not progress.
The Healthcare system is going downhill and Insuance premiums up.

 

[tryptakid]

I can't even image what the insurance costs would be. The Lawyers would have a field day suing every shrink who used psychedelic medications.

The costs would be astronomical because doctors in so many states would get sued left and right.

Have you gone to a therapist and had a bad reaction to psychedelics; call 1-800- Sue -Them; right now for your free no obligation consultation. We get no money till you get paid.

If doctors don't prescribe opiods hardly ever, what chance does do psychedelic medicines have?

I am a fan of psychedelic integration as part of my therapy model:

You come in and discuss thinking of doing mushrooms to process your anxiety - whatever the thing may be.

We discuss the possible benefits and risks, come up with a plan for how you want to do this etc (as deeply as you feel is needed, maybe you're experienced and you don't need much lead in work, maybe you're new and want to have a good plan going in, YMMV), we agree upon some goals/intentions/perspectives you want to keep in your mind during your experience.

You go do your thing on your own time with whomever you want to do it, wherever you want to do it. Want to do it alone/with friends/with your partner? Want to do it at home/on a trip somewhere out of town/indoors/outside - all your call.

You come back in after your experience for a visit and we discuss the experience, anything that may have come up, any insights you may have had. Explore how this fits into our established treatment goals/plan. We use it as just another life experience to inform the overall therapeutic work we're doing - but it's not the focus of our work nor is it a necessary component of our work. You could come in and discuss past trips without embarking on any new psychedelic experiences during our work together - we can still discuss those experiences and how they've impacted you.

That's my preferred model at this point in time - always open to changing it. At one point, I wanted to be a psychedelic guide, but as things began to happen and I really considered what that might look like/saw the motivation behind some people who were involved in this/considered the ways in which some plant medicines are being sanitized in a western medical model and stripping them of their traditional spiritual use, at the expense of traditional practitioners, I started to become wary.

 

[deficiT]

Recreational drug use; while denying pain patients opiods, is not progress.
The Healthcare system is going downhill and Insuance premiums up.

Sure it is. And it's not just recreational, cannabis and psychedelics have plenty of medical uses.

Yeah, the opioid situation is worse than it was 25 years ago. I won't argue that. But plenty of other things have improved.

 

[deficiT]

I am a fan of psychedelic integration as part of my therapy model:

You come in and discuss thinking of doing mushrooms to process your anxiety - whatever the thing may be.

We discuss the possible benefits and risks, come up with a plan for how you want to do this etc (as deeply as you feel is needed, maybe you're experienced and you don't need much lead in work, maybe you're new and want to have a good plan going in, YMMV), we agree upon some goals/intentions/perspectives you want to keep in your mind during your experience.

You go do your thing on your own time with whomever you want to do it, wherever you want to do it. Want to do it alone/with friends/with your partner? Want to do it at home/on a trip somewhere out of town/indoors/outside - all your call.

You come back in after your experience for a visit and we discuss the experience, anything that may have come up, any insights you may have had. Explore how this fits into our established treatment goals/plan. We use it as just another life experience to inform the overall therapeutic work we're doing - but it's not the focus of our work nor is it a necessary component of our work. You could come in and discuss past trips without embarking on any new psychedelic experiences during our work together - we can still discuss those experiences and how they've impacted you.

That's my preferred model at this point in time - always open to changing it. At one point, I wanted to be a psychedelic guide, but as things began to happen and I really considered what that might look like/saw the motivation behind some people who were involved in this/considered the ways in which some plant medicines are being sanitized in a western medical model and stripping them of their traditional spiritual use, at the expense of traditional practitioners, I started to become wary.

All of this makes good sense. I think that'd be the best way to integrate psychedelics with therapy.

Tripping with a medical provider, seems a bit, much.

 

[-5MeoAmt-]

Send them to jail, so you all are saying that psychedelic users seeking lifesaving medicine should be criminals and incarcerated?

Personally I think legal regulation and implementation by accredited practitioners (doctors) works best. If we take away the framework for medical research and legal regulation, the the de-facto result is criminalization of folks (veterans included) seeking life saving treatment for PTSD.

Then we are back at the economically and racially prejudiced American mass incarceration program.

I think the policies of Barack Obama and Eric Holder were wiser. Barry also had good taste in music. (-;

 

[Pissed_and_messed]

People feel safer if they hear that these new (well...) freaky drug medicines are at least used "under supervision". That's an expression of materialist authoritarianism.

yea, this is one of the most concerning possible futures... legalizing psychs... under supervision.

 

[specialrelativity]

maps...schmaps.