The influence of therapists’ first-hand experience with psychedelics on psychedelic-assisted psychotherapy research and therapist training
ELIZABETH M. NIELSON and JEFFREY GUSS
Journal of Psychedelic Studies, 2018
Clinical research on psychedelic-assisted psychotherapy is rapidly advancing in the USA, with two drugs, psilocybin and MDMA, progressing through a structure of FDA-approved trials on a trajectory toward Drug Enforcement Agency rescheduling for therapeutic use. Researcher’s and clinician’s personal use of psychedelics was cited as a potential confound in psychedelic research studies conducted in the 1950s and 1960s, a concern which contributed to the cessation of this research for some 20 years. Currently, there is no empirical research on personal use of psychedelics by current academic researchers and clinicians; its influence is undocumented, unknown, and undertheorized. This paper explores the history of personal use of psychedelics by clinicians and researchers, the potential impact of personal use on psychedelic-assisted psychotherapy and research, and the rationale for opening an academic discussion and program of research to investigate the role of personal use. We propose that there are factors unique to psychedelic-assisted therapy such that training for it cannot neatly fit into the framework of modern psychopharmacology training, nor be fully analogous to psychotherapy training in contemporary psychological and psychiatric settings. We argue that scientific exploration of the influence of therapists’ first-hand experience of psychedelics on psychedelic-assisted therapy outcomes is feasible, timely, and necessary for the future of clinical research.
Keywords : psychedelic therapists, psychotherapy training, psilocybin, MDMA, LSD, ethics
Self-experimentation with psychedelic compounds by researchers and therapists played an important and largely undocumented role in the psychedelic therapy and research of the European and North American psychiatric mainstream from the 1950s through the early 1970s. Often cited by researchers as the very source of inspiration to study psychedelics in the first place, there was a substantial concern that the first-hand experience had contaminated the objectivity of the researchers (Mangini, 1998). Academically sanctioned research and clinical work with psychedelics, sometimes referred to as above ground work, were disrupted by increasingly restrictive laws that emerged in the mid-1960s and culminated in the passage of the Controlled Substances Act of 1970. These laws were created in response to the warning regarding the use of psychedelics in recreational and non-medical settings and criminalized use of psychedelics outside of sanctioned research settings and placed stringent restrictions on their use in sanctioned research settings. Although research on psychedelic-assisted psychotherapy was technically still legal and possible, a second trend toward increasing focus on double-blind trial design, for which psychedelicassisted therapy was a poor fit, coincided with the changing drug laws such that the research was effectively stopped for some 20 years (Oram, 2012). The influence and centrality of psychedelic therapists’ and researchers’ personal experience with psychedelics was a controversial point and consensus on the topic was not reached.
Sanctioned research on the effects of psychedelics in humans was reinitiated in 1990 by Strassman (2001), who studied the effects of intravenous dimethyltryptamine (DMT) on healthy volunteers at the University of New Mexico. Numerous FDA approved clinical trials followed and we are now 25 years into the second wave of academic psychedelic research; however, the influence of first-hand experience with psychedelics on those who conduct clinical research and therapy with them remains underexplored and undertheorized. With this paper, we seek to open an academic dialogue on the role of researchers’ and clinicians’ personal experience with psychedelic compounds (be it as part of a training program, religious/shamanic ceremony, alone, or with a peer group) by asking what may be the impact of this experience on therapeutic outcomes. We propose that this should now be an askable and researchable question, and as such it should be moved from theoretical debate to a subject of formal inquiry. We will explore the history of personal use of psychedelics by researchers and psychotherapists who work with these compounds and then focus on the role of personal experience in therapist preparation and training among contemporary therapist training programs. The parallels and divergences from psychoanalytic training and mindfulness-based interventions will be a part of our discussion.
BACKGROUND: WHAT IS PSYCHEDELIC-ASSISTED PSYCHOTHERAPY?
Following the discovery of the psychoactive effects of lysergic acid diethylamide (LSD) by Albert Hofmann in 1943, the compound was made available by Sandoz Pharmaceuticals to researchers with two explicit indications: to “elicit release of repressed material and provide mental relaxation” in psychotherapy and for psychiatrists to take in order to “gain an insight into the world of ideas and sensations of mental patients” (Hofmann, 2005, p. 73). Clinicians also obtained LSD and used it in psychotherapy and alcoholism treatment outside of research settings, a practice that was legal in the
USA until the mid-1960s (Abramson, 1976). When the above-ground clinical and research work came to a halt, therapeutic work and research with psychedelic compounds did not end, instead it continued outside of mainstream institutions and without government approval or oversight (Nickles, 2015; Sessa & Fischer, 2016). A full discussion of this underground work is outside our present inquiry, but we do not dismiss the relevance of these endeavors in any way.