Those of us who are professional counselors are probably most likely to recognize psychedelics by their leisure or street names – acid, magic mushrooms, ecstasy – and view them as drugs of abuse that can be dangerous to our clients. This is, in fact, the narrative that has been passed since the Controlled Substances Act (CSA) of 1970. All psychedelics have been classified as Appendix I, indicating that they have a high potential for abuse, have no intended medical use, and are very dangerous.
It is sometimes surprising how the public's perception changes and how quickly knowledge can be forgotten. Before the CSA, psychedelics were of great interest to many psychiatrists and psychologists. These professionals were curious about the ability of psychedelics to help substance abuse patients and gain spiritual experience. Dozens of research studies involving thousands of patients were completed prior to 1970 with LSD and psilocybin with promising results, in direct contradiction to their Schedule I designation.
In view of these research studies, it is more likely that the planning status of psychedelics is related to their use outside of medical contexts, especially given their association with the counterculture and anti-war movements that the sociopolitical forces of the time perceived as threatening. Over the decades, public perception also changed and the discussion of psychedelic research in academia became taboo, although researchers were familiar with its potential interest.
Potential and use in treatment
Finally, psychedelic research began again in the early 2000s to investigate the safety and use of psychedelics in substance use and mental health treatment. Psychedelics currently being researched or used for treatment include MDMA (also known as molly), LSD, psilocybin (the active ingredient in magic mushrooms), ibogaine (a compound found in iboga root), and ayahuasca (a brew of numerous psychoactive ingredients ) Plants that contain DMT). The results have shown that all of these drugs show promise in treating a variety of conditions, including post-traumatic stress disorder (PTSD). Fear of the end of life; social anxiety in adults with autism; Depression; Obsessive-compulsive disorder; and alcohol, opiate, nicotine, and poly-substance use disorders. Psychedelics are also being evaluated for the treatment of Alzheimer's and other neurodegenerative diseases because of their obvious neuroprotective factors and their ability to improve neuroplasticity. Outside of their use as a treatment in clinical populations, psychedelics have been found to improve self-acceptance, increase openness, and improve social relationships. Their recreational use has even been linked to decreased incarceration and suicide over the past year.
Psychedelically assisted counseling in treatment-oriented settings typically consists of a few preparatory sessions with two counselors (mostly a man and a woman). These sessions are more like traditional counseling sessions. During the preparatory sessions, rapport is built, skills imparted, and intentions and expectations for the psychedelic session are reviewed.
The counselor couple then supports the client throughout the drug administration session, which lasts between six and eight hours. The client is provided with visors, headphones and specially selected music from the counselors who, through their presence, provide assistance and instruct the client to follow their own internal experiences as the medication progresses. These counselors later meet with the client for shorter integration sessions that begin the day after the drug is administered and then take place weekly for a few weeks before treatment is complete.
Time and again, research has shown that these drugs are safe and viable treatment options that deserve considerable attention from psychologists. In fact, the potential of psychedelics to treat mental health and substance use disorders has led to two drugs, psilocybin and MDMA, being rated "breakthroughs" by the Food and Drug Administration for treatment-resistant depression and PTSD, with full approval being estimated at some point occur in the next two years.
Implications and challenges for the profession
This research has attracted public attention and has been featured in shows such as 60 Minutes and Michael Pollan's 2018 New York Times bestseller How to Change Your Mind. Pollan has since hosted a special event discussing his book and the future of psychedelics at the American Psychological Association Convention in 2019. The counseling profession, however, has been seriously silent on this issue, as no university counseling program has conducted research using psychedelics. Instead, psychedelic research takes place primarily in the areas of psychiatry and pharmacology, although counselors and other master-level psychiatrists actually help prepare, facilitate, and integrate the psychedelic experience in treatment-oriented settings.
As research in these areas continues, psilocybin mushrooms have been decriminalized or legalized to varying degrees in the California cities of Santa Cruz and Oakland, Denver, and the state of New Mexico. In addition, they can be incorporated into the state mental health infrastructure in Oregon as part of a 2020 election initiative (see voteyeson109.org). It is easy to see that what has come to be known as the “psychedelic renaissance” is happening at breakneck speed without the voice or values of the consulting profession being heard and integrated. This is a challenge as the consulting profession is affected and affected by these developments, regardless of whether we choose to participate.
First and foremost, results-oriented research has failed to take into account the characteristics and competencies of counselors who will provide psychedelic assisted counseling. This poses a serious risk to clients as practitioners who inappropriately use psychedelic assisted counseling are far more likely to suffer harm than from the drug itself, as extremely vulnerable conditions arise while clients are under the influence of clients.
This position is supported by the fact that the use of certain psychedelics such as ayahuasca and mescaline is legal in the context of religious practices. Some individuals have taken advantage of this reality by promoting these psychedelics as treatments or spiritual sacraments, resulting in underground networks of neo-shamans or leaders whose qualifications in treating mental health and substance use disorders may be questionable or non-existent. For example, consider Steve Hupp's Aya Quest Retreat Center as featured on the VICE TV show Kentucky Ayahuasca, in which Hupp uses ayahuasca to treat opiate use, eating disorders, depression, and other problems.
As psilocybin, MDMA and other psychedelics gain broader approval, skills, regulations and professional infrastructure will need to be developed to distinguish and delimit their use as treatment from their use as sacraments. As necessary as these steps are, such a process is inherently difficult because of the apparent relationship between psychedelic use and spirituality. Participants in studies using psychedelics have reported improved spirituality, morality, and mindfulness. They often describe the experience as profoundly influential in their lives and on par with other formative experiences such as witnessing the birth of their children.
It is clear that counselors involved in psychedelic assisted counseling need to be able to work with clients to process such intense experiences. This requires different skills and perspectives, which may differ greatly from our traditional toolbox of approaches such as cognitive behavioral therapy or solution-oriented short therapy. Determining whether these skills can best be developed through personal experience with psychedelics will also be challenging, although many current and previous researchers have suggested that experience is beneficial.
The role and historical stigma of "mystical" experiences
In clinical research, the degree to which the participants have a “complete” mystical experience was positively correlated with the treatment results. Mystical experiences often include "nondual" states in which people experience a sense of unity between their outer and inner world and feel that they have experienced "the infinite" or "ultimate reality". Individuals may believe that their experience has exceeded time and space and they may feel a deep sense of peace, ecstasy, or awe. Perhaps the most common feature of mystical experiences is that language cannot adequately capture them. Describing the experience means applying some form of "violence" to it.
It is important to note that psychedelics have been used in indigenous cultures around the world for thousands of years to gain access to such states of consciousness. However, similar experiences have also been prominently described in many major religions, including Christianity, Judaism, Islam, Hinduism. Taoism and Buddhism. Within these religions, such experiences are accessed through the development of spiritual practices, increased devotion, or sometimes spontaneously.
Although the subjective experience of spontaneous, practiced or psychedelically conditioned mystical experiences may appear similar, many may argue that the latter are not valid, that they are “only” drug experiences. These claims are in stark contrast to user reports of mystical experiences and the enduring effects attributed to them. A recent study found that mystical experiences with psychedelic occasions are more intense and useful than those occurring in other ways.
Such a dismissal of mystical experiences with psychedelic occasions may be due to a centuries-old stigma that began when the conquistadors used indigenous practices underground using psilocybin mushrooms (known to the Mazatec people as "the flesh of God") enforced is blasphemous towards Christianity. After the conquistadors suppressed the use of psilocybin mushrooms, psychedelics remained in Western culture until their rediscovery in the 1940s and 1950s with the synthesis of LSD and the publication of an article entitled "Seeking the Magic Mushroom" in Life Magazine to forget. Psychedelics were then briefly the focus of medicine and counterculture before being repressed by the authorities again because of concerns about their impact on society. Groups like the Native American Church and Santo Daime, who used these plants for religious purposes, were then forced to argue before the Supreme Court that the ban on certain plants and drugs affected their freedom of religion. Exceptions were granted to these groups to allow their use in religious contexts.
Final thoughts
Given the obvious relationship between psychedelics and spirituality, we need to take stock of how we want to use these tools and what skills are required to do so. We also need to consider carefully who these tools are for or to whom they belong. As a profession, we work according to a wellness model and have a duty to promote both the safety of our customers and social justice. Psychedelic assisted counseling poses an extremely complex problem regarding these three aspects of our profession, as psychedelics can be beneficial to non-clinical populations, are closely related to certain religious practices that have been suppressed in the past, and pose a risk to the safety of the Clients present both a medical and a practical point of view.
Analysis of each of these problems in relation to psychedelics and the counseling profession must be done intentionally and preventively in order to develop psychedelic assisted counseling in a safe, ethical and equitable manner. Such an endeavor takes time, expertise, care, and critical thinking – which we haven't started yet. Regardless, psychedelics will return to counseling in the near future and we have to ask, "Are we ready?" If not, the profession could be forced to respond rather than plan and follow rather than lead in the exciting but high-profile “psychedelic renaissance”.
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Benjamin Hearn is a PhD student at the University of Cincinnati, where he is developing approaches for the counseling profession to use psychedelic-assisted therapies for mental health and substance use disorders. He is also interested in the integration of spirituality into counseling and is an active member of the Association for Spiritual, Ethical and Religious Values in Counseling. He has practiced in a variety of settings including school-based mental health, private practice, and wilderness therapy. Contact him at [email protected].
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