What is Psychedelic-Assisted Psychotherapy (PAP)?
Psychedelic-assisted psychotherapy (PAP) is a form of psychotherapy that involves the use of psychedelic substances such as psilocybin, MDMA, and ketamine for the purpose of facilitating therapeutic breakthroughs and insight for clients.
It is a broad term that encompasses a number of different approaches and protocols using psychedelics, and which has been practiced in the Western medical model since the 1950s. Though psychedelics like LSD showed promise for therapy in those years, they became prohibited beginning in the 1960s until very recently. Similar to the medical marijuana movement, an opening up at state levels has begun as the therapeutic benefits have begun to be demonstrated again through various studies.
Compelling research with psychedelics demonstrates promising benefits for improving mental health and spiritual well-being across a variety of clinical populations as well as those seeking personal growth.
The stages of this evidenced-based treatment paradigm are an intake screening and assessment, a series of preparation sessions, one or more psychedelic medication sessions (where psychedelic drugs are taken), and a follow-up series of integration sessions after the psychedelic experience. In many trials, the preparation, medication, and integration series is repeated multiple times over the course of treatment.
The last decade has seen a significant body of encouraging research supporting the efficacy of this work for a number of mental health issues, especially depression, anxiety, addiction, and PTSD. Psychedelics are still regulated substances but the legal and medical landscape has been rapidly evolving, and more treatment options are starting to become available.
Ketamine is currently approved for off-label use by qualified clinicians working with an authorized prescriber, such as a primary care physician, a prescribing nurse, or a psychiatrist. It is the only form of psychedelic-assisted psychotherapy that therapists can legally participate in at this time as ketamine-assisted psychotherapy (KAP). This work includes preparation sessions before a ketamine session, with the setting of intention and clarification of what you hope to gain or experience with the use of ketamine. It also includes integration work following ketamine sessions to fold the experiences and realizations of the session back into day-to-day life. Unlike other psychedelics, there is the potential for legal ketamine-assisted psychotherapy where the therapist is present during the session.
Psilocybin, which is the component of "magic mushrooms," has shown results for the treatment of depression, end-of-life anxiety, addiction, and other mental health conditions and there are legalization efforts underway in Oregon, California, Colorado, Washington, and many other states. Depending on legislative changes, there may soon be a pathway to lawfully engage in psilocybin therapy with qualified clients. Until this time, the only legal avenues for therapeutic support is the preparation work before sessions and the integration work after them where a client self-administers psilocybin that they have acquired on their own without the involvement of a therapist.
While it is not the role of a therapist to directly participate in illegal activities, it is recognized that people will make their own decisions of what is best in their lives. It is the role of a therapist to support individuals in the decisions that they make for themselves and in harm reduction to reduce the potential for dangerous outcomes of independent decisions.
A Holistic Approach and Integration
My approach to working with clients around psychedelics is rooted in a fundamentally holistic approach that centers on the whole person and on harm reduction. It is informed by a deep compassion for the struggles that all people go through in their lives but also a willingness to support clients in the life decisions they choose to make as autonomous individuals.
My specific therapeutic practices use a combination of the person-centered (or humanistic) approach combined with mindfulness and Internal Family Systems (IFS). IFS has been very successful in helping people with psychedelics, as Richard Schwartz and Bob Grant discuss in the video below.
A holistic model of care takes into account the whole person: physical, mental, emotional, spiritual, and social well-being. Holistic care often depends on a practitioner’s intuition and understanding of their client’s full health picture, taking into consideration family history, developmental events during their lifetime, and any trauma that they may have experienced. According to the MAPS Manual for MDMA-Assisted Psychotherapy in the Treatment of PTSD, psychedelic-assisted therapy practices should operate on an "inner healer directive" in which "It is essential to encourage the participant to trust their inner healing intelligence, which is a person’s innate capacity to heal the wounds of trauma. It is important to highlight the fact that the participant is the source of their own healing."
This suggested approach to psychedelic therapy hinges on the intuition of the therapist and their understanding of their client as a whole person. The therapist discerns when to intervene and how to allow the person’s "innate capacity" to heal themselves.
One of the most critical pieces of a holistic psychedelic-therapy journey includes an integration protocol, so that people can apply what they have learned from their psychedelic experience into their daily lives. According to Dr. Ingmar Gorman, "Individuals who have had difficult experiences can benefit from a better understanding of the often-challenging feelings stirred up by psychedelics; while those who have found the use of psychedelics to be a positive method of gaining insight can use supportive therapy to bolster and integrate that knowledge into their daily lives."
Ultimately the power of a holistic approach to psychedelic medicine is that it seeks to both understand the person as a complex and multi-layered being, and simultaneously unveil the systemic causes of imbalance. Once root causes come to light, practitioners can address them according to their expertise, training, and intuition.