Is first-person experience with psychedelic drugs a prerequisite for providing effective psychedelic care?
As I sit down to write my first blog post for Psychedelic Medical News, I can’t help but reflect on what’s been a momentous week in the world of psychedelic health care.
Earlier this week, MAPS Public Benefit Corp. filed a new-drug application with the Food and Drug Administration for MDMA in conjunction with psychotherapy. If the application gets the green light from federal regulators, it would be the first psychedelic-assisted therapy approved for the treatment of individuals with post-traumatic stress disorder.
Coincidentally, Rick Doblin, founder and president of MAPS (the Multidisciplinary Association for Psychedelic Studies), was a featured speaker in a webinar called “MDMA-Assisted Therapy and Education – Past, Present and Future” – just a day after MAPS PBC announced the filing of its new-drug application. The webinar was hosted by Fluence, a provider of continuing education in psychedelic integration and psychedelic-assisted therapy.
Doblin is a bit of a rock star in the study of psychedelics – a throwback to iconic figures such as Timothy Leary. In fact, Doblin conducted a follow-up study to Leary’s infamous Concord Prison Experiment. Published two years after Leary passed away, Doblin’s findings echoed “the emphasis in the original reports on the necessity of embedding psilocybin-assisted psychotherapy with inmates within a comprehensive treatment plan that includes post-release, nondrug group support programs.”
Doblin’s conclusion has aged well since the report was published in 1998, just as Doblin – who recently turned 70 – seems to be aging well himself.
As Doblin noted during the Fluence webinar, research shows that psychotherapy outcomes and the “therapeutic alliance” are inextricably linked. Given the highly experiential nature of psychedelic treatment, the practitioner’s role in facilitating psychedelic healing takes on heightened significance and deeper meaning.
In Leary’s Concord Prison Experiment, the researchers took psilocybin alongside the prisoners to break down barriers between the study administrators and the subjects. With MDMA moving closer to approval – the culmination, hopefully, of a 37-and-a-half-year journey for Doblin and MAPS – a key challenge for federal regulators is the fact they’re evaluating a drug and psychotherapy in tandem. That’s uncharted territory for the FDA.
Considering the magnified role of the psychedelic therapist in delivering successful outcomes, the notion of “therapist self-experience” could be a tricky one for regulators to navigate as they weigh the merits of MDMA and other psychedelic treatments. Is first-person experience with psychedelic drugs a prerequisite for providing effective and compassionate psychedelic care? If so, Doblin wondered out loud, how will the FDA create a “legal context” for licensed therapists to obtain that firsthand experience?
“Whether the FDA will find any way to do that – that’s the big challenge,” he added.
A Complex Ethical Question
Nathan Emmerich and Bryce Humphries delve into this topic in the Cambridge Quarterly of Healthcare Ethics. Their article – “Is the Requirement for First-Person Experience of Psychedelic Drugs a Justified Component of a Psychedelic Therapist’s Training?” – tackles a complex ethical question that’s undoubtedly a source of debate in online discussion groups throughout the psychedelic-care community.
After reading the article, I can see how someone on either side of the argument could make their case.
Viewed through the lens of traditional Western medicine and psychotherapy, it might seem easy to dismiss the thought of requiring therapists to have firsthand experience with the drugs they’re administering.
“There has never been any serious suggestion that therapists who prescribe antidepressants or other psychoactive medications ought to have first-hand experience of such drugs,” Emmerich and Humphries explain, “and although the value of first-hand experience is sometimes recognized … the consumption of any therapeutic medication in the absence of any direct clinical indication for doing so arguably conflicts with ‘the institutional logic of psychiatry.’”
However, the authors also note that many therapists are required to participate in therapy as part of their training, and health care professionals typically are required to stay current on their vaccinations “to engage in clinical practice.” So, “the notion that trainees might be required to undergo a drug-induced psychedelic experience is not entirely without precedent.”
While the examples noted above might suggest that requiring trainee therapists to have their own psychedelic experiences is justifiable, the authors also assert that requiring trainees “to engage with a practice that directly impacts one’s psyche” and ingest a psychoactive substance constitute “an unusual demand for almost all kinds of training programs.”
“Nevertheless, one might note that training to be a sommelier requires ingesting (or, at least, tasting) wine,” Emmerich and Humphries counter. “However, if one chooses to train as a Master of Wine, one is choosing to develop an expertise in tasting wine. Whether a similar thing can be said of training to be a psychedelic therapist is far from clear, meaning that requiring trainees to undergo a drug-induced psychedelic experience may not be justifiable.”
Then there’s the question of what patients might prefer.
Some patients might take comfort in the fact that their therapist has firsthand experience with the effects and benefits of psychedelics, “whereas others might consider it to be a prerequisite for any therapist they might consider working with.”
“Equally, other patients might think that those who would experience psychedelics without clear clinical justification for doing so are entirely unsuited to the role of therapist and may refuse to work with such individuals,” Emmerich and Humphries theorize.
On such a complex issue, I’m inclined to defer to the likes of Doblin, who has been immersed in the study of psychedelics for decades. During the Fluence webinar, Doblin asserted that the most important tool for aspiring or practicing psychotherapists “is yourself.”
“And the most important thing you could do is to have your own psychedelic psychotherapy experiences with not just MDMA, but a range of different drugs in a supportive therapeutic context, if you can arrange that,” he added. “That’s the single most important thing that will help you refine your own instrument.”