Psychedelic Psychotherapy: Building Wholeness Through Connection

Abstract

Background

We are confronted with dire statistics that document our current mental health crisis. New treatment modalities are desperately needed to address escalating mental suffering and trauma. Psychedelic medicines are attracting increased attention in psychiatry as effective treatment for a range of conditions. The mechanisms of actions and context necessary to maximize their full healing potential represent a radical departure from current psychiatric frameworks and present an opportunity to reimagine psychiatry as a healing art.

Objective

Psychedelic psychotherapy leverages biological, psychological, and spiritual domains to harness innate healing potentials. A novel psychotherapeutic methodology utilizing psychedelic medicines as catalyzing agents is presented, one that provides a developmental model to promotes self-actualization. The paper outlines transformational psychotherapy, the therapeutic process and corresponding practice implications.

Conclusion

Psychedelic psychotherapy represents a paradigm shift in healing, one that promotes self-integration and whole health. These shifts in internal health are correspondingly reflected in enhanced empathy, improved relatedness, and increased capacity for social connection. Much of human suffering and disregard for the planet is a reflection of our own collective inner impoverishment, fundamental disconnects, and unaddressed trauma. Psychedelic psychotherapy offers a healing approach to restore beauty and health to both the inner and outer worlds we inhabit.

Background

We are confronted with dire statistics that document our current mental health crisis. Approximately one in five adults in the United States have been diagnosed with a mental disorder, a quarter of which are deemed serious mental illness. Suicide rates are escalating at an unprecedented rate over the past decade: suicide is now the 10th leading cause of death in the US, and the second among young adults. Data regarding escalating substance abuse is equally disturbing. However, these sobering statistics reflect pre-Covid pandemic prevalences and do not adequately reflect the true scope of our current climate.

New treatment approaches are required to address the escalation of mental suffering. Indeed, novel frameworks to re-conceptualize the underpinnings of mental distress and concomitant treatment approaches are essential. Simplistic symptom assessments as diagnostic tools and biologically based medication adjustment are inadequate and have largely failed to address the more complex, whole person internal and external societal breakdowns that result in a feedback loop of disintegration, loneliness, hopelessness, and existential despair.

Novel uses of psychedelic medicines are attracting increased attention in psychiatry as effective treatment for a range of psychiatric conditions ranging from treatment resistant depression, major depression, PTSD, anxiety related to terminal illness, and a variety of addictions.^{1,2,3,4,5,6,7} Receptor level activity, enhanced neuroplasticity and connectivity support a trans-diagnostic mechanism of action and treatment approach ^{8, 9, 10, 11} while corresponding changes in subjective experience, emotional processing, intersubjectivity and social cognition appear to contribute to the therapeutic efficacy.^12,13 Wellness and healthful measures such as enhanced compassion, empathy, social connectedness, and nature relatedness are sustained following psychedelic sessions ^14,15,16 and hold the advantage of encompassing community and ecological health. The manner in which these medicines work and the context necessary to maximize their full healing potential represent a radical departure from current psychiatric frameworks and present an opportunity to reimagine psychiatry as a healing art. New approaches provide an opportunity to draw on traditional knowledge, methods, and cultural practices that have deployed these sacred medicines in healing practices for millennia.

Psychedelics as Healing Agents

Psychedelic therapeutic sessions provide an opportunity for the subject and therapist to process emotional experience together and through this process, a field reminiscent of the early regulation field of the infant/parent dyad is evoked, offering a unique environment for emotional regulation repair and self-soothing development. ¹⁷ The working through and processing of trauma blocks allows for effective reconnection with disavowed aspects of the self and attachment repair that contributes to integrity and resilience

Fundamental to this treatment approach is the belief that we are all intrinsically perfect and dis-ease and distress are secondary to being out of an alignment or balance. Being perfect in this context simply means that all adjustments and distortions that have resulted in the current imbalance have a history and function that attempted to serve us, but at a cost to the overall integrity and potential of the whole. An analogy might be a plant that has been stunted in growth, or twisted in appearance in order to survive and adapt to a sub-optimal environment, an effort that certainly permitted survival and growth during the original adversity, but at a cost to thriving into its fullest, innate potential.

An associated tenet is the concept of inner healing intelligence—a principle of directed living systems to perpetually re-establish equilibrium, to restore and recover towards wholeness and wellbeing. To activate this innate capacity, one must remove the obstacles that inhibit healing, and adequate conditions for recovery, healing, and growth need to be created. Consider human ontogenesis as a model: at birth every infant contains the blueprint and potential for development and growth but the unfolding process depends heavily on the provision of an adequate environment for full developmental progression and mental, emotional, physical, and spiritual thriving. The inference is that as coupled living systems we innately possess the ability to both heal ourselves and each other. We require the balance of both individual and interdependent systems to obtain wholeness and contribute to collective health.

Psychedelic healing practice allows for an exploration of one’s self sculpture and represents a unique way of discovering through direct experience. Each individual is a dynamic composition of various identities (self-states), creative expressions, protective systems, fears, memories, and sensations. During a medicine journey conducted within a field of safety and support, an individual discovers how to navigate a psychedelic experience for exploration. This creates a remarkable space in which to discover all the components of self. Similar to psychoanalysis, where the removal of obstacles towards free association provides both the methodology and healing process, experiential awareness of the self-sculpture allows for acquisition of knowledge and correction simultaneously. Various self-components that have become exaggerated are softened, this leads to correction of imbalanced protective systems. Trauma blocks and interferences come to be released which in turn permit correction and repair. Access to the knowledge and wisdom held in the mind and body foster enrichment, development, and growth.

The invocation of a spiritual dimension has become a loaded term, especially within medical circles where it is routinely relegated to religious and new age discourse.

Spirituality is defined in the following way by the Oxford English Dictionary:

An animating or vital principle; the immaterial or sentient element of a person; that which gives life to a body, in contrast to its purely material being: the life force, the breath of life. This irreducible component of human experience can offer unexpected access to restorative and transformational repair.

Meditation practices have long been demonstrated to provide a valuable tool for healing, wellness and for a multitude of physical and mental conditions ^18,19,20,21 In analogous ways, guided psychedelic experiences allow for expanded access, discovery and presence that is often received by the subject with awe and deep gratitude. At higher doses, the experience of an awareness beyond the margins of self, so called “ego dissolution” states, are encountered. Such experiences of oneness are highly valued ²² and have been associated with significant improvements on symptom rating scales of mental distress as well as enhancement across many wellness parameters. ²³ Primary in these improvements is the connection to self-essence and to unity fields beyond self-margins that are firmly spiritual in nature and are generally characterized as mystical experience. ²⁴ A welcome aspect of this healing modality is the return of the spiritual component of human experience to medicine as an important ingredient necessary for the cultivation of health.

Psychedelic Psychotherapy, the therapeutic relationship

As a field Psychiatry has been described as a profession that swings like a pendulum between “psychological” and “biological” theories and therapies. The biological emphasis over the past several decades, narrowly focused on diagnosis and biological treatment regimes has been disappointing and has not yielded the hoped for results. Psychedelic psychotherapy provides a notably interesting and useful integration of psychological and biological perspectives. Psychedelic medicine impact neural systems, brain plasticity and potentiates learning. The brain is therefore primed and receptive for psychotherapy to be especially impactful and potent . ⁸

Drawing on knowledge from traditional psychoanalytic theory, meditation practices, intersubjective relational work as well as certain indigenous healing practices, a novel psychotherapeutic methodology able to complement and leverage this healing environment becomes possible. Under the psychedelic influence previously inaccessible psychological developmental fixations and corresponding compensations are renegotiable. The methodology permits foundational identity deficit repair—an appreciation and revision of core ideas and narratives that underlie and inform identity and self-esteem. In addition, accelerated defense system work, trauma metabolism, regulation repair, and new capacity emergence arrives along with growth possibilities alters and advances the existing dominant psychiatric treatment paradigm from a system that revolves around psychopathology and symptom management to one of health building, resilience, and deep healing.

Transformational Healing

Transformation is defined as a thorough or dramatic change in form or appearance. The psychotherapeutic process inspired by psychedelic psychotherapy warrants such a dramatic verb since the change involves a foundational reorganization of psychological structures and capacities that have been arrested or interfered with in early survival. The process promotes the release of protective strategies to assemble active psychological frameworks for connection, coherence, creative expression, and growth.

Given every subject’s unique endowment, background and history-- the components that coalesce to form an individual—no treatment or psychotherapy is similar to another and each needs to be tailored to the individual, be it frequency of sessions, dose requirements, preparation and integration details.

Psychotherapy process overview

• 1. The process allows for a corrective relational experience. By creating an environment of emotional safety, release from defensive protective systems occurs allowing for simultaneous healing, correction, and growth.

• 2. Learning about the self-sculpture through experience. This includes focus on foundational identity, the narratives that form identity, introjects or parts of the self, mechanisms that have been relied on to cope, protect, and navigate experience.

• 3. As new creative capacities and new potentials become available so called “emergent phenomena” can be observed and fostered.

• 4. The therapist provides functions to promote the unfolding process.

Therapist Functions

To see and reflect the patient accurately; to bring awareness to inaccurate ideas or self-narratives

Through the vicissitudes of life a core sense of self develops from childhood and endures. Through dynamic processes of mirroring, being witnessed and reflected through the eyes of surrounding caregivers and family, the kernels of identity are formed. ²⁵ Early childhood experiences of being seen, mis-seen, projected into and ignored form and influence core impressions about the self that continue to be reinforced through life and prove highly stable and resistant to change. During psychedelic sessions the threads that weave together identity become discernible. Different parts of self, reflective of various developmental stages, often become accessible so that through the therapeutic process more accurate identity updates, consolidation and integration become possible.

To feel and process emotional experience along with, or for, the patient

The processing of emotional experience is an achievement. Infants are dysregulated and rely entirely on a caregiver’s nervous systems to regulate their own and together they operate as a dyadic pair. As the maturation process unfolds, an infant develops self-regulatory capacities and learns to process experience. A caregiver’s capacity to contain, process, and metabolize experience is central to the infants subsequent ability to develop emotional self-regulation and self-soothing capacities. ²⁶ Deficits in maternal functions historically would be compensated for by extended family and members of the community but as nuclear families became increasingly common, with diminished community participation and social supports there came to be less redundancy and corrective influence available in the system. ²⁷ Maternal capacity deficits are transmitted to infants with limited corrective influence resulting in failures that require infants to adopt primitive coping strategies of disconnection to numb painful dysregulation states. Various infant maternal attachment difficulties that contribute to subsequent relationship problems are seen as a consequence of early primitive coping defenses, internal disconnects, and fragility.

To accompany the journey as a companion, without interference

The therapist offers themself as a companion to provide safety, support, and presence on the patient’s journey. The therapist listens deeply and intuitively to the unfolding process and supports the unfolding process while serving as a witness, guide and model, displaying an attitude of curiosity, mindfulness, and compassion.

To identify organization maps that shape and color life experience

Experience is filtered through early patterns shaped from the earliest memories held in both the body and mind.^28,29 Psychotherapy is designed to provide recognition and insight into these influences that contribute to the repetitions and narrative replays in life. It is common, reflecting on the course of life, to identity a multitude of situations, contexts and stories in which characters and events change but the storyline remains consistent and repetitive.

Identification and awareness of the maps that inform and shape experience are an important aspect of psychotherapy. The psychoanalytic therapist will promote further investigation and understanding of the past using the therapeutic relationship; behavioralists will favor techniques and tools to attempt to halt these repetitions. In direct contrast, psychedelic psychotherapists will bring awareness to these maps and through the psychedelic sessions will support release from these organizing influences to cultivate a true liberation from these early maps. This shift induces a correspondingly broad range of new possibilities of experience.

Conclusion

Whole Health: Building a Happier World

Psychedelic psychotherapy may be represented as a paradigm shift, one that promotes whole health and self-integration. This modality cultivates respectful conditions for self-healing and fosters a blossoming of innate creative potential. As internal disconnects and trauma are processed, internal resilience and enrichment results. These shifts in internal health are correspondingly reflected in enhanced empathy, improved relatedness and increased capacity for social connection.

The world we have created, rife with pain, suffering, disregard for the value of life and the condition of the planet is a reflection of our own collective inner impoverishment, fundamental disconnects, and unaddressed trauma. Psychedelic psychotherapy offers a healing approach to restore beauty and health to both the inner and outer worlds we inhabit.

ORCID iD

Gita Vaid https://orcid.org/0000-0003-3370-9545