The Future of Psychedelic Therapy: Collaborative Counseling

In regards to psychedelics, there’s a bit of a debate. If they are so safe compared to other drugs, maybe they should be completely legalized? Should they only be available when there’s a doctor or a psychologist present? Wouldn’t that really restrict who has access to these very helpful tools & processes?

Conversely, the other argument is that these substances are quite powerful. Notice how easily cult members and nefarious groups can recruit and train people. Add in psychedelics to the mix and this can easily trap those individuals looking for healing & growth. 

Also, there’s something to be said for having your first few psychedelic experiences occur with a trained professional, who can frame and model a healthy use of these substances.

Consider a drug much more dangerous than any psychedelic out there: the drug of Alcohol. I know of plenty of French people who have started drinking much earlier than their American counterparts. And yet they have what appears to be a much healthier relationship with alcohol. Less prone to binge drink. Less prone to become alcoholic.

What happens is that French kids learn to drink from their parents, from their family. They place the drinking in a larger context of enjoying it with a meal. Drinking is taught as a means of enhancing mood and connecting with others. Most importantly, the kids are taught to pace themselves. That the goal isn’t to get drunk but again, enjoying yourself and others.

When the French kids are taught healthy drinking habits with their family, it seems they are better off than the American kids who are taught to drink from, well, other kids. You learn to drink at a frat or a sorority, chances are you just may end up overdoing it. Drinking to excess and to escape. Drinking to close the eyes, rather than open them.

Clearly, alcohol can be used to enhance things, a good dinner, a nice conversation. Learning to drink with loved ones, in a family contexts, may be crucial to ensuring this drug is used in a safe manner in the context of enhancing life.

The mushrooms, ketamine, MDMA, all seem to behave in a similar fashion. For example, I’ve met individuals who have used MDMA just when out dancing. Just to party. Many are quite surprised that it can be used for therapy. If they were to take it, within an hour all they want to do is dance. Conversely, others only take MDMA for therapy or personal growth. They spend the entire time on a couch or bed. After a few of those sessions, most wouldn’t think to dance, they just want to talk, process, and connect.

It may be that, as with alcohol, it’s those first few experiences that seem to frame and contextualize the proper use of the drug.

This explains why taking psychedelics doesn’t necessarily lead to personal growth or change. The intention matters. The mindset matters.

So if we have a situation where psychedelics are pretty safe but those early experiences are important for personal growth, it may make sense to copy the same rules that are in place for cannabis. Individuals 18 to 21 can use psychedelics but only under the guidance of a health care professional. A therapist, specifically trained and licensed. After 21, those restrictions are lifted. This can be reviewed on a case-by-case basis for substances. It may be that cannabis and psilocybin can legal for those over 21, for example, whereas MDMA and ketamine, may always require a prescription.

Either way, the first few experiences should always be with a trusted therapist to guide the young adult. There are a few reasons I think this would be a good idea.

First, by working with a therapist, we can best frame these substances as a tool for growth and personal development.

In the future, to use these substances with other people for bonding and connection. This can be thought of a psychedelic primacy effect. Your first few experiences with psychedelics may shape future psychedelic experiences. Have those first few experiences with a trained therapist, and you might just be more likely to frame subsequent experiences in a therapeutic framework, even if you’re just doing it with a significant other, friends, or your tribe.

Next reason, these substances can leave the person in a vulnerable state.

This is especially true with MDMA. The feeling of rapport and connection can be very strong. And indeed, that’s what I think fuels the therapeutic work. It also leaves the person open to exploitation. At least, working with a therapist, there are regulations that prohibit certain boundary crossings and exploitative behavior. There will be the occasional therapist who may engage in an inappropriate sexual relationship. But there will be recourse, that therapist may lose their license, their ability to practice and may even face jail time. So working with a therapist who is licensed is generally a good idea, at least for the first few psychedelic experiences.

Working with a therapist can also help with managing expectations.

It’s tempting to see psychedelics as a magic bullet. Something that will just by itself eliminate trauma, or depression, or social anxiety. Truth be told, although there can be many quick therapeutic fixes, part of the process is simply learning to live with a certain level of anxiety and self-doubt. It’s about learning to love yourself, even with your scars, even if you’re not always 100%.

Additionally, the therapist can help provide what’s known as a “safe container.”

Bad trips are far less likely to happen if you do it in a safe spot with someone you trust. This safe container can be essential, at least until you find others in your life who can provide a similar environment. The therapist can help frame and integrate the experience. Provide both the breaks and the gas pedal from the psychedelic experience.

What do I mean by this? Suppose you have an attorney that has a psychedelic experience. And the big insight? I need to leave everything behind and go live in nature. Well, now at first, the therapist may help provide the breaks. A good rule of thumb is to not make any major decisions in the first few months after the experience. With some discussions, with some reflections, what may come to pass is that this lawyer is overworked and needs to spend more time in nature, hiking, camping, just like when she was a kid.

So now, there’s no need to throw the baby out with the bathwater. But you don’t want to ignore the experience all together. At some point the therapist may also need to apply the gas. Remind the client about their experience. The importance of a balanced life. A life that, yes, includes time in nature. That maybe a position can be found that doesn’t involve working 60 hours a week. 

The insights gleaned from psychedelic therapy are not always exactly true. There’s certainly always room for interpretation, no matter how true they feel at the time. Working with someone can help temper these insights, again to at times push the gas and also, pump the breaks.

This can all be considered integration work to make the most out of the experience. 

Finally, towards the end of their work the therapist can help the individual develop a healthy community, a tribe.

What to look out for, who to avoid. And in the future, the individual can contact the therapist, provide an update. This is what can be known as “divided counseling.” Inevitably, an individual is not going to want to have psychedelic experiences just with a therapist. At first it might be with an intimate partner. And then, yes, their tribe.

You may be familiar with the concept of “set and setting.” The setting, the environment of where you’re taking a psychedelic substance will influence the experience you have. There’s also the “set” as in mindset. The attitudes and beliefs of the person going into the experience will shape it. When doing psychedelic therapy with a therapist, their attitudes and beliefs will also shape the experience, along with the integration. So it may certainly be helpful to engage in psychedelic therapy in different settings, with different people.

I’m a white, male, cisgender therapist. That’s inevitably going to shape how I deliver therapy. So if I’m working with someone of a different culture, different background, it’s especially important I help them find their own group, have experiences with different cultures.

Hence: collaborative counseling. You start with one therapist, one program. You then graduate to joining a community. By continuing to work with their original therapist, even just once a month or so, it can provide a check in the balance of power. If the community ever becomes toxic, exploitative, the individual can work with the therapist to create boundaries and perhaps shift towards a healthier group. Likewise, the group can provide more perspectives and just a more direct intimate relationship than what the therapist can provide.

It’s entirely possible the rise of psychedelic therapy will mirror that of the internet. Growing up in the 90’s, I saw the internet first be a niche thing, the domain of the technically savvy. Then, with the rise of the social networking, the internet exploded in popularity. Now, it’s unfortunately in the corporate stage, where the search function is less about genuine results and more about what multinational conglomerates want to show you. I would not be surprised at all to see psychedelic therapy follow in the same footsteps. At first it was mostly a select few hobbyists, who managed to get a lot of benefit from the substances. The social stage will occur, the 5th wave so to speak, of using these substances to bond with others and get healing from that bond. The worrisome stage is when bad actors come in to use this enhanced connection for nefarious ends.

Just as parents and guardians are called upon today to teach our kids how to use the internet safely, it may be the primary role of the psychologist to help guide young adults into a healthy community to engage in psychedelic therapy without being exploited.  

So all that taken together, I believe that in the future psychologists will serve to guide young people into early adulthood, often with the use of psychedelic substances. The focus will shift from treatment towards prevention. How to heal the wounds of childhood, connect with other people, and prepare for the road ahead.

Up next the role of AI or LLM and its impact on the future of psychedelics and the field of psychology.

On to Section 9