Psilocybin-Assisted Therapy
Authored By: Denise Rue, MA, MFA, MSW
When we think of mental health treatments, we generally consider two modalities: psychotherapy and/or medication. Understanding psilocybin-assisted therapy (“PAT”) requires us to widen our perspective. It’s not a pill you pop once or, as in the case of many anti-depressants, every day for decades. Nor is it a weekly visit to a professional who listens, empathizes, and educates. PAT is a different animal altogether.
PAT involves the use of a moderate dose of psilocybin in the context of a short-term sequence of therapy sessions. Banish the idea of the dispensary model, where you wander in to purchase your dose of shrooms, then head out to the backyard to trip under the stars. PAT is highly structured and entails a screening process, preparatory, medication, and integration sessions. The process is led by a trained and licensed psilocybin facilitator, and there is great attention given to “set” and “setting” to optimize the experience. Let’s dig a little deeper.
The Screening Phase
While psilocybin is non-toxic, non-addictive and generally well-tolerated by most people, it’s not for everyone. In the screening phase of PAT, the professional will let you know if you have a physical or mental health condition that could make taking psilocybin unsafe. These may include:
Personal or family history of schizophrenia, bipolar disorder, or psychosis
Seizure Disorder
Certain cardiovascular conditions
Taking certain medications, like lithium
People experiencing suicidal ideation
For people who aren’t suited to psilocybin use, other options, like breathwork, are available.
Preparation
During this stage, the licensed facilitator and client meet, either in person or virtually. They speak about the client’s intentions and hopes for healing. The facilitator provides psychoeducation about psilocybin - how it works in the brain and the physical and psychological experiences associated with use. This is the phase in which the facilitator establishes a foundation of trust with the client, so he or she will be better able to relax and surrender to the psychedelic experience. The facilitator will explain topics such as informed consent, the safety and transportation plan, and consent for comfort touch (such as a grounding hand on the shoulder,) and the client will sign several forms. If the facilitator feels the client needs more preparation, another session will be scheduled.
Medication Session
This session lasts approximately 6-8 hours and is conducted with eye shades and music to foster introspection. After the client takes the mushrooms, the effects will generally begin in 30-60 minutes. The client is instructed to relax, breathe, and surrender to the experience. The facilitator is present to maintain safety and provide support and direction if the client encounters challenges during the session. Support can take the shape of holding the client’s hand or speaking words of encouragement. The facilitator also ensures the client stays well hydrated and is accompanied to the bathroom. Whatever the client experiences—emotional catharsis, ego dissolution, or a mystical experience—it’s the facilitator’s job to remain present, supportive, and grounded, much as a midwife does during labor and delivery.
Integration
Integrating a psychedelic session involves translating the client’s experiences into long-term change. Through a process of non-directive inquiry and exploration, the therapist assists the client in understanding the cognitive insights, emotional breakthroughs, and mystical experiences from their session. The work of operationalizing these changes into everyday life can unfold for weeks, months, and even years following the medication session. Ongoing integration may involve things like journaling, meditating, creative arts, or continuing in traditional therapy. The weeks following the psychedelic session is an optimal time to make changes in thinking and behavior, as the brain has increased neuroplasticity.
Denise Rue, MA, MFA, MSW is a psychotherapist and founder of the New Jersey Psychedelic Therapy Association. Denise has had the privilege of working with hundreds of clients with psilocybin, supervising over 1,500 sessions. Denise is also on the Board of Advisors for Psychedelic League.