Psychedelic Augmented Psychotherapy: Science vs. Expectation

Some patients seek psychedelic-augmented psychotherapy with quite high expectations. How should therapists approach this?

Psychedelic therapy: advancing knowledge, but study settings remain limited

Netflix series, exuberant newspaper articles: Psychedelic Augmented Psychotherapy (PAP for short) is on everyone's lips described often as a miracle cure. Not many years ago there was still deep mistrust and prejudice against "drug therapies". Stigma has reversed somewhat in recent years, but now the (medical) reality is far from being able to live up to the exaggerated expectations being placed on this medical field, emphasised Dr med Andrea Jungaberle emphatically. This point in particular, she added, must be made clear to every patient who wants to undergo PAP.

Despite advancing medical knowledge on the use of psychoactive substances, for example in the context of the EPIsoDE study, it is important to note, according to Dr. Jungaberle, that although many of the substances are in clinical trials, the road to concrete scientific applications is still long. This is due to policy regulations and very limited study settings. Except for ketamine (and still to a limited extent), there is no legal authorisation in most countries. Concrete application possibilities of augmented psychotherapies therefore still remain limited.

Physicians are no gurus

However, due to media-hyped expectations, patients sometimes come to the practice expecting far-fetched benefits from a PAP. There is also an increasingly popular reference to a "brain reset", or a perception that receptors should be "readjusted", or (as soteric beliefs are brought into the clinical setting) an expectation that a communication with the "great spirit of the universe" should be initiated by the therapy. Some examples of the expectations that Dr. Jungaberle has encountered in her therapeutic experience can be summarized by statements such as:

"I want everything to be the same as before. I want my life back."
"I want to finally understand what trauma is behind everything. There must be something. This is the solution to all my problems."

Many people expect Psychedelic Augmented Psychotherapy to provide quick fixes that a scientifically-based medical procedure is unable to. PAP cannot manage to simply reset decades of trauma or depression. "We cannot make a person new," Dr. Jungaberle emphasises. People who come to the practice with spiritual concerns would have to be made aware immediately that therapy with psychedelics was not intended for that purpose: "A doctor is not a guru!", Dr. Jungaberle clearly states.

Psychedelic-augmented psychotherapy: do not raise false expectations

There are cases of patients who report healing after only one or a few sessions, but Dr. Jungaberle insists that these are absolutely exceptional cases. As a rule, augmented psychotherapy is a long, sometimes exhausting process. And these are at times some particularly difficult cases: sometimes patients have interest in PAP because they see it as their last hope before considering assisted suicide.

So how to proceed in such cases, and generally with people who have excessive expectations? Dr Andrea Jungaberle summarises some suggestions for this:

Do not give patients hopes that cannot be fulfilled.
Point out the limits and restrictions of PAP right from the start of the conversation.
Never start treatment without realistic therapy goals.
Make clear that psychedelic-augmented psychotherapy is a long, arduous process.
If necessary, refuse treatment to patients who come to the practice with too preconceived opinions; unfortunately, this also applies to those who see PAP as the last option before suicide.

Article translated from the original German version.

References:

Presentation in German only: Dr. med. Andrea Jungaberle: Therapieziele und Erwartungsmanagement in der Psychedelisch-Augmentierten Psychotherapie (PAT). INSIGHT Conference 2023; 01.09.2023, 10.00 - 10.30 Uhr.