Psychedelic therapy: How it works and where danger hides

Psychedelic therapy and psychotherapy - differences and similarities and potential problems for therapists. Prof. Matthew Johnson (Johns Hopkins University) shared his work at the INSIGHT 2021 Conference.

Avoiding the pitfalls of therapy through guidelines

Psychedelic therapy and psychotherapy - differences and similarities and potential problems for therapists. Prof. Matthew Johnson from the Johns Hopkins University gave an insight into his work at the INSIGHT 2021 Conference.

Prof. Matthew Johnson is Professor of Psychedelics at the Johns Hopkins University School of Medicine. The expert in the field of psychedelic therapy has, according to his own statements, already conducted hundreds of psychedelic therapies and accompanied just as many with younger colleagues. He has already been able to help tobacco addicts and treat cancer patients. In his lecture at the INSIGHT 2021 Conference, he describes the application of psychedelic therapy, what it has in common with psychotherapy, what problems might arise in therapy due to a lack of standards and how they could be avoided.

Important factors for successful psychedelic therapy

Psychedelic therapy was first described in a scientific paper in the late 1950s. In this process, psychedelics were administered in high doses after intensive preparation, i.e. education and the establishment of a relationship with the therapist, in order to achieve a therapeutic effect. Johnson emphasises that this was not simply the administration of a drug. Factors such as the use of blindfolds, a comfortable environment and discussions afterwards are intended to increase the patient's confidence during the therapy.

Psychedelic therapy brings forth lasting benefits, whether in healthy people or sick people with major depressive disorder or with alcohol addiction, because it causes biological or physiological changes in the body - behavioural changes. "I believe we need to think more about how psychotherapy works and then about the biological mechanisms that I and others are exploring", says Johnson.

For him, psychedelic therapy is a form of psychotherapy. It is the most emotionally charged struggling relationship between patients and professionals who believe they are responsible for psychological healing. It differs from other helpful behaviours such as conversations with friends and family members because there is a framework specifically for therapeutic healing. In 2011, Johnson had discovered in a study on psilocybin that at a high dose, the person became more open to new experiences. This is a property of the classic psychedelics used in psychedelic therapy.

Psychedelic therapy requires an intensive relationship with the therapist

A particularly important factor in Johnson's work is the trust he invests in his patients, which he obtains through extensive educational work before therapy. In this way, he also prepares them for the challenging experiences in therapy, for possible bad trips. Patients with military combat experience had later found the therapy to be the most intensely frightening experience of their lives. In psychedelic therapy, in case of earlier traumatic experiences, they tend to say: You feel as if you are losing your mind, as if you will never come back. In this therapy, the therapist accompanies the patient on their "walk through hell and back", they calm them during the session and stay by their side the whole time. After the session, there is this strong bond between both of them in terms of emotional experiences. Perhaps the patient's perspective also changes.

Smoking, for example, is tied to self-identity for many people. Psychedelic substances seem to have a profound effect when it comes to providing personal insights. "With people, it can really be a shift in life priorities", Johnson says, "a shift in the way they think about things and what meaning they have in their lives. Participants I've worked with have said, 'I could really just decide to quit smoking.' Another said, 'It's really like flicking away a bug. I can really just decide to stop smoking.'"

This happens because of the heavy psychological work that the patients have gone through. People would feel completely emotionally and physically exhausted after a session. That is why Johnson would not recommend several sessions in quick succession. "People feel that they have really gone into the depths of their mind, that they have wrestled with the issues that are bothering them. I think that can lead to self-efficacy, where people feel they've really gotten to the psychological roots of their problems." Instead of just observing and only treating the symptoms, it goes far below the surface, he says. But this is exactly where the pitfalls are according to Johnson, as these emotions and the strong attachment to the person treating them make them vulnerable.

Pitfalls: Mystification and abuse

Johnson published guidelines on the safety of psychedelics as early as 2008, which he would recommend to be used in clinical practice if such therapies were approved. Johnson pleads for appropriate regulations for the use of psilocybin, for example, and that the treatment is only carried out by trained therapists. There should be guidance on psychedelic therapy and research with psychedelic substances.

But there are other, less obvious pitfalls for him on the metaphysical level. Johnson fears that therapists are being pushed into the role of religious priests or gurus and are expected to clarify philosophical questions that cannot be answered empirically at all. For example: Is the psychedelic experience a glimpse into ultimate reality? Is it a glimpse into the mind of God? Does it somehow increase our perception of other dimensions that may exist? This is where therapists don't know more than anyone else, and why therapy should not be about confirming or denying interpretations, but simply about creating the background for safety and psychological healing. The person should not be pushed in one direction. "For example, if you push someone to believe in God, is that a good thing or a bad thing?" asks Johnson. One also doesn't know whether recovered memories are really true, for example in cases of sexual abuse. You have to be very careful here. It can be difficult to make such distinctions in this area.

Johnson makes it clear that the temptation to abuse the power in psychedelic therapy is great in many different ways. For example, by making oneself out to be the person who has the knowledge of these metaphysical belief systems. "We just need much more precision in the use of the word 'consciousness' in this research, because there is a lot of talk about it."