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Hopes and Fears about Psychedelic Assisted Therapy (by Crystal)

Updated: Mar 11, 2023

I've been fortunate/privileged enough to have been able to benefit from (medically prescribed-) ketamine assisted psychotherapy (KAP) with a trusted trauma-informed professional at semi-regular intervals for over a year now, and I can't say enough about how much it has benefitted me.

A few caveats: I've been able to work with someone I already deeply trusted, who was already very familiar with me as a person and had a great deal of knowledge about my trauma history and personal vulnerabilities, fears, hopes and strengths. I also have ongoing access to regular complex trauma therapy, which means that for me preparation for the future KAP sessions and integration of the past KAP sessions are constantly unfolding in between KAP treatments. I accordingly have a safe space in which my insights and experiences can continue to unfold, be held gently and be worked through, even when incredibly difficult things arise (as is natural in any complex trauma therapy, and can sometimes be intensified by the ketamine therapy).

Without those conditions I've mentioned above firmly in place, I personally wouldn't feel safe enough pursuing this kind of therapy, but that's not to say that everyone's needs and limits will be identical to mine. Different people have different strengths, vulnerabilities, trauma histories and internal and external supports and obstacles in place. I have some big limits that other people may not have, and I've proceeded very cautiously to honour them as I've sought out "healing"**/coping in the ways that work for me.

I also very much look forward to trying MDMA-assisted therapy when it's legally available. Based on what I've learned about it, I have strong reason to believe that it may someday be an important part of my "healing" journey.

As you can see from what I've written above, I am someone who is very *hopeful* about the potential of this kind of therapy not only for myself but for others (though I'd never presume to know what may be helpful for someone else, and I know that what helps one person under one set of conditions may harm another person, or even that same person, under a different set of conditions).

That said, I have fears both for myself and generally. I won't get into all of them but the one on my mind lately is: I fear the potentially destructive effects of the concept of *big*/*rapid* healing. What makes psychedelic therapy so appealing (for good reason) to so many others is the very thing I fear about it.

From as early as I can remember, my life was deeply affected by all kinds of different experiences of trauma, some directly affecting me and some affecting those around me (those who were supposed to protect me and those I wanted to protect). For me there are so many different dimensions to my difficulty in coping with the trauma I've experienced. Some are more practical in nature (physical, emotional, cognitive effects), some more existential (my sense of meaning and self).

My fear about grand rapid life-altering healing is that it will create expectations on and within some survivors that are neither fair nor realistic, resulting in the abandonment of survivors whose needs are less convenient or who are less amenable to this sort of healing. As trauma survivors, we're often told to just "get over it," "shift our perspective," and all kinds of coercive platitudes suggesting that the real problem isn't what happened to us. We're constantly told (in an often very re-traumatizing/dismissive way) that we should just hurry up and embrace the real truth of how grand and okay and beautiful life is despite what we've seen and experienced: like our trauma can be erased and rendered irrelevant with a dramatic flash of sunshine, rainbows and gratitude.

Do I believe in such grand flashes of insight and beauty that can sometimes yield dramatic effects on our ability to cope and survive? Absolutely. And from as early as I can remember in my own ways (short of psychedelics) I've experienced them many times. They were real. They were big. They were life-altering. Without them, I'd never have made it as far as I have (for whatever, if anything, that may be worth). --Music, love, kindness, the beauty of the natural world, literature, television, deep philosophical contemplation after too much coffee at 3 am -- All of these things have sometimes brought enormous flashes of "healing" and shifts in perspective, some of which left me over time, some of which remain with me in some form to this day.

But as someone whose trauma has its own depth, complexity, intelligence, personality, enduring truths, and ability to flash suddenly and powerfully out of nowhere at various points across my lifespan, I also know that grand "healing" can be fleeting or incomplete. Not only don't I fully trust it, I don't want to or choose to.

I don't believe that (the more responsible) proponents of psychedelic therapy would suggest that a psychedelic experience should simply be a grand flash of healing that resolves all of a survivor's trauma. Otherwise there would be no need for the integration phase that's an inherent part of the model.

But, whether they mean to or not, I really fear that any new exciting form of treatment touted as game-changing and grand as this one touts itself to be can have potentially destructive effects.

On a grander scale unlikely to directly affect me, I cried one night after a ketamine session because it suddenly struck me how there was going to be this big roll-out of psychedelic therapy at a time when there is already a therapist shortage and a lot of therapists who would otherwise have been in the trenches accompanying survivors in a slow steady not-so-grand-but-every-bit-if-not-more-beautiful way week-after-week for months or years may suddenly feel called to become part of this supposedly new revolutionary way of healing more and more people faster and faster.

Which is great for those survivors who want it, can afford to access it and feel safe enough and comfortable enough to do so, but what about the ones who don't? The ones who want and need slow healing? Will therapists abandon or (unintentionally) devalue their existing clients who've been counting on them week after week if those clients don't feel safe or comfortable embracing this new more rapid model of healing?

More applicable to my own healing, I sometimes fear: will therapists who repeatedly are deeply moved by experiences of many clients taking big beautiful powerful previously unthinkable leaps forward in their healing still be able to really appreciate the value in the slower healing that some other clients choose to prioritize, and the potential wisdom and beauty in that? Will my own therapist observe over and over again all these other deeply and complexly traumatized people just like me healing in BIG rapid ways and feel less able to appreciate the little 3 steps forward 2 steps back healing that is so essential as part of my own process? Will I be experienced as a failure even if I'm really happy with the work being done and it's genuinely benefitting me in the ways that matter to me?

If some clients don't want that kind of healing, or feel safe choosing it, will there still be a place for them and the deep connection that can come from a shared movement towards healing even when it's not so big? The slow baby steps as we each discover and follow our own bread-crumb-like path towards our own version of healing?

The image that came to me was a conveyer belt of suffering traumatized people being taken to a contraption that stuffs them full of sunshine and rainbows and ~Healing!~ before the conveyer belt moves each one away into an unknown future. And that's the least safe version of healing I can imagine (for me).

This may seem like a foolish concern, but I've seen this happen to survivors in our impatient resource-limited world. Those of us struggling to heal are constantly explicitly and/or implicitly interrogated about and judged for whether we are doing everything we can to "take responsibility" for our own healing, whether there's some fix we aren't taking advantage of, etc. The pressures, both emotional (when used as a basis to withdraw compassion and connection) and practical (when used as a basis to deny access to supports) can be enormous. If there's something deemed life-changing for us and we don't choose to take it, or choose it but don't benefit in the grand ways others do. will we be deemed to be "wallowing" in our suffering? A waste of time, energy, care and resources? "Treatment-resistant," overly "dependent" on resources others manage to make more efficient use of? "Manipulative"?

My safety after complex trauma resides in what is slow, steady, dependable.

The patience, the accompaniment, and the compassion even when things are frustrating and difficult, are the antidote to what I've been through. There is no fast-track version of that. Experiencing that kind of care and finding my own path to living and "healing" within that context are essential to me. Repeated experience is more powerful and real to me than a single dramatic burst ever could be.

I'm eager to seek and receive all the grand beautiful rainbow-and sunshine--infused perspective-shifting revelatory experiences I can. All the big "breakthroughs." But then I need to take them, put them in their place, and slowly unpack them in the context of the trauma I know will always be with me (not because I stubbornly refuse to "heal" but because there is real enduring truth in what I experienced no matter how many rainbows precede or follow it): where slow patient accompaniment through ugly inconvenient realities is every bit as cherished and nurtured as dramatic powerful gift-from-God ~Healing!.~

**I have concerns about the usefulness of the concept of "healing" in any grand universal sense which is why I always put the word in quotation marks.

***Below is some AI generated art that I created for this blog

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