How to Learn How to Help People on Psychedelic Trips

April Short of AlterNet highlights MAPS' Zendo Project psychedelic harm reduction program, a service where trained volunteers travel around the world to provide compassionate care for people undergoing difficult psychedelic experiences. The article features an interview with MAPS Director of Harm Reduction Linnae Ponté about training Zendo Project volunteers, and how psychedelic-assisted psychotherapy research and harm reduction mutually inform one another. "I think people who are in training to be psychedelic therapists need more experience working with the difficult parts of the experience," Ponté explains.

Originally appearing here.

Psychedelic drugs can explore regions of the mind that would normally remain unexamined, transporting us on mystical tours of our inner psyches and reshaping our perspectives on the world around us. They have inspired great music, literature and paintings as well as enormous scientific and technological breakthroughs (like the discovery of DNA structure and Steve Jobs’ creation of Apple). However, psychedelic experiences can also go dark. In the snap of a finger, an esoteric wandering through Alice’s Wonderland can turn into a terrifying passage though Dante’s Inferno.

Aggravating an already frightening experience, a so-called bad trip in the wrong setting can land you in the hospital or behind bars, since most psychedelics are Schedule I, criminal drugs according to the federal government. But what if drug use was seen not as a reckless crime or mental illness, but a part of human nature, as demonstrated throughout history? What if, instead of locking up people for their inherent drive toward personal exploration, growth, or self-transcendence, we helped them examine and navigate the psychological traumas psychedelics can bring to the surface? And what if we took that one step further and figured out scientifically how to use the powerful psychoactive effects of these substances to treat psychological afflictions like depression and anxiety?

These questions drive a Santa Cruz, Calif.-based nonprofit called the Multidisciplinary Association for Psychedelic Studies (MAPS) to seek answers. For decades, MAPS has conducted government-approved psychiatric studies using psychedelics, and worked to shift the way we deal with psychedelic drug users to a more practical, public-health-oriented approach that won't land people with debt-inducing hospital bills or dark marks on their permanent records. Its aims are to develop psychedelics, and marijuana, into prescription medicines and to educate the public honestly about the risks and benefits of those drugs. Since its founding in 1986, it has turned over promising results with government-approved studies on illegal drugs including MDMA, LSD, psilocybin and others. 

Harm Reduction

Linnae Ponté, MAPS' director of harm reduction, travels to some of the world’s largest music and art festivals like Burning Man, AfrikaBurn, Envision and Lightening in a Bottle with a team of volunteers who sit with festival-goers who are having difficult psychedelic experiences. Their hope is that together they can help turn the experience into a valuable learning opportunity and offer some personal insight. This part of MAPS’ mission is called the Zendo Project, named after the open-air yurt-like structure used at Burning Man, donated by Zen priest Vanja Palmers (photos below courtesy of Zendo Project). 

“When someone is having a difficult experience, what they need more than anything is to feel safe and secure so that they can deepen into the experience, and that involves someone who is ready to compassionately listen to them or just hold space for them,” Ponté said in 2013. “Medical volunteers and law enforcement at festivals just don’t want to deal with people who are tripping because they don’t know how, it makes them uncomfortable, and they don’t want to arrest somebody because they’re just tripping.”

Ponté, who is working toward her degree in counseling psychology, says that while the Zendo is focused on harm reduction and does not attempt to provide any official therapy to its visitors, its main principles are naturally informed by psychedelic therapy, and vice versa.

“I think when they do the harm reduction work [people are] able to experience firsthand what it’s like to help someone through a personal transformation,” Ponté said. “I think for most people in the world, in the career of therapy, that is really what lights us up and what brings us joy and it’s why we do the work. … The method we use in the principles of harm reduction really does reflect the therapeutic method that MAPS uses in their studies.”

Similar to the way MAPS trains its psychedelic therapists, all Zendo volunteers complete training in how to oversee people on psychedelics and sit with them during their experiences. They are also trained in how to help people talk through their experiences.

In an essay for the MAPS Bulletin, Chelsea Rose, a therapist in training who has volunteered for two Zendo harm reduction programs, wrote:

"The trainings provided me with the basic foundational understanding that we can create a container for someone going through a psychedelic crisis by attuning our innate gifts and simply holding space. We didn't need to 'do something' other than be a presence that allows another to discover more of who they are in a safe, compassionate, loving way….

"At Burning Man 2013 my fiancé Aleh and I worked as a team, sitting with a young man who wanted to hide his head beneath a blanket and hold our hands. At the time I didn't feel like I was doing much, but later on the guest told me that was exactly what he needed to feel connected to reality." 

Since the use of psychedelics for any therapy outside of government-approved trials is illegal, most therapists have little to no experience working with someone in an altered state of consciousness. This can become problematic as more and more research looking into the medical efficacy of psychedelics gains government approval.

“It’s so important as a therapist to know about the drugs people are using and the effects they have, because—especially on the West coast of the US—people go to festivals and they take drugs, and then they try to integrate these really big experiences,” Rose said. “If the therapist isn't educated about what that might look like, I don't know how they're going to help the person integrate that experience.”

Legalizing Psychedelic Therapy

In 1982, after Alexander Shulgin rediscovered MDMA (3,4-methylenedioxy-N-methylamphetamine), many psychiatrists, marriage counselors and therapists were using the not-yet-illegal substance to enhance the therapeutic process. When it became clear that MDMA would be criminalized due to its increasing recreational use as the street drug “ecstasy,”  MAPS was founded as a response. Today, in addition to other psychedelics and cannabis, MAPS continues to study the healing potential of MDMA-assisted psychotherapy on psychological and emotional damage caused by sexual assault, war, violent crime, and other traumas.

To date the organization has completed several promising phase II clinical research studies involving the use of MDMA to treat chronic, treatment-resistant post-traumatic stress disorder (PTSD). The next round of studies will be much larger phase III studies, requiring 50 to 100 new psychedelic therapists.

Rick Doblin, executive director of MAPS, said during an Evolver Learning Labs online course on psychedelics
this year that the studies so far have shown positive results across the board, in both short and long-term follow ups with participants. They have also shown that MDMA-assisted therapy can be effective regardless of the cause of PTSD.

"What we’ve learned so far is that the cause of PTSD is not related to treatment method," he said. "What that means is that whether it's childhood sexual abuse, adult rape and assault, combat, military combat, accidents—something about trauma, regardless of what caused it, when it turns into chronic, treatment-resistant PTSD, the treatment that we offer works regardless of the cause of trauma. That was really important because that tells us we have a therapy that can apply to everybody with PTSD. When we do our phase 3 studies we don't need to limit them to people with a particular trauma."

A common question from attendees of the online course was "How do I get involved in psychedelic therapy?" Ponté says she hears that question all the time. 

“I’m contacted all the time by people who are like, Hey, I want to be a therapist in your phase III studies,” Ponté said. “And we really do need people to get training.”

This is where harm reduction can inadvertently fill a logistical gap. Since psychedelic therapy is federally illegal outside of specified, FDA-approved studies (like those of MAPS), most therapists have not worked with people in non-ordinary states of consciousness. While MAPS provides opportunities for aspiring therapists to receive training, such as being an adherence criteria rater (which involves watching and rating videos of psychedelic therapy sessions), and suggesting alternative trainings such as Holotropic Breathwork, there is no legal route for therapists to experience hands-on work with people on psychedelics.

“That is why I see harm reduction work as being so important [for would-be psychedelic therapists], because we’re not just working with people who are having a wonderful mystical experience and feeling the oneness of the universe,” Ponté said. “We have the people who are in the throes of terror, where unprocessed trauma is rising to the surface and they don't have the feeling of safety and support that they need to reprocess whatever’s going on with them. I think people who are in training to be psychedelic therapists need more experience working with the difficult parts of the experience.”

Ponté says harm reduction can add tools to any therapist’s toolkit by giving them the chance to sit with someone who happens to be having a difficult psychedelic experience.

“I think in our world today where drug use is taking place, therapists need to be more well-versed in the short-term and long-term effects of those drugs and the experiences that they engender,” she said.

It can be overwhelming to lose control of reality and face your demons. But in the right setting Ponte says, it can also be transformative.

“One of the most scary parts [of working with people on psychedelics] is when somebody thinks they're dying,” she said. “What do you do in that instance? Well, you might just say, ‘This is an opportunity for transformation,’ and ‘Your body’s not going anywhere but your ego might be ready to die and transform, so breath into the experience and surrender into it, and we’ll be here.’ But I don’t think it’s appropriate to say ‘No, you're not dying,’ because what they’re experiencing in the moment is completely real for them, and it does feel like they’re dying.”

Ponte says it’s important for would-be psychedelic therapists to get as much experience as they can with people undergoing those experiences, and harm reduction is possibly the only legal avenue left in which to do that.

“You can read about this stuff and you can watch videos about it, but it's not really until you’re in that context, sitting with somebody having the experience with them and realizing how just complex it can be, that you can really get the training to do this work.”