Is it time for Counselling Psychology to join the psychedelic revolution?

To cite this article: Ruger, Michelle (2019). Is it time for Counselling Psychology to join the psychedelic revolution?, The Millennial [Online], Available at: (this page URL).

Introduction
Within recent years psychology and psychiatry have seen an expanding interest in the therapeutic uses of psychedelics (MAPS, 2010). However, despite this knowledge their uses continue to remain unknown in mainstream society (ibid.). The current illegal status of psychedelic drugs currently makes their consumption considered unethical and dangerous by mainstream western society (ibid). Such prohibition may have led to the field of Counselling Psychology (CoP) not being aware of their positive psychotherapeutic effects.

Prior to the current prohibition status, psychedelic plants had been utilised as a medicine by humanity for thousands of years (Winkelman, 2014). The large consumption of psychedelics in the ‘sixties’, which have been linked to radical societal and political changes, resulted in the formation of a negative impression of the substance and consequently its prohibition in 1970 (Grinspoon and Bakalar, 1979). More recently, empirical trials have begun demonstrating that psychedelic substances could be a safe and effective adjunct to psychotherapy in the treatment of many psychological problems. These include: obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), death anxiety and substance abuse (Winkelman, 2014).

To elaborate on the effects of psychedelics for psychotherapy, studies have shown that the substances intensify the change process in therapy, as they help individuals to access their emotions and assist in the strengthening of trust in the therapeutic relationship (Mitohefer et al., 2011). Such findings may be of particular interest and relevance to CoP as the field emphasises the importance and benefits of the therapeutic relationship above all other components of psychotherapy (Clarkson, 2003). Moreover, stronger transference and improved self-reflection are additional specific effects induced by psychedelic experiences during psychotherapy (Passie & Durst, 2009).

Considering these positive findings, it is therefore surprising that there is no literature into how psychedelic psychotherapy may enhance the field of CoP. Hence, this article aims to provide an overview of topics within the literature regarding psychedelic psychotherapy and the recent empirical findings, in order to evaluate how such research may impact CoP. To do so, it is important to acknowledge the current risks involved in using psychedelics in therapy, such as the importance of taking psychedelics in a safe setting, at an appropriate dose and with an appropriate knowledge of the effects one may expect to feel. Thus, risks and safety precautions will also be explored in this article.

The lack of literature regarding CoP and psychedelics is further surprising when considering that psychedelic therapy comes under the umbrella of ‘transpersonal psychology’. Stanislav Grof, a czecksolvakian psychiatrist, carried out psychedelic psychotherapy on an estimated 4,000 people, using LSD to cause an altered state of consciousness (ASC). Criticisms of Grof’s studies have suggested that because he never used a control group, his findings were not valid (Nutt, 2006). However, the sheer volume of success that he had with his patients could be argued to counteract any shortcomings of his experimental design. LSD therapy allowed powerful psychedelic experiences of regression, access to repressed memories and intense transference, which have in turn been demonstrated to assist and speed up some of the processes in psychodynamic psychotherapy; a quality that considering the stretched resources of the NHS, could greatly assist healthcare systems (Grof & Halifax, 1980; Carhart-Harris et al., 2012). CoP has reiterated concerns about the function of short-term psychotherapeutic work in the NHS (Gallagher & Hawarth, 2015), which again supports the need for exploration of what psychedelics may be able to offer psychotherapy.

The majority of humanistic counsellors rejected the idea of spirituality, mystical experiences and cosmic awareness, resulting in Grof and Halifax (1980) founding a new post-humanistic psychology named “transpersonal”. Transpersonal psychology is today widely regarded and utilized in CoP, such as in the use of mindfulness based meditative practices (Epstein 2012). Considering the time and finances that CBT practitioners have invested into meditation as a useful ASC (Altered State of Consciousness) (Shonin, Gordon & Griffiths, 2014), it is surprising that psychedelics, which offer similar ASCs (Grob et al., 2011), arguably with less preparation and skill required, have not been investigated with the same interest. Considering the positive impact that meditation has had in CoP (Arulmani, 2007) it seems important for CoP to take an interest into the rapidly expanding field of psychedelic psychotherapy. Furthermore, it is interesting to consider why CoP might have refrained from taking an interest in the psychedelic area of transpersonal psychology. It is possible that the dominant prohibitive discourse that reigns in relation to psychedelics may have been involved in this. Such a negative discourse may have been formed intentionally from the political issues in America at the time in psychedelic use detracting from the Vietnam War; a statement that Richard Nixon’s personal assistant, Ehrlichman, admits to (Baum, 1996).

Vera and Speight (2003) suggested that CoP should endeavour to have a responsibility beyond direct therapy to issues of social justice. He acknowledges dissatisfaction with CoP’s attention to social causes given CoP’s involvement in the development of feminist theories. He notes that much of feminist practice involves recognition that individual struggles are often rooted in oppressive political social and cultural forces, and thus postulates that such struggles cannot be resolved in the absence of changing the structures and systems that they arise from. In line with this critique of CoP, it could be argued that it is important that the field explores whether there is a political agenda behind the prohibition of psychedelic drugs, which have been shown to have such profound positive implications for psychotherapy (Grob et al., 2011; Cahart Harris et al., 2013). If an individual’s struggles can be alleviated with these substances, CoP could benefit psychotherapeutic practice significantly by taking an interest in balancing out the dominant prohibitive discourses with the resistive discourses that refute this.

Indeed, the need for a more social justice–oriented attitudes in counselling psychology has been strongly argued and supported by practitioners for a number of years (Vera & Speight, 2003). Social justice-orientated counselling psychologists’ ideas are heavily influenced by feminist movements (Bond, Belenky, & Weinstock, 2000). Feminists discuss the importance of sharing power and giving voice to marginalised individuals, and in doing so allowing for oppressed groups to emerge (Bond, Belenky, & Weinstock, 2000). It has long been argued that individuals who have used psychedelics as mind altering tools for psychological progression are a marginalised group (Letcher, 2006). Thus, given the extensive supporting literature of the profound positive benefits of psychedelics to psychotherapy, it could be argued that, in line with CoP’s strong social justice orientated aspirations, it may be appropriate for counselling psychology to provide a voice for this group.

This article will thus seek to understand and present such discourses in the hope of empowering them, and noting their potential benefits for future therapeutic practice in CoP. In addition, giving voice to such marginalised groups has also been argued to allow groups who traditionally hold power to re-examine their perceptions and opinions, and acknowledge the potential strengths of the marginalised group’s ideas (Letcher, 2006). Again, in terms of psychedelic therapy, counselling psychology may be able to impact such a cause where the strengths are so often going unnoticed despite the compelling literature (MAPS, 2010).

An additional motive for such a literature review to be conducted from a CoP perspective is in response to Van Duerzen’s (2006) powerful paper on the philosophical underpinnings of counselling psychology. The renowned author articulates her desire for counselling psychologists to remain open and accommodating of the notion that there is “a lot more to psychology than is written in the academic text books”. The author identifies counselling psychology as a place where “we can rediscover what has been so skilfully hidden elsewhere” (Van Deurzen, 2008). This quote invites attention to be drawn to the discourses that had potentially enabled psychedelic research to be “hidden”, by not only CoP but also psychology more broadly, despite the expansive positive findings. In this review I hope to shine light on such discourses in order for practitioners to move closer to engaging with the research in a more objective capacity, as opposed to within the tight confines of the current prohibitive discourses which dominate the field (Letcher, 2006). Here, attention is drawn to the ways in which the attitudes that CoP has towards current psychotropic drugs on the market may impair the way that they approach the literature on psychedelics, despite the profound differences in affects between the two substances (Carharrt-Harris et al., 2013).

A brief history
Psychedelics have been used as sacramental tools by non-western cultures for thousands of years (Henderson, 1994). Many religions existing today have been shaped by their use. For example, “Soma” often appears in Sanskrit texts that heavily influence the Hindu religion. Anthropologists believe that Soma is derived from the hallucinogenic Amanita Muscaria mushroom (Henderson, 1994). Psychedelic research in western cultures was inspired by studies on peyote in 1896 (Henderson, 1994). Ibogaine was studied in the 1920s prior to a large rise in psychedelic studies correlating with the discovery of LSD during World War 2 (Grof & Halifax 1980). Returning soldiers fuelled such research as psychedelics were used as psychomimetics to further understand various psychoses. Freud’s ideas of dreams being “royal roads” for studying the unconscious emphasised the power and important of accessing the unconscious in a conscious state (Grof & Halifax 1980).
From the 1950s onwards, psychedelic research boomed (Carharrt-Harris et al., 2012).

In Gloucestershire, England, Dr Ronald Sandison pioneered pscholytic therapy with the aid of LSD in accessing repressed areas of his patients’ psyches (Carharrt-Harris et al., 2013). On the other side of the Atlantic Albert Hoffman, LSD’s founder, was collaborating with Timothy Leary in investigating the power of administering LSD to overcome mental health difficulties (Grof & Halifax, 1980). Word of their therapeutic capabilities spread and studies involving psychedelics such as mescaline, psilocybin and LSD were being conducted all over the world. Indeed, between 1950 and 1965, one thousand papers were published on LSD alone (Grof & Halifax, 1980). The studies led to the treatments of 4,000 patients. Adverse incidents were remarkably low and psychiatrists began to evolve the best method for psychedelic exposure, often using the methods from Eastern cultures; the aim of which was to create a relaxed and facilitative environment (Grof & Halifax, 1980).

Despite the success of psychedelic research, by 1966 LSD was made illegal in the USA. The seemingly miraculous effects of LSD were popularised by writers such as Aldous Huxley who stated, “I was seeing what Adam has seen on the morning of his creation – the miracle, moment by moment of naked existence.’ Academics such as Dr Timothy Leary, a clinical psychologist from Harvard, began to promote the use of psychedelic drugs to the public. Ironically the US government, the creators of psychedelic prohibition, also promoted the use of LSD in the public (Friedman, 2006). The project “MK-Ultra” was designed to develop LSD as a truth serum for military use. Random members of the public were unknowingly administered LSD and examined by a team of researchers in a famously unethical experiment. Upon illegalisation, the US government blamed LSD for causing left-wing behaviours, opposition to the Vietnam War and negative social changes (Friedman, 2006).

The funding for LSD research was soon cut by the government resulting in research coming to a dramatic halt (Friedman, 2006). Whilst research stopped recreational use continued to increase often in impure and contaminated forms leading to public euphoria into the potential toxicity of a physically harmless compound (Friedman, 2006). Media scare stories of the non-clinical use of LSD eventually resulted in many therapists and academics ignoring the previous decade of research and turning to other therapies (Friedman,2006). As mentioned later, there are two clear dominant discourses regarding psychedelics since this point, the “pathological” and the “prohibition” discourses.

Nonetheless, some individuals were so convinced about the therapeutic positives psychedelics could bring, that they investigated and synthesised another psychedelic compound named 3,4-methylenedioxy-methamphetamine or MDMA (Mitohefter et al., 2011). MDMA is a less potent drug lasting 2 to 5 hours compared to the 8 to 12 hours for LSD. Similarly to LSD, MDMA allows patients to explore repressed memories and also promotes the capacity to emphasise. Psychotherapeutic analysis upon administration of MDMA was promising, however MDMA was made illegal in 1985. Like LSD, recreational use boomed following its illegalisation (Mitohefter et al., 2011).

The 30-year hiatus in psychedelic research appeared to mark the demise of the discovery of a potentially remarkable tool for mental health practitioners. Once said to be for psychology what the microscope was for biology, it appeared that the western cultures had missed a unique opportunity to understand the human psyche (Grof & Halifax, 1980). In 1990 however, the renaissance of psychedelic research was initiated at the University of New Mexico. A small study was approved to investigate the effect of N,N-Dimethyltryptamine (DMT) on human participants (Carharrt-Harris et al., 2013). By investigating a relatively unknown psychedelic substance, public and media-driven sensationalism was minimalised, allowing for uncompromised, responsible and reliable research (Carharrt-Harris et al., 2013).

However, in 2002, studies at the University of South Carolina began investigating the therapeutic effects of MDMA in treating PTSD following approval from the National Institute of Health and the university’s institutional review board (MAPS, 2010). Research into the therapeutics of psychedelics has since grown extensively, similarly to the initial LSD research in the 1950s (MAPS, 2010). In America, studies are underway at the universities of California, Arizona, Harvard, Duke and Purdue investigating a range of psychedelics including MDMA, psilocybin and LSD, on PTSD, addictions and anxiety disorders (Grob et al., 2011; Carharrt-Harris et al., 2013). In England, Imperial College have undertaken studies into LSD and psilocybin, neuroimaging the patient’s brain after consumption (Carhart- Harris et al., 2013).

Recent psychedelic psychotherapeutic studies
Recent research into the benefits of psychedelics as an adjunct to psychotherapy has begun investigating a wide selection of mental health difficulties, such as obsessive-compulsive disorder (OCD), depression, social anxiety and many more (MAPS, 2010). The majority of research historically has focused on their effects with substance dependency (PTSD) and death anxiety in individuals who are terminally ill (MAPS, 2010). Due to the scope of the academic research, this review will focus on the most recent studies involving these particular difficulties, as at present they have the most vast and substantiated literature base and so can provide readers with a deeper understanding of their benefits. The four studies below were selected because – unlike other research being conducted in to psychedelics at present – they involved the use of psychotherapy in the trial, which is most relevant to the field of CoP. The studies are all quantitative, and at present there are not studies which have looked at individuals’ experiences of psychotherapeutic treatments with psychedelics as an adjunct from a qualitative perspective.

Psilocybin and alcoholism
Bogenschutz et al. (2015) recently carried out a ‘proof of concept’ study investigating the effects of using psilocybin alongside therapy in the treatment of alcohol dependency. The research involved ten participants with DSM-IV diagnosed alcohol dependence. Participants were given psilocybin once in a supervised session and partook in motivational enhancement therapy sessions before, alongside and after this session. In the four weeks prior, to the administering of psilocybin participants’ abstinence was not significantly different. However, following the psilocybin administration the abstinence significantly increased. Furthermore, following this gains were shown to be maintained when investigated 36 weeks later. The strength of the experience of the psilocybin effects were shown to strongly predict decline in drinking 5-6 weeks after the treatment.

In addition, the intensity of the experience also significantly predicted decline in cravings and increases in abstinence self-efficacy. In terms of safety, no adverse events were reported. The authors suggest that such preliminary findings offer a strong rationale for further research in to the effects of psilocybin as an adjunct to psychotherapy with large samples. Moreover, from a CoP perspective, it would be interesting to understand how the psilocybin administration impacted the therapeutic relationship, as this is not documented. It would thus be useful to conduct qualitative research in to participants’ experiences. It is also interesting to understand how different traditional psychotherapeutic approaches may impact the findings, for example using a person-centred model as opposed to motivational enhancement therapy.

Psilocybin and tobacco
There have been many reports of successful abstention from various addictions after psilocybin psychotherapy. Since the renaissance, a study into the treatment of tobacco addiction with psilocybin was conducted at John Hopkins university in Maryland. The study represented the first of its kind in investigating the power of a psychedelic on smoking cessation (Lawrence, 2014). The trial involved administering psilocybin to 15 patients, all of whom were heavy smokers. Each individual received 15 weeks smoking cessation treatment involving regular sessions of cognitive behavioural therapy (CBT). Psilocybin was administered at week 5, 7 and 13. Afterwards, the patients were encouraged to listen to music and have an introspective experience. During CBT the individuals were told that today would be there last day of smoking. 6 months after the trial, 80% of the patients had remained abstinent from smoking; an impressive statistic considering that none had used nicotine replacement therapies.

In contrast to this study, currently traditional psychotherapy (without psychedelics) is estimated to have a success rate of between 11 and 33%; a drastic reduction when compared to psilocybin treatment (Lawrence 2014). When studying the literature in smoking prevention psychotherapy, the highest smoking cessation rate at the 6-month point is 59% (Lawrence, 2014). These statistics further highlight how psychedelic psychotherapy could be revolutionary for the recovery of individuals who suffer from addiction. Whilst these findings are positive it is important to take in to account the small sample size, as it is difficult to generalise from this sample. In addition, it would be interesting to learn of what the individual’s experiences on the psychedelic substances were, as historically there are lots of different experiences evoked with psychedelic consumption such as, intense transference, reduction in feelings of guilt, and an increased felt sense of trust in the therapeutic relationship (Grof & Halifax, 1980). Thus it would be helpful to understand in more detail what experiences enabled the psychotherapy to be more effective.

MDMA and PTSD
PTSD is an anxiety disorder which is characterized by hyper arousal, intense re-experiencing of past events and avoidance symptoms. Currently the most utilised form of psychotherapy for PTSD is cognitive behavior therapy (CBT) (Gowing et al., 2009). A review of CBT in PTSD found that the dropout rate of psychotherapy with this client group is 20-30% and response rates were between 60% and 95% for participants who received active treatment and finished the trials (Gowing et al, 2009).

Studies have shown that MDMA induces a 2-4 hour experience and typically participants experience feelings of euphoria, increased self-confidence and extroversion, sociability, improved well-being and a decreased fear response (Gowing et al., 2009). Such findings informed the rationale for the potential uses of MDMA in the treatment of PTSD as this disorder involves an uncontrolled fear response (Gowing et al., 2009). Many psychotherapeutic approaches with this client group involve inducing these autonomic responses by revisiting the traumatic experiences in the therapy sessions. However, treatment is often ineffective as clients find the feelings evoked in revisiting the trauma intolerable (Gowingt al., 2009).

Mithoefer (2011) conducted a study that demonstrated that MDMA-assisted psychotherapy is effective in individuals with chronic and treatment-resistant PTSD. The study was of between subjects design and involved a control group. The results demonstrated that MDMA assisted psychotherapy, when compared with the same psychotherapy with an absence of MDMA, produced significant improvements in participant’s PTSD symptoms. 85% of participants in the MDMA group no longer held a diagnosis of PTSD as opposed to 15% in the placebo group. The results had been sustained at a follow-up of 3.5 years. Indeed, no further MDMA treatment was required. Of particular importance is that no drug-related adverse events occurred. In addition, no impaired cognitive function was measured. This research showed that all individuals who received MDMA assisted-psychotherapy, who were unable to work prior to the treatment due to PTSD, then returned to work. This finding is particularly relevant to the aspirations of Lord Layard in 2006, who developed the IAPT mental health services in the NHS, in order to enable individuals who were signed off work with mental health problems to return to work, thus supporting the economy (Lord Layard, 2006).

LSD and death anxiety
Individuals who are nearing the end of their life often don’t obtain satisfactory emotional relief with the current treatment options available (Gasser et al. 2014). Chronic pain, depression, anxiety and unresolved relationship issues are all things that this client group struggle with (Gasser et al., 2014). This client group are increasingly being recognised as a significant public health concern (Gasser et al., 2014) thus it seemed of additional importance to discuss here.

Recently Gasser et al. (2014) conducted a double-blind control trail to investigate the efficacy of LSD assisted psychotherapy. The study involved 12 participants all of whom were experiencing anxiety associated with their life-threatening diseases. The treatment administered involved drug-free psychotherapy supplemented with two LSD assisted sessions. The study demonstrated that at a 2-month follow up the State-Trait Anxiety measure utilised demonstrated positive trends for reduction in anxiety. In addition, the study investigated the safety of using LSD with the client group and reported no chronic adverse effects in relation to the treatment administered. The reductions in anxiety were sustained at a 6-month follow up.

Again, similarly to the studies discussed previously, there was no mention of the details of the alterations to the therapy itself, such as how this impacted the therapeutic relationship, the felt experience between the client and therapist and the level of psychological connection. All of these elements of psychotherapy are widely regarded for being very important to positive change (Clarkson, 2003). Thus it seems necessary for future research to investigate how these components of the therapy are impacted. Perhaps qualitative research would allow for this as the phenomenological underpinnings would capture the subjective experiences of participants.
Overall, the results of the studies detailed provide interesting findings for the use of psychedelics as an adjunct to psychotherapy. It is important to be cautious with the findings due to the small sample sizes, and since psychedelics offer such profoundly different and personal experiences (Grob, 2005).

It is important to conduct much larger studies to gain an understanding of their potential to be able to generalise to wider population. There is a dearth of literature investigating the subjective experience of both the client and the therapist. Since CoP values the relational element of psychotherapy greatly (Clarkson, 2003), it seems imperative to understand how this is impacted prior to drawing conclusions about how the research may benefit the field. Thus it seems important to conduct qualitative research on the lived experiences of both clients and therapists who have undergone or delivered such treatments.

A critical evaluation of psychedelics and the therapeutic relationship
Martin Buber (1937; 2008) proposed an understanding of the relation between the self and the other that is widely recognised in psychotherapy today. Buber (ibid.) denoted that people are ‘twofold’. He argued that we respond to the people who we encounter as either an “I-Thou” or an “I-It”. The “I-Thou” relationship refers to an authentic, holistic relationship between two people. This is the form of relationship that is mostly sought in humanistic psychotherapy. In contrast, Buber notes that “I-It” relationships are more in relation to one’s self and can be understood as a monologue as opposed to a dialogue. In addition, Buber (1937/2008) states that an individual can only becomes an “I” in the mutual recognition with the other (Hudson, 2010). Thus, an individual’s self-existence is dialogical in nature and is fundamentally comprised of encounters with others.

These fascinating ideas that inform much of the emphasis on intersubjectivity in CoP are interesting to consider in relation to the psychedelic research that has been presented here. Much of the historical literature has suggested that a large proportion of the psychedelic experience is profoundly introspective and involves deep self-awareness (Grof & Halifax, 1980). However, it does not comment on the way in which such substances impact the individual’s relationship with others and the wider world. More contemporary research has made some gestures towards MDMA enhancing the relationship with the therapist (Mitohefter, 2011), but to date no study has placed particular emphasis on this part of psychotherapy in relation to psychedelic treatments. When considering Buber’s contribution to the field and it’s subsequent attitudes towards relationship, this seems of significant importance as an area of research in the future. It is important to explore what happens in the shared intersubjective space of client and therapist if the client is in such an introspective headspace.

Most psychotherapeutic approaches now acknowledge the therapeutic relationship as fundamental to psychotherapy (Clarkson, 2003). An important aspect of this is considered to be the shared empathic understanding between the therapy and client (Mearns & Thone, 2007). Empathy is typically conceptualised as the process in which therapists seek to enter their client’s unique phenomenological world. Arguably, this poses difficulties in relation to psychedelic assisted psychotherapy, as firstly, if the substances induce such a deep level of introspection that the client no longer experiences the intersubjective “I-Thou” nature of their relationship, they may not have a felt experience of the empathy that the therapist is communicating to them. Secondly, in terms of the therapist being able to provide empathy, if the client’s experience is of such a depth of introspection, and the ideas that are emerging are are in such an abstract form (Grof & Halifax, 1980), it may be difficult for the therapist to connect and empathise with the client. Again, inhibiting the therapeutic relationship. Thus this element of psychedelic therapy research needs to be explored in much greater detail.

Risks of psychedelic psychotherapy
Despite the possibilities that psychedelic treatment offers, the uncontrolled use of such substances does undeniably have risks attached. It should be reiterated however that the proposition of this literature review is to evaluate whether psychedelics have benefits in a controlled clinical setting, as opposed to for recreational use. Indeed, there is a wealth of research regarding the importance of the setting, the expectancies of the user and the awareness of the dose administered; all of which are controlled in the therapeutic environment (Friedman, 2006). There are also several meta-analyses that have investigated the link of psychedelic and psycholtyic therapies and adverse effects on over a thousand participants (Carharrt-Harris et al., 2013). These analyses concluded that psychedelics are safe to administer in psychotherapy, investigating parameters such as suicidal rates, psychoses and hospital rates (Friedman, 2006). Moreover Nichols (2004) conducted an extensive search of various medical research databases such as Medline on LSD-induced psychoses, finding only three incidences within the last 20 years.

Nonetheless, psychedelics may have a negative effect upon individuals with a family history of psychotic disorders such as schizophrenia or on individuals who have pre-existing mental illness (Walsh, 2003). A study conducted by House (2007) compared the diagnoses of patients with LSD-induced psychoses and those with a diagnosis of schizophrenia with no psychedelic consumption. Both groups showed similar psychopathological symptoms as well as having a significantly high rate of psychoses within their family history. In obtaining these results, it was concluded that the psychoses that were supposedly induced by LSD may have been triggered later in life by other triggers. Such a finding therefore indicates that the family history of psychoses is an important factor to consider on whether psychedelic psychotherapy Grawe (1995) investigated the findings of several toxicologists who compared frequently used psychedelic compounds in the potential for harm, such as the their potential for dependence. The findings concluded that none of the psychedelics used in research cause physiological toxicity or any evidence of psychedelics having an addictive potential.

These findings along with the fact that no reputable researchers have found any direct toxic effect (Carharrt-Harris et al, 2013) are surprising when considering how widely touted their toxicity is. Some research does exist however on the use of psychedelics causing accidents such as an individual developing hyperthermia due to over exertion and exhaustion under MDMA influence at a rave (Gowing et al., 2002). Such incidents further outline the importance of set and setting which is provided within the psychotherapeutic room.

The continued prohibition dilemma
Despite new studies being conducted in psychedelic research, funding still remains a major issue for the future. Since 1967, psychedelics were classified as schedule 1 drugs under the United Kingdom’s misuse of drugs regulations (Carharrt-Harris et al., 2013). Psychedelic drugs have also been classified as Class A since the UK misuse of drugs act in 1971. In the same year Psychedelic drugs were also classified as schedule 1 of the United Nations Convention on psychotropic substances; a classification is required to be accepted to receive UN membership. The classification was decided due to the UN deeming psychedelic drugs as having no accepted medical use and a great potential to cause harm, despite the previous two decades of research contradicting this (Carharrt Harris et al., 2013).

John Ehrlichman, Richard Nixon’s former assistant, infamously admitted that the harmful effects of psychedelics had been greatly exaggerated and that media had been manipulated to exacerbate this for political advantage (Friedman, 2006). Despite Ehrlichman’s confession and the evidence that psychedelic drugs do not cause dependence or toxicity (Grawe, 1995), they still remain classified as schedule 1. Considering that heroin and cocaine, two drugs that do cause dependence and toxicity, are classified as schedule 2 psychedelics classification in schedule 1 seems misleading to the public. Indeed organisations are beginning to question such outdated restrictions (Carharrt-Harris et al., 2013).

As well as the bureaucratic obstacles imposed by such strict classifications, the financial implications greatly limit future psychedelic research. For example, the UN’s schedule 1 has resulted in only one manufacturer offering psilocybin at a quality that is sufficient for research (Carharrt-Harris et al., 2013). The Imperial College psychedelic group were quoted an extortionate £100,000 for 1g of psilocyin, the equivalent of 50 doses (Carhart-Harris et al., 2013). Furthermore, in the UK for a hospital to store a schedule 1 drug a license must be bought for £5,000. Regular police checks are also required and transport is extensively over-regulated. Even to be prescribed a schedule 1 drug the prescriber must hold a license that costs £3,000. The theoretical cost of providing licenses for 100 volunteers in a field study is thus £305,000 for licenses alone (MAPS, 2010). The financial burden is increased by the reinforcing negative burden of schedule 1 classification causing grant funders to be uncomfortable in providing funding (MAPS, 2010). The difficulties in conducting research, which are outlined here, lend themselves to an exploration of the dominant discourses that might be maintaining them.

Discourse
Considering the strong bureaucratic, financial and political obstacles, that face researchers in conducting clinical investigations of a compound that could be revolutionary for the psychotherapeutic use, it is helpful to understand the discourses behind such prohibition. As mentioned earlier, CoP seeks to give a voice to marginalised groups and ideas (Passer, 2002). By adopting such a social justice orientated attitude repressed voices may be heard and thus result in positive change for the field of psychotherapy. This quest seems well applied to psychedelic discourses as the predominant prohibition discourses is proving extremely inhibiting of psychedelic research (Carharrt-Harris, 2013).

From a Foucauldian point of view, psychedelics appear to have suffered from “scientific classification”, meaning they have been socially constructed on the observation of how they appear to symptomatically and objectively affect an individual (Letcher, 2006). Discourse, meaning the way of understanding an object, therefore becomes relevant when talking about psychedelics (Phillips and Jörgensen, 2002). Such western discourses, such as ‘pathological’ and ‘prohibition’ discourses, which dictate that psychedelics have no therapeutic benefits, have arisen from the scientific classification. From these dominant discourses resistive discourses have arisen in counteraction, these include ‘psychological’ and ‘psychedelic’, ‘entheogenic’.

Two functions related to discourses are relevant when referring to psychedelics. The first is how they function to divide individuals into set, boundaried and objectified subjects. The second is how they draw boundaries around how an individual can act and what they can say. A scientific classification results in not only objects becoming classified but also individuals (Letcher, 2006).

Objectifying an object
These dividing practices that occur from such categorising are perfectly demonstrated in the predominant cultural discourse of the “drugs”. The word can usually have two wide antithetical interpretations in western culture. The first is pharmaceutical drugs, which are produced by giant, regulated and thus reliable companies and are administered by well-trained health-care professionals for analgesic or pharmacological actions. The second, refers to a group of plants, chemicals and plant extracts which are grown, extracted or synthesised illicitly and self administered by an un-trained hand for pleasure, escape, curiosity and introspection, consequentially however such substances are criminalized, usually due to a high toxicity to public health (Letcher, 2006).

The different types of substance in the second category are wide and highly variable and have variations in their qualities, including, psychophysical effects, chemical action, toxicity, ecstatic states and dependence. However these experiences are overridden by a shared delineation of potentially being abused (Letcher, 2006). Furthermore, if an individual was to self medicate such a substance they would be labelled the undesirable term of “drug abuser” and would be consigned to the boundaries of society, becoming a target in the much talked about “war on drugs” (Voase 2003). The main negative connotation of “drug abuser” is thought to be mainly due to the constructed image of an individual injecting heroin and becoming a vector of disease or a “drugged up criminal” (Jay 2000; Davenport-Hines2001). In contrast using a drug from the first category results in no negative stigmas and the use of highly addictive drugs such as caffeine and alcohol are not even considered as a drug and are merely “drinks” (Letcher, 2006). Such attitudes in society seem important to draw practitioners awareness too as they may impact on the way that clinicians engage with research.

Discourses result in boundaries
In addition, the negative discourse behind “drug” also results in boundaries of what individuals can say and do. Foucault explains that discursive practices are virtually impossible to think outside of and that to do so would be mad, incomprehensible and out of reason (Voase 2003). Therefore to postulate the possible use of the “drugs” psychedelics as a positive aid in psychotherapy is against the dominant scientific-materialist discourse. Letcher (2006) suggests that in counteracting such a discourse an individual could be labelled as mad, delusional or as a drug-consuming hippy. Such negative discourses appear to be why funding agencies are uncomfortable in providing funding for psychedelic psychotherapy investigations. In funding such a study the agency fears societal judgement and thus the agency becoming less reputable (Letcher, 2006). Again, it is likely that such discourses will have impacted the way that CoP practitioners engage with such research.

The pathological discourse
Literature has termed “pathological”, “psychological” and “prohibition” discourses as dominant when thinking about psychedelics in regard to Foucauldian scientific classification (Letcher, 2006).
The pathological discourse refers to the emphasis of psychedelics as drugs that induce physiological and mental toxicity (Letcher, 2006). The reason as to why such a discourse came about can be split into the pathological discourses of mushroom based psychedelics and that of LSD. The former is a long-lasting delineation that originated from antiquity when mushrooms were either considered to be edible, or poisonous. Experiences ingesting psilocybin mushrooms were considered poisonous as opposed to psychedelic or transcendent, resulting in ones recovery being regarded as a fortunate escape (Letcher 2006). In the 18th and 19th century this led to treatments including emetics, stomach pumping and the ingestion of leeches to treat such conditions.

Ford (1926) named a distinguished type of mushroom poisoning named mycetimus cerebralis, based on the hallucinogenic symptoms. 30 years later, psilocybin and mescaline were identified as causing these effects. However, as mentioned earlier, their toxicity is less than that of caffeine. Around the same time, Lewin (1924) invented the term narcotic and stimulating drugs composed of a group named “phantastica” that induce hallucinations. Lewin proposed that the effects induced by phantastica drugs were the same of the individuals who were psychotic, putting the effects down to the excitation of nerves causing a disruption to the function of the brain. This materialist neurological basis behind the hallucinations helped introduce the neuroscientific discourse of hallucinations causing psychosis in western medicine (Letcher, 2006).

The link between hallucinogens and subsequent psychosis became further fixed in the 1960s and the 1970s after the US government made LSD illegal and described their properties as mind-altering and psychosis inducing (MAPS, 2010). Moreover, as LSD became illegal the drug was synthesised in homemade labs resulting in toxic impurities that caused morbidity or mortality as opposed to the actual LSD itself. Such cases led to the moral panic over the use of psychedelics and further confirmed the pathological discourse (Stevens 1989; Farber 2002).

Lewins description of “phantastica” was a brief term that did not catch on following the 1940s, however the pathological discourse that was created by the term reveals various assumptions that are now assumed of psychedelics (Letcher, 2006). These included the terms “schizogen” (mimicking or producing schizophrenia), “intoxicant” (inducing posinoing), “psychomimetic” (mimicking psychotic states) and “hallucinogen” (producing hallucinogenic states). The terms created assume that psychedelics cause alterations and aberrations to the “normal” human state via their poisonous mode of action.

Such divergence, impairment, and interference of the normal physiological and mental state of the human body are assumed to be the reasons behind the production of visions and hallucinations which therefore, although real at the time, lack ontological substance (Letcher, 2006). Therefore the phenomenological psychedelic experience is one of little value in this discourse, except perhaps to empathise with individuals who have psychosis. Indeed such assumptions led to many psychiatrists encouraging their colleagues and pupils to consume psychedelics in order to fully understand the nature of psychosis (see Melichi 1997;; Letcher 2006).

The prohibition discourse
As previously mentioned, following the clinical application of psychedelic therapy, their use leaked out into the public creating a psychedelic counterculture (Letcher, 2006). As this culture increased western governments illegalised their use (MAPS, 2010). This was enforced in both clinical settings and recreationally, so as to supposedly protect public health (Letcher, 2006). Such an argument does hold power as taken in the wrong environment, state, dose or with impurities psychedelic ingestion has been shown to trigger psychotic breakdowns (Letcher, 2006). However due to the rarity of these incidents and the much higher risk to public health with substances such as alcohol and tobacco this appears dubious (Carharrt-Harris etal., 2013). Indeed the admissions of Ehlirchman further cast doubt about whether the protection of public health was the reason for their prohibition (MAPS, 2010).

Due to the prohibition discourse psychedelics have thus become classed as toxic substances with no therapeutic value, of which physical and mental health are only negatively affected (Letcher, 2006). The mere presence of the new psychedelic studies in the renaissance provides evidence that the legal boundaries may have been reduced, however the vast amount of time, resources and finance that are required in order to create a study that uses psychedelics is huge compared to that of other drugs such as anti-depressants, despite the minimal toxicity levels that psychedelics present (Letcher, 2006).

It is therefore important that we acknowledge and explore the resistive discourses to those of prohibition and pathological, as a result of the compelling empirical research that has been presented in the last 20 years that supports such resistive discourses. This is arguably especially important to the CoP as the field aspires to highligt, examin and ultimately changes social injustices (Ivey and Collins 2003). Arguable the cost imposed by the classification of psychedelic drugs, which is supported by the prohibition discourse, is a social injustice, considering the findings that demonstrate it’s potential benefits for psychotherapy and low safety risks.

Psychological Discourse
In this discourse the effects of a psychedelic are purely noted as objective experiences, which have psychotherapeutic value. Although strictly speaking, a resistive discourse to those of prohibition and pathology, it does not reflect the subjective experiences of the individual. Such a positivist discourse is one that prevails even in the renaissance of psychedelic research (Letcher, 2006). For example the studies conducted in the new age of psychedelic research have not been qualitative. Instead the research has endeavoured to find objective results. Indeed the research up to now has only been from the view point that psychedelics cause biologically different mechanisms in the normal functioning of the nervous system, and for example in psychloytic work, cause repressed memories to become consciously realised and then safely integrated (Grob et al., 2011). This research does not align itself with CoP’s phenomenological underpinnings (Lane & Corrie, 2006), as it fails to reflect the subjective experiences of the individual. Again it seems important to be aware of the dominant psychological discourse’s implications for research direction and to perhaps consider utilising other research methods for future studies.

Entheogen
Finally, the resistive discourse of “entheogen” was created by a group of academics who wished to further differentiate the psychedelic compounds from connotations with the medical model and also that of recreational use (Letcher, 2006). The term “entheogen”, originating from Greek etymology, means “inspired by god” and has religious and sacramental contexts (Letcher, 2006). By consuming psychedelics as entheogens this discourse refutes the “prohibition” and “pathological” discourses by claiming that they are substances that are not illicit or dangerous, nor ones of toxicity. Instead the entheogenic discourse claims by affecting consciousness, religious and ontological experiences of significance are produced (Letcher, 2006). Indeed some individuals critique the term as too exclusionary, and awkward (Saunders 2000; Weil 1998).

Nonetheless, the term has become a popular discourse used by both new and old age academics (Letcher, 2006). Indeed the use of the term has helped in gaining funding for psychedelic research as its steers emphasis away from the negative connotations of psychedelic compounds (Carhart-Hariss et al., 2013). This discourse is still not considered dominant within mainstream society (Letcher, 2006), and thus it seems important to continue to explore what the discourse is trying to expose and inform society of. In doing so we might draw further light on how psychedelics may be of benefit to psychotherapeutic research, and furthermore what the current positivist psychedelic research is missing.

Psychedelic research implications for psychological prescription privileges
Having thought about the implications of the prevalent and resistive discourses for psychedelic research, it now seems important consider how some of CoP’s common attitudes may impact the way that the field engages with psychedelic-therapy literature. Counselling psychologists commonly negate overreliance on psychotropic drugs in the treatment of psychological problems and disprove of the argument that mental health can be wholly conceptualised in the medical model (Newnes, 2004). Thus, the compelling research, which suggests that psychedelics have a transformative capacity (Grob et al., 2011), poses potential problems for the field of CoP.

To elaborate, it raises the question of how counselling psychologists can disapprove of overuse of drugs in mental health treatment and not reject psychedelics’ compelling potential to support and contribute to the humanistic aims. It may be helpful to consider the distinctions between the functions of psychedelics and psychopharmacological drugs on the market currently when reflecting on how such a question can be reconciled. Current psychopharmacological prescriptions can generally be seen to be constrictive of feelings (Carharrt-Harris et al., 2013). Moreover, in the constriction of emotions, for example sadness in relation to the intake of antidepressants, we may come up against a tension with regard to CoP’s conceptualisation of sadness as a potential stimulus for psychological growth specifically during psychotherapy (Friedman, 2006). More problematic is their replacement of depressive feelings with numbness thus preventing the opportunity for individuals to experience happiness when under the influence. Finally, the impact that this has on the relational depth between therapists and clients in the therapeutic context has been noted as a cause for concern (Friedman, 2006).

Research has demonstrated that the biggest predictor of change in psychotherapy is the quality of the therapeutic relationship. Literature shows that without this component change is much less likely to occur (Clarkson, 2003), therefore if anti-depressants supress emotions it could have negative implications the development of feelings in regard a client’s relationship with their therapist. Therein lays a profound difference between psychedelics and currently predominant psychopharmacological treatments. Psychedelics expand psychological processes. Therefore, they could in this regard compliment CoP’s direction towards facilitating psychological growth through the exploration of emotions and experiences. They may act as a powerful adjunct to humanistic talking therapies. Indeed, such discussions have occurred previously between psychiatrists over the past decade; Victor (1999) expressed sadness towards Western culture’s contradistinction between humanistic and biological treatments. He contrasts this with other cultures around the world that more commonly understand biological and spiritual components of existence to be intrinsically connected to each other.

Conclusion
To conclude, would CoP benefit from psychedelics being used as adjunct to psychotherapy? Both the early research of the sixties and seenties (Grof & Halifax, 1980), and the contemporary research of the last 15 years (Grob et al., 2011), suggest that psychedelics can enhance psychotherapy in many ways. Western mental health is experiencing a rapidly growing epidemic in mental health difficulties (WHO, 2003) and thus financial resources are being stretched (Lord Layard, 2006). This is causing an over reliance on pharmacological drug prescriptions, as health care professionals endeavour to manage the increasing demand on mental health services (WHO, 2003). Thus the research outlined here, and the further expansive reports from the 1950s and 1960s, also mentioned here, seem important and worthy of further investigation, as the literature presented suggests that combining psychotherapy and psychedelic substances can quicken and deepen the therapeutic process (Grob et al.,2011). Thus perhaps alleviating some of the issues that mental health professionals are grappling with.

However, despite the evidence of the therapeutic potential, and low risks with psychedelic-assisted psychotherapy, it is important to endeavour to be objective. In the past psychedelic psychotherapy became marginalised and the benefits largely went unseen, because clinicians became somewhat biased and thus at times oblivious to the inevitable risks and dangers of the substances (Letcher, 2006). Thus it is important to continue to investigate the risks with as much depth as the therapeutic uses. Nonetheless, it seems important to ensure that we do not allow the strong prohibition and pathological discourses to impair our reception of the emerging research in to this field, which demonstrates expansive positive potential for psychotherapy. Indeed, it is important to look beyond the prejudices that are largely associated with recreational drug abuse to enable us to tentatively embrace the compelling research that is being presented in the current literature in relation to clinical uses.

Whilst research is in it’s infancy with this topic the evidence of psychedelic therapy from the past (Grof & Halifax, 1980), some of which has been presented here, is at the very least enough to power future research in to the uses of these substances as an adjunct to psychotherapy. It has been strongly suggested that the anecdotal nature of some of these studies should not act as a deterrent, as this is often the way that medical trials begin (Carharrt-Harris et al., 2013). Medicine, neuroscience and philosophy are increasingly contesting the scheduling of psychedelic substances as drugs with high abuse opportunity and few medical uses (Carharrt-Harris et al., 2013). However, there are not many clinical trials being conducted in the U.K (Carhartt-Harris et al., 2013) and thus it seems important to continue to endeavour to carry out such research in order to make more informed conclusion about the question of whether it can benefit CoP.

Finally, it is important to pay further attention to the implications of psychedelic-assisted psychotherapy for the therapeutic relationship, since to date no research has directly investigated this. Since CoP has a particular interest in this element of psychotherapy (Clarkson, 2003), it seems reasonable to suggest that such research would benefit the field greatly. Thus it could be argued that as a profession we would benefit from undertaking qualitative research in this area. Furthermore, much of the research has focused on the experience of the client, but it seems interesting to also acknowledge the experience of the therapist, who from a humanistic standpoint is of paramount importance to the therapeutic process (Clarkson, 2003). Indeed, it would be interesting to explore their phenomenological experiences of working psychotherapeutically with individuals in a different state of consciousness to that which we work with in traditional psychotherapeutic practices.

Dr Michelle Ruger, Psychology Author The Millennial Blog

References
• Arulmani, G. (2007) Multicultural competence social justice and counselling psychology. Applied psychology. 56(1),69-82.

• Bogenshutz, M., Forechims, J., Wilcos, E., & Strassman, J. (2015). Psilocybin assisted treatment for alchol dependence. A proof of concept study. Journal of psychopharmacology. 3, 289-299.

• Braunstein, P., William, M & Doyle, W (1997). Druges of Liberation: From psychiatry to psychedelia, London: Routledge.

• Buber, M. (1937/2008). I and Thou. London: Continuum

• Carhart-Harris, R., Leech, R., Williams, T., Erritzoe, D., Abbasi, N., & Nutt, D. (2012) Implications for psychedeliv-assisted psychotherapy: functional magnetic resonance imaging study with psilocybing. Journal of Psychiarty. 200(3),238-244.

• Clarkson, P. (2003). The therapeutic relationship (2nd Ed.). London: Whurr.

• Davenport-Hines, R (2001). The Pursuit of Oblivion: A Social History of Drugs. London: Phoenix Press

• Farber, D (2002). The Intoxicated State/Illegal Nation: Drugs in Sixties Counterculture. In Imagine Nation: The American Counterculture of the 60s and 70s.

• Friedman, H. (2006). The Renewal of Psychedelic Research: Implications for Humanistic and Transpersonal Psychology. The Humanist Psychologist. 34 39-58.

• Ford, W (1926 ). A new Classification of Mycetismus (Mushroom Poisoning). Journal of Pharmacology and Experimental Therapeutics. 10, 305–309.

• Gable, S. (1993). Toward a comparative overview of dependence potential and acute toxicity of psychoactive substances used nonmedically. American Journal of Drug & Alcohol Abuse, 19, 263–281.

• Gasser, P., Holstein, D., Michel, Y., & Doblin, R. (2014). Safety and efficacy of Lysergic acid assisted psychotherapy for anxiety associated with life threatening diasease. The journal of nervous and mental disease. 202(7), 513-520.

• Grawe, K. (1995). Grundriss einer Allgemeinen Psychotherapie. Psychotherapeutics. 40, 130- 145

• Grinspoon, L., & Bakalar, J. (1979). Psychedelic drugs reconsidered. New York:

• Grob, CS. (2005) Psilocybin research in advanced-stage cancer patients. MAPS Bulletin 15: 8

• Grof, S., Goodman, L. E., Richards, W. A., & Kurland, A. A. (1973). LSD-Assisted Psychotherapy in Patients with Terminal Cancer. Int. Pharmacopsychiatry. 8,129-144.

• Henderson, L. A. (1994). LSD: Still with us after all these years. New York: Lexington Books

• House, S. G. (2007). Common processes in psychedelic-induced psychospiritual change. In M. J. Winkelman & T. B. Roberts (Eds.), Psychedelic medicine (Vol. 2, p. 169-193). Westport, Conn: Praeger.

• Hudson, S. (2010). Intersubjectivity of mutual recognition and the I-Thou: A comparativeanalysis of Hegel and Buber. Minerva – An Internet Journal of Philosophy, 14, 140-155.

• Lane, D.A., & Corrie, S. (2006). Counselling psychology: It’s influences and future. Counselling Psychology Review, 21(1), 12-24

• Lewin, L(1924). Phantastica: Narcotic and Stimulating Drugs. Their Use and Abuse. London: Keegan Paul.

• Lane, D.A., & Corrie, S. (2006). Counselling psychology: It’s influences and future. Counselling Psychology Review, 21(1), 12-24

• Jay, M. (2000) Emperors of Dreams: Drugs in the Nineteenth Century. Sawtry: Dedalus

• Lawrence, A. (2014). Psychedelics entering a new age of addiction therapy. The pharmaceutrical journal. 6, 243-152,

• Letcher, A. (2006). Mad thoughts on mushrooms. Anthropology of consciousness. 18(2), 74098

• MAPS. (2010). Retrieved 13.03.2010, from http://www.maps.org/research/

• Mithoefer MC, Wagner MT, Stevems AT. (2011) The safety and efficacy of {+/-} 3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: The first random controlled trial. Journal of psychiatry. 213,36-42.

• Mearns, D., & Thorne, B. (2007). Person-Centred Counselling in Action (3rd Ed.). London:Sage.

• Voase, R. (2003). Diagnosing Power Relationships: A Foucauldian Perspective on the Photographed subject. Paper given at the Tourism and Photography Conference,Sheffield Hallam University

• Phillips, L., & Jörgensen, W. (2002) Discourse Analysis as Theory and Method. London: Sage.

• Van Duerzen, E. (1990). Philosophical underpinnings of counselling psychology. Journal of counselling psychology. 5,8-14.

• Victor, B. (1999). Transpersonal psychiatry and psychopharmacologic practice. Psychiatric Annals, 29, 465–468.

• Walsh, R. (2003). Entheogens: True or false. International Journal of Transpersonal Studies. 22, 1–5

• Winkelman, M. (2014) Psychedelics as medicines for substance abuse rehabilitation: evaluating treatments with LSD, peyotes, ibogaine and ayahuasca. Current drug abuse reviews. 7(2), 101-116.

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