Wednesday, July 6, 2022

Ways Forward in the Wake of Psychedelic Therapy Abuse

By David S. Prescott, LICSW, and Natalie Villeneuve, MSW, RSW

Several weeks ago, we wrote a blog post highlighting concerns about abuse taking place within psychedelic therapy. This centered on revelations from a podcast titled, Cover Story: Power Trip, which uncovered how practitioners have engaged in abusive practices, often seemingly ignored by researchers. We have also recently written an article that explores the issues and offers some ideas on the way forward. In many cases, the evidence has been shocking. The main forces behind this podcast (and many other efforts), Lily Kay Ross and Dave Nickles, are to be commended for their efforts. As always, we have been grateful to the survivors who were willing to help us by telling their stories and reviewing drafts of our writings.

Since our first blog, other allegations have surfaced, such as this example, in which a therapist is reported to have taken millions from an elderly client who was a holocaust survivor. Although legal action against the therapist, Vicky Dulai, reportedly began in May 2021, the case was only reported in April 2022. These allegations were especially noteworthy given that Dulai is on the board of directors for the Multidisciplinary Association for Psychedelic Studies (MAPS), which initiated an investigation only after the case was reported publicly. Not surprisingly, MAPS trials are now under review over the alleged abuse of study participants.

For their part, MAPS has not appeared to prioritize the needs or rights of those who have been harmed. The above linked reporting discusses how it took several years for them to review video recordings of abuse that took place under their auspices. More recently, the distinguished trauma researcher Bessel van der Kolk has become the principal investigator for MAPS in Boston. Of course, van der Kolk himself had been fired from a position he held for many years following allegations of employee mistreatment in 2017.

It has seemed clear to us, as professionals working in the field of trauma, that the practice and research efforts in current psychedelic therapy have not fully accounted for the unacceptable risk of harm that takes place when abuse occurs. Setting aside the more overt forms of abuse already covered, it’s worth repeating that discussions of informed consent, and the withdrawal of consent have remained in short supply. Two recent examples come to mind.

The first example appeared on Twitter recently, when Ronan Levy, the founder of Field Trip (whose mission is to “bring the world to life through psychedelics and psychedelic-enhanced psychotherapy”) posted to Twitter about a man who had accidentally taken “magic mushrooms.” The original story described a police officer who had “unwittingly” taken this drug and now takes microdoses of it every day to alleviate his depression. Levy’s summary is, “From unwitting to witting. That’s the nature of wisdom.” The tweet implies that giving someone these drugs without their knowledge is acceptable. It also implies that microdosing psychedelics with no plan for termination is also acceptable. This has led us to wonder where the boundaries are in implementing psychedelic therapies are.

The second example is in some of the historical underpinnings of psychedelic therapies. A Google search on the term “There is no such thing as a bad trip” can be enlightening. Much of the history of this statement is addressed in the Cover Story: Power Trip podcast, but it is worthy of a deeper dive, such as in this post in Psychology Today, this paper in the International Journal of Drug Policy, and this article in Medium. Each is optimistic about the nature of psychedelics, but none seems to acknowledge that some bad experiences can be very bad indeed. Some survivors have described lingering effects from these drugs, as well as increased usage of them after the purportedly therapeutic experiences. While reframing adverse events in one’s life can be profoundly healing, it seems bizarre to tell people who have had bad experiences that they are looking at them incorrectly. It is completely contrary to what we know does and doesn’t work across all forms of psychotherapy. One early proponent, Salvador Roquet, was well known for initiating difficult experiences as part of his work. From the Psychology Today post linked above:

Another fascinating example is the therapeutic model of Mexican public health doctor Salvador Roquet, who had reasoned that the perennial human fear of death was the root of all forms of anxiety. Hence, Roquet purposefully subjected his patients to abuse and showed them violent and pornographic footage under the influence. This may seem crude, but some patients were allegedly better off after their trips.

Tying these threads together, there is ample reason to be concerned that the use of psychedelic therapy is not staying true to its Indigenous roots and that sub-cultures within it are emerging that tolerate and, in some instances, even encourage abusive behaviors. This is especially concerning when one considers what is at stake: the effective treatment of anxiety, depression, and trauma. It seems that psychedelic therapies as currently implemented need to examine not only the abuses taking place within them, but also the cultures that permit them. To that end, it is our hope that:

·       Practitioners and organizations such as MAPS, Field Trip, and many others will enlist the assistance of trauma experts and use survivors’ voices as their strongest guidance in moving forward. Advancing too quickly without this guidance poses an unacceptable risk of harm not only to deeply vulnerable clients, but also to these efforts more broadly.

·       These same entities can conduct extensive work into the nature of informed consent as it applies to research and practices that use these drugs. The nature of psychedelics makes them different in kind from other interventions. This work can involve considerations of how clients can withdraw consent.

·       As we indicate elsewhere, these entities can also develop active cultures of feedback from participants to ensure that the voices of those adversely affected are heard. By “active,” we mean working diligently to develop a culture in which each client’s voice is solicited, and each voice is heard, understood, and respected. This must be a collaborative culture, one in which the client is welcome to speak out with no concern about judgment or negative repercussions.

·       Finally, these entities can also guard against a practice which is too common elsewhere. All too often, psychiatric medications are assigned very quickly after brief office visits. These entities will benefit from guarding against processes that are so brief that they neglect the potential downside impact of these drugs.

It is our hope that deep considerations in these areas will be helpful to everyone involved, starting with the survivors themselves.






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