Elements of Comprehensive Psychedelic-Assisted Psychotherapy with Andrew Penn, PMHNP
In this episode of the Psychedelic Medicine Podcast, Andrew Penn joins to discuss the recent BrainFutures white paper on the elements of psychedelic-assisted therapy which he co-authored. Andrew is a psychiatric nurse practitioner and a professor at UC San Francisco who is also a psychedelic psychotherapy researcher and nationally invited speaker. Additionally, Andrew is the co-founder of the Organization of Psychedelic and Entheogenic Nurses (OPENurses).
In this conversation, Andrew discusses his white paper and breaks down the five key elements which need to be present in all psychedelic-assisted psychotherapy to ensure safety and efficacy. These five elements are safety and establishing set & setting; screening and assessment; preparation; the medication session; and integration.
In terms of screening and assessment, Andrew mentions the interesting place the field finds itself in currently, as up to this point screening practices have been rather intensive and erring on the exclusionary side since this is the standard when drugs are being tested in clinical trials. However, with psychedelic therapy continuing to become more accessible with patient options outside of these trials on the horizon, the field will need to decide what makes the most sense in terms of balancing accessibility with potential risks, and in doing so more data will be collected which will give a better picture of exclusion criteria. Andrew also stresses the need for psychiatric screening in addition to focusing on medical consideration, mentioning that it’s essential for a psychedelic therapist to know a patient’s trauma history, as this is something that may come up in a session and the more preparation the better.
When it comes to preparation, Andrew suggests that this should include establishing a relationship of trust, educating the patient, obtaining informed consent, and establishing safety measures. On the topic of consent, Andrew discusses the intricacies of dealing with this gracefully in a context where a patient will be undergoing a drug experience where consent cannot be adequately given in that moment. As such, he stresses the importance of explicit conversations between the patient and therapist around topics such as whether or not the patient would want their hand held during an intense moment. Rather than dry, procedural conversations, Andrew thinks discussions of consent are actually crucial moments where the therapist and patient can establish a relationship of trust and also more thoroughly explore the possibilities of what may come up for the patient in the session so that they feel better prepared.
In terms of the psychedelic therapy sessions and integration, Andrew suggests that the therapists play different roles in these two contexts, with the medicine sessions being more about supporting the patient in their experience without providing too much direction or prompting so that the experience may unfold naturally and autonomously, whereas in integration the therapist can take a more active role in helping the patient explore what the experiences brought up. One interesting feature about psychedelic therapy, and a reason why integration is so important, is that the intensity of the medicine experiences and the insights triggered during sessions can actually be destabilizing initially. As such, Andrew maintains that integration is a crucial aspect of psychedelic therapy in order to better ensure that these experiences can lead to deep and lasting healing.
Andrew hopes that this white paper can introduce the crucial elements of psychedelic therapy to a wider audience and encourage a standard of practice.
In this episode:
How might screening and assessment change once psychedelic therapies are more widely authorized and not only accessible as clinical trials?
Reckoning with the exclusion criteria around psychedelic therapies
The importance of thorough preparation in achieving the best patient outcomes
The dynamics of consent in preparation versus in the midst of the session and how therapists can more intentionally approach these questions
What should therapists do when a patient is not in a calm state of mind at the time of the scheduled psychedelic therapy?
Why integration is critical to facilitating healing in psychedelic therapy
Quotes:
“Trauma is likely to come up during the session and we want to at least know if there’s something there then we can anticipate that and also start to create a safer environment for that patient.” [7:53]
“We’re gonna have to figure out what is the right dose of medical screening, and then, certainly, introducing some level of psychological screening will be really important.” [10:27]
“Informed consent is this ongoing conversation with the patient where the patient can withdraw their consent at any time—they can revoke that—but people really need to know what they’re getting into if they’re going to make meaningful informed consent.” [16:12]
“What we’ve learned from psychedelic therapy is that there’s a lot of value in just letting things unfold… really the goal of the therapist should be to support that inward focus, and not try to influence the session itself in one direction or another other than to maintain safety.” [33:19]
“Psychedelics are things that tend to shove your face in whatever you’ve been avoiding and that’s something that therapists need to be really aware of—that they might encounter patients who get worse after the session, at least for a transient period of time.” [44:41]
Links:
Previous episode: When *Not* to Proceed with a Planned Psychedelic Journey with Rick Barnett, PsyD
Translational Psychedelic Research Program - TrPR