The Implementation of Psychedelic Treatment

In this video, Psych Congress Steering Committee Member Andrew Penn, MS, PMHNP, shares advice for clinicians interested in psychedelic treatments with Heather Flint, senior digital managing editor, Psych Congress Network during 2021 Psych Congress in San Antonio, Texas.

“Probably the biggest misunderstanding of psychedelics is that it is the drug that does all the work. I would say it's the therapy that does the work, enhanced by the drug,” Penn shared.

Read the Transcript:

Heather Flint:  Marrying the idea of diagnosis and treatment resistant mental health disorders, what would you tell the clinicians that are looking into this field, that want to get into this field, as far as education? Can they just, "We want to do psychedelics. Now we're just going to order all this medication. You can just start right away?" How would you tell them to educate themselves? 

Andrew Penn:  This is a lot of what I'm going to talk about today in my session. For a long time, probably good 30 plus years now, we've had two silos in mental health care. We've had people that prescribe medication, and we have people that provide therapy. 

People forget this. That before the age of psychopharmacology, most psychiatrists were trained psychoanalysts. They were therapists. This idea that one person does the medicine, the other person does the therapy is a fairly new idea. I would argue, it's not necessarily been all that successful. 

A lot of times, what happens is you get one clinician doing something the other clinician doesn't even know about. They're not communicating very well. The patient is seeing both of them. It's like the blind man and the elephant. One person is treating the tail and the other person is treating the tusks. They're not realizing they're actually treating the same problem. 

With psychedelics, you can't just give somebody a pill and walk away. Probably the biggest misunderstanding of psychedelics is that it is the drug that does all the work. I would say it's the therapy that does the work, enhanced by the drug. People center the drug, especially in the media and such. It's provocative. 

"Party drug treats veteran's trauma." I've seen that headline so many times. The reality is it's therapy that treats that veteran's trauma that has been enhanced, deepened, and catalyzed by the drug. If you're not willing to do therapy, you probably shouldn't do psychedelic therapy. You probably shouldn't do psychedelic treatments. 

There has to be a therapeutic component in this treatment because these compounds, the treatment is contextual. We always talk about set and setting in psychedelic therapy. Set refers to the mindset, the intention which you go into the treatment with. Setting is the physical context. Not just the physical context, but the relational context as well. 

You have to have that safe and strong container, which is created by therapy before the drug is ever given, in order for this to be successful. Otherwise, it can actually be frightening. It can be traumatic. Without that support, without that safe container, that the patient feels like they have permission to feel whatever comes up during that session. 

Express that whatever way, as long as it's safe, that they need to, that unless they feel that, this can be a very frightening experience because these are very powerful agents. These are not trivial agents. I think anybody who's familiar with psychedelics has a deep respect for their power and understands that these are not trivialities. 

You have to hold this with a lot of intention, a lot of thought. This isn't something that you add to your menu of offerings to your clinic unless you're prepared to do it properly. This is where the training part comes in. 

Let me back up. Matthew Johnson, who's a researcher in psilocybin at Johns Hopkins, recently talked on and made a comment on Twitter saying that psychedelic therapy is more therapy than most pharmacologists and pharma companies are familiar with, and it's more pharmacology than most therapists are familiar. 

That captures a lot of the problem is that if you're not familiar with doing therapy, you're going to need to become more adaptive to therapy. If you're not familiar with pharmacology, you have to understand how this drug works. 

Those two things need to come together. That's why there's a lot of these programs that are popping up offering, Sana included, to try and help people understand this model. It is different than what we've done up till now. 

Heather:  Something that came from a Sana center. There was a table talk that Rakesh Jain did. He talked about having a mentor and being a mentor. You can simultaneously do this, but not just diving in by yourself.