Culturally responsible care: 5 Questions for therapist Sara Reed

Reed discusses her experiences with MDMA therapy — both as a practitioner and a patient — and why she founded a company.

In 2013, two of Sara Reed’s family members died. At first, work served as a distraction from her heartache; her three jobs — working at a massage clinic, tutoring, and launching a non-profit that mentored teenage girls — had her routinely working 12-hour days. But she knew she couldn’t hide from her grief forever. She prayed: “Lord, if you get me out of this situation, I will do whatever it is that you want me to do.” And the answer she received? Go into marriage and family counseling. 

As an undergrad, Reed had taken philosophy and bioethics classes and had vowed never to get involved with the medical field after learning about its history of experimenting on people of color. But she listened to that calling, and moved to Georgia the next year for a masters in marriage and family therapy. After she graduated, she was connected with psychology researcher Monnica Williams, who asked her if she was interested in joining a MAPS training for providing MDMA-assisted therapy for PTSD. Reed became the first Black therapist involved with MAPS’ phase 2 clinical trial using MDMA to treat PTSD.

After completing training, Reed founded a mental health company called Minds iHealth, which offers psychedelic-assisted therapy and integration coaching. She’s a scientific advisor for the company Journey Colab and a current board member for the Board of Psychedelic Medicines and Therapies. The Microdose spoke with Reed about her experiences with MDMA therapy — both as a practitioner and a patient — and why she founded a company.

You recently wrote a piece in Self, about your experience as a therapist taking MDMA and what that taught you about psychedelic therapy. You mention a particularly difficult moment when you felt frustrated and misunderstood by the therapists working with you. You write,

“I said to my therapists, “You all don’t understand what I’m really trying to say.” “Maybe there is a part of you that doesn’t want to be understood,” one of the therapists said. Silence. There is nothing more I want in life than to be understood. Malcolm X once said, “The most disrespected, unprotected, and neglected person in America is the Black woman.” I’d like to add misunderstood to that phrase too.

What did you take away from that experience?

It's not about providing culturally competent care; it's about culturally responsible care. The way that cultural issues are talked about in mental health training programs, and definitely in psychedelic assisted therapy programs, is: “If you're working with someone who is representative of particular social identities, here are some considerations.” And I'm like, no, no, no, no, no. It’s actually the guides’ or facilitators’ responsibility to fuse cultural elements within the work. If those tools and practices are not integrated in the work, there are going to be consequences for the person that you're working with. 

It's critical for providers to learn cultural sensitivity because when you're talking about working with folks in psychedelic medicine, or particularly in dosing sessions, these are folks who are vulnerable for a variety of different reasons. Most of the folks that I've worked with have been in therapy for many, many years, if not decades, with minimal symptom relief. They've tried medication management and traditional talk therapy, and things haven't worked. I've heard people say, “Psychedelic therapy is my last hope.” If you know that people are going into these experiences in a very vulnerable, expansive, conscious state, practitioners need to be grounded, and to be facilitating from an inviting place. Because if we don’t, our stuff is going to come up in sessions. We will be triggered by what the folks that we work with say, and our stuff can be actual barriers to a participant's practice. That increases harm, that increases risk. As health care professionals, we have an ethical obligation to do no harm. Part of doing no harm includes being culturally sensitive. 

The MDMA experience you wrote about was an opportunity for therapists in an MDMA training program to try the drug. How important do you think it is for practitioners to have direct experience with psychedelic therapy?

I believe that it’s important to have a relationship with the medicines that you're working with. Without it, therapists would be coming in from a disconnected, disembodied perspective, and could maybe even reproduce harmful practices.

Now, how that relationship manifests is dependent upon the person. For example, I know a woman who was doing some work with ketamine, and she had an opportunity to experience ketamine for herself. She wanted to experience it prior to doing treatment sessions but because of a health condition, she was ineligible to participate. While I think it is important to have experiences with these medicines if possible, I also want to name and respect the folks that might not be able to have the same access to it. That’s why I’m more focused on having a relationship with the medicine, not just reducing it to taking the medicines. 

I will say that personally, my experience with MDMA therapy gave me a lot of insight into what the treatment would be like. It was important for me as a practitioner to experience what it’s like in a medical setting —  to experience what I would be asking other folks to do. 

How do you think a more medical environment, like the one you’re describing, affects the overall experience of taking MDMA?

I find a lot of medical practitioners, folks in academia, or healthcare professionals who say we've got to medicalize treatment because it'll help reduce harms, and we can give folks a “safe experience.” But we can't guarantee safe experiences; I am not the only person of color who has gone through a psychedelic-assisted experience with a white practitioner and experienced challenges. 

We need to continue the conversation around the importance of integration. One thing that I see in my clinical work is that people are starting to put too much power in the medicine. They say, “Oh, I'm not feeling well, so I need to go microdose mushrooms,” or “I need to have an experience with LSD or ketamine.” They're having these experiences without the full integration, and integration of the experiences is a huge part of being able to maintain the therapeutic gains.

I advocate for both psychedelic-assisted use in medicalized contexts, and psychedelic-assisted therapy in recreational, ceremonial, or personal contexts. I think both can be safe and effective. We would be delusional, arrogant and irresponsible if we just completely focused on medicalizing psychedelic assisted therapy because Black folks and Indigenous folks have been using plant medicines for centuries. This is not anything new. There are folks who are already exposed to the potential therapeutic benefits of psychedelic medicines, and they want to try it at home and they're having wonderful, powerful experiences. We would be missing out on an opportunity if we didn't talk about training practitioners to be integrative therapists, because not everybody's going to be able to afford this treatment in these medical settings.  For the people that are going to do it in their homes with their friends, how can we get folks the protections, the information, and the resources that they need to have safe, meaningful experiences? 

To make psychedelic treatment more accessible or affordable, some researchers and companies are experimenting with removing hallucinogenic effects from psychedelic drugs. What do you think of that?

It's scary and strange to me. “Scary” feels a little dramatic, but yeah, to think that there are some people who are wanting to extract parts of natural plants and medicines to attempt to control these experiences? It's giving colonizer vibes. 

A medicine person once told me that when you remove a plant from its natural environment, it loses some of its properties, so I think it's I think it's quite arrogant to think that one can manipulate certain elements of a medicine and think that it’s only going to retain the more desirable effects. There's so much variability in living, breathing organisms, and so much variability in life. If we try to remove the variability, we're going to miss what makes it so special. 

Your company, Mind’s iHealth, offers integration support for clients online, and you’ll be rolling out some virtual reality offerings soon. Can you tell us more about how VR will be used, and how to foster a sense of connection digitally?

The application that we're offering is by no means a substitute for therapy. We're not trying to induce a psychedelic experience for folks; rather, we're trying to help people make sense of the work that they've already done. What I found in my clinical work is that most folks want more than 60 minute sessions every week, and therapist burnout is real. So how can we support folks in continuing their integration?

So the virtual component we are creating will help supplement therapy, and we have different levels of the experience available: there will be individual and group experiences, sound healing sessions, and guided meditations. 

You can't replace human connection, and there are also issues around accessibility as well, so we are being intentional about how we're doing our pilot. One thing we are really focusing on is helping folks to remind themselves of their own inner healer, their own innate capacity to heal. With therapy, and with Western medicine, sometimes folks put too much power in the provider — to be like, “I need my therapist, I need my session this week.” I was always told that therapy is about helping you in different seasons in your life; it's not meant to be a replacement for you living your life. So the virtual reality experience we're creating helps users connect with themselves in a more intentional way. It's not to say that we want you to spend hours on this app and not connect with other human beings.

This interview has been edited and condensed for clarity and length.