Bufka discusses how the APA and its members are responding to psychedelics’ rising popularity, and how the organization makes decisions about issuing guidance to its members.
Speaking from my own experience is an idiosyncratic frame. However, there are millions of people walking around who have experienced psychedelics, and their range of similar and diverse experience is something that should be able to be mined via deep data mining and perhaps the emerging tools of AI.
Because the mindset and setting are so important to how a psychedelic experience will unfold for a given person, and because each person has their own particular brain substrate and experience, a one size fits all approach is not going to work. There has to be sensitivity to what a person on the psychedelic is expressing, and an awareness and preparation that allows a person to undergo such an experience so that they can "change the channel". Because of how sensitive to stimulus a person on a psychedelic is, they are both uniquely vulnerable and also able to use stimulation to which they are already deeply sensitive to enable moving out of a state that may be distressing. Music, a fragrance, a talisman to which the person has strong positive associations are all things that someone who is going through a psychedelic session should have with them.
Outcomes are going to vary - just as they do with any treatment - and everyone will bring different things to and from a session.
Scientific research will help us to better understand methods of action, and clinical studies will start to show patterns that have broad brush applicability, but each person and each experience with each type of psychedelic is unique. Don't be surprised - or rather be surprised but not shocked - that you have to be present with a person, trusted by them, and that you must be aware of your own state so as to not impose or impinge your own issues because a person on psychedelics is extremely sensitive and will pick up on unconscious cues. If it is important in non-psychedelic therapy to be aware of your state, multiply that by at least a hundred when being with someone going through a psychedelic experience.
Adding Any person who is acting as a sitter or psychotherapist *MUST* have significant personal experience with psychedelics to build awareness of what psychedelic states are on a deep experiential level. This is not a treatment that can be administered without that deep experiential knowledge.
Having gone down this road on my own in order to treat my own Complex PTSD, I can say that not all treatments are effective for all people. In my case, I had an adverse physical and psychological reaction to MDMA which I received from a guide I hired. The session itself was helpful in terms of unpacking a lot of trauma. In the aftermath, I experienced depression, insomnia and severe digestive issues. I have also done a number of sessions with psilocybin that were quite impactful, but that did not result in a cure of my condition. The sessions were intense and emotional. It was hard to find a guide that was trauma informed and knew how to work with someone like me.
Ultimately, I found more relief with Ketamine infusions and Spravato treatments (Spravato is covered by our health plan) along with psychotherapy. These treatments are already legal and widely accessible.
A good follow-up question for Dr. Bufka would be about the need to better understand to what extent a washout period is really needed for patients using medications for depression, etc. It makes sense in clinical trials, but poses problems in clinical practice.