Culture and psychedelic psychotherapy: Ethnic and racial themes from three Black women therapists

Abstract

Psychedelic medicine is an emerging field of research and practice that examines the psychotherapeutic effects of substances classified as hallucinogens on the human mind, body, and spirit. Current research explores the safety and efficacy of these substances for mental health disorders including anxiety, depression, and posttraumatic stress disorder (PTSD). Although current studies explore psychotherapeutic effects from a biomedical perspective, gaps in awareness around cultural issues in the therapeutic process are prominent. African Americans have been absent from psychedelic research as both participants and researchers, and little attention has been paid to the potential of psychedelics to address traumas caused by racialization. This paper examines cultural themes and clinical applications from the one-time use of 3,4-methylenedioxymethamphetamine (MDMA) as part of an US Food and Drug Administration (FDA)-approved clinical trial and training exercise for three African American female therapists. The primary themes that emerged across the varied experiences centered on strength, safety, connection, and managing oppression/racialization. The participants' experiences were found to be personally meaningful and instructive for how Western models of psychedelic-assisted psychotherapy could be more effective and accessible to the Black community. Included is a discussion of the importance of facilitator training to make best use of emerging material when it includes cultural, racial, and spiritual themes. A lack of knowledge and epistemic humility can create barriers to treatment for underserved populations. Implications for future research and practice for marginalized cultural groups are also discussed, including consideration of Functional Analytic Psychotherapy (FAP) as an adjunct to the psychedelic-therapy approaches currently advanced. As women of color are among the most stigmatized groups of people, it is essential to incorporate their perspectives into the literature to expand conversations about health equity.

The Need for Psychedelic-Assisted Therapy in the Black Community and the Burdens of Its Provision

“…These concerns are not unfounded. Psychedelic-assisted therapy can be unsafe when it is led by an inexperienced provider or a therapist who does not understand the nuances of racism ( 14 ). This paper aims to shine a light on the situation of those in the BIPOC community who could benefit from psychedelic treatments and provide a road map for greater access to psychedelic-assisted treatment.…”

“…It is important to note that psychedelic substances are not designed to be a panacea of racial healing or trauma healing. Without a trained specialist in the treatment of trauma, and specifically race-based trauma, these experiences can leave the patient vulnerable to their emotions and further add to their trauma (e.g., ( 14 )). In fact, true healing relies on societal change within multiple institutions and community support along with corrective interpersonal experiences of safety.…”

Set and Setting in the Santo Daime

“…Issues of personality and identity have received some attention in research on set and setting. Early psychedelic research proposed that personality structures play a large role in determining therapeutic outcomes ( Sandison, 1956 ; Eisner and Cohen, 1958 ), while more recent writing focused on identity ( Saldanha, 2007 ; Cavnar, 2014 ; Devenot, 2016 ; Neitzke-Spruill, 2020 ; Williams et al, 2020 ).…”

Ketamine-Assisted Psychotherapy for PTSD Related to Racial Discrimination

“…A study by Hook et al (2016) found that some of the most common microaggressions committed by therapists included a denial or lack of awareness of stereotypes and bias, and avoidance of discussing cultural issues. This can cause problems in psychedelic-assisted therapy if cultural or racial materials arise during sessions and therapists are not prepared to address it in a skillful manner (Williams et al, 2020b). When treating clients who have experienced discrimination, it is important that they approach these disclosures with openness, curiosity, and maintain cultural humility.…”