The global renaissance of psychedelic drugs in the treatment of mental health gains further legitimacy in Australia as psychologists sign up for clinical trialsJenny ValentishSat 29 May 2021 21.00 BST
Last modified on Sat 29 May 2021 21.02 BST
When growing up in Yea, in rural Victoria, Campbell Townsend took a dim view of drugs.
“My parents were born in the shadow of Nixon’s war on drugs, and I was a very simple country boy,” the psychologist says, sitting in his cottage outside Castlemaine. “I grew up with stories from my parents about friends of theirs at university going crazy just from one choof of a bong.”
Townsend’s fears persisted until he read journalist Michael Pollan’s 2018 book, How to Change Your Mind: The New Science of Psychedelics. The book found favour in the most mainstream of media, from Timemagazine to The Late Show with Stephen Colbert, and became a New York Times No 1 best-seller as the so-called renaissance in psychedelic research took hold around the world.
“I just got stuck into this research vortex,” Townsend says. “As a clinical psychologist who believes in evidence-based practice, I couldn’t ignore the research that began 50 years ago and the resurgence in the last decade. I thought: ‘I need to be on that train. I need to have access to this so I can give it to my clients.’ ”
Townsend is part of a wave of mental health professionals training in psychedelic-assisted psychotherapy. While Australian universities have generally been conservative in their interest, the field gained legitimacy with the announcement in March that the federal government intends to back psychedelic clinical trials with $15m.
That announcement followed a growing worldwide interest and positive research developments: at the forefront is the US-based Multidisciplinary Association for Psychedelic Studies (Maps), which has been conducting trials for MDMA-assisted psychotherapy for PTSD since 2011. In April 2021, the results of its first phase 3 trial were released: more than two-thirds of participants who took a dose of MDMA no longer qualified for a diagnosis of PTSD two months later. Participants with more treatment-resistant forms of PTSD had their depressive symptoms significantly mitigated.
Australia’s part in the psychedelic movement has been observed by Dr Martin Williams, executive director of Psychedelic Research in Science and Medicine Incorporated (Prism) Ltd, who identified the pivot point of professional interest as coming two years ago. That’s when Melbourne’s St Vincent’s hospital announced that its clinical psychologist, Dr Margaret Ross, would oversee Australia’s first psychedelic trial, using psilocybin – the psychoactive ingredient in magic mushrooms – to treat people in palliative care.
“Until that time, people had been concerned for their professional standing, but suddenly it had become legitimised and destigmatised,” Williams says.
Interested healthcare professionals tended to fall into two categories: those sympathetic to psychedelic psychotherapy and have been waiting for legislation to catch up, and those medical “elders”, such as psychiatrists, who have become recently convinced.
“There’s a cohort of psychiatrists and psychologists who have been frustrated by the demonstrable lack of positive outcomes for a certain proportion of the patients,” he says. “They’ve come to the conclusion that the current drugs – antidepressants and mood stabilisers and so forth – just don’t work for everybody.”
So far, all Australia’s psychedelic trials involve psilocybin or MDMA, but the training needs for each are very different. With a “classic psychedelic” such as psilocybin – which lends itself to the treatment of addiction, depression and anxiety and mood disorders – the participant has a very internal experience, so the therapist may provide minimal intervention, leaving the main work to follow-up sessions. Psilocybin has been researched in the treatment of palliative care patients suffering existential distress – its properties have been known to produce profound alterations in thought and perception and, in some cases, “ego dissolution and mystical-type experiences”.
A dose of MDMA – regarded as more useful in the treatment of PTSD – tends to enhance trust and increase communication, so a therapist can explore traumatic memories with the participant while they are in their altered state.
The MDMA trial that Townsend has been recruited for – along with 24 other Melbourne-based practitioners – is overseen by principal investigator Dr Paul Liknaitzky, who heads up the the clinical psychedelic research lab at Monash University.
In Liknaitzky’s estimation, the government’s $15m is enough to fund about six clinical trials. He hope the money is used in “rigorous research that is neither biased toward panacea thinking, nor ignorant of the best-practice track record and literature to date”.
The trial will happen in the second half of this year, pending ethics approval, with the sessions held in the meditation room at Monash’s neuroscience research clinic, BrainPark. Though the protocol hasn’t been finalised, one therapist will accompany a participant throughout their treatment, which is likely to involve lying down with eyeshades and headphones after taking the dose.
Some aspects of being a psychedelic clinician will require less rigidity than in standard practice, such as being able to comfort a participant with a touch of the hand or even a hug. Such arrangements would also have to be approved by a trial’s ethics committee, as well as by the participant beforehand. As the Maps code of ethics states: “We obtain informed consent for any physical touch by describing the type of therapeutic touch.”
Often during training programs there will be role play in which the therapists take turns playing the participant. Townsend experienced this when training for a psilocybin trial earlier this year. He lay down with eyeshades on and listened to a playlist as another therapist sat with him.
Townsend says that even without the substance – which is still not a legal option in Australia – the experience was moving: “There were all these psychiatrists and psychologists in tears, having deep perceptual shifts while listening to the music, having images, memories, profound things happening. What it demonstrates is if you put enough ritual and intention into something, amazing things can happen.”
Another of Liknaitzky’s recruits is Sarah Pant. Before training in psychotherapy, Pant worked in theatre, something she thinks puts her in good stead for immersing herself in people’s alternative realities. Now she has her own private psychotherapy practice, but it’s her time spent as a wilderness therapist, taking young people struggling with substance use on a journey through nature, that she feels will be closest to working as a psychedelic psychotherapist.
“It’s the having a journey of some kind and then lots of integration work,” she says. “So much of my work was just getting out of the way, witnessing and being there to understand more about the experience that the client was having, and then integrating it.”
Integration refers to the extensive psychotherapy sessions held after dosing: “I always liken that work to when you hear people going off for a great holiday, and they come back and say, ‘It changed my life!’ I always think, ‘Did it? How? What are you doing differently now?’ How do we take that learning and be sure that it feeds into your everyday life? Otherwise there’s a risk of it just being a great experience you had once.”
David Spektor, another recruit, has been a clinical psychologist for 17 years. He may have a more traditional background than Pant and Townsend – he’s never held retreats or sustained sessions – but as someone trained in intensive short-term dynamic psychotherapy focused on helping people build their capacity to tolerate their emotions, he’s curious about the way in which MDMA is thought to open up emotional processing.
“I’m a bit sceptical of it being that simple, but what better way to learn firsthand than to be part of this training?” he says. “I’m not a typically spiritual person, but it’s undeniable that people experience things that are very interesting. I’ve never had the experience myself, but the anecdotal evidence has always fascinated me.”
Spektor had been approached by Liknaitzky and was immediately interested, despite not being sure if and when he’ll wind up integrating psychedelic-assisted psychotherapy into his practice.
“Maps is the most famous and reputable training, from what I can tell, so to be part of a program that is helping research in places like China, Israel, Canada, American and now Australia, is an incredible opportunity,” he says.
Spektor, Pant and Townsend express concern that this sphere can attract evangelists pushing to move ahead faster than the research will safely allow, or who are unwilling to concede that psychedelic psychotherapy is not a panacea.
“This field has suffered from people being a little bit too careless,” says Spektor. “It needs to be appropriately researched and treated in a very serious manner in order to gain the reputation it deserves and help as many people as possible.”
There’s no confirmed timeline for when psychedelic psychotherapy will become a reality in Australia. Pant isn’t sure where the training will take her yet, though she’d like to work with a team, such as through a retreat. Even if that winds up being only once a year, she thinks the training will benefit her professional development more widely. “People experience altered states in many different ways – often mental health symptoms can take people into altered states to varying degrees,” she says, “so I think any framework and skill development in this area will be advantageous.”
For Townsend, the potential of this work dovetails nicely with what he does in his private practice and makes him the ideal candidate for overseeing eight-hour MDMA dosing sessions. He specialises in deep trauma work, but also “marathon therapy”.
“I see couples for seven-hour intensive sessions,” he says. “It really does mirror the psychedelic journey.”