The Renaissance of Psychedelic Therapy: A Case for the Slow and Steady Approach with an Integrative Twist

Overview: Psychedelic Somatic Interactional Therapist and Webdelics’ Subject Matter Expert Steve Elfrink explores the resurgence of psychedelic therapy and its current focus on macrodoses, contrasting it with the alternative approach of psycholytic therapy. He discusses the benefits of low dose ketamine therapy for certain mental health conditions, emphasizing its rapid relief and short duration of effects. Additionally, he explores the integration of Internal Family Systems (IFS) therapy with psychedelic therapy, highlighting its potential for holistic healing. Elfrink advocates for a balanced approach to psychedelic therapy, incorporating diverse methodologies to meet individual needs responsibly.

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Navigating the Psychedelic Renaissance

In the realm of mental health treatment, we are witnessing a remarkable resurgence of interest in psychedelic therapy, a domain once relegated to the fringes of scientific research and practice. This reinvigorated exploration has been termed the “psychedelic renaissance.” 

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The current wave of psychedelic therapy is notably characterized by its emphasis on macrodoses, high doses of psychedelics aimed at inducing transcendental, mystical-type experiences. This approach coincides with the practices of the initial research wave in the late 50s and into the 60s.

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This contrasts with approaches that were particularly prevalent in Europe during that time. There, psychedelic therapy predominantly involved guided therapeutic sessions using smaller doses of LSD and psilocybin  (the active component of “magic mushrooms”) in what was known as “psycholytic therapy.” The use of lower doses in psycholytic therapy aimed at facilitating emotional release, introspection, and psychological insight, rather than inducing profound mystical experiences.

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This historical backdrop serves as a critical lens through which we can evaluate the potential for deeper and more profound healing offered by a more measured approach to psychedelic therapy.

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Exploring Healing Avenues: Macrodoses and Psycholytic Therapy Compared

The allure of macrodoses for transcendental experiences is understandable. Such experiences can offer patients dramatic shifts in perspective, often described as life-changing, by fostering a profound sense of connection to the universe and dissolving the ego's boundaries.

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This approach, however, is not without its challenges. The intensity and unpredictability of transcendental experiences can sometimes lead to difficult, if not traumatic, episodes for individuals, necessitating a highly controlled environment and expert facilitation.

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Contrastingly, the initial wave's emphasis on smaller, more controlled doses within guided therapeutic sessions hints at an alternative path — one that potentially offers a more accessible and gentle entry point into the healing capabilities of psychedelics. This slow and steady approach, characterized by its focus on creating a supportive and nurturing environment for the patient, allows for the gradual exploration of the psyche.

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Psycholytic therapy opens the door to healing without overwhelming the individual, enabling a process that is both transformative and manageable. Through a historical studies lens, Professor of Psychiatry Torsten Passie and colleagues offer the following insights: 

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“After a hiatus of about forty years since the United Nations’ prohibition of psychedelic substances in 1971, therapeutic research resumed some 30 years ago. However, there seems to be a recent dominance of psychedelic therapy and a neglect of psycholytic therapy. This is somewhat surprising, given that less than one third of the publications about hallucinogen-assisted psychotherapy in the 1955 to 2000 timeframe had been about psychedelic therapy, the other two-thirds about psycholytic therapy. For various reasons, the psycholytic approach hasn’t been developed or cultivated in North America and is virtually unknown to most researchers and therapists today. The distribution of psycholytic therapy with more than 30 treatment centers and around 100 outpatient psychotherapists was much broader than that of psychedelic therapy.”

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Dr. Stanislav Grof, a renowned psychiatrist acclaimed for his groundbreaking work in psychedelic therapy and transpersonal psychology, outlined the following processes of psycholytic therapy:

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• Stimulating emotional and sensory awareness
• Reduction in mental barriers
• Visualization of emotions through personal symbols
• Segregation of ego processes while maintaining the ability to self-reflect
• Expansion of mental connections
• Deep and vivid re-experiencing of previously denied conflicts and recollections
• Experiencing a profound journey back in time to earlier life stages
• Strong emotional releases
• Enhanced transfer of feelings directly observed in the current interaction with the therapist
• Natural self-analytical revelations

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Rapid Relief: The Promise of Ketamine 

Among the psychedelics available, ketamine stands out as particularly accessible for such an approach. Ketamine, known for its use as an anesthetic, has gained recognition for its rapid-acting antidepressant effects.

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While ketamine therapy hasn't received approval for treating mental health conditions, its U.S. Food and Drug Administration (FDA) approval as an anesthetic allows off-label use, making it accessible in therapeutic settings. This sets ketamine apart from classic psychedelic compounds like LSD and psilocybin, which presently face significant legal and regulatory hurdles until their therapeutic efficacy is confirmed. 

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Ketamine’s pharmacological profile (how it behaves in the brain) allows for short-duration, dissociative experiences that can provide immediate relief from symptoms of depression, anxiety, and other mental health issues, making it an invaluable tool in the psychedelic therapist's arsenal.

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In the landscape of contemporary psychedelic therapy, one of the most accessible and efficacious formulations of ketamine is the sublingual troche — a small, flavored lozenge designed to dissolve under the tongue for rapid absorption into the bloodstream. Companies such as Joyous offer these troches through a process of online consultation, providing a convenient and controlled approach to ketamine administration.

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Within my own practice, I have adopted a self-administration model for ketamine therapy, where the therapeutic facilitator does not directly administer the substance. This model empowers clients to take an active role in their therapeutic process under professional guidance.

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I have observed that a dosage range of 45 to 60 milligrams of sublingual ketamine effectively facilitates a state in which clients are sufficiently disengaged from their routine cognitive processes, or “offline.” This condition allows for a more profound exploration of the subconscious, minimizing the mental filtration that often impedes therapeutic progress.

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Such an approach not only leverages the psycholytic properties of ketamine to enhance therapeutic outcomes but also respects and upholds the autonomy and agency of the client within the therapeutic setting.

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From Parts to Wholeness: IFS Therapy in Psychedelic Healing

Integrating the evidence-based model of Internal Family Systems (IFS) therapy with this psychedelically augmented therapy approach offers a compelling and holistic path toward healing.

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IFS, with its focus on understanding and harmonizing the various sub-personalities or “parts” within an individual, aligns seamlessly with the introspective journey facilitated by psychedelics. This combination allows for a nuanced exploration of the psyche, where IFS provides a framework for organizing and making sense of the complex experiences and revelations that can emerge from psychedelic sessions.

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The synergy between IFS and psychedelics, particularly in a controlled, psycholytic therapy context, enhances the potential for personal growth and healing. IFS’s structured approach to identifying and addressing the needs of different parts within the self complements the expansive and often unpredictable nature of psychedelic experiences. It offers a roadmap for integration, helping individuals to assimilate their psychedelic experiences into their daily lives in a meaningful and sustainable way.

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Furthermore, the controlled and measured use of psychedelics within a therapeutic setting addresses some of the key concerns surrounding safety and, particularly in the case of ketamine, the potential for abuse. By prioritizing a supportive environment and professional guidance, this approach helps mitigate the risks associated with psychedelic use, ensuring that the focus remains on healing and personal growth.

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Embracing Slow and Steady Healing Paths in Psychedelic Therapy

While the current focus on macro doses for transcendental experiences offers significant value, there is a compelling case for revisiting and embracing the principles of the initial wave.

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A slow and steady approach, exemplified by the use of substances like ketamine, opens up a path to profound healing that is both accessible and manageable. Integrating IFS into this therapeutic model enhances its potential, offering a comprehensive framework for understanding and integrating the complex inner experiences facilitated by psychedelics.

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As we continue to explore the vast potential of psychedelics in mental health treatment, we must remain open to diverse methodologies, tailoring our approaches to meet the nuanced needs of individuals seeking healing. In doing so, we can ensure that the renaissance of psychedelic therapy unfolds in a manner that is both responsible and transformative, enriched by the depth and structure offered by therapeutic models like IFS.