“Even within the male-centric model, women have accomplished incredible feats of athleticism, smashing long-held beliefs about what women can or cannot achieve. Imagine what would happen if everyone had access to better information and guidance.” These are the words of Christine Yu, in the introduction of her book “Up to Speed: The Groundbreaking Science of Women Athletes”. In this episode of The Appetite, Opal’s Director of Exercise+Sport and Co Founder, Kara Bazzi, LMFT talks with Christine about her reflections on the intersection of sport and gender through the lens of her work as a journalist and author. Christine is working to disseminate much needed information (and highlighting the work that is still needed) to better understand gender differences in sport in an effort to support all athletes in their similar and differing experiences.
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Thank you to our team…
Editing by David Bazzi
Music by Aaron Davidson: https://soundcloud.
Sound engineering by Ayesha Ubayatilaka at Jack Straw Studios
Transcription by Rev.com
Lexi Giblin (00:05):
Welcome to the Appetite, a podcast brought to you by Opal Food and Body Wisdom, an eating disorder treatment clinic in Seattle, Washington. On this podcast, we talk about all things food, body movement, and mental health. I’m Dr. Lexi Giblin, your host for today. I’m joined here by my co-host, Cari. Hi. And I am excited this morning to bring you a conversation regarding psychedelics, and we have brought some amazing guests today to talk us through what psychedelics are all about and what it looks like in the modern age. And so I’d love to introduce Dr. Brian Pilecki and Temple Morris. Hello and welcome to the podcast. Hello.
Temple Morris (01:03):
Thanks for having us.
Lexi Giblin (01:04):
Yes, temple. Do you want to start by just sharing a bit with us about your interest in psychedelics and the work you do?
Temple Morris (01:13):
Yeah, so I am a licensed clinical social worker in private practice, and I became interested in psychedelics about 10 years ago after my personal experience of psychedelics, which sort of began at that time. And so that prompted more interest and I’ve since expanded that interest to include work on clinical trials here in Maryland and to be part of a small psychedelic training company for mental health professionals. That pretty well sums it up. I can’t think of anything else. Interesting. Brian, how about you?
Brian Pilecki (01:51):
Yeah, thanks, temple. Good to be with you all today. So I’m a psychologist based out in Portland, Oregon at a clinic organization called Portland Psychotherapy. I’m involved in clinical research on psychedelics. Most notably, we just are wrapping up our first clinical trial of MDMA for social anxiety. I also see clients in my private practice for harm reduction and integration therapy. Let’s see, I’m a licensed facilitator here in the state of Oregon. We get to do psilocybin work. I’m an instructor for Fluence. I provide training to study therapists and mental health clinicians really around the world at this point for psychedelic assisted therapy. And I am one of the co-owners of prospective retreats with Temple, as she mentioned, offers training and personal experience retreats for mental health professionals.
Lexi Giblin (02:50):
Okay, wow. It sounds like they’re bringing some heat, bringing a lot of information, a lot of experience, a lot of expertise in this conversation. Yeah. Okay, so let’s just start off with helping the listeners understand what are psychedelics, what is included in this category?
Temple Morris (03:10):
So within the category of psychedelics, we generally sort of divide them into two categories, classic psychedelics and atypical psychedelics. And the classic psychedelics are kind of what you might imagine LSD, psilocybin or magic mushrooms. That category also includes DMT, which is the active ingredient in ayahuasca and mescal, which is the active ingredient in peyote or San Pedro. The other category of psychedelics we would call the non-classical or the atypical psychedelics. So that would include ketamine, MDMA, and a host of other molecules. And psychedelics as a class of drugs are drugs that create non-ordinary states of consciousness that have been described as mind revealing, mind manifesting. In fact, that’s where the word psychedelics comes from, the Greek derivatives of psyche and deic. Yeah.
Kara Bazzi (04:06):
Okay. So for our listeners, could you describe a little bit more the use of psychedelics in the therapy room and what does that look like? Psychedelic assisted therapy as a whole for people that are unfamiliar? Can you flesh that out for people?
Brian Pilecki (04:22):
I imagine for a lot of people the word psychedelic and therapy being put together might be a strange combination. Yes. And so obviously psychedelics have been used in a lot of contexts, including recreationally, where a lot of people kind of associate them with. But when psychedelics were introduced into the western culture, really in the 1940s with the development of LSD, right away, there was this kind of interest or thinking about them in terms of their potential applications to A, help us understand the fundamental nature of consciousness and then B, to treat mental health problems. And so I think there’s less of that. I mean, there’s still, I think some who look at psychedelics as ways to understand the mind, but obviously we’re two therapists. We’re more steeped in the world of using psychedelics as a way, the way I think about it as a way to enhance the therapy.
(05:22):
And we could talk more about this because I think this is one of the debates in this field to how important is the therapy. And my bias is clearly, I think the therapy is super important. So it’s really, I sometimes joke that I wish it were called therapy assisted by psychedelics because would make therapy front and center. But of course it’s, that doesn’t, it’s not as attractive as psychedelic. So even though they’re put first and there’s a lot of attention placed on these non-ordinary states of consciousness, the that’s created, I think that really is important in creating therapeutic outcomes for clients.
Lexi Giblin (06:07):
That’s so helpful too. I love that. What did you say? Therapy
Brian Pilecki (06:12):
Assisted by psychology
Lexi Giblin (06:13):
Therapy assisted by psychedelics. That feels really like a really helpful way of distinguishing, because a lot of folks, I know we see folks who are doing psychedelics, but not doing any of the integration work or doing any of the prep work, and just hoping that the medicine itself is doing all of the work. So maybe it’d be helpful to understand how you think about their effectiveness, what is actually happening that is making them effective for folks?
Kara Bazzi (06:53):
Or in other words, why would you suggest somebody uses psychedelics to enhance therapy? How is it additive? What is it getting at that talk therapy and other forms of therapy?
Temple Morris (07:07):
That is potentially a very long answer. So I’m going to speak to a little, and then I’m going to invite Brian to jump in. I think that psychedelics are operating at a number of levels at the same time, they’re operating at the level of receptors in the brain. They’re operating neurobiologically, operating at the level of functional brain networks, and they’re operating at the level of this objective, what people are actually experiencing inside of the journey. I think that when we think broadly about how psychedelics are helpful to people, what we’re seeing, and this is supported by the research, is that what psychedelics tend to do is to foster psychological flexibility in individuals. And what I mean by psychological flexibility is a willingness to act intentionally in the present moment, in the direction of what matters, even in the presence of discomfort. So we’re looking at cognitive flexibility, we’re looking at openness, we’re looking at a willingness to accept uncomfortable feelings.
(08:14):
And in our experience, people might have that experience inside of the journey. Ideally, what we are hoping that psychedelics will foster is increased openness and mindfulness and willingness to take risks and to be uncomfortable following the journey. So part of the role of psychotherapy following psychedelics is just to bolster those enduring changes and to support integration as you mentioned, because the drug itself generally, I mean they do have effects on people on their own. Some people experience them passively and experience great benefit, but generally speaking, we are of the, that we have to participate in integration that if we want to see change in our lives, that we’re going to have to start behaving differently. And psychedelics can be really helpful in illuminating what that might look like and why it might be important. Brian, what would you add to that?
Brian Pilecki (09:12):
Yeah, I would agree. There’s so many ways to answer this, and we are really only beginning to scratch the surface from a scientific perspective of understanding why they work, right? We’ve got much more data on outcomes. We’re seeing that they work, but the underlying processes are still not completely known and probably different for different people. I would add to what you said there, temple, that psychedelics seem to really bring up what matters to people. They really tend to clarify what’s important, meaning and purpose, values, whatever lens you want to apply to that. But people will often be in contact with things that are super important to them. They just have a way of getting to the heart of the matter and stripping things away and showing what’s important. Almost in the way I’ve been playing with this metaphor of a near-death experience. You hear people talking about the life flashing before your eyes, and suddenly there’s a clarity in that in some ways.
(10:17):
And so psychedelics, I think can do that. I think just to expand on what you share their temple, they are teachers of acceptance. They are, they’re promoters of pushing us, sometimes gently, sometimes less gently towards pain, and especially things we’ve been avoiding, things we’ve been suppressing, whether that’s trauma memories, whether that’s a problem in our lives, whether that’s a particular emotion that we struggle with, but with the right support and safety, people can navigate those successfully. And they’re not just blissful, pleasant experiences. Of course, people could have very positive transcendent emotions, which I could talk about why that is potentially therapeutic, but they’re kind of like an ordeal sometimes. They’re kind of going through this very, very intense event that can set somebody on a different path afterwards.
Temple Morris (11:21):
Really, Brian, what you reminding me is what they do in large part is it’s sort of a short course of what we’re very often trying to do in therapy is to help people make contact with painful stuff that they’ve been avoiding to see that they can do it, to learn, oh, I can do that. I can have those tears and not be overwhelmed or swallowed up by that grief, and now I can see clearly what I want to make important in my life. I’ve been stuck for so long so they can really, there it is, right? Catalyze the therapeutic process. And then there’s the therapeutic process to help you figure it out and learn how to figure out how to weave it into your life.
Kara Bazzi (11:59):
One of the things I’m thinking of as I’m hearing you talk about this that’s relevant for our clients is we talk a lot about R-O-D-B-T and the goals of R-O-D-B-T have a lot of similarities to what you’re describing of increasing flexibility and openness, and we have a lot of clients that are more connected to being more over controlled. So though that therapy is very helpful in opening those things up, yet the client has control over that process. And I think of with psychedelics, one of the maybe cautions or fears is there’s now a substance that’s doing this, and the fear of it being out of their control of making those openness changes happen. And so I’m curious how you’ve counseled people that have that fear of being out of control with a substance versus I’m choosing to do these things that could create different states of being.
Brian Pilecki (12:55):
Yeah, it’s a great question and indeed is a very common fear that people have. And for some clients it is a barrier. It is something that they are turned off by that idea and understandably so. It’s scary, right? It’s a scary idea to think about maybe giving up control. And I do think that is very often what people will experience some degree of loss of control. And that is kind of the advice and the wisdom of that. We’ve learned from, if you could go back to indigenous cultures and this idea of surrendering and opening up to something greater than ourselves, I think of a lot of psychopathology as being so we get so interior focused, we turn ourselves into a problem, and it’s just like this draws our attention inwards. And so these experiences that kind of push us out into the world, the sensory world or the relational world or the physical planet or the whole universe can be really helpful and kind of shaking things up a bit.
(14:03):
I think for clients who are real, that’s a real high piece, that’s a real big barrier for them. There’s ways to work with folks around that. So good preparation to really help them understand what this means. It could mean choosing a smaller dose to start out with so that not, it depends a lot on the dose. So if you take a smaller dose, you’re less likely to give up complete control. Or working with a substance like MDMA where loss of control or loss of sense of self is not one of the primary features of that particular medicine. So I think there’s ways to work with clients who feel particularly anxious about that aspect of it.
Lexi Giblin (14:43):
Well, I think I love all of this language. You’re bringing to us the word surrender, clarifying and teachers of acceptance of such powerful language. And I’m wondering if you could take us into some of the qualities of a psychedelic experience. What do you often see during the psychedelic experience?
Temple Morris (15:12):
Wow, we see, I mean, I think of all these different potential subjective effects, auditory and visual distortions, loss of a sense of time and space, connection with the universe, connection with nature to name just a few nausea, dizziness, I mean their physical, their visual. They’re often very deeply embodied. And I think for each person, I think of it as sort of a grab bag of effects. So some people will have a really visual trip and some people won’t have visuals at all. Some people will have a physically uncomfortable trip and other people are up dancing and skipping. So there’s such a variety of experience and you never know what you’re going to pull out of that grab bag. So it’s different for every person, every time. So every journey in every journey, we’re venturing into territory where no one has ever been before. We don’t know what’s going to happen.
(16:07):
And I do want to highlight back to that trepidation question, that that’s part of the reason that it’s so important to have a qualified sitter or guide or therapist with you. Because even though you are undertaking the journey by yourself, we are also right there with you guiding you available the whole time to keep you safe and to help you when you get stuck. But in terms of the subjective, I think there’s that grab bag of experiences that people have. I think the ones that I think that are particularly interesting for me as an act therapist is the way that psychedelics really shake up our sense of what should be, that it can shake up our sense of the rules, really invite us to challenge our stories about ourselves, about other people, about our bodies, about the world, about reality. I think in so many of the presentations that we see, there’s a lot of rigidity in thinking.
(17:04):
And what psychedelics can help do is loosen that rigid thinking and allow more bottom up processing so that we can begin to reexamine and revise and maybe even just experience those beliefs differently in ways that can be really transformative. And I think that that is so central to how people are able to create change after psychedelics to realize, I am thinking of a client I had recently who is very controlled and has been depressed for about 10 years. And so she did the journey and she emerged from it and she said, well, it turns out that love is all that matters. She said, that sounds very cliched. I thought, yeah, it does. And it’s a cliche for a reason. There’s a reason that people say that after psychedelic experiences, it’s like, oh, you just touched something really important to you. And so then the work for us becomes how are you going to enact that? How are you going to manifest that in your life moving forward? So that’s one of my favorite effects. Brian, I’m betting you have some favorites.
Brian Pilecki (18:12):
Yeah, I love the metaphor of the grab bag. Yeah, you never know what you’re going to pull out. It’s so true. And some other examples come to mind are reliving memories, revisiting important people or some sort of relational content that comes up. It could be family members, loved ones currently alive or deceased conversations, kind of sharing of information that seems to on the whole lead to some sort of healing or growth. Also, other positive emotions besides love, emotions like gratitude, feeling really grateful for what one has. Even simple things like, and this is probably another cliche, gratitude for having a body that’s alive and working. We had a client in our MDMA trial who and MDMA is not associated as much with these kind of more psychedelic effects, but really contacted this wonder about her own body and how every single body is so amazing.
(19:26):
So these experiences also can, sometimes I think of them as almost like returning to a childlike state where we’re not the sort of top down filters, which another way to kind of describe the rules temple is pointing to we accumulate all this gunk as we go through life, and some of it’s helpful and a lot of it isn’t, right, and it’s sort of a temporary removal of all of that, and then it comes back. But that kind of freedom from it and the way it comes back, it’s not going to be exactly the same. And that can be a really helpful way, I think, for people who’ve never used psychedelics to get a sense of why this might be helpful to them.
Kara Bazzi (20:12):
Yeah, I was just thinking too, some of what you’re describing would be, again, really appealing for a lot of folks thinking of getting past some of those rules that rigid thinking, because I think most people would agree that that can be really hard to live with that and to feel really stuck in rigid. And I think for our clients, that’s appealing. But again, the fear of doing a journey like this can sometimes override what’s familiar of having that control. And so I guess I think it could be really helpful to hear more about that preparation and the integration side of it, because it really sounds like that could just be helpful of understanding how much support one is getting before and after doing something that could be really scary, even if somebody is interested in those benefits.
Temple Morris (21:08):
So Kara, that kind of depends on where you’re doing it. I think Brian and I in our private practices both work with people around preparation, and we have tremendous latitude in doing that. I mean, I can work with someone for six months in preparation or for six weeks, which is about the minimum that I would agree to work with someone. And in that context, what I’m really focusing on is helping them practice willingness and certainly talking about the subjective effects of psychedelics, what they might anticipate happening so that they are as informed as they can be, but also really talking about how do you want to undertake this journey? What do you want to bring to this journey? And I think that that can be helpful for folks who are really trepidatious around losing control because while to a certain degree perhaps completely, there will be a temporary loss of control. And I think that we can also support a sense of agency, and I’m choosing to do this and I’m choosing to bring courage. I’m choosing to bring self-compassion, choosing to bring openness or curiosity. I think that that can maybe offset the trepidation a little bit. And I also don’t think there’s any way around the trepidation. I would be concerned if someone had no trepidation about stepping off into the unknown in this way. So in our private practice, I think we have a lot more latitude and figuring out how to best prepare people.
(22:38):
The clinical trials that I’m on for psilocybin and MDMA, we usually have about three sessions to get people ready, and we spend a lot of that on describing subjective effects, what they can expect practicing, how do you put on your eye shades when you’re wobbly, how are you going to put on your headphones? Let’s go and check out the bathroom. We also practice touch, right? So what’s okay with you in terms of touch? Is it okay if I offer you touch? How would you signal to me that you want touch if you’re not able to speak or if you don’t feel like talking? So we do a lot of practicing for the day. We don’t in the clinical trials generally, and the ones that I’m on, we don’t, and I think this is generally pretty true, we don’t spend a lot of time talking about the issue that they’re bringing, whatever they think might be the cause of their depression or perhaps it’s a trauma. We don’t spend a lot of time with that material in part because there’s not time. Our aim is really to help them practice grounding exercises and willingness exercises so that they are as prepared as one can be for the journey.
Kara Bazzi (23:49):
Does anyone want to speak to the integration side of that? What happens on the other side?
Brian Pilecki (23:55):
Yeah, the integration side is very important. I think for some clients in some experiences it’s almost less like what happens in the trip is not as significant as what happens after. There’s this term that I really like called unfolding process where it refers to this idea that, I like to think of it this way. The moment you decide to go on a journey, if I decide I’m going to do psilocybin in six months, the trip has begun and the trip will never end as long as I’m alive, you’re still on the trip. So it kind of plays with this idea of it’s the six hours and then what you do after. Because psilocybin, we are having some emerging research to show that it might lead to increased states of neuroplasticity for maybe several weeks, or this idea of reopening a critical window of social learning, which basically means in a simplified version that social interactions or more reinforcing.
(24:59):
So it’s not just what happens that day, but what happens in that critical couple of days or weeks after. So a lot of these experiences can be really profound and really helpful, and they tend to fade with time. And if you don’t make changes based on the insights or perspectives or experiences, you’re likely to revert back or more likely to revert back. So I think the integration phase, so psychedelics are not a passive drug like Temple said. They’re not something you just take and then your things are fixed, right? There’s a phrase they can show you the door, but you have to walk through it. And it does, I think, make some of those changes organically easier. A lot of people will come out of experiences, for example, with addiction and just they don’t have cravings, they just don’t have the urges to use alcohol or other substances. But I think if there’s not some additional frameworks that are put in place to help sustain that and strengthen that, it’s just the nature of the way our brains are wired to revert back to older habits or ways of thinking.
Temple Morris (26:16):
I want to piggyback on what Brian is saying about integration because I think in the psychedelics community, everyone agrees integration is very important. And what Brian and I have learned, what we learned early on when we started Perspectives Retreats was that it was so much more important than we realized and that it was particularly powerful in the context of groups. And I want to underscore that because psychedelics are going to be hard to offer at scale. It’s an expensive labor intensive service to offer. And so the more that we can work with people in the context of groups, the more accessible we can make it, especially to the most vulnerable and marginalized populations. And there’s something really powerful. I mean, I think we see this at our retreats. There’s something really powerful about not just sharing your own experience, but hearing about other people’s experiences.
(27:12):
There’s this symbiotic relationship. I’m not sure that that’s the word, but we learn so much from each other and other people’s experiences I think kind of amplify our own learning in ways that are, I think, difficult to describe. And for the record, I think it’s also a really amazing way for people on their various journeys to connect with each other and to keep supporting each other because while psychotherapeutic support in integration is great and important, we also need community. We need other people, we need connection in order to bring those changes about and to support us when we stumble. So I really want to highlight how valuable I think that is.
Lexi Giblin (27:58):
Wow. I’m struck by how much of what you all are talking about is a perfect fit for our clients in many ways. In terms of connectedness, in terms of flexibility, in terms of being in discomfort and kind of learning how to be in discomfort and learning from discomfort. Our clients and many of our listeners are working to recover from eating disorders or in some phase of recovery from an eating disorder, and often are experiencing comorbidities like PTSD and OCD and major depression and generalized anxiety disorder. So I guess I’m curious to how you all would think about how psychedelics may be particularly well-suited for a client recovering from an eating disorder in terms of body acceptance. I think Brian, I already heard you talking about someone sitting in wonder of their body, so I could see how that would be super powerful, but any other thoughts to add?
Brian Pilecki (29:12):
Yeah, I think the body acceptance piece or just the self-acceptance piece, the physical body, but just the self, and it’s very common for people to have these experiences of love. And I’ve heard from multiple clients that self-love or self-compassion, or however you want to describe it, turned from some intellectual concept that they knew they should be doing, but somehow weren’t able to actually experience turned into an organic experience of self-love. And I think that is really, can be really powerful. And often I think is at least the root of a lot of these problems that our clients are facing is self-criticism or the more extreme and self-hatred. So I think people often come out feeling like I’m important. I matter. My life is meaningful, and I really like who I am.
Kara Bazzi (30:24):
The other connection I’m making is, again, a lot of our clients are living in their heads and in the weeds and in the thoughts and in the rules and in the to to-dos and just focusing on the food, really hyper fixating on a lot of these things. And so what you’re describing about how it opens you up to the really what matters, what are our values, what is most important in life, that channel gets opened. And for a lot of our clients, it’s so hard to actually open up that channel and live in that channel. It’s because they’re living in their head and their food rules are guiding them and their exercise compulsions are guiding them or whatnot. So to have that window into breaking out of that way of being,
Temple Morris (31:09):
Yeah, I’m thinking of a client of mine who has body dysmorphia and she binge eats. She went off and did psychedelics one weekend. She didn’t know that I worked around psychedelics, so she showed up and fessed up not knowing that I would be completely fine with it. And she told me about the experience. She did it with friends, and what she described was this fabulous music was playing, and everyone’s sitting around on the sofa, but what she really wants to do is get up and dance. And so she doesn’t want to bring attention to her body. She’s afraid that it’ll be annoying if she’s dancing in front of people. And she has this realization inside of the trip that, well, to quote her, she says, oh, it doesn’t matter. It doesn’t matter if people don’t like me dancing, it doesn’t matter. And so she got up and she danced, and that attitude, that sort of practice with it doesn’t matter, kept generalizing.
(32:07):
And I think it was her next experience of psilocybin that she said she was playing with a roll of flesh on her belly and looking at it, saying, this doesn’t matter. It doesn’t matter. And she’s looking at other people, she’s like, we’re all so funny looking and what are these ridiculous rules we have about how we’re supposed to look? We sweat, we have crust in our eyes. We’re all these different shapes. But she really got to have this sort of blood and bones, deeply experiential experience of this doesn’t matter. And while, as Brian mentioned, the regular comes back, she got to touch that. She got to walk through the world in that for a little while. And in our work together, she just keeps pushing on that and expanding that and returning to it as part of her integration. And I think she’s such a great experience of so many of the things that we’re talking about.
Kara Bazzi (33:09):
Yeah, I love that example. And it reminds me of what you’re saying. She’s doing it in community. She was doing it with friends, at least in that experience, and she was doing that interacting. And so I guess for the listeners that are new and haven’t done a psychedelic journey or don’t know what the journey side looks like in a therapeutic setting, I know you mentioned the shades, but some people wouldn’t know. So can you share what the protocol would be for the types? What is someone actually doing in their psychedelic journey in terms of what does that look like? How much time, what is the invitation in the actual journey part?
Brian Pilecki (33:48):
So the model that’s emerged, and this really can go back to the sixties where there was this early wave of research and psychedelic assisted therapy was really developed in this western model that we still use today. The model is you do your several preparation sessions, but the actual day, the client arrives to the clinic early in the morning, kind of settle in, maybe have some ritual, repeat the intentions. There’s no new information, they know what to expect. They’ve kind of done a run through, they’ve been in the room, they might’ve even laid down on the couch where they’re going to be. And the invitation is to go inside for as much of the time as they’re willing and able to do. So that means putting on eye shades and headphones, and there’s music that’s kind of selected for these purposes, and they’re always free to come out and talk and share.
(34:47):
But the idea of going inside is that we want to remove stimulation. We want to remove external stimulus so that if it’s a therapeutic experience where they’re there for some sort of inner intention, that removing that stimulus really allows the mind to manifest, which is the word psychedelic, mind manifesting. So there is that kind of container that’s placed, and the therapists are there to provide support. And so what it actually looks like is some clients spend most of the day inside, and some of them want to come out and talk and process. Some of them need support, they want to ask for help, or they’re scared or they’re confused. And so there’s no rules here, but there’s an encouragement and gentle suggestion. And I think this is where the art and the expertise of being a psychedelic therapist comes into play that I’m still just learning is how to navigate those six or eight hours when you’re together.
(35:48):
And because talking and being in conversation can often keep one in a certain state of consciousness. And when I talk to clients about this, I’ll say in some ways, we’re trying to get beyond language, and if we’re staying in linguistic concepts, it might prevent you from going to a deeper place. And so we’re there to be supportive. But really most of the day is spent inside. Now there’s differences based on different medicines, like MDMA is I think more of a talking therapeutic drug. So that’s a separate kind of category. But when it comes to the classic psychedelics, I think it’s really about them having an experience.
Lexi Giblin (36:34):
Cool. I can see how the internal experience could be super powerful, and I could also see how a more external experience in the group context, what you were talking about with your patient temple, could be also powerful of having a different experience and through connectedness with someone else. Yeah. What other questions, I know I feel like we’ve covered, I have other ones, but would you think if a person’s dealing with a particular disorder like PTSD or Major Depression or OCD, are there particular psychedelics that you would point them to at this point? Is the research giving us that level of information yet?
Temple Morris (37:31):
Not really. Although I will say that the bulk of the PTSD research has been MDMA research, so we’re looking at MDMA for PTSD for lots of good reasons. I think it’s an excellent choice. And I think one of the reasons is that MDMA tends to be, it’s described as an ingen, a drug that enables one to touch within or heart opener. So what it tends to do is help people sort of drop their fear, shame, defensiveness, make them more willing to move toward material that has been avoided and more willing to sort of examine it and try to make sense of it very often in a deeply emotional way. It really depends on the individual, but we’ve seen great results using MDMA with PTSD in the maps LACO trials. So we see less work around PTS with psilocybin, in part because psilocybin is more unpredictable, and I think that clinicians wisely are cautious about using that with trauma survivors. That said, what we see in the trials of MDD and treatment resistant depression with psilocybin is plenty of trauma survivors.
(38:48):
Trying to not treat trauma survivors is tricky. And so we don’t really know which is better, and I don’t think we’re going to know for a long time. It also depends on the individual. Some people really do not find MDMA to be their medicine. Others really don’t find tremendous value in psilocybin. So hopefully when these medicines are rescheduled, we’ll have more information about what might work best at the end of the day. I think they all operate in different ways and important ways that compliment each other. So I’ll leave that there. Brian, what would you add to that?
Brian Pilecki (39:28):
Yeah, just to make it explicit that I think you would agree with this temple that
(39:33):
We don’t believe psychedelics might be for everybody. They might not be right. There might be some people where it doesn’t make sense or at least at a certain time in their lives. And I do think these substances need to be approached with caution and respect and a certain degree of thoughtfulness. And so sometimes when people encounter stories or people who are interested in psychedelics, there’s this kind of idealism or fervor that everybody should be tripping all the time or something, or it’s going to solve all of the world’s problems if everyone did LSD. I’ve been seeing a lot of that in the news lately. I’m not sure about that, but I think I can imagine if things continue in the way they’re going, maybe 30, 40 years from now, there are psychedelic clinics where we have a good sense of which medicines might be best suited for which problems for which people. But yeah, we’re just at the beginning of the beginning in all this, and while this initial research is really encouraging, really strong, there’s still a lot left to learn. And I think that message can be lost too in some of the new stories and the way psychedelics are covered in the popular press.
Temple Morris (40:49):
So what I was going to add to that is we don’t necessarily, because the research is in its nascent, we really don’t know. There’s so much we don’t know. One of the questions that remains unanswered to is what modalities are most effective working with psychedelics? And so that remains to be determined as well. And that’s I think part of the reason that Brian and I are here. It’s part of the reason that we work with clients around psychedelics, that we participate in clinical trials, that we formed this retreat company to train mental health professionals. It’s because we are of the mind that evidence-based therapies are the best framework for understanding how psychedelics work and for promoting benefit after a journey. So while we don’t know for sure, we feel really optimistic and excited about how evidence-based therapies can operate in this space because I think right now we’re in the minority.
Brian Pilecki (41:48):
Yeah.
Kara Bazzi (41:50):
Yeah. I felt curious if you’ve, in terms of who this is for or with your experience of doing journeys with folks, do you notice a difference between people who have already done a lot of therapeutic work and are more psychologically minded versus a quote newbie to doing a journey? And I know your retreats are for mental health professionals, so obviously they’re more psychologically minded to come into an experience like that, but yeah, is that a differentiating factor?
Temple Morris (42:24):
That is such a great question. I’ve never been asked that before. And oftentimes when I work, I’m thinking about where I work as a clinical investigator in clinical trials. We do see people who have tried everything. We’re doing trials on major depressive order and treatment resistant disorder. We see folks who’ve done so much therapy and they are not necessarily more receptive. They’re not necessarily more willing to allow for whatever shows up in the journey than people who haven’t done a lot of therapy. So I love that question. And I mean, I’m thinking about sometimes people who are sort of therapy naive are not as sort of hardened against therapy and the inefficacy of therapy, they’re a little more open to the wonder of it in my limited experience. So doing a lot of therapy, I’m not sure, is a predictor of how beneficial someone will find a trip.
(43:25):
I think what we do know from the research is that when people are willing to approach it with openness and more of a sense of acceptance, that they do tend to see greater benefit because they’re not in there fighting it. They’re in there really deriving benefit and moving through the difficult parts and learning what there is to be learned as opposed to the folks. And I am sure Brian has seen this as have the folks who say, yeah, I said I was going to do this, and no, I’m not. I’m willing to have that. And that can produce a really challenging experience that has value, but that also costs them, I think, insofar as they don’t get to move to the other side and see what they’re capable of and that willingness is possible and that they can cry those tears and mourn those losses and be okay.
Brian Pilecki (44:15):
Yeah, I’ve thought about this recently because in my doing psilocybin sessions in Oregon is a very different context than
(44:26):
What other contexts, like the research or even ketamine work. And this is just my anecdotal observations, but it seems to be, if I look at the handful of clients I’ve worked with that those who’ve been to therapy seem to have a more positive or more therapeutic experience. And so I don’t know the answer to that question, but I think I definitely can think of clients who were talking about their psychedelic experience in language that was evidence that they had been through. They’d done a lot of self-reflection. They’ve done a lot of work. And again, this idea of translating things that they knew on an intellectual level to a more felt experience of it, I’ve heard language, it was converting my therapy into a lived experience or turning 10 years of therapy into this really memorable event or moment or afternoon or something. So it’s an interesting question. And with the clinical trials, there is the confounding aspect that a lot of these participants are folks who have been failed by current treatment. So they’re the non-responders, they tend to be the non-responders. They’re very, very committed to being, you have to do so much work as a participant to be in a clinical trial. I had no idea how much was required. So these are folks who are persistent and willing to see it through, which is a bit another kind of confound in trying to glean generalizations from these early small studies.
Lexi Giblin (46:13):
This is probably a big question that maybe could you give us an overview of where we’re at in terms of legalization?
Brian Pilecki (46:25):
Yeah, that is a big question. It’s confusing out there. And by the time you publish this, we’re recording on Friday. If you publish this on Monday, it’s probably going to have changed. But in general, psychedelics are still illegal. The exceptions are psilocybin in Oregon and now Colorado. Some other states are coming on or proposing similar programs. So at the state level, they’re accessible to adults with sort of minimum criteria you need to meet. The downside there is they’re not accepted by insurance. You can’t use insurance. That might change in Colorado, but for now, that’s mostly the case. And then the other exceptions are ketamine is a dissociative drug that can have psychedelic properties and is used in ways like psychedelics, and that is legal. And there are lots of ketamine clinics around the country. Other exceptions are religious organizations. There are mushroom churches and psilocybin churches, and then there’s more traditional ayahuasca communities like Santo Dime and others that have legal protection.
(47:39):
But that can vary state by state. And then sometimes it’s in this gray area where it’s not clear if it’s how legal it is. So there’s no FDA approved psychedelic assisted therapy yet. We came close to that last summer when maps put forth their FDA application for MDMA assisted therapy. Unfortunately, the FDA said, no, you’ve got to go do some more research. There were some criticisms of the application, and so probably the next milestone will be in two or three years, a company called Compass Pathways is far ahead in their clinical research of a psilocybin substance for treatment resistant depression. And that will likely be the first FDA approved drug therapy as of today, as of Friday.
Lexi Giblin (48:35):
If any of our listeners wanted to have a legal psychedelic experience, where could they go? I understand the ketamine is available, but outside of ketamine.
Brian Pilecki (48:48):
Yeah, I should say too that the other exception is other countries. We run our retreats in the Netherlands, so people often ask, why are you going to the Netherlands? Well, it’s a country where psilocybin is legal. Jamaica is another country. I think there might be a couple of others. So with clients who have resources, they can travel to a country where there are kind of psychedelic assisted therapy options. I think most clients that’s not within their means. So yes, ketamine is one option, or at least to find a therapist who is familiar enough with psychedelics to have a conversation with you about what it is you’re looking for. Does psychedelics make sense? What are your options? And as Temple said, we work with clients who will kind of construct their own psychedelic experience, and we kind of meet with them before and after to provide the support.
Lexi Giblin (49:41):
If a listener wanted to work with either of you, is there an easy way for them to access your care?
Temple Morris (49:51):
I am only licensed in the state of Maryland, so I only work with folks who reside here. Brian’s is a different story.
Brian Pilecki (50:05):
So I’m also licensed in Oregon and Washington. So for therapy clients it would be limited. But in Oregon, I have folks travel from all over the country to come access psilocybin services. So folks who are interested can reach out. I could provide my information, or if you’re interested in our retreat prospective retreats, we also provide information about that as well.
Lexi Giblin (50:32):
Okay, great. We’ll include those in the show notes for listeners. Great. Before we wrap, is there anything you all want to be sure to touch on?
Temple Morris (50:43):
I think for me, I think some, oh, go ahead, Brian.
Brian Pilecki (50:45):
I would say one important thing that we haven’t talked about is the cultural piece. And I think when we are talking about substances like psilocybin, we are talking about sacred medicines in the eyes of some cultures, some communities, and there’s a long history of traditional use of psychedelics. And I think a lot of us who are involved in psychedelics assisted therapy today, we make a lot of effort to try to pay homage and respect to the lineage, to the folks who’ve worked in this area before. And the knowledge that we have today is in part due to the knowledge that we’ve gotten from interacting with some of these cultures. But our interest in the west has created harm in a kind of colonialistic fashion where there is an increase in psychedelic tourism, certain cultures are running out of their medicines because more people are interested and they can’t find the cactus that provides their psychedelic medicine or the bush that grows the buried and so on.
(51:57):
So I think there’s a lot of complicated layers to that, which not, this is not the place or time to go into, but just to name that that’s there and that there’s, I think, a need to bring this psychedelic assisted therapy to as many communities and folks as possible. And unfortunately, largely due to systemic factors, it’s probably going to be very expensive. I mean, that’s the way it is now. In Oregon, the sessions are very expensive, and so in the beginning, as it starts to become disseminated, it’ll probably be folks who have more wealth, who will able to access it. So it’s a really important topic in the psychedelic community, and I just want folks to be aware that there are people putting thought into it and trying to make this as accessible to everybody who could benefit, if not just people who have wealth or being.
Lexi Giblin (52:53):
Thank you for bringing that. It’s critically important. Temple, you were going to say something?
Temple Morris (53:01):
I was going to say something sort of similar to that, but Brian said it so much better than I did. I’m just going to leave it there. Okay.
Lexi Giblin (53:07):
Okay. Brian and Temple, thank you so much for this conversation. I know our listeners are going to get a lot from this, and I hope it opens some minds into this possibility.
Kara Bazzi (53:23):
Yeah, thank you. It’s really great to get to have this conversation.
Temple Morris (53:28):
It’s been great talking to you guys. Thank you so much for having us.
Brian Pilecki (53:31):
Yeah, thanks for having us.
Lexi Giblin (53:33):
Thank you to Jack Straw Cultural Center for Sound Engineering. Thanks to Aaron Davidson for the Appetite’s original music, and to David Boi for editing. If you want to learn more about Opal’s programming, go to opal food and body.com. Until next time.
