In almost all research on the efficacy of Ketamine and psychedelics like MDMA Ecstasy, Psilocybin Mushrooms and Ayahuasca plant medicine, almost no attention has been given to the Therapeutic Alliance psychotherapists must create with their clients in psychotherapy sessions, either in the test groups that get the medicine or the placebo groups that don’t.
Research designs for the vast majority of studies typically focus on pharmacological effects, clinically controlled dosages and the physical setting, rather than attempting to grasp the impact of the Therapeutic Alliance created by psychotherapists and clients even though researchers will tacitly admit that measuring the efficacy of the medicines is highly dependent on the ways in which psychotherapists and clients relate to each other and the therapeutic relationships they create together.
The efficacy of Ketamine, MDMA, Psilocybin or Ayahuasca can never be fully understood without taking into account:
- Preparation: The creation of a Therapeutic Alliance between therapists and clients during preparation sessions that establish trust, safety, and a sense of shared purpose that are essential for taking on challenging experiences that clients may face while ther are on the medicine.
- Trust and Vulnerability: During the Ketamine or psychedelic experience itself, the degree of trust between therapists and clients can profoundly influence how fully clients can allow themselves to engage with painful, often traumatic emotions or memories.
- Post-Session Integration: How the Therapeutic Alliance can help clients make emotional and cognitive sense of confusing, sometimes frightening experiences after they’re off the medicine and attempt to apply insights gained while they were on the medicine to their daily lives, with the help of a caring, compassionate psychotherapist.
Few studies attempt to account for the impact of the Therapeutic Alliance created by psychotherapists and clients because the illusive nature of human relationships defy quantitative measurement. For example, how could researchers quantitatively mesure Karl Roger’s humanistic, Unconditional Positive Regard for his clients? How could they measure the empathy expressed by Rogers’s when he stated: I have come to see that when I am able to let myself enter fully into the world of what [the client] is saying, I gradually lose all sense of criticism, and [my] self-awareness seems to fade away. [In] such moments, I am simply there, ready to respond to whatever the [the client] is expressing. It’s as if I become part of his world for the time being.
Rigorous evaluation of the quality of the Therapeutic Alliance between patient and therapist is a daunting task that defies quantification using of measurement scales. Researchers have been trying for years to measure empathy – a therapist’s grasp of what patients (not to mention, the therapists friends and loved ones) are actually feeling. Self-administered questionnaires like The Interpersonal Reactivity Index (IRI), The Empathy Quotient (EQ), The Toronto Empathy Questionnaire (TEQ) may not capture the full range of the psychotherapist’s empathic abilities, particularly the therapist’s cognitive empathy or capacity to understand the subjective perspectives of others. These questionnaires also miss the subtle distinctions between sympathy and compassion. Compassion is especially challenging. None of these questionnaires can satisfactorily measure Ordinary Human Compassion, the Compassion of Curiosity and Understanding, the Compassion of Recognition, the Compassion of Truth and the Compassion of Possibility.
Brain scans can offer valuable insights into the Therapeutic Alliance created by psychotherapists and clients by providing evidence that the neural basis of empathy involves complex interactions between multiple brain regions that express both emotional and cognitive processes. However, in the words of Stephen Kosslyn, a well-known cognitive neuroscientist and psychologist: “fMRIs are like flying over Manhattan at 10,000 feet. Some brain regions light up and others don’t, but we never really know what’s going on in each neighborhood,”
Perhaps the closest researchers will ever come to grasping what really occurs qualitatively between psychotherapists and clients during psychotherapy sessions is by actually filming what happens as in dramatic scenes from moving films like: Far from the Madding Crowd, A Woman Under the Influence, My Life as a Dog, Cider House Rules, The English Patient and I’ve Loved You So Long.
A strong case can be made for the proposition that: 1) The Therapeutic Alliance created by psychotherapists and clients is impossible to measure quantitatively, 2) This Therapeutic Alliance can only be grasped from emotionally moving, dramatic metaphors drawn from literature and films, and 3) There is a crying need for a deeper appreciation and understanding of the Therapeutic Alliance created between psychotherapists and their clients.
At Marriage Couples Counseling, Andre Moore, LMFT, Certified Psychedelic Assisted Therapist by the Integrative Psychiatry Institute will learn about your current life stressors, early childhood attachments, very early and/or later PTSD, the extent of your struggle with depression and what you hope to achieve in your daily life after your experience with the medicine.
