The dramatic resurgence of interest in psychedelics and low dose (anxiolytic) anesthetics like Ketamine for treating mental health conditions has drawn attention to their potential to facilitate deep emotional healing. However, the crucial importance of a Therapeutic Alliance with a psychotherapist is neglected in most studies of efficacy.
In this post I describe the importance of establishing a deep Therapeutic Alliance with a knowledgeable, trusted, compassionate psychotherapist before taking Ketamine, MDMA, Psilocybin, or Ayahuasca plant medicine, and the life giving impact this alliance can have on desired therapeutic outcomes such as the reduction of Treatment Resistant Depression, Anxiety, and PTSD after taking the medicine.
The therapeutic alliance is a cornerstone of Emotionally Focused Therapy, Sensorimotor Therapy and Family Systems Therapy all of which emphasize the expression of emotions deeply rooted in the body, mostly without words. The expression of these emotions in a safe, trusting, collaboration with an experienced, compassionate psychotherapist is crucial.
This collaboration includes:
Creating a Sense of Safety
Ketamine and Psychedelics like MDMA (Ecstasy), Psilocybin (Mushrooms) and Ayahusca plant medicine can trigger intense, often frightening emotional experiences. A solid Therapeutic Alliance with a trusted psychotherapist provides a foundation of trust and safety, allowing you to fully engage in the experience of the medicine. Research has shown that people who feel safe, emotionally supported and deeply known by their psychotherapist are more likely to get more insights, reassurance and hope than from the medicine by itself.
Enhancing Mindset and Setting
Your mindset while you’re taking the medicine and the setting or emotional environment you’re in both before and after you’ve taken the medicine are absolutely crucial in psychedelic therapy. The setting, i.e., a supportive therapeutic relationship both before and after you’ve taken the medicine will you help reduce your anxiety and foster more cursiosity and openness to the experience. Both your mindset and setting are crucial for maximizing the therapeutic potential of Ketamine, and psychedelics like MDMA, Psilocybin and Ayahuasca.
Facilitating Integration
The integration of your Ketamine or psychedelic experiences into your everyday life is a crucial aspect of psychotherapy. A strong Therapeutic Alliance with your therapist will ensure that you have the necessary emotional support to process and make sense of your confusing, often frightening experiences. A trusted, knowledgeable, compassionate psychotherapist can guide you in applying emotional insights gained during your medicine sessions to your personal life and enhance the long-term benefits of the medicine.
Reducing Anxiety and Enhancing Comfort
Trusting and being able to count on your psychotherapist can significantly reduce your pre-session anxiety. Emotional reassurance from your therapist will encourage you to surrender to the experience of the medicine. Studies have demonstrated that lower anxiety levels going into the medicine correlate with more positive therapeutic outcomes when off the medicine.
Numerous studies have highlighted the importance of The Therapeutic Alliance in Psychedelic Assisted Psychotherapy:
The Multidisciplinary Association for Psychedelic Studies (MAPS) emphasizes the importance of The Therapeutic Alliance in their clinical trials of MDMA Assisted Psychotherapy. Psychotherapists at MAPS receive extensive training to build and maintain compassionate, trusting relationships with patients that have been proven to enhance treatment outcomes.
Researchers like Rosalind Watts at Imperial College, London have underscored the Importance of the Therapeutic Alliance in Psilocybin Assisted Psychotherapy. Rosalind Watts’ studies have highlighted how a strong Therapeutic Alliance with a compassionate, empathic therapist can facilitate deep emotional processing and the integration of confusing, often frighening emotions while on the medicine. These studies have resulted in significant reductions in Treatment Resistent Depression.
Clinical trials with Ketamine have demonstrated that the Therapeutic Alliance is absolutely crucial in patient outcomes. A strong, trusting, compassionate alliance with your psychotherapist leads to reduced depression and anxiety.
To optimize the efficacy of Psychedelic-Assisted Psychotherapy, it is essential to:
Ensure that therapists are trained in building and maintaining a strong Therapeutic Alliance with patients that foster compassion, empathy, active listening, and supportive communication.
Create and Develop Qualitative Measures to capture the elusive, non-verbal emotional nuances of the therapeutic relationship and its impact on treatment outcomes. This is a real challenge for researchers because these nuances are extremely difficult to capture in words and may often require videos of people before and after they’ve taken the medicine.
Detailed Reporting must include comprehensive descriptions – ideally expressed in moving stories or case histories – of the emotional condition of people before and after they’ve taken the medicine. Again, this is a real challenge for researchers who’ve been trained to write abstract summaries or expositions as opposed to truly moving, often dramatic stories.
Use highly personalized therapeutic approaches that take into account the particular needs and circumstances of each patient, facilitated by a strong Therapeutic Alliance.
Provide caring, compassionate support that will encourage patients to integrate their emotional experiences, often confusing and terrifying, into their everyday lives. Creating a strong Therapeutic Alliance to ensure the lasting benefits of the medicine is absoluely crucial.
The Therapeutic Alliance is a frequently neglected part of Ketamine and Psychedelic Assisted Psychotherapy that focus on the strictly medical aspect of treatment. Creating a compassionate, trusting Therapeutic Alliance with a psychotherpist trained in Emotionally Focused Therapy, Sensorimotor Therapy and Family Systems Therapy before administering Ketamine, MDMA, Psilocybin, or Ayahuasca can significantly enrich and deepen life-giving therapeutic outcomes.
Future research and clinical practices must prioritize the creation and enhancement of the Therapeutic Alliance much more than they do now in order to fully realize the potential of Ketamine Assisted and Psychedelic Assisted Therapies.
