Psychedelic-Assisted Therapy: A dialogue with Evan Sola, PsyD and Casey Paleos, MD

Evan Sola and Casey Paleos both have chapters in a soon to be published American Psychological Association textbook on psychedelic therapy, which formed the basis of our dialogue.

Introductions

* Matt Segall, PhD introduces himself as a philosopher with a deep interest in psychedelics due to personal experiences and their potential as agents of belief change and philosophical research instruments.

* Casey Paleos, MD follows, detailing his background as a psychiatrist and psychedelic researcher. He recounts his journey from his residency at NYU, involvement in the Psilocybin Cancer Anxiety Study, and his transition to private practice and work with MAPS (Multidisciplinary Association for Psychedelic Studies).

* Evan Sola, PsyD then shares his experiences as a clinical psychologist. He talks about his initial exposure to MDMA therapy during his grad school years, his work with Michael Mithoefer on adherence rating, and his doctoral research on the qualitative processes in MDMA-assisted therapy.

Discussion on Psychedelics in Therapy The conversation delves into the therapeutic potential of psychedelics. Matt emphasizes the importance of understanding the philosophical and spiritual implications of psychedelic experiences, while Casey and Evan discuss their professional experiences and the transformative impact of these substances on mental health treatment.

Ethical Considerations and Therapeutic Approaches

* The participants explore the ethical complexities in psychedelic-assisted therapy, such as the issues of consent and the role of touch during sessions.

* Casey Paleos emphasizes the necessity for therapists to do their own inner work to manage transference and countertransference, ensuring they maintain clear professional boundaries.

* Evan Sola highlights the importance of being present with clients’ experiences, managing conflict and disappointment, and not rushing clients out of negative feelings but rather helping them navigate these emotions.

Philosophical and Ontological Insights The discussion touches on various philosophical perspectives, such as dual aspect monism and the idea that consciousness may be a non-local phenomenon. They discuss how these perspectives can enhance the understanding and practice of psychedelic-assisted therapy.

Challenges and Future Directions The conversation shifts to the challenges in the field, including maintaining ethical standards and the potential for psychedelic-assisted therapy to be misrepresented as offering reductive solutions or “cures.” They address the importance of nuanced and ongoing research, proper training, and establishing a community and clinic with high standards for safety and efficacy.

Some background reading material:

* Psychedelics and the ‘inner healer’: Myth or mechanism? By Peill J, Marguilho M, Erritzoe D, et al. in Journal of Psychopharmacology. 2024;38(5):417-424.

* Comment to FDA advisory committee looking at MDMA therapy by Nese Devenot

* “A Theological Reckoning with ‘Bad Trips’” by Rachel Petersen.

Watch the video of this conversation here:

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