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Dr Paul Liknaitzky: Future directions for Psychedelic Research
238 Plays2 months ago
In this episode, I talk with Dr Paul Liknaitzky, Head of the Clinical Psychedelic Lab at Monash University. 🌱
We explore Paul’s journey into psychedelic science and therapy, challenges & opportunities in psychedelic rescheduling in Australia, The critical skills needed for psychedelic therapists, future directions for psychedelic research, and why collaboration is key in this space
Paul is Head of the Clinical Psychedelic Lab and a lSenior Research Fellow in the Department of Psychiatry at Monash University. He has played a central role in establishing the field of clinical psychedelic research in Australia and is the principal investigator on a program of psychedelic trials. He is involved in numerous psychedelic studies across the country and collaborates with many international experts and organisations in the field. He has led several world-first studies, including the first trial to use psilocybin in the treatment of a primary anxiety condition, the first study testing the utility of psilocybin as a therapist training tool, and the first trial testing a psychedelic-augmented virtual-reality treatment.
keep in touch with me at Insta: dresmedark
Linkedin: www.linkedin.com/in/dr-esme-dark-627156a0/
website: https://www.esmedarkpsychology.com.au/
Find Paul and Monash Clinical Psychedelic Lab at www.monash.edu/psychedelics
Disclaimer: This podcast if for general information only and does not constitute an endorsement or recommendation for psychedelic- assisted psychotherapy.
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Transcript
Introduction to 'Beyond the Trip' and Purpose
00:00:04
Speaker
Hello and welcome to Beyond the Trip, a psychedelic therapy podcast with me, Dr. Esme Ta. During this podcast, I'll be bringing you conversations with thought leaders and other inspiring humans, exploring a wide variety of themes relating to the use of psychedelic-assisted psychotherapy in the healing of human distress.
00:00:26
Speaker
Whether you're an aspiring therapist, already a therapist, or just simply interested in the emerging field of psychedelic therapy, then this podcast is for you. Join me for a journey into the psychedelic world. Before we get started, I want to take a moment to acknowledge the traditional custodians of the unceded land on which this podcast is recorded. The Wadda Wurrung people. I pay my respects to elders past, present and emerging.
00:00:54
Speaker
and I extend that respect to any Aboriginal or Torres Strait Islander peoples listening today.
00:01:03
Speaker
hi
Paul Litnitsky's Journey and Impact on Psychedelic Research
00:01:04
Speaker
everybody welcome to this episode of beyond the trip Today, I'm going to be interviewing Paul Litnitsky, who heads up the clinical psychedelic lab where I work at Monash University. He is someone whose work I deeply respect and has been a really key figure in my journey into this field. In this episode, we talk about his journey into psychedelic research from the early days as a kid child up till now. The rapid growth of psychedelic science and research in the time in which he's been involved in it.
00:01:36
Speaker
education and training in psychedelic therapy, challenges and opportunities in Australia where these medicines have been rescheduled. We talk about the importance of skill building in psychedelic assisted psychotherapy. We talk about future avenues that he would love to research and future projects that are in the pipeline. And we talk about the importance of establishing best practice in this space and in documenting longer term outcomes.
00:02:03
Speaker
Paul is the head of the Clinical Psychedelic Lab and a senior research fellow in the Department of Psychiatry at Monash University. He has played a central role in establishing the field of clinical psychedelic research in Australia and is the principal investigator on a program of psychedelic trials. He leads the country's largest and most experienced group of psychedelic researchers and clinicians, has involved in numerous psychedelic studies across the country and collaborates with many international experts and organizations in this field. He has led several world-first studies, including the first trial to use psilocybin in the treatment of primary anxiety disorder.
00:02:44
Speaker
and the first study testing the utility of psilocybin-assisted therapy as a therapist training tool. In Australia, he established the first psychedelic lab, coordinated the first applied psychedelic therapy training program, and obtained industry-first funding for psychedelic research. Together with clinical and industry colleagues, he co-founded Australia's first purpose-built psychedelic-assisted therapy clinic.
Evolution of Psychedelic Research in Australia
00:03:11
Speaker
His work is focused on investigating novel applications for psychedelic therapies, translating evidence into best clinical practice, exploring under-examined risks and delivering next-generation therapist training, as well as some really important things around improving accessibility and affordability. So let's get into it, this conversation. I hope you enjoy it as much as I did. Hi, Paul.
00:03:37
Speaker
Hey, it's me. Welcome to Beyond the Trip. Thank you so much for taking the time out of your, I'm sure, very busy schedule to come and have this conversation with me. I feel really honored and really excited to be diving into some of these issues with you. No, thanks for having me. It's a real delight. It feels pretty exciting to have that we're at the podcast phase in our development of our field.
00:04:01
Speaker
I know. and I know. I was thinking just before that, you know, really, if it wasn't for us crossing paths and me beginning to work with you, I wouldn't be here doing this podcast and I wouldn't be working in this field. So I'm so, so grateful for for you and for all of the amazing work that you're doing in this space. And so it feels really great to have you here and to become diving into this together. Thanks. It is me feeling mutual. Yeah.
00:04:27
Speaker
Yeah, well, one of the things that I feel really inspired by when I talk with you and is just how many different projects you've always got on the go and how many different ideas and the level of detail that you that you hold about all of them is pretty amazing. And so I'd love to start with, but wherever it begins for you, really, like, where did your interest in psychedelic research begin, like from a, you can take it to a personal place or professional place, wherever you want to go.
00:04:56
Speaker
Yeah, thanks. it's you know It's a story that I suppose traces back all the way to when I was a kid because this is you know my interest is an interest in certain kinds of altered state experiences or perhaps you know the varieties and potential of the human eye you know what what is it to be this conscious creature oh yeah why do we suffer how do we end up paying all these questions i feel have been alive to me since i was pretty young. And for me, you know, the the interest in non-ordinary states and perhaps, you know, what some people call peak states of consciousness probably stems back to this image. I i often recount this kind of earliest image I have of myself as an eight-year-old boy pouring over a coffee table book of Tibetan meditators, black and white pictures of the ancient city of Lhasa, and for some reason being just so captivated by what I was seeing there, even though I clearly didn't know
00:05:54
Speaker
really what I was seeing there. And yeah, I kicked off some experimentation with with meditation. and When I was a teen, probably a bit young for that kind of experimentation in some ways and got a little lost, but it was interesting nonetheless. And I guess, you know, many adventures later, fast forward to a PhD where I was in a depression lab looking at really the varieties of what you might call induction methods until
00:06:29
Speaker
cross them and why they seem to be useful in the treatment of certain psychopathologies. So it was kind of like a common factors project. I was looking at yeah things like run as high and meditation and psychedelics and rituals and pain and all kinds of things that seem to have a fair bit in common neurobiologically and subjectively and also seem to be good for people's mental health, ah depending on how they were used. And so while I was doing my PhD, the field of psychedelic science was growing pretty dramatically. It was still, you know, a very small college industry. When I started reaching out to the people overseas who were doing this work already, there were only a small handful of labs around the world. And they were, you know, the people who reached out to the lab heads, they were very flattered to hear from a PhD student on the other side of the world in a country they'd never really heard of And now, of course, they you know they're famous and no one's got time for anything. But um yeah, but I yeah think I ah made a couple of decisions that seemed a little bit like they were decisions being made for me and seemed a little bit silly for a few years. ah One was to apprentice myself to people who were doing psychedelic research overseas and had been at it for a long time. I felt feel very fortunate that I had
00:07:49
Speaker
just so much time to spend with you know wonderful researchers and clinicians from different groups around the world and that they were so generous to me in sharing their insights and their protocols and all sorts. yeah And you know alongside that, I guess I made the decision to specialize in a field that didn't exist here in Australia at the time, really not believing that I would necessarily play a part in it or or even that there would be a psychedelic field to speak of ah during my lifetime in Australia. so you know And now that what has come true has come true, I still feel like a bit surprised and and very grateful and very energized by this opportunity to have what feels like really interesting and really useful work.
00:08:33
Speaker
Yeah, absolutely. I think even you know when I started stepping into this work with the clinical psychogenic lab at Monash three or four years ago now, I had no idea we'd be where we are now. And it's really it's really exciting and also has challenges which we'll get into, but Yeah, I think I was just listening to you talk about that the beginnings and when you were young and that meditation was a part of this for you. And I just had a memory of when I was in, them when I did my clinical psychology training, which was a long time ago now, I am ended up being really curious about this conference. It was this this tiny little conference and it was called Meditation in Healthcare. care
00:09:17
Speaker
And like no one was really, and all of my friends kind of were like, why are you going to that? You know, that, but you know, my
Monash University's Contributions to Psychedelic Science
00:09:24
Speaker
science friends were like, that won't catch on, you know. And if you think about that, compared to where we are now, that would have been in, I don't know, probably 2007, even, or something. And if you think about where we've come to now, it's such a different space, isn't it?
00:09:39
Speaker
Yeah, absolutely. I guess you know the the long arc of history will be the will be the judge of where it's headed. When you're living through something in you in the in the eye of the storm, you can't quite tell what real lasting impact a field will have you know on the population at large. But it does feel like something pretty remarkable and big and dynamic is underway in the psychedelic space. you know Only a few years ago, perhaps five years ago,
00:10:09
Speaker
I might have said, well, well let's see, you know this could be a cottage industry and kind of relegated back to that again very soon. But in a sense now, we're off in for better or worse, in all kinds of ways, and that the field is is is growing so quickly and in such a diverse manner that it's unlikely for psychedelic science and psychedelic therapies in my view to be put on pause again anytime soon.
00:10:36
Speaker
a ah Yeah, absolutely. Yeah, I hope that's true. And I think, you know, I think about kind of the the journey that I've had in this space at the and the work of the clinical psychedelic lab. And, you know, we've spoken about it quite a bit already on this podcast, the different research trials that have got off the ground. But maybe from your perspective, it would be good to share a little bit about the lab and what what it's done so far from from your perspective as well. Because like I have like my version, but I think there's a lot more to it a lot more than I haven't been involved in as well. Yeah, well, it's been a very busy productive you know four or five years now since i set up the lab
00:11:18
Speaker
and you know what we've yeah We've run trials and training and been involved in all kinds of activities and projects and so on. I guess if I step back, I feel like what's clear and you know what I kind of was referencing at the beginning of this call is you know that we we've all as a team come, I think, a very long way to the degree that there is you know just real experience onshore here in Australia and kind of that next generation of
00:11:48
Speaker
of work that's happening where you know people are being supervised and trained and you know data is being shared at conferences and knowledge is being transferred and that feels very exciting. It takes some time and we only really did enter the kind of psychedelic science conversation about five years ago and it takes you know, usually, at least quite a few years before we feel like there's kind of considerable expertise on the ground to the degree that it can kind of, you know, start to taking on the the role of passing, but passing down the line, if you like, and also, you know, data that we can kind of speak to takes a long time for a clinical trial to to run. So, you know, we, we started off, I think, I think the group, you know, really kind of sprang We grew from you know just me and a couple of collaborators at Monash to probably about 30 people over the course of that first year. And we're one of the greatest joys. and
00:12:56
Speaker
you know ways in which i get so much satisfaction my work is having this privilege to work alongside such fantastic people like you yes me and So many on our team. I think one of the remarkable things about psychedelics is just what an attractive force it is. There's so there's a lot of potency in the psychedelic experience and in psychedelic treatments.
00:13:17
Speaker
course it's also a shiny thing that attracts you know people for all kinds of reasons but one of the reasons is people who want to make the world a better place and really you explore their minds and those of others and assist people who are in distress attracted to the syndromes. And so I had just the great privilege of being able to handpick such a great team of people and that's been really it's been such a joy for working with such you know experienced people who are so good on their tools and self-re reflecttive
00:13:48
Speaker
and i think that you know when we started this work as a team together. Obviously there'd been quite a bit of work prior to that in setting up the lab. and obviously acquiring initial funding and then building protocols and going through all the permitting and whatever But we did kick off our training, you'll recall, to pretty early on and during the heart of COVID, in fact. And and and then we started yeah our first empirical work with our Monash Therapist Study, which I thought was just a fantastic way to start where we were testing the utility of psilocybin.
00:14:27
Speaker
so it's a pretty good way to start get to know each other. Yep, definitely. You were on that and I was ah envious to not be on that as a, but my role of course is not to clinical. So that wasn't for me. But yeah, that that felt like a really brilliant start to then and kind of having perhaps two years of, nearly two years of pretty intensive work on the psilocybin for generalized anxiety disorder study. Yeah. you You worked on that.
00:14:54
Speaker
almost every week, I suppose, for nearly two years. Yeah, yeah every week. It was weekly dosings and then prepping integration with yeah with David Speicher who's been on the podcast and such an amazing project to be a part of. So much to so much learning working that intensively, I think, is is it actually really rare in this space to get to do that. I was really grateful for that.
00:15:18
Speaker
Yeah, me too. you know It was also just wonderful to kind of you know work as a team and have so much ongoing. just the learning curve for all of us has been steeper i i certainly feel i keep looking out for my learning curve, tapering off or dropping down a bit, but it really hasn't in these years in all kinds of ways. But that was a very special project and you know culminated in a really great outcome in terms of the data statistically. Of course, we also learned about limitations of that particular model of treatment and had a whole lot of ideas for how to
00:15:54
Speaker
do better in future. yeah But I really feel like it was a genuine learning experience on the ground and also you know from from a bird's eye view, looking at the whole kind of ecosystem and coordinating it. from From my side, it was fantastic learning. a yeah yeah and Then of course, know we've been we've been running a couple of other trials, so MDMA for PTSD study, the 5MBO DMT for depression study of another few coming down the line and then these are just the drug trials of course we then have you know there's all kinds of other projects and substudies and other things attached as well as students in the lab and qualitative research projects and survey studies and and the like. And then of course training training is another area that I'm very interested in training in education in the space. Of course it's um yeah you know it's just one of the critical factors I think that will determine you know the health and viability of
00:16:51
Speaker
psycho like therapies going forward yeah what is what is the quality and capacity of the yeah the the key stakeholders and support people around the street yeah So i' I'm really excited now that you know finally we're going ahead with a Monash accredited education program which kicks off next year in psychedelic sites and therapies. Yeah, it's so great. It's so great to be able to bring yeah all of the learning from the research and also the actual clinical practice into something like that, isn't it? You know, and to have that on the ground. I'm learning from the Saiga study and all of the other studies that people have done because, you know, we've moved into clinical use here in Australia and there are so few people who've actually had their chance, opportunity yet to actually really do this work. And so I think we have a, I feel like we have a responsibility to to be teaching people.
00:17:43
Speaker
then someone says, well, that's also acknowledging we're all still learning in this space. and know I think that's really important. I mean, I'm still learning as a therapist every day anyway, right? Like I know what I'm doing, but I also every client I'm working with, like this teaches me something and it's even more so. Sure.
Trends and Challenges in Psychedelic Therapy
00:18:01
Speaker
Yeah, and also, you know, not everybody does psychotherapies the way we tend to in our group. and And, you know, we can get into the start down the line in this conversation, but there's, there's some different trends in the field at large that are trending away from some of the things that we want to trend towards and so my one of my principal concerns for our role as a group and and for you know our colleagues as well who kind of of the of the same bi mind is to is to further develop and and assess the methods that we use in delivering psychedelic assisted therapy because of course future patients to depend on good good methods and the only way we will only way we will have an opportunity to determine what best practice is is if we have
00:18:55
Speaker
you know a variety of options out there that are getting pited against each other and <unk> not yeah triming and one strong direction and leaving aside some of the things that we already think are really important. Yeah, absolutely. i mean' sometimes mean What you're alluding to is part of the reason I wanted to start this podcast, I think, because I'm really interested in the psychotherapy part of psychotherapy, assisted p psychotherapy, and that yeah there's a big conversation there, isn't there, about like what that's going to look like going forward and what it should
00:19:27
Speaker
you know, the things that are important to bear in mind, which we can get into in a moment. I want to just take us back to what you were saying about bringing together all these different people. One of the things I, yeah, I mean, I've often felt like a bit of an alien from out of space as a clinical psychologist in Australia. And one of the things I love about the psychedelic space, particularly working at the lab is that There's just so many people who are similar in the way they think, like minded practitioners working in a similar way. And I think that's a really amazing thing. I don't know how you managed to do such a great job for you're very good at picking humans to work together. So thanks for that.
00:20:05
Speaker
Yeah, no, that's true. I think I think i discovered that i that I must be good at bringing good people together because they're all here. But I also, like I said, I think there's an attractor field in the psychedelic space. And to be honest, while I think you you know you're right to identify some pretty strong common threads and alignment,
00:20:26
Speaker
with the people that are working in our group because we're working in ah you know in a manner that is leaning pretty heavily towards psychotherapy and feeling like even you know the psychotherapy that we build into our trials, which is sometimes more extensive than what than many trials We still feel like we'd like more and you know really interested in what what the psychotherapeutic change looks like. but you know yes Alongside that commonality in the team, I've also been quite interested in bringing together pretty diverse people as well. and i think there's actually
00:20:59
Speaker
you know it's quite a lot of There's quite a lot of diversity certainly in terms of skill set, background, training, and I think quite a you know quite pluralistic in terms of world views and so on. I think the common threads bind us together really well in services.
00:21:19
Speaker
but i think it's also really great to be in in a context in which you know group think can be checked as well and different perspectives can be floated and so on, and certainly in terms of like some of the more you know dogmatic views that we see in our field. I think we've had quite a bit of diversity in our group in terms of perspectives around how psychedelics work, or or um yeah what these altered states mean, you know or how we interpret psychedelics, nominology, etc.
00:21:49
Speaker
ah Yeah, absolutely. You know, it's it's something that I think is a real strength is that it's almost like the, well, we do have a multidisciplinary team, don't we? We've got psychiatrists, psychologists, clinical psychologists, and other types of psychologists, psychotherapists, mental health nurses, researchers, kind of all coming together to work on these topics, which I think is really important. And one of the things that I feel nervous about in in the rollout of these medicines is is that they've kind of been, in general, there's a prefer preference for psychiatrists and clinical psychologists to be working with these medicines and i actually think we need a multidisciplinary approach with people, including psychotherapists particularly, and also, but we of course, we need the research to be going on as well.
00:22:32
Speaker
a Yeah, absolutely. and you know i guess but It's such an an early stage and in understanding what are standards of treatment and standards of training, and let alone how to assess for those and so on. So we end up just borrowing from adjacent standards, I suppose, or using kind of proxy accreditation. But yeah in reality, there are a whole set of capacities and competencies and
00:23:04
Speaker
context that are uncommon across other mental health care situations and some that seem to be less common and very unique. Yeah, and so, you know, just simply leaning on an adjacent qualification or a qualification that's kind of generally related, but not specifically related, is I think just a feature of the kind of early stage in which we find ourselves as ah as a field. And that's definitely something I'm quite keen to. That's something we're doing already, you know, as you know, Georgia commuters like Dougal's leading this therapy competency project in our group and, you know,
00:23:38
Speaker
There is training and education coming down the line and I think that's a very very important. area to focus on you know what are these standards of care what are these standards of training what what do we think yeah constitutes competency to deliver this work how do you measure that how do you assess for that If we don't, um I often say this for for training, but also for for research. if we if we don't If we're not able to articulate what's important, and if we're not but then we're not able to measure it, and if we're not able to measure it, then we're not able to defend it.
00:24:11
Speaker
yeah its it complicated because because a centerpiece of psychedelic ah treatment is this s ineffable, you know otherworldly kind of experience. But yeah, my my conviction is you know that we can do a lot more to f the ineffable and that these are there are many, many babies that that lie in the bathwater you know about to be thrown out.
Therapist Competencies and Training Standards
00:24:36
Speaker
And they only will be thrown out because people are not aware that there's a baby in that bathwater. And so yeah we really need to
00:24:44
Speaker
need to be able to articulate what that baby is in measure to get evidence for it and that's the only way we well firstly you know not only not only to you know defend what we think is right or important or valuable in facebook you know to improve our understanding of what that is because no doubt our image of whatever that baby is is yeah imperfect and partial. Yeah, yeah absolutely. and i think you know I hope to have Georgia on the podcast at some stage to talk about her research actually and say about therapist's competencies because I think that's something that's really important in Australia as we're starting to move into what we have moved into the clinical use and the rescheduling.
00:25:21
Speaker
Yeah, we're going to be needing to get much better at that. And it's such a new field, you know, the measurements that we have are not going to necessarily be up to capturing what we need them to capture. And so I feel like we need that qualitative research and the quantitative research to be brought together to develop new tools. But it takes so long. It takes a long time to yeah develop a new tool, as I'm sure you know and have tried to do. Yeah.
00:25:43
Speaker
It does, it does. But also, you know, in the long arc of things, we can also move quite quickly. You know, already our kind of therapist competency framework is pretty extensive and large. And it's about to enter this global multi round expert Delphi study, great attempt to reach consensus with many trainers and supervisors around the world, you know, actually in the scheme of things, if we can have, you know, a standard of therapists competency that can be accessible in the next couple years
00:26:14
Speaker
that's incredible And that's yeah that's what we aim for. Yeah, great. That's really great news and and exciting. And so maybe we'll kind of start, we've started already to kind of talk around this, but maybe the next place to go is is to talk a bit about the rescheduling. And you know obviously we've rescheduled psilocybin-assisted p psychotherapy for treatment-resistant depression, and then MDMA-assisted psychotherapy is now available for PTSD.
00:26:42
Speaker
What do you think are the challenges for the field as we expand into this use here in Australia? We've started to kind of allude to some of this. So let's go there first, and then maybe we can talk about that the hopes and the positives as well. But let's start with the challenges. Yeah, so, you know, I mean, in the context of my general optimism for the field, and I have a lot of optimism for the field, there are some concerns, I think a lot of the concerns that I have are not the typical concerns that I hear people ah talk about, although some of them are. you know The one that I think we all in the field talk about a lot, and I think the kind of most damaging and central misunderstanding is what I sometimes call the pharmacocentric trap, which is this overemphasis on a drug.
00:27:31
Speaker
this view that the psychedelic experience is an epiphenomenon that doesn't necessarily play any meaningful therapeutic role. And that it's rather inconvenient to have you know people tripping for eight hours. It's rather expensive to have therapy and therapists. And probably that's not necessary. Let's see if we can get rid of all of that. There's a huge trend in that direction within the field. And I just want to be clear that you know while I think there may be all sorts of good outcomes of that line of inquiry, that notion that maybe we can generate psychedelic inspired molecules that
00:28:08
Speaker
have a different experiential profile or no subjective experience. There may be some utility that for for mental health patients down the line, but it's a very different class of treatments and it is not pursuing the same line of of promising inquiry that we're in now when we talk about psychedelic assisted therapy.
00:28:29
Speaker
Also, there's you know an unwitting alliance i think between the old regulatory structures and the commercial incentives whereby it really trends towards developing and commercializing a product, not a service. yeah And so that's, again, I'm fine for that to happen if it's sensible and safe and is considered just you know an additional option for patients down the line, but not at the expense of you know, what it is we're doing here and why we're all so excited, which is to do with high dose augmented psychotherapy. Another issue that I see happening, which is kind of adjacent to that is is what I call a superfluous patent. You know, we've got psilocybin LSD, MDMA, these are drugs that have been off patent for decades. And there is really no like, therapeutic
00:29:17
Speaker
impoverishment in these compounds. I mean, certainly we can think about compounds that have different profiles, maybe do different things. And that's interesting to explore, but people don't, you know, bathe in the waterfall of psilocybin experience for eight hours and then come out, you know, complaining that there wasn't much there for them. Typically, that's not what we hear. But what we see is companies wanting to protect ah intellectual property and deriving that from some molecular modification that actually has no community value or community benefit and in my view that's a problem. There's certainly IP that should be explored and protected and this is an important part of how we protect innovation and the huge investment in innovation but that ah that that should always add value to the world and to the community. So I'll rattle through a few more things that I think are
00:30:09
Speaker
a problem here. One of the one of the problems that that I see a lot is this kind of, again, something that I call symptomatic fixation. So this is a ah a fixation on targeting surface symptoms and single diagnoses. ah This is a problem well beyond psychedelic therapy. Of course, there are yeah the the ways in which we diagnose people, psychiatric are very useful. There are all kind they're heuristic elements that make it a very useful system, but it's also simply a symptomatically defined and arbitrary model that
00:30:47
Speaker
is not an account of reality. It's an account of of a heuristic or a set of kind of yeah modeling ways to think about human stress. And so, you know, the issue there is, of course, we are lumping certain people together, removing other kinds of people, thinking about, you know, human suffering and experience in a very rarefied way and then trying to target surface symptoms. And with psychedelic therapy, as you know, we're not we're not attempting to clip symptoms often what we're doing is is bringing bringing about yeah much more clarity and contact with the symptoms and what underlies those symptoms. so you know So it's kind of a strange thing when we report, for example, in clinical trials that we've had an adverse event because somebody is you know crying a lot the next day when, you know in many cases, that is exactly what we're trying to achieve therapeutically, this kind of process of
00:31:45
Speaker
exploration and catharsis and uncovering and contact. So that's an issue for for all of us in in mental health care. And in research in general, right? Like it's, yeah, yeah, I have lots of thoughts, Paul, but I'll let you carry on. and I'm rattling off a list that's rather long. But yeah, I'd love to, I'd love to feel free to chime in. And an issue that a frustrating issue for me is is what I call the the blinding bind, which is this notion that we, you know, we cannot be confident in psychedelic therapies in this we can achieve
00:32:19
Speaker
adequate functional blinding, which is to say, we give some people a psychedelic, we give other people a different drug, everybody's confused about which drug they've had, and we thereby remove the expectancy and the placebo effect and so on. This is this is not only practically difficult, because in general, there's There's no point for guessing who's had the real thing, for the therapist, for the rater, for the the participant. But even more deeply than that, my view is that this is a form of experiential medicine. like What we're doing here is through the therapeutic container and the selection process and the drug and so on, is we're generating the preconditions to allow for a transformative experience, which we can we can achieve. and but you know
00:33:09
Speaker
ah quite reliably that we can get these phenomenal experiences if we set it up right and get the right dose of drug. And in the context of experiential medicine, the notion of attempting to remove or hide insightful experiences, it just doesn't make any sense.
00:33:27
Speaker
Yeah. So and another issue that I see in the field, and this I think is going to become much more of an issue over the over the next five or so years than it has been previously, because we're moving into questions of translation into the community. yeah And we're talking about access and affordability and training of therapists and how it looks in the real world. And so the next issue that I see is what I call the cheapness fallacy, which is this notion that if we lower the costs, we will therefore be able to deliver better bangs for buck.
00:33:57
Speaker
and That's never never the case for service delivery. In fact, there's always what we call an inverted U curve where something that is very cheap is likely to be ineffective. Something that's very expensive is likely to not be worth it. And there's some optimal point between those two where you get the most cost effective outcomes. yeah And my guess Although, you know, this is an empirical question, we need to explore this. But my guess is that the most cost-effective psychedelic therapy will be quite expensive. My hope is that we can test that out with good health economic analysis. And if it is cost-effective, then it saves the payer money. And it's not only, you know, when I say the payer, I mean the reimburse of the insurer, the government like in Australia with Medicare, for example. And and that is exactly the kind of pivotal
00:34:48
Speaker
data that we need in order to address this question of scale. Now, this is kind of aspirational, but it is definitely, you know, it would be ah such a ah shame if we were to prematurely foreclose on what we call an expensive psychedelic treatment and never explore the promise of that more extensive, intensive, longer term tailored psychedelic care.
00:35:17
Speaker
When that may be the most cost effective and it may be, you know that's why I often invoke the notion of of surgery. you know Surgery is intensive and high cost and usually the people in the in the room have been training and working for decades. But if you've got evidence-based surgical technique, it's often incredibly cost effective and worth it and governments will pay for it. Even $30,000 procedure in one day can be paid for by government. yeah And if you also think about how expensive it is to keep someone in a psychiatric hospital, the public, or if if they're paying privately as well, like it's it's it's a lot of money. Exactly. I mean, that's right. They they always say you know the most expensive psychiatric patient is is somebody who is severe and in the tertiary care system because it's a revolving door. $30,000 for you know some weeks in an inpatient psychiatric ward, which
00:36:14
Speaker
generally does not lead to durable benefit in the longer term. It keeps people alive. Sometimes it gets people through a period, but they return often. So it's not addressing fundamental causes. It's not, it's nothing like that. and And it's still very expensive. Yeah. So I've got, I've got a couple more only of the things that I worry about. It it sounds like I'm a worry wart. As I said, I am very, im very optimistic and excited by the field. and And part of that is because I think we need to keep our eyes open to the concerns of the risks and and the issues.
00:36:42
Speaker
and and explore those. Another concern that I'm hearing you know that I have heard for years and I still continue to hear is what I call the last resort error. This notion that you need to exhaust all other options first before you attempt psychedelics. Now that makes a lot of sense for a payer.
00:37:02
Speaker
when when this is a high burden high cost treatment for sure you know if i'm actually going to you know be if i'm an insurance company i'm going to reimburse somebody thirty thousand dollar psychedelic care i want to find out that they've tried a couple of antidepressants first or whatever it is that is it more affordable short make sense but in terms of a clinical decision making That isn't, it's a fallacy in my view because what we're attempting to do with psychedelic therapy is not analogous to what you attempt to do with say an SSRI yeah or a benzo. We're not attempting to clip symptoms and and allow people to kind of get through life. It's highly aspirational. In fact, that is why we have so many people who do not have a psychiatric diagnosis and are relatively well, in fact could be very well,
00:37:49
Speaker
still deriving enormous benefit from psychedelics and and wanting to have them. So yeah yeah, I think i think the the previous i ah you know kind of view that we've inherited still to some degree was that psychedelics are kind of risky and wild and crazy and we should only really give them to people who are dying or going to kill themselves. Really now we know that we can achieve very high levels of safety with the protocols we have in place and there are many good reasons why somebody would want to engage in psychedelic assisted therapy, even if this isn't their last resort.
Patient Considerations and Therapeutic Approaches
00:38:22
Speaker
In fact, yeah even more than that, where is somebody's last resort? That is, they're so severe and they're dealing with such entrenched issues and maybe be a lot of complexity in their lives. Often, I would suggest psychedelics are not
00:38:35
Speaker
appropriate because it takes a certain degree of capacity to not only answer to the call of the psychedelic invitation, but to to go through that in a safe manner without being so destabilized by the process.
00:38:48
Speaker
Yeah, yeah, absolutely. And I think it's been something that we, you know, we've obviously spoken about a lot as a team around the, you know, using psilocybin-assisted psychotherapy and treatment-resistant depression. And some of those people, if they're really, really, really unwell, and things are really unstable in their lives. It feels like a tricky time to be doing that. And then maybe they need lots more therapy first and lots more therapy after and lots of holding. And yeah,
00:39:16
Speaker
Absolutely. Absolutely. I agree. I mean, I think it's, you know, it's hard to predict because we do see situations where somebody is very unwell and they have a very complex situation and and this can be a game changer for them, but but the risks go up. and And even more than the risks of something, you know, but in terms of safety, this is just a risk that they won't be able to get to take advantage of that opportunity because, you know, in a sense,
00:39:42
Speaker
You're wanting, you know, I think about, you know, the the mental health journey, if you like, and and that, you know, a lot of the treatments out there represent certain kinds of vehicles. And if you can't, you know, actually be inside of a regular vehicle, like a car, which might resemble something like ah talk therapy, then it's ah it's a bit intense to expect somebody to jump in a rocket and handle that.
00:40:06
Speaker
yeah the final The final thing that I want to say is maybe a little bit cynical, which is you what I call a palliative resignation, which is this unfortunate place that our field of mental health care finds itself in, which is to say that we generally have given up on cure.
00:40:24
Speaker
we built you know there's a very strong norm in in psychiatry and in other mental health care sectors that we need to manage symptoms and that's a palliative approach. and Of course, managing symptoms is important and we we we need to recognize that mental health is is a journey and and a process. but I think it's unfortunate that cure has become a you know ah a banned word. And yeah the I guess the cynical bit there in in psychiatry is if you if you really do give up on cure as a part of your business model, then then you get to keep your customer. And that's part of what is challenging in psychedelic R and&D, which is you know if we can actually you know fulfill the promise of psychedelic therapies, then we lose our customer. And that's what we should be aiming for.
00:41:14
Speaker
Yeah, absolutely. Thank you so much, Paul. And I think one of my hopes, and I still hold it, and I've spoken about before I think on this podcast, is that, you know, because psychedelics do kind of take us underneath beyond just symptom management, beyond this kind of ah focus on on the outer world into what's actually going on underneath that's creating the distress, that maybe that can be right, that maybe that can be a cure. And also, maybe there's an invitation there to go, okay, maybe the way that we're talking about mental health and be medicalising human distress needs to shift. And and to to actually talking about what's the underlying causes of this. And yeah,
00:42:00
Speaker
I hope that and I feel worried that these medicines have been rescheduled within a very medical framework. That's something that I understand how that happened and why in Australia, but I wonder if that will, I hope that doesn't take us away from my my hope for yeah creating a different way of understanding distress in a more mainstream.
00:42:20
Speaker
Yeah, I hear you. I mean, I think my guess is that we'll see a mixture of of of those kind of different ends of a spectrum playing out in different ways. So they say psychedelics are too medical for psychotherapists and too psychotherapeutic for doctors. But, you know, yes, there will be ways in which I think the psychedelic assisted therapy approach becomes overly medicalised and interventionist, etc. But I also think there's more prospect in this field for transformation in the kind of
00:42:55
Speaker
yeah mainstream medical care or or psychiatric care than than in any other situation because you have an opportunity to take a drug and anybody can do it including you know a psychiatrist training how to in in how to be a psychotherapist and that occasion's phenomenal experience that can shift your views on reality and shift your priorities and and so on. So I think actually there's never There's never been a ah a better vehicle to bring about you know a more holistic transformation in mental health care than this one.
00:43:31
Speaker
Yeah, I think so. I agree. I think one of the things that I would have liked when there's many, you know, there's I think it's really great that they that that the body have rescheduled it. And I do think it's a really positive thing, but I would have liked more emphasis on the kind of training that people needed to have. And I know there has been some talk about that, but I think, you know, I agree, it's it it is like psychotherapy augmented, so psychotherapy on steroids, you know, you go people going into very deep places in the dosing, but also, in my experience, like the stuff that comes up in the preparation and the integration sessions,
00:44:10
Speaker
is is you can get to these deeper places more quickly and so that requires I think as therapists us to be really good at supporting that process and to really know how to work with that kind of intensity of material and and you know I've talked a bit about the counter-transference and transference piece on this podcast a little bit before and when someone told me that they were like steroids in psychedelic therapy work, I was like, Oh, yeah, I've got this, it's fine. You know, and and I do, but it's been, I had no idea just how magnified they would become, you know, how, how intense people might have very strong feelings towards me as a transference or the count transference, and, and there might be strong things in me towards them. And so for me to work with that usefully, and therapy, I really need to have very good supervision, to know myself to have done my own work,
00:45:02
Speaker
and And to have a really solid relationship with my diet partner, which luckily for me, i I've had some really amazing ones. But that's not always the case. And there's so many factors that are really important in terms of thinking about how we kind of develop people's skills in the psychotherapy space. And I think Also, we were very lucky but as as you spoke to before to be able to have a go at having a self experience with the medicine so that we had an idea of the terrain that people were going towards. And something that I feel nervous about is that many people don't have that opportunity, at least not legally and and in that space. So that can be tricky as well. Yeah, I hear you. Well, we're we're hoping to launch the next iteration of the monash psychilics therapist study next year
00:45:50
Speaker
and so that will be good, a valuable thing to do based on our first study. It was certainly something to pursue and and makes a lot of sense, of course. you know it's I guess, again, it doesn't guarantee anything and sometimes there's some downsides or risks of downsides, but certainly it seems that particularly when we're dealing not only with what I would think of as an experiential medicine where you know the nature of acute psychedelic phenomenology and what you do with it in your subjective experience afterwards seems to be central to ah the the therapeutic utility here, but also when the psychedelic phenomenology is so you know inconceivable, indescribable, and profound, that's a good case.
00:46:45
Speaker
or it's a good case for you know having access to what you might call first-person perspectives. you know it's it's not It's a very different scenario than the one that people imagine when they say, well, I don't need to take Prozac to prescribed.
00:47:00
Speaker
you know, Prozac is not primarily an experiential medicine. yes So so i think I think having that as ah as an opportunity, an option for therapist training is great. And I think ah once again, we need, you know, standards of training that can be accessible so we can understand, you know, what does undergoing psychedelic exposure do in terms of therapeutic confidences obviously it does other things than competencies as well as we know from Our work, we've seen that the vast majority of clinical patients who who want to access psychedelics also want their therapists to have
00:47:37
Speaker
undergone psychedelic exposure before. In fact, some feel very strident about that and say they wouldn't they wouldn't go they wouldn't do it if if it weren't the case. yeah yeah But it's ah it's ah it's it's ah it's one of those again, it's one of those interesting ones. where In the whole psychedelic space, where we're continually coming up against new territory, you know renegotiating boundaries. It's just a theme across the board here. and This is one of them again. I often find whenever we talk about something in but you know in a therapeutic context to do with patients
00:48:09
Speaker
ah think about how often that mirrors what applies to the field and vice versa so you know what you're talking about there in terms of like amplification, and what Stan Groff called nonspecific amplification that I think is only half true, but there is something nonspecifically amplified about psychedelic treatment, but also in the field, rick large, there is something amplified here where, you know um for better or for worse, the light and the dark, people get intense in the space and yeah yeah things can you know things that would normally be kind of within what's the word like a you know within kind of standard regulation and you know I mean that in terms of like you know personal regulation can often become highly unregulated when people are involved in the space as patients or professionals or otherwise people can easily get triggered for example that's quite interesting to to think about the the the non-specific amplification that plays
00:49:09
Speaker
That's so true.
Cultural Significance and Diverse Perspectives
00:49:10
Speaker
You know, I... my previous life working in and trauma, work in various not for profits. I used to think a lot about that, that kind of the systems around the clients, they like the staff teams and there was often and so much mirroring that would happen in terms of that kind of big emotions coming up in those spaces too. And I feel like I really i agree. Do I see that a lot in this space? And it's good, right? There's some really beautiful, positive things about that and some harder things as well.
00:49:41
Speaker
Yeah, absolutely. I mean, it makes sense in a way because you've got you know you've got a lot of big feelings in the mix and a lot riding on this on on this class of treatments. and And even, you know, it's pretty diverse what psychedelics mean to people. So, you know, even calling this a class of treatments offends some people, you know, when we talk about these as drugs that can offend some people. So, you know, because we're, you know, we're at a at a crossroads for so many different people, you got all these people converged at a crossroads. And some have come from
00:50:18
Speaker
you know indigenous practice some have come from spirituality, some have come from mental health care, some have come from pharmacology, some are, you know, data nerds, and they're all just crossroads trying to talk about this thing, psychedelics, or do this thing, psychedelics, and feeling very differently about what it is we meet. Yes. So I think it's a, yeah, it's, I think, I think there's a kind of invitation for us in this space to continue to foster you know i guess like open-mindedness and and you know
00:50:52
Speaker
kind of ah sense of welcome to you know all the varieties in which people you know feel and think and relate to psychedelics. yeah Because it's it's certainly the case that while people can become more flexible in the way they think and more open-minded with psychedelics, people can also seem to be become more ideological, dogmatic, and even tribal.
00:51:14
Speaker
Mm, totally. And I think for a healthy ecosystem, it's really important to have multiple perspectives so that we don't get stuck in our lane, right? Like, and I'm very mindful that my lane is is like, i'm ah I'm a psychologist and a psychotherapist. And so that is, I see these medicines as being very important.
00:51:32
Speaker
part of augmenting psychotherapy. And, and that's how I'm viewing it. And there's plenty of other people that, you know, in indigenous cultures, they weren't just used for therapy, they were used for all, they've been used for all kinds of other things as well. yeah So that's just one piece.
00:51:48
Speaker
And so what do you think in terms of the first that are working in the field already or people are listening to this that are wanting to work in the field, how might they kind of mitigate some of these challenges as they start work? I guess what I'm hearing and what you're saying is something around finding ways to come together and share our learnings and share our information as much as we can. And that gets kind of complex when you've got we haven't even spoke to the fact that a lot of these, the way that this is working is kind of a business model as well. And so that can be challenging in terms of sharing information. But yeah, what do you think?
00:52:22
Speaker
It's a tough question. I mean i do think you know to the previous point that taking a kind of pluralistic approach to to the psychedelic space in general is useful. That psychedelics can mean different things to different people and and be done and you know delivered and motivated in in all kinds of ways. I think that's really helpful. Of course, that's easier said than done if your you know view is you know deeply spiritual. and associated with you know
00:52:53
Speaker
maybe there's some sort of a particular right way in which these drugs or compounds or entities are or whatever the frame is are engaged. I really think of about, you know, I feel like it's useful to think about psycho versus tools yeah and i don't mean you know In a funny way, yeah I don't mean to instrumentalize them either. So it's not only that like we need to be extractive about you know what psychedelics are or what what they can afford.
00:53:26
Speaker
yeah but But I guess I think about them as kind of you taking on many different roles and that and yeah If they're, for example, commercial projects or companies or activities out there that are using them in a particular way, it it might not accord very well with people who are using psychonics in a completely different way for, say, indigenous learning or or some spirituality. and i just think it I think it will will benefit a lot from being able to have conversations across you know very diverse perspectives. I also think that benefits
00:54:02
Speaker
patients because patients who want to access treatment come from very different perspective two and really we undermine basic clinical safety if we impose very particular narrow perspectives on what these what these treatments are what they should deliver what you should experience how you should interpret it, et cetera. So I think just getting getting real comfy with you know maybe doing a bit of exposure therapy for those people who have a very strong you know trigger reaction about the way some people are using psychedelics, for example, might be good to do a bit of exposure therapy, listen to the other kinds of podcasts or whatever it is, and just get comfy with like the varieties of psychedelic use.
Risks and Regulatory Complexities in Therapy
00:54:46
Speaker
yeah yeah But was your question more specific to doing
00:54:51
Speaker
you know people working in psychedelic therapy and how to kind of mitigate some of the concerns or risks in that space. Yeah, we can take it there as well. I think that would be useful. I think that, you know, yeah, i think that's there was open, but yeah, whichever way you want to go. Yeah, interesting. My sense is that the the risks that we tend to think about and focus on and have done maybe for you know, 60, 70 years are ah worth paying attention to, but not necessarily the main concern. And those risks are, you know, what I think of as risks of overwhelm. They happen in very low prevalence, but they're important and and they they inform our screening and and our clinical procedures, so risks of massive destabilization retraumatization psychotic break
00:55:41
Speaker
behavioral problems you know it's certainly people who use psychedelics in the wild have bad things that can happen to them. yeah And sometimes in the in in in clinical trials too, but very, very rarely. So it's not to say these are not risks worth paying attention to. I think this, you know, and particularly in a very multidisciplinary space where people have come from all walks of life and you know sometimes they're really just very focused on psychedelics. I really would say it's very important for people who are wanting to get into the clinical scientific space you really get good on the tools before like you know
00:56:14
Speaker
yeah and not to start with psycho it's not to start in the rocket so in the other vehicles Yes. One of the things I wanted to share is is that I think it's, it you know, the the TGA, our regulatory body is set up to, that's designed to assess drug treatments. They're not designed to assess psychotherapy treatments. And because it's a drug and a psychotherapy, it's almost like we needed something else. Yeah.
00:56:41
Speaker
And I understand how it had that it had to happen this way, but it's had all kinds of ramifications, I think, and yeah and that you're speaking to. And I feel really nervous about that, because I feel like we'll lose some of the really important stuff that happens around it if we're not careful. And so that's part of the whole reason of this doing this podcast and, you know, i' been talking about this with so many different people. So, yeah, really important point. Yeah. I hear you. I mean, in fairness to the regulators and and also some of the companies and the other organizations involved, the stakeholders in the space, I think that there's been actually, to my mind, a surprising amount of accommodation and awareness and openness toward the psychotherapeutic. It's just trending away from that. But I'm kind of amazed that there's been that much
00:57:28
Speaker
space you know afforded to psychotherapy. i also have you know so I feel reasonably optimistic about all kinds of things. one of the One of the things that gives me some optimism in the space is what psychedelic experience can do for people's conception of what psychedelic treatment should be. you know like It's almost like there are some pretty impressive lessons that can come down to people through psychedelic encounters that can inform practice and so that's one of the reasons why I think you know it's very useful for us to continue to test out psychedelic exposure as part of therapists training i also think
00:58:12
Speaker
it can be useful for other stakeholds in the space who are involved in kind of building the industry a field e etc to have that first person data if you like the first person perspective on it. But I think there's something, you know, pretty impressive and informative about psychedelic experience that can assist yeah people in well, okay can kind I think it is likely to encourage a further protection of some of the things that we think of as important in psychotherapy, because it's not also, as you know, it is not just that we do therapy, and we want to make sure that people do therapy at the same time they do psyul it's a particular
00:58:53
Speaker
set of approaches attitudes, postures, priorities, tones. feelinging you know It's not not to be overly prescribed. Of course, there's a lot of diversity there, but it's like a quality, a recognition that is somehow matching and mirroring the quality and recognition that people have when they experience psychedelics.
00:59:16
Speaker
yes and i often feel like Yeah, it's you know what is it when when you're being asked to be equal to the person you're supporting in some way, equal to what they're going through.
00:59:29
Speaker
that's tough when somebody's in in distress and suffering with some major you know psychological, psychiatric issue to really attune to what that distress is like, to be there for them, for them to kind of feel that, you know, see you, but not alone, supported. Again, it's like a very different thing to be equal to the psychedelic experience. And, you know, I would suggest incredibly challenging if you've never been there before. Not impossible, but challenging.
00:59:56
Speaker
I totally agree with that. And I think maybe this kind of flows a little bit into my ah question that I want to make sure we get to, which is, what are your kind of what are your hopes for the
Future Aspirations and Research Goals in Psychedelic Therapy
01:00:08
Speaker
field? And also, what are you really wanting to start exploring in terms of your research and your goals for the next phase? Because we, you know, we're in this exciting time where we've rescheduled, but there's so much more to be done in this field in terms of research. So yeah, what would you like to Yeah, oh gosh, if I could just, you know, live five lifetimes or find that universal pause button. It's endless. It's endless. Well, um so i'm I'm thinking of kind of a number of things about, you know, when I think about how to make myself useful, I'm thinking about what are the most kind of potent levers that we can pull, you know, whether that be in, in terms of the future of the field or in terms of like,
01:00:52
Speaker
you know, helping people into stress. And where are other people not going so much? You know, where where where can we go where others are not going so that we can we can assist in kind of filling out the gaps? Where have we identified? So, you know, the we've talked about this quite a bit now. Therapist training competencies and standards of care certainly feels to me like something that's really important and a really, you know, critical factor in in the future of the psychedelic space and i feel like yeah id be quite happy for
01:01:23
Speaker
others to do this and and some others are doing it to some degree, but there are different gaps in what and we're called, it seems, to to fill some of those. And one of those is around therapist competencies. Also, I think about – and sorry, just on that last point, really, the opportunity for psychedelic self-exposure for therapists and other stakeholders is is another piece of that. It's not just about how do you measure and assess for standards of care and standards of training but how do you deliver what do you think of as gold standard in training yeah
01:01:54
Speaker
and actually do it. the The other ways I think about you know where we where I want to put my energy is in terms of the factors that are either upstream of psychopathology, the causes of psychopathology, if you like, or the predictors, and then also extending out beyond just the folk who are yeah in in a critical degree of distress such as they have a diagnosis and they're engaged in healthy
01:02:25
Speaker
So one of the one of the things that I'm, one of the projects or set of projects that I'm really keen on pursuing focuses in on family relationships and you know specifically targeting conflictual relationships in the home. And part of that is a focus on inter intergenerational trauma. And you know we know this now that possibly the single strongest predictor of all psychopathologies and addiction is exposure to early adverse experiences and trauma as a kid
01:02:59
Speaker
and the majority of that happens in the family of Origin Home. yeah It is this you know issue that I think is really hidden in plain sight. There's actually you know frighteningly high prevalence.
01:03:13
Speaker
of problematic levels of family conflict and and of course domestic violence and all forms in which it takes and i think of course and many people in that family ecosystem that need support and assistance in various ways and end one of the things that i think is really critical about is because this is the the site in which so much late test psychopathology is forming. And then another another place that I'm really keen to go is is beyond the family home to yeah to the to the wider community now. you know I'm really interested in whether there's a role for psychedelics in addressing the very you know alarming and topical issue of polarization in our communities and lack of social cohesion. We've got just this
01:04:06
Speaker
massive rising tide of ah polarization and people living in what look like you know parallel universes that that barely ever overlap, obviously supported you know heavily by a very online culture that we find ourselves in. yeah And of course, you know that some of the preconditions for violence are dehumanization and breakdown in social cohesion. And so I'm very keen to do a project ah that we've been working on in planning phase for a little while now that is focused on
01:04:43
Speaker
leaders from highly polarized groups putting it together into a coaching framework alongside suicide and exposure in order to see whether we can get again looking at these kind of these leading ver points if you like you know looking at whether we can get downstream effect um the communities of those leaders by engaging in a particular process with the leaders, just like looking looking at whether we can get downstream effects on children by engaging the parents.
01:05:11
Speaker
Yeah, absolutely. Yeah, so important. That sounds really interesting. I can't wait to have you on again, hopefully when that's up and running to dive into a bit more because yeah it so it feels like there's so many factors working against people that want to be against people and creating more polarization in terms of the online spaces and people are talking about all of that and we're kind of we're so aware of that.
01:05:34
Speaker
But then what do we do about it? And so starting to think about like a house like this can inform that feels really important. Yeah, yeah. yeah and And I just want to say, you know, like, you know, we've discussed before, but my sense is if there is a wrong.
01:05:53
Speaker
you know parental conflict, family violence, or polarization in the community, that it will only be a feasible and prompt you know useful thing to do if it's done alongside something else. you know Just like with our clinical trials and we have therapy, I don't have any real hope that we can just simply you know get a bunch of leaders to drop psilocybin and they'll be l b you know better and less polarized human beings in fact there's probably some reason to consider that
01:06:25
Speaker
psilocybin and other classic psychedelics might have a tendency to increase polarisization and tribalism and off group differentiation and so on so I think it has to be done alongside support. it's kind of these These compounds allow for these dramatically different perspectives and ah and a rush of inspiration and motivation to change. That that all needs to be harnessed for whatever purpose.
01:06:52
Speaker
and yeah i mean you know this is we've got ah we've got a um a project but we're also developing now very early stages but it's it's a project that i also feel incredibly energized about which is looking at but possible role of mdma system therapy side, evidence-based men's behavior change to address violent behavior and perpetrators of family violence. And again, it's ah yeah it's a this is experimental. it's ah There's a big question about how we do this well and how it will work and what what are the safety parameters around this and so on. But this is the kind of work that I'm called to do. It's kind of like it's work that
01:07:38
Speaker
i can see a feasible and so storyline to this butts. it's difficult to do and it's going to take a lot of resources and multidisciplinary perspectives and care and dedication and and being super meticulous throughout the whole thing, just to have a chance at seeing whether ah you know this is ah this is a viable approach. But again, we don't really have very effective treatments for many who use violence in in domestic contexts. And you know it would be a shame if we didn't you know experiment or move in correctional research whether we have an opportunity to use psychedelic
01:08:24
Speaker
in a useful manner in this context just because it's too hard or or not politically you know favorable at this moment in time. Yeah, I see. I mean, if you just have to take one look at the current stats around in Australia about violence against women, then even the number of women who've died in Australia this year from violence perpetrated by men to feel like that we really do need to be doing what we can to explore this and to really research it. So I really hope that those products can get off the ground soon because it feels really essential to me.
01:08:59
Speaker
Yeah, so there's a lot to do and you know that's just the tip of the iceberg. Of course, there's so many different projects and trials and you know this is part of why I've been working towards establishing this center of excellence at Monash in psychedelic therapies. And and the the the purpose of the center of excellence is to develop up best care in treatment and training and to yeah explore on the frontier at you know application to try to understand
01:09:30
Speaker
what can we use psychedelic compounds for in what context? And you know while being incredibly safe and careful also going where others tend not to go for whatever reason through fear or because it's not popular because there's no commercial outcome that they can see to my mind, it's really just about looking at you know what value we can add to the lives of people and communities and just being true to that. What value can we add in the long term in particular, not just you know the day after or the week after? I think if we keep our eyes really um constantly entrained on the people who need the
01:10:18
Speaker
We don't let our eyes falter from from that to to all the other things that draw our attention when we're in such a wild, colorful, interesting, controversial field. I think that will see us in good stead and that's really my my focus is just on the on these outcomes for these individuals in the long term. Brilliant.
01:10:39
Speaker
Thanks very much, Paul. I'm mindful of
Closing Thoughts and Call to Action
01:10:41
Speaker
time. I feel like I could keep going with you for a long time, but is there anything but that you would like to say that you haven't already covered that you feel it would be important to say in the wrap up before we finish today? No, other than to say, well, we will be able to carry on as me for more than some hours. In fact, I hope for many, many years together, it's been a real pleasure working with you over these years. And with all of our colleagues, I think we have like a ah little family, a community of sorts, and I hope that grows over time and spreads out to all the good people that are stepping into the space to work with Psychedelics. Yeah, it's been a pleasure to talk with you and thank you for doing this podcast too. I feel like it's a wonderful community service. It's so great that you are
01:11:23
Speaker
You know, we always got to think, how do we, you know, how do we share what we know? How do we share the, you know, also just the exploration and the conversation? We're often having so many wonderful, fruitful, inspiring conversations. So I'm just glad you're, you know, inviting others into this conversation. It's great. Yeah. Thank you. Yeah. It's been such a wonderful project actually, and has had so many interesting guests and nearly, nearly at the end of recording season one and already thinking about season two. So.
01:11:52
Speaker
great's really Great. Congrats. Well, I'll watch and listen with interest. Thank you. Thanks so much, Paul. Thanks for listening. If you're interested in following along on the journey with me, check out my Instagram or website details listed in the show notes. And if you enjoyed this episode, please leave a review and share this podcast to help get this important conversation out to more listeners.