Transcript
Speaker: Hello, and welcome to Beyond the Trip, a psychedelic therapy podcast with me, Dr. Esme Dark. 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.
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.
Speaker: 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 Wadawurrung people. I pay my respects to elders past, present and emerging, and I extend that respect to any Aboriginal or Torres Strait Islander peoples listening today.
Speaker: Hello and welcome to this episode of Beyond the Trip, where I'm joined by two members of the Psychedelic Consultancy, Monica Schuichel and Chris Rain, who co-founded the Psychedelic Consultancy together.
Speaker: Monica Schuichel is a clinical psychologist and MDMA-assisted therapist with over 20 years of experience across diverse mental health settings. She was the first psychologist in the world to provide legal MDMA-assisted therapy to a client with PTSD outside of a clinical trial.
Speaker: Monica is known for her practical and collaborative approach, drawing on her extensive experience in mental health program directorship and development. Her clinical background spans federal and state government mental health services, private practice, veterans and their families, domestic and family violence survivors, and adult survivors of childhood trauma.
Speaker: She is a psychology board approved supervisor, an experienced trauma therapist, and a yoga and meditation teacher. Chris is a mental health care entrepreneur and an executive dedicated to pioneering innovative treatments for addiction and mental health.
Speaker: He founded Hello Sunday Morning, one of the world's largest online communities supporting recovery from alcohol dependence. And he co-founded the Clean Slate Clinic, a telehealth service that has supported over 3,000 alcohol detoxes across Australia.
Speaker: As a 2024 Kenneth Meyer Innovation Fellow, Chris spent 12 months contributing to the establishment of Australia's Psychedelic Assisted Therapy System, helping to enable treatment access for the first 100 patients.
Speaker: He holds an MBA from Oxford University and a Master of Public Administration from Harvard University. He's been recognized as Young Australian of the Year in Queensland and Westpac Social Change Fellow.
Speaker: We had a great conversation. We talked about their respective and different journeys into the field of psychedelics. We talked about the importance of working with the system to support psychedelic assisted therapy in Australia.
Speaker: We talked about what they do at the psychedelic consultancy and our collective hopes for psychedelic therapy's impact on the wider mental health system. We had a very passionate and for me at times emotional conversation around the importance of providing to support for people to come off their antidepressants. when i And there we talked about the therapeutic modalities that we use in psychedelic assisted psychotherapy.
Speaker: We mentioned the Morsley guidelines on deprescribing, which um I've linked in our show notes, along with the contact details for the psychedelic consultancy. So without further ado, let's get into it. I hope you enjoy this conversation as much as I did.
Speaker: Hello and welcome to Monica and Chris from the Psychedelic Consultancy. It's so wonderful to have you here. no One of the reasons that I started the On The Trip podcast was in part to kind of ah document, I guess, the rollout of psychedelic-assisted therapy in Australia and that rollout needs many things and many different types of people. We often think about the kind of therapists that are in the room.
Speaker: Monica, you're obviously one of those, but It's not just about that, is it? It's about looking at the systems and the infrastructure that's in place as well. And you have been really key in supporting that infrastructure. So I can't wait to get into some of that today. And yeah it's really awesome to have you both here. So thank you. Thank you.
Speaker: Thank you for inviting us. That's all right. um So Monica, do you want to start by just telling everyone a little bit about your background and what drew you into working in psychedelic assisted p psychotherapy?
Speaker: Sure. i So I'm a therapist, a trauma therapist, a clinical psychologist, and have been working um as ah as a therapist for 20 years. And I've always been interested in how we can support people who still struggle with the legacies of trauma despite engaging in really good psychotherapy, um really good supports and trying kind of everything.
Speaker: um So that sort of drew me to look into psychedelic assisted therapy, particularly when i was working in a role with Department of Veteran Affairs and I heard about MDMA assisted therapy in a ah training that I was doing and and thought the outcomes were really incredible. And when I heard that the type of work, I thought that's something I'd be really interested in doing personally as well.
Speaker: And um kind of drew me to follow that and track that ah and then sort of moved into a healthcare organisation in a leadership role that would be um trying to integrate that within their um mental health offerings and was drawn to that role for for that. So um that kind of drew me to it, really just looking at a pathway for for people who are stuck in the after effects of trauma.
Speaker: Yeah. Yeah. Yeah, so it's um been a a lot of um sort of building the infrastructure around the work has been really important in order to to get it to this point where you can actually treat people and help people.
Speaker: Absolutely, and we're going to get more into that later because it's such an important part of what you do and an important thing for any kind of new innovative technology. treatment right that needs to go into the space um and and I was just thinking back Monica when to when we met I was just working this all out today before the podcast and that was on the first very first MAPS training wasn't it yeah um quite a few years ago now but not that long ago too like if you think about where we are and where we were then it's lots of exciting developments Yeah, it was in 2023. So I think the the rescheduling had just happened and no one really knew what was what it was going to look like and we were all sort of wondering and... um
Speaker: yes yeah was um Yeah, that was fun, that was training. It was. And Chris, I met you on the training the following year as well. You joined us for that one. What a place to make. know. Maths is bringing us all together. It's great.
Speaker: So do you want to say a little bit, Chris, about your background and what drew you to this work? Because you're coming from a different background to therapeutic direct work, aren't you? Yeah, so MAPS is bringing us all together in that way. So i my background before coming into psychedelic assisted therapy was in, and it remains to be in mental health innovation.
Speaker: So i started a nonprofit called Hello Sunday Morning, which was focused on helping people change their relationship with alcohol. And then that led into building a social enterprise, co-founding a social enterprise called CleanSlate Clinic, um which is a point of people with a home medicated detox ah for alcohol and other drugs. And then, yeah, ah always been fascinated by drug policy and and the intersection between mental health and the drugs that we use.
Speaker: And then, and yeah, MAPS has always been a guiding light in that. And um Rick Doblin has always been a... and kind of aspiring sort of person that I wanted to get around and understand better. and And so that led me to going and doing a Masters of Public Administration at the Kennedy School where Rick Doblin did that and meeting him and thinking about how MDMA is the medicalization of MDMA as a pathway to future post prohibition.
Speaker: And at the same time, the regulations were changing in Australia. So when did that, MPA came back to Australia and was really interested in the infrastructure and the and the the pathway to support that work grow in Australia. And then I tried for several months, um you know including when I was at MAPS to get something going and then met our Monitor, who was on a similar path in doing it um and sort of supporting the bureaucracy in the back end of this work and joined forces with MON to make this more accessible to more health professionals across the country.
Speaker: And it's been a great, we've been working together for 12 months. um or so and little bit over six months now now and we've you know now helped over 20 psychiatrists become authorized prescribers of psychedelic assisted therapy and all the accoutrements of things that they need to do around that and um now have our own little pack clinic as well That's fantastic. what a What a year that you've both had. And it's a really, you know, as was listening to you introduce yourselves, i was thinking, yeah, it makes so much sense that you would come together and do this work because they've got really similar interests, but also different skill sets, right? And we need so many hands when we are rolling out something new and innovative and that has the capacity to really change systems and change the way that we work with mental health, the way we think about human distress. But there's a lot of
Speaker: There's a lot of things that need to be shifted to make that happen and and a lot of bureaucracy and paperwork and back-end support as well. So, yeah.
Speaker: and it's ah It's kind of a cool grassroots movement as well, you know. um but We have a community of practice of 50 psychiatrists, you know, little WhatsApp channel where they're all those that have become APs or are interested in ah this work and they're learning. you this ah You know, it's not something that they...
Speaker: got taught through their medical degree or or yet to be really encouraged or supported through the college to do. So it's very, and it doesn't exist anywhere else in the world, you know, in in the way that it does in Australia. And so there isn't,
Speaker: you know, extreme power hierarchies. Everyone's sort of learning from each other on how to do it and sharing knowledge on how to do it well. And that's a very exciting place to be in any form of care.
Speaker: um There's a lot of goodwill and and a lot of really great community energy. Yeah, yeah, exactly. and i think it's so important, isn't it? You know, I think about the the two MAPS trainings, you know, the the one, Monica, that you and I were on, the first one has been such a beautiful, supportive um kind of group in just that WhatsApp chat that we're in. You know, there's just so, is it goes off every day almost, you know, with people just supporting each other or asking a question.
Speaker: And, you know, it's a really important thing to do to hold each other up and to it this work is is is amazing and deep and it requires it requires us to support and hold on one another in a collaborative way, I think.
Speaker: So do you want to share a little bit about the psychedelic consultancy and like what you're, what you're doing just for people who, so many listeners in Australia will have heard of you already, I'm sure, but we have people listening from all over the world. So what, tell us a little bit about that and what you are doing.
Speaker: Monica. so Okay. it a switch one So we're doing ah quite a few things. Probably the core of what we ah started doing a year ago is helping psychiatrists who want to do this work safely with their own patients in their own communities.
Speaker: ah but maybe aren't familiar with ethics committees and application processes to the TGA, weren't really sure how to find out how to to put it all together, but ah would would be really great clinicians to offer this to their their patients and patients.
Speaker: yeah want to do it safely, want to do it well, needed some guidance. So we support them with the the whole process from considering doing this work to actually writing their first script on the dosing day.
Speaker: um So we we try and facilitate everything around them to be able to do this safely, confidently um and well with their own patients. So that includes their ethics submission, helping them design their protocol. um We do training for both the authorized prescribers and therapists and supervision. And we also connect them with supervisors who can support them in doing the work.
Speaker: And then we um assist them with the application process until they're approved. And then once they are approved, then we we can help them with the tracking of their patients and ensure all of the different pieces are in place. So with psychedelic assisted therapy, it's, you know, such interesting and life affirming and rewarding work. It can be incredibly challenging. And it's it's super important to have the scaffolding around the clinicians doing that work. Yeah.
Speaker: operating really well so that everyone knows what's happening. People are informed in this new modality and they can be in their sort of, you know, their best self when they're sitting with the client um and know that all of that other stuff is taken care of and they've tracked it and they're on top of things. There's quite a lot of...
Speaker: sort checks and balances that are needed like at this early stage of the work. So we kind of help with all of that that's needed and where we notice a gap, we try and look at how we can offer like another service or a way of supporting people um with that. So yeah, in a nutshell, that's that's what we're doing.
Speaker: And what was it? Yeah, thanks, Monica. And it's such a, i can you know, the the amount of kind of logistical work that goes into those applications is huge, right? I can imagine for someone who really wants to start in this work, it could feel quite overwhelming so it's really great that you're supporting psychiatrists and and all first prescribers in that way.
Speaker: and What was it that drew you Monica into kind of wanting to and work in this way? Is it just something that you've always naturally been good at or is there kind of a deeper reason why supporting the systems and infrastructure is something that has been a passion of yours?
Speaker: That is a great question. I find that like in most of my roles and jobs that I've had, that's sort of the role I end up taking is like, okay, how do I lift other people up? And that's, um, that's happened everywhere I've worked. Um, so I, I sort of with the psychedelic therapy, um,
Speaker: clinics that that I worked um for a Monarch Mental Health Group before and setting those up, um like I learned quite a lot and thought, you know, there's there's so much that other people need to understand and information that I had and people were seeking it out. So I thought I could help other people to do it well.
Speaker: But I think um systems is always something I've been curious in, like, you know, internal systems, but also family systems and then broader systems and how that can support therapists to, you know, do this work sustainably.
Speaker: And, yeah, we have such an incredible opportunity in Australia that it just really needs to be done well. And, um yeah, just sort of drawn to helping things to flow well so that more people can do this really special work.
Speaker: Yeah, and then it just kind of, I just learned this is a very specific thing that I seem to be um very enthusiastic and passionate about, but kind of have a, yeah, quite a lot of experience now. I think we've done, we've helped 22 people get approved or psychiatrists get approved or they're in urals and then we've got another sort of five to 10 in the pipeline at the moment.
Speaker: So the more we the... more we do use that Yeah, the the more skills you get around it and just kind of feeds itself. Yes, because it's a huge process, right? and And, yeah, and I think that, you know, I'm just going to speak for myself, you know, this is and as a therapist, you know, I think...
Speaker: my trip I did my clinical psychology training in England with Lucy Johnson who wrote the Power Threat Meaning Framework. She's my teacher. um Lucky you. I know. She's amazing. And she was terrifying and amazing all at the same time. It's really, really fantastic. And I think that...
Speaker: the way in which we learned how to formulate and an internal system like a human when you're kind of working as a psychologist you you draw on that don't you like looking at all the different parts and the different things that feed into that someone's experience of distress and actually it's a really important thing to then look at systems and how they feed into that but also how the setup of them feeds into what is happening in in the world around us and I think they they sort of i don't know there's something about psychology that's naturally useful for for that as well although it's something that a lot of people can find really challenging within myself I wouldn't say that I'm great at administration or paperwork personally but I am good at thinking about systems and how they operate operate and I like to do that.
Speaker: I don't think we can effectively work with humans and their distress without thinking about the systems which they exist in. yeah cutsy and The really amazing thing about HUT is, and power threat meaning frameworks, is, um you know, the industrial model of mental health care is about putting someone in a box, you know, it's and it's very square and you're this or you're that, you've got this diagnosis or that one or, and this
Speaker: and New model of treatment requires multidisciplinary teams to deliver it, you know, and that's what's been amazing about the TGA making these changes in 2023 is that requires psychologists and psychiatrists and pharmacy to work together in a constellation.
Speaker: ah That's a much more circular approach to helping a person. it It makes it much harder and more bespoke and every patient kind of different, you know, while systems get set up. But in the end, I think it's a a better framework to look at human suffering in this way, even though it's more difficult um and does require a lot more administrative effort.
Speaker: And, you know, the the vision for PAC, I think, is that but perhaps other forms of mental health care could be you know viewed in this way as well and and people could be supported in this way. um And this is the really the innovative vanguard towards that that future vision.
Speaker: Yes. Yeah. Right. Completely agree. Yeah. you know I've talked about this quite a lot on this podcast, but I think and you know the way that psychedelic assisted therapy works is is not necessarily tied in in, although people need to have a a certain diagnostic label to seek treatment, of course, but that's really only one part and only one small thing that we look at and actually really looks at what's the distress underneath that label.
Speaker: and well That's what Pat does. We all know that right in this space. But I think and I really hope that it allows us to start to view more mental health issues in that way. Yeah, I could go on a big tangent about all of that but and I have in other episodes so I won't repeat it here.
Speaker: yeah we We talk about like how the, you know, psychedelic therapy, you know, sort of creating the systems around it. But I also think that the more that psychedelic therapy is coming into the system, it's going to change the system and the way that like the teams work. So, you know, like I think like psychedelic therapy patients, like as you know Chris is saying, they're giving this really great care, like really collaborative multidisciplinary that's like looking at their medical health, psychological health, you know, the medications they're taking, like really reviewing them, tapering them, like thinking about why they're on them. um And yeah, looking at the, what the support network's like, really being careful and intentional about what we're doing and why, and
Speaker: Yeah, I think there's even understanding, know, we're seeing these treatments have these incredible outcomes for people that have trialed all these other other other treatments first and then having like how that teaches you as a mental health professional to think about human distress and as, you know, a psychiatrist and some some biological psychiatrists that maybe haven't been trained to think, um you know, maybe about sort of spirituality or somatic therapy and and having to then learn about these things because they're seeing this changes I mean these patients in front of them so i think that you it's gradually going to hopefully change the system for the better and that will hopefully help more people do this work absolutely and you know and I yeah I think one of the things I want read other reasons I wanted to start the podcast is hopefully to help people to understand a little bit more about this all of those themes really as we as we move out into the
Speaker: into the clinical use here. It's a lot of kind of community awareness as well that I think is really important. um And even extending out beyond ah clinical practice too, i think about the way we use drugs as individuals and society, you know, from alcohol to nicotine, caffeine and the medicalised drugs we have. Yeah.
Speaker: the coupling of their use with ceremony and protocol and deeper consideration of the way that we use them. I feel like particularly MDMA-assisted therapy is like, the if you were going to design a way to safely take MDMA, that would be yeah you know sitting with two therapists and like enormous amount of prep and integration and you know that this should be the way that we use all drugs and this is a model to go this is you know in a kind of um western medical model how we retrofit retrofit that kind of ceremony into something that is a new paradigm and
Speaker: i yeah It's very expensive, hard to access for people and requires diagnoses. But I think as a model of care, it's ah kind of it's pretty punk rock to be doing it. though it's a lot of paperwork and admin and stuff, it's pretty cool to be doing that.
Speaker: It does feel DIY some days when you're trying to connect the Bluetooth speakers and the videos. Oh, my gosh. Yes. Yeah, see, Monza and Tom Groker from way back, so, you know. That's right. I learned this about you. She's perfectly suited for the role.
Speaker: I learned this about you, Monica. Yeah. Yeah. Glutee. Yeah, totally. Yeah. I think, you know, it really does have the potential to turn the medical model up on its head, and I think, I really hope that that is part of what happens, that it kind of really makes us question why we are tying trying to tie people into these small little block fears when actually being human is so much more complex than that. And I think that part really shows us shows us that, but it also shows us how we can really support people to meet with those deeper parts of themselves and to move towards
Speaker: change um It's an and, you know, I think it's not necessarily, and you know, anti-medical model. In fact, that the the way this is, you know, come through a medical medicalised model, I think is a really powerful thing because, um you know, even thinking about our clients,
Speaker: a lot of them don't want to be seen just as drug prescribers, you know, and that's what a lot of psychiatrists, you know, we end up going, no, your your job is just to do, just to write the script, you know, or just give the diagnosis and write the script.
Speaker: And they don't want their life to be like that for the rest of their days. You know, I think they want healing for people. They want people not to need drugs forever, you know, anymore to use them well and,
Speaker: You know, and even our co-founder, Joe, is an amazing example of a psychiatrist that thinks about people integratively and thinks about their formulation and their diet and their nutrition, like all these things in a deeper way that and thinks about them medically.
Speaker: You know, like there's it's a yes and, not a throw the, you know, industrial medical model out the window. There's a lot of value to it. Yeah, absolutely.
Speaker: i i almost I was going to um invite joe I hope to have him one another time. i've had the pleasure of working with him with some clients, which is pretty incredible. And one of the trials here down in, in we worked with some clients using MDMA assisted therapy with first responders.
Speaker: and So, Yeah, that's a pretty amazing clinician. Incredible. Incredible, Jim. You know, like one a very unique psychiatrist that has ah a great vision for psychiatry, you know, that, um that yeah, definitely worth an hour and a half conversation with them. Just just know your brain is probably going to hurt at the end.
Speaker: Yes, I am. Yes, yes, indeed. Well, actually, feel like you're kind of segwaying us, Chris, into one of my next questions, which is really about your de-prescribing program pilot. i' I'm actually just going to let you kind of maybe outline a little bit about what that means. You've already both actually alluded to it, but maybe just explain in a little bit more detail for the people listening that maybe don't understand ah medical terminology as well. So to kind of just walk through.
Speaker: That'd be great. Yeah. So, i mean, personally, i was on antidepressants for most of my twenties. Um, and yeah, I was going through a rough patch was prescribed them. And luckily I was prescribed, mean, luckily could afford, um you know, one that didn't come as severe withdrawal, um, so symptom symptoms, but wasn't really reviewed, uh, for a long time. The psychologist that I,
Speaker: was working with as well, never really brought them up. It was sort of this other part of my life. And in Australia, you know, there's 3.9 million Australians that are, you know, prescribed to antidepressants and that rate's going up. Wow.
Speaker: And they, you know, as a medicine, the ideal range of their use is sort of six to 12 months, according to the clinical guidelines.
Speaker: But half of that 3.9 million people are on them beyond a year. And, know, That's a real challenge. And there's an element of, if it ain't broke, you know don't fix it.
Speaker: yeah Like, oh, I'll stay on them. and But there's a large proportion of the of people that are prescribed antidepressants that are stuck on them because when you start to come off them, ah you can have withdrawals and then, you then you know well, I should just stay on them forever. And there's a lot of mis...
Speaker: you um misinformation, I guess, that only until um the last few years, there's been a movement and a lot of clinical work being done into developing new antidepressant deprescribing guidelines bonds that um and known as the Maudsley Deprescribing Guidelines, which show a pathway towards people coming off them in a much slower rate um to reduce those withdrawal symptom symptoms that people experience.
Speaker: So there's a new model endorsed by the RICGP, the GP College, a lot of work going into trying to get education doctors to change their prescribing patterns but the infrastructure isn't set up to do it well so where we came to it from is we you know our clinic has ah patients that um you know want to access psychedelic assisted therapy and our clients want to provide that for patients and they need to come off their antidepressants and ideally not as quickly as they've historically been
Speaker: So we built this pilot to look at helping building a program to help um patients come off them. Joe was the prescriber to support people and then having an online group for people to support each other because it can be quite lonely to to come off them. Yeah. we put roughly 10 patients through the pilot, um you know, i learned a lot about the system and the length of time and the complexity around dealing with compounding pharmacy and and where that pilot has evolved to is we want to help patients understand
Speaker: easily access compounding pharmacy, also help patients with the psychosocial support around the the medication reduction. And normally takes, you know, sort of six to 24 months to come off them according to these guidelines. So it's a so bit of a journey to go on.
Speaker: And then we also are looking to... help train psychologists and GPs in the deep ascribing process as well, you know, and especially supporting them as their patients are coming off. So it's a systematic problem. um You know, one,
Speaker: you know, our vision would be across the system, and there's ah there's a number of people working on this problem, um and we're all responsible for it, is what if Australia could be one of the first OECD countries to the actually reduce rates of prescribing in antidepressants? What kind of system would that look like where people have the psychosocial support that they need to come on them and then come off them safely?
Speaker: um Whereas the rest of you know the OECD countries are just continuing to increase their prescribing rates as the first kind of pathway for a person with a mental health um challenge. So that's ah that's our vision and where that goes to, we're we're really open to working in partnership and and working with people, but where it's in a really important one. um you know And you obviously share that that mission as they do.
Speaker: It's a challenge. Yes, this is um ah really an issue that's close to my heart from both professional and personal level. um i i couldn Unfortunately, i've I've lost count of the amount of clients who I've worked with who've really struggled to come off the antidepressants because of the side effects.
Speaker: um And it it really, actually, I feel a bit emotional. It's kind of, it's just, I find it say upsetting that that people are just not made aware of how challenging it can be and that can go in different directions. You know, some people just think it's fine just to stop their antidepressants and anybody who's listening to this, absolutely don't do that. Like it you really have to slowly, slowly come off them with the guidance of medical professionals and hopefully some psychosocial support like you're talking about.
Speaker: because otherwise you can have some nasty side effects and you can feel like you're getting worse, right? And that's that can be really confusing for people. And yeah i am the compounding pharmacy piece is really important because it's actually really difficult for people to get the amount of medications, isn't it, that they need if they're coming off, you know, they they kind of slice their tablet up a little bit, but then that's a half dose. But what if they want even less than that?
Speaker: And one of my dearest ah friends and colleagues spent many, many years and is very open about this and will be coming on to talk about it actually, um trying to come off metazapine and found it extremely difficult as a clinical psychologist working in mental health. And it was one of the hardest things that he's ever had to do i'm So, yeah.
Speaker: Monica, I'm sure you've got lots to say about this. I could go on, but I'd like to hear from you. much. Yeah. It's I really like I'm sure Chris feels like exactly what yeah that feeling your your hand was here. I'm like, yes, I have that too.
Speaker: ah In my clinical psychology training, our sort of neuropsychopharmacology training was antidepressants aren't addictive. Some people get a discontinuation syndrome, but it's not addictive.
Speaker: And so that's what i had kind of in my head. It's like, a you know, that's a university, a reputable and university and we train. um And then when I started working as a psychedelic assisted therapist and seeing people sort of tapering off these medications with the kind of advice of like, oh, just halve it and then halve it again and see how you go and then halve it and, you know, just, yeah, see how you go, kind of work it out. But there's just seeing how much people really struggle and the the harm that that causes in terms of people's meaning making because they don't have the right information. So there's a sense of,
Speaker: you know oh i took my medication again and how awful i felt stopped therefore my brain's really broken i'm really broken and i need this medication like a diabetic needs insulin it's like actually that's not true you're having withdrawal so i i love a coffee and if i don't have a coffee i get a headache it's not because coffee is fixing my headaches it's because my brain is uh neuroadapted So just even people being able to see that that's not a personal failing and deciding to relate to their own emotions differently. So Chris mentioned the peer support is so important, like the sort of group support and hearing a lot of these things are normal and people aren't alone. So yeah, we are very, very passionate about this as well.
Speaker: Yes. um And I think, you know, just have being able to meet for that peer support and people being able to meet others is feels so important. And I think You know, not to mention when people are trying to come often, but I think even when people are taking them, when everyone has the side effects explained properly, that like it can affect your sex drive or your ability to orgasm, for example, you know, and that's actually a really important part of life, right? And people don't realize that that can be really significantly significant.
Speaker: impacted and I've had many clients who were started in their teens and unfortunately that number is rising. I i read recently that people being prescribed them younger um and then you know that's such a long period of time by the time you get to adulthood in a developing brain. I really feel quite concerned about those statistics. I didn't realise the general number was still a rising, Chris, actually.
Speaker: I'm a bit disheartened to hear that and hopefully we can start to work on it all together. Let me know how I can help. yeah i same I said some people your way. The Morsley guidelines, I think, um ah were a critical piece in prescribing culture change.
Speaker: You know, the fact that there's now new guidelines that are there in place and they've you know they're quite recent. It's just going to take hey um a bit of time for prescribing behaviour to catch up.
Speaker: um And you know to be fair to GPs who prescribe 92% of antidepressant prescriptions, their job's really hard. You know you have a so of small amount of time, 15 minutes to see someone, and maybe 45-minute mental health being you've got to have you know a solution there for a person and you're also taking on the clinical risk of that person making decision to prescribe or not to prescribe.
Speaker: And so you understand how we are in this situation. um But it is, i you know, I think to Mon's point, education across health professionals.
Speaker: um um You know, it's the responsibility of all health professionals and to know this, to the others, to better to help um clients and patients. And i think improving um improving the the pathways and mechanisms mechanisms for patients to improve slowly come on them and then slowly come off them and with the yeah intention to always be looking to come off them or or reduce your dose if and when that's necessary. And I think that that also leads to a lot of ultimately healthcare cost savings in terms of PBS um cost reductions as well. So it is a systematic challenge.
Speaker: I think, you know, I'm yet to meet you know, the majority um the majority of people, um there's a stigma around using them and there's a desire to come off them if they can, you know.
Speaker: ah So, yeah, hopefully the the culture can change over the coming years. Yes, I hope so too. And I think... um you know, I think is one of those sort of challenges that really is best ah ah approach from multiple angles, right? And in a way, the work you're doing in this space is very ah related to psychodexistic psychotherapy because, of course, you know, on the trials that I've worked on and in my clinical practice doing cat work, it's the coming off the medication that can be one of the hardest things for people, right? And with trials too, like you have to stay off your medication for quite long periods of time and at the end as well until with the
Speaker: data collection is complete. So, you know, and that's great because for some people who really want to, but it's, it can be really challenging for people to come off as well. and So I think, you know, it's one of those spaces where Pat can inform and help to shift, but also it needs to be looked at from multiple different angles. So it's really great, Chris, to hear that you're it's involved in some of that, those conversations.
Speaker: Yeah. Awesome. And so changing tactics a little bit now, Monica, into unless there's anything you really want to share that you haven't said so far from on the de-prescribing, can we go on to the next section?
Speaker: Yeah, of course. So just that this podcast is also all about the therapy part of psychedelic assisted therapy and um as well as doing all this the work that you do in the background um in the infrastructure and systems change, you're also a psychedelic therapist yourself. And so i' always love to get a bit nerdy with people and ask kind of what therapeutic modalities that you find really useful for the work that you do.
Speaker: um and anything that you really want to share about your practice in that way. I could talk forever on that. um Yeah, I feel very fortunate that I get to, you know, it feels like such a are a gift to be able to sit with people and be a psychedelic therapist as well as do the the things around it.
Speaker: um I think in terms of modalities, yeah, like If I had to sort of say modalities, I would say internal family systems probably informs a lot of my sort of thinking about what happens in dosing sessions and in terms of understanding what might be challenging for someone when we're we're talking about preparation, like what might come up and how they might mean make meaning out of it. And I'm an EMDR consultant, so I'm a big fan of EMDR for just about any anything. um So I use that a lot for um for integration um and then also sometimes for preparation.
Speaker: um But it's not it's not always needed. Like often the medicine does so much of the work that... um you know traditional sort of although the emdrs and the dbts and cbt they're not really that um applicable because a lot of it's ah the person and the medicine and just the therapeutic space and only really needing to use intervention when when someone's stuck or really requiring it um in those in those cases but I feel very very fortunate to have have worked with a few different co-therapists and authorized prescribers and a few different locations now Sydney Melbourne Newcastle and um learn a lot from all of my dyad partners and the way that they work too but I think
Speaker: Yeah, like as a profession, it's really interesting, like supervising therapists and helping them to find how they can use their existing sort of repertoire of skills. And most most people drawn to this work are really interested in trauma and sort of thinking about, you know, maybe less conscious parts of the self and how they might show up in in psychedelic therapy. Yeah.
Speaker: And so how we adapt or modify the way we would normally work with a person to when we're when we're doing psychedelic assisted therapy and how that's it's quite different sort of shifting into PAT mode. Yeah.
Speaker: Yeah. So, yeah, I do quite different things to normal talk therapy, which, um yeah, feels a lot more sort of defined, whereas as Pat, I think there's a lot of sort of space holding and this idea of sort of almost like a midwife, you're just kind of being being with a person a lot of the time as well.
Speaker: So, wound yeah. Yeah. It's so good. I love this opportunity to hear about this because I'm not in the diet ad, you know, so. Yeah.
Speaker: um It's really cool to hear. And not i don't I guess you it's making me want to ask questions too, Esme. Sure. And maybe as a non-therapist, I guess like these are some of the questions I think you know and non-therapists might have. like um what what's the what's the you know You have the three preparation sessions and then that goes into the dosing.
Speaker: like Just building on Esme's question, like, because yeah the person's in a different state than they are in the preparation, what a do you apply the same modalities and thinking? and And what are the threads that come through the preparation that come into the dosing that then you can work with? And and maybe the what would it what would the experience be like if you didn't have the integration, and i i didn't have the preparation, if you were just thrown into that room with someone? And how does it make a difference to the therapeutic outcome?
Speaker: Yeah, I think that's a great question. i could talk about this for ages as well. um i very rarely only do three preparation sessions with with clients. I usually do a lot more and they're usually clients that are well known to me or my co-therapist.
Speaker: um purely because like in Australia, these medicines can only be used for people that have quite high levels of distress and often mistrust and don't feel safe in their bodies, don't feel safe with people. And so having that relational safety is really important. So usually um usually I'd see people more than three times, but...
Speaker: if we I think just ah if you would take the sort of person that would be eligible for MDMA-assisted therapy, they have severe chronic PTSD and just kind of um put them in there with people they've never met before, and i don't think that would go well. I think that there'd be parts of them that would um be resistant to PTSD opening up and and sitting with whatever arose and being curious about it making sense of it um and even and with psilocybin I think maybe would heighten anxiety even more I think there's people are often less a lot less verbal in psilocybin than in MDMA in general and you're re like really reliant on that resonance and how they feel in your presence which I just think
Speaker: It takes a certain amount of time for people's nervous systems to feel comfortable with another human that we haven't been able to speed up or are um or rush or replace with an app yet. You know, hopefully never, but I think there's just a certain amount of time that's needed for people to feel like they can, you know, be a little bit, you know, non-ordinary with you and maybe say something that's really difficult brings a lot of shame or they've never shared before or it's really hard to admit even to themselves um so yeah i think um that's that's really important like in other types of therapy but um in psychedelic ghosting sessions um never going in with a sense of like i'm going to do some cbt today that would be terrible like never going in with like ah i'm going to do you an intervention um
Speaker: Often, you know, people will have people have an intention for the dosing day. It might be something that you you sort of think ah of some good in EMDR. We call them cognitive interweaves or they're like little prompts that, you know, when when you're sort of helping someone process a trauma memory.
Speaker: maybe will help them to generate some of them their own insights around um something that might be keeping them stuck so you know if someone has a lot of shame you might think of a couple of really good questions if somebody's feeling embarrassed about what they're feeling um for it for example and in psychedelic therapy often you have a bit of a formulation of what parts of them might come up that could um you know create uh challenges that not that you need to fix or change that but how you can help the person meet that in a helpful way that it becomes uh learning and like something they could be curious about that brings them deeper to knowing themselves better rather than leading them somewhere um more directly um yeah yeah does that make sense
Speaker: Yeah, so like i've got lots to say but yeah yeah yeah i I love that what you're sharing there, Monica, because I think um something that I think can be really important, you know, is that it's obviously really we ask people to set intentions, don't we, in psychedelic therapy, which is different to regular therapy. um And very often people will come with maybe a kind of general intention, like I want to feel less anxious, for example.
Speaker: And then one of, I think, my my job as a therapist is to help them to get a little bit deeper and to say, okay, what's that actually, let's explore what's actually kind of creating your anxiety and come up with a formulation, which is really a co-created understanding, meaning of distress.
Speaker: for that person or the reasons for distress of that person is experiencing and then kind of really help them to create ah an intention that sits a little bit more into okay maybe this is to do with your relationship with your mum or with that trauma that happened to you when you were five or something like that and that people don't always come in with a clear example ah understanding of what that is and that's why i also really like to know people quite well before I take them through dosing. We're really lucky in Australia that we have that flexibility, right? like And on the trials, um often if you don't, you have sort of usually the protocols. ah Actually, three is a generous amount of preparation sessions. you know I've seen in some
Speaker: places just one or two and but in the trials that I've you know involved in in Australia there's always at least three um in my clinical practice I like to know people pretty well for all the reasons that Maureka just shared I think yeah safety is such a ever-changing thing for a person right Absolutely. And it's, it's um I think the interesting thing with this work as well is, you know, when you can see the dots there and you can see that the person might be connecting something with something else, but just not jumping in and going, oh, have you thought that that might relate to to that, but just sort of waiting and that there's like this unfolding of layers and you can see that a person's going to get there, but you have to be very patient and like the gift of being patient with someone and just trusting.
Speaker: like that time will like they'll actually come to that themselves and then when they do yes yeah yeah yeah i had that experience on friday it was like oh shit it's gonna happen and then it happened and it's something was a it was actually a fifth mdma session with someone who um seen over a number of years or now a year and a half and um they've spaced them out quite a lot but you know for this person with complex developmental trauma and it you know Often you meet clients and you can see like, you can see where the issues come from and they know that intellectually, but until they have an experience of it, they have an experience of feeling different and no amount of talk therapy is going to get them there and for them to experience themselves differently.
Speaker: and then they just go, oh, that was because of this and they connect it themselves and it just dissipates and something just shifts that doesn't unshift or, you know, it just continues to to grow for them.
Speaker: But yeah, and I'm aware that as I'm talking about this, unless you've done psychedelic therapy, it may sound really wishy-washy. So let me know. I need to make it sound more sciencey or say neuroplasticity a few times. Just let me know. um nice Default mode network.
Speaker: You're fine, Monica. i think um I think it's really important. There's something about the people coming to the felt sense in their body, right, of what it is that you're speaking to that really it helps them understand.
Speaker: So it helps to stay that helps them to stay in that place. But also what I find fascinating about this work in terms of the integration is there's, it really, MDMA assisted psychotherapy and some psilocybin assisted therapy really unfolds over such a long period of time. You're talking about that person who has spaced out their five doses, the space in between is so important. And of course, it's not all going to be and what happens in the room, in the therapy room. It's all the things that happen outside that person's life um and helping them to kind of work out how they want to be in the world with these new insights too.
Speaker: um But I just find it really interesting how a how long sometimes that can can continue for in a really positive way. People can be kind of having insights many months after the dosing that relate to the thing that they were working on.
Speaker: and Yeah, absolutely. And I think as a, like the way that psychedelic therapy and having done psychedelic therapy for about only two years, but I think the way it's changed the way that I and as a normal, normal therapist, whatever that means, I'm probably not a normal therapist, but when I'm doing standard therapy without um psychedelics is just how much in traditional talk therapy, I feel like we, we kind of like rush people or trying to sort of sort of you know, give them some sort of meaning making that like sort of speeds it up because capitalism and whatever it is, we've got a, we've only got our 10 Medicare rebates, which is not, not much, but, um, yeah, like being able to give people a lot more space to sort of work out their own answers to things. Um,
Speaker: Yeah, I think a lot of psychology is very much about sort of doing doing things to people and like there's collaboration. But yeah, in psychedelic therapy, there's so much more space and sort of trust for people's ability to to work through things.
Speaker: think it's changed the way that work as well in in traditional therapies. And that's why IFS I think is such a good partner for it because I do feel like the IFS therapy has a similar ethos in terms of the way that it it is used in a session. like you you know You're guiding the person to recognise their parts or to work with the pain, but you're not telling them what's there or suggesting that you know. And and I'm often really surprised when I'm using using that method with people as to where we go.
Speaker: yeah yes Christian, I don't think you have some more questions for, there something you want to say or ask? i um I'm curious about shame, like how often shame for, you know, like parts comes up in the, or like parts that that a patient has felt a ashamed about or protective of.
Speaker: Does that come up every single time or is it, um you know, sometimes or? who Who's that? Monica, do you want to answer that? I can answer and then you can answer. Yeah, we can both answer that probably.
Speaker: this I think in the medicine session, often the shame, ah the parts that might sort of shame us up shame somebody, um soften back um and that's that's kind of what the medicine will do and then it's the next morning in integration there's can be a little bit of backlash like what do you mean you love yourself like you did this thing and that thing that thing and what do you mean you think you're a good person worthy of love no you're not so there can be um it's almost like a like a ricochet effect the next day but it's
Speaker: then you're you're working with it, you're talking about it, it's in the field, it's conscious. um So it yes, it then can be explored and witnessed rather than it's just something that the person feels is just happening to them. There's maybe a bit more of an understanding where it comes from and the role of shame, like how it, you know, where it came from, its story, that part that that did that, whose voice it was, how that that helped them to cope with life at that point in time. So, but Esme, what are your thoughts?
Speaker: Yeah, I mean, I agree with all this, what you shared there. And I think, I think, you know, it can come up and be, present in in and preparation for sure. So people, you know, with psilocybin, for example, psilocybin therapy, we might ask people kind of, is there anything that you really don't want to come up with that you don't want, that you're worried about will come up in the dosing to kind of, because sometimes if there is something that they're not mentioning because of shame and it can come up more strongly. But of course, we really want to try to support people to be safe and to share. And that's why it's really good to solidly know someone beforehand. but
Speaker: I think, you know, I always say that shame likes to stay in the dark. We all have shame. Well, most most people experience shame in some capacity. And if you have empathy, you have shame. So they live together. um And shame likes to stay in the dark. And if we turn and shine our light on it together, often it can kind of begin to move um and and evaporate to become less problematic, at least for people.
Speaker: We're not going to be eradicate it though. And we wouldn't necessarily want to, but it's when it's misplaced into these wrong into these areas that it doesn't need to stay in anymore. Maybe it was there for a good reason originally, and now it doesn't need to be there anymore. And so that can be a really important part of the work of psychedelic therapy and as therapists really bearing witness, I guess, to that process.
Speaker: Kurt, I think as someone that's accessed a lot of therapy in my time, you know, years and years of different therapists, and i think and I think maybe this is a common experience for a lot of people is um you kind of get good at talking therapy, you know, like you sort of get good at explain you know explaining your trauma and this is happening and it's like you arere in charge that the ego's in charge of the situation and it's really once you get into a loop of that it's hard to
Speaker: Um, and you get in a pattern of it. So even if you have 10, 20 sessions with people, it's like, you're, you're never, you're just still on the surface. no And, you know, the experience that I've had with psychedelics has been, there's a ah real trusting of the medicine and whatever guidance is there to, um, give over control a little bit. Um, uh,
Speaker: yeah, it's it must be must as a therapist take a much longer time. Well, for a lot, I mean, for hard-headed people like me, it must take a long time to get to that place.
Speaker: Yeah. As opposed to doing, you know, working with medicines, it's like, I kind of would feel like, Oh yeah. maybe um Yeah.
Speaker: It's true. I think, um, Yeah, I think it is common. I reckon that's a really common experience, Chris, of people being good at therapy and that and often people trying to be good at therapy as well, by the way, like clients that come in and think they have to be doing this right, you know. um but But medicine work is a whole different thing. It just takes you into that altered state where the parts do often give people space to access more of what's actually And and you have so much more time. Yeah, more time well. Put your headphones on and, like, you really think about...
Speaker: yeah yeah Yeah, totally. Wow, this is great. I could keep going um on all of this. I'm mindful that we're kind of getting towards the hour. um Definitely the converted choir, aren't we? the one that We need to have dissenting voices. I know, I know, I know. We should. But I mean...
Speaker: Actually, should we the person who I was talking about before who's coming on the podcast. Yeah, I think so. think the person who I was talking about before who's a friend and colleague from the UK is going to come on and she actually doesn't know much at all about psychedelic therapy and is has been skeptical but does it also just doesn't have the knowledge. So we're going to have a conversation live. We're all going to record it about what it is and have a bit of a debate. So I'll look forward to that. shouldn have had this bigco There's a handful of psychiatrists that, you know, do you think that this moves too quickly with the TGA, um you know, and and have has some valid points around that.
Speaker: um you know, good practice, ah that I think it would be kind cool to hear that perspective. um Definitely. Definitely. I think so too. I think, you know, ah this work really does teach us the importance of being slow, doesn't it? You know, a slow rollout too. And, and While some people think it's been quick, it hasn't been as quick as it as it could have been. right like it actually has Because the process is so complex for people, it has rolled out in a way that's been slower than I had originally and imagined, which I think is good, actually.
Speaker: I mean, going back to, a you know, sort of come back to the surface of the regulation and the system. um Yes. The thing, you know, that worries me about what's happening in the US and with kind of FDA approvals is them coming through and being regulated like any other drug, you know. Yeah.
Speaker: And I think the thing that we are extremely lucky to have the regulator um in Australia that we have that has set the system up um in a much more... like The system that we have was not set up to do what it's doing now, you know, like having HREC approvals and yet it's they they took the chance to do it and it's happening and now the system is adapting.
Speaker: you know it would be good to see this system up of a required multi-disciplinary approach a considered protocol a really in-depth ah training that happening upward in other countries and theory is that with other regulators just approving the medicines and the way they are that it will be more industrial and i think that's trying to find a balance with that that's very difficult um
Speaker: Yeah, to maintain, I think, the essence of what value brings. Absolutely. that Well, you're kind of segwaying into one of my other questions, really, which is, you know,
Speaker: ah which is kind of related, like what do you think is, a what kind of systems do you think need to shift to really accommodate this new model, Chris, like in terms of you're working a lot with the systems around it and there's a lot of things that are really good. What would you hope will happen in the future and what would you like to see shift and change to help us roll this out even more effectively and maybe more cost effectively as well?
Speaker: Well, the pay is critical um yeah in Australia and abroad. So, you know, lucky to have and a health insurer in Medibank, even though it's constrained in many ways um to invest in this area.
Speaker: and DBA as well, and seeing more payers come on board, whether they pay for the whole thing or partial or whatever. But it's it's very di it's very expensive for people to access um you know as it is.
Speaker: And um so that's a that's a critical thing. And I think more will come on board with you know outcomes published from, A, new registry, um and health economic outcomes as well for more patients and comparing this to you know traditional approaches to treatment or no treatment at all.
Speaker: um So I think those are systematic things that you know in kind of need to happen and then endorsement by some of the institutions such as the colleges and AMA and and you know I think it would be great to see endorsement from the Australian government as well.
Speaker: um that I think know we are letting the world in, particularly with MDMA-assisted therapy. and I you know think it's a a great model that we could explore abroad um in terms of how it's regulated. so That would be a cool vision, I think, for our work beyond yeah yeah in the next few years.
Speaker: Yes, ah that sounds really great. And I know you hear so often, how do we make it cheaper, but actually, how do we make it more cost effective for the people accessing it so it's not as expensive for them, i think is a more important question, really, rather than stripping back the therapy or how you know um the number of people in the room, for example, or something like that. I think actually, let's look at what we've got here, which is really a best practice and what's been shown to be effective in the trials and then look at how we support how we bring more payers on board. That's how it has how I feel anyway.
Speaker: And the DBA is the Department of Veteran Affairs for many non-Australians listening who are also um have funded some funding some of these treatments for their veterans. Yeah, and giving people more patients agency too. You know, like I so i saw a psychiatrist for psychoanalysis for a year, you know, and and, you know, hit the safety, Medicare safety net and ah very early on into that.
Speaker: um You know, so I would have, you know, cost myself and the system, you know, probably tens of thousands of dollars in in that treatment. um And if I had the agency to go, I could do that or I could have done, you know, psychedelic assisted therapy,
Speaker: over a period of three months and like do the end to perhaps an integration, I'll be at the same price, you know, I think. um Yeah. um And I definitely would have done that for sure.
Speaker: And that's why we need the, you know, the health economics perspective on this, I think. um And I really, know, it's not my area of expertise, but it is other people's area of expertise and that's where we need to bring those people in to show, to look at that, what actually is it costing and versus say, you know, psychiatric inpatient treatment, which is extremely expensive and often quite distressing for people as well in the aftermath, which can then mean for needing a lot of extra psychological support, even once they're out of hospital for some people too. So
Speaker: Yes, it's a complex question. I've even thought but how we even, um you know, this calendar year of Medicare funding, like who decides that a mental illness is like calendar year based? Like where did that come from? Like why can it not be over like a chunk of years and you can use it like a fund, like you have your rebate fund and you can use your your Medicare quota for like, I don't know, your lifetime expectancy or like five, ten years.
Speaker: um and and have a more intensive treatment that addresses the underlying causes of things and rather than this kind of like almost palliative care of like one-a-month check-ins with a psychologist and same medications you've been on for however long. Why is that not...
Speaker: ah possible so you know just thinking about those kinds of things but also like group therapy as like a way of um yeah i think it's a really underutilized um type of of therapy in general in mental health so i do group therapy love group therapy personally as a client and get so much out of it so it's not just about being cost effective but it's um incredibly meaningful and very relevant to to what psychedelics bring to the table and then how do we sort of look at having
Speaker: ah you know, we we can't sort of have access at the expense of safety. However, could there not be other types of medical practitioners on site? So where you have like a psychiatrist that's writing the script and they do the suitability assessment, but you could have another practitioner on site to do the vital sign monitoring and prescribe medications if needed. And that might lower the cost, make it more accessible in say rural areas, regional areas where on-site psychiatry is not going to happen. So I could talk for another hour on ideas but uh yes we'll have to have you on again yeah yeah happy day yeah well thank you so much both of you where do people find you how do people get in touch if there's any a any psychiatrist listening or any anyone else that would love to to ask you more about your work where would they reach you
Speaker: Probably our like website, so www.thepsychedelicconsultancy.com. Probably a good one. We're both on LinkedIn as well.
Speaker: But, yeah, probably a website and you can contact us through that. Or peridoclinic.com. Yeah, www.periodoclinic.com. I'll put both of those in the show notes for everybody. So it's really easy. i am It's been so lovely to have you. Is there anything else that you want to end on or anything that you haven't shared that you really want to say before we wrap up today? Thanks for having us, Esma. It's been great. No problem.
Speaker: Thank you Thank you so much. This has been really, really fun chats. yes hopefully can have more fun chats together and i'm sure we'd love to have you on again and i'd love to i will be chatting with joe about having them on too so yeah and come back to like macquarie soon because i'm on this day again i would love that in fact actually post podcast chat i think i am going to be coming up soon so i will get in touch great all right i'm gonna press all right thanks everybody see guys
Speaker: 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.
