OPEN Foundation

Alberto Cantizani

Truffle therapy in the Netherlands is running ahead of the science

The promising results of psychedelic treatments in small scale clinical trials are feeding an emergent health and wellness industry around these substances. The Netherlands, where psilocybin truffles remain unregulated, has become fertile ground for entrepreneurs aiming to position themselves at the cutting-edge of the psychedelic medicine market. Even though most of these psychedelic retreats cater to healthy participants, an increasing number of companies are planning to offer truffle sessions as psychedelic therapy to psychiatric patients. At the current stage, when scientific evidence proves promising but not yet conclusive, researchers are worried about the risks of commercial providers running ahead of the ongoing research. Should companies tread more carefully and let clinical researchers take the lead in the development of psychedelic therapy?
Psilocybin in the Netherlands
Psilocybin is a controlled substance in the Netherlands and the possession and sale of any species of psilocybin containing mushrooms is forbidden. However, this regulation does not apply to truffles, given that these are not strictly mushrooms but a different part of the fungus. This legal loophole has allowed the spread of psychedelic retreat centers offering truffle ceremonies for self-development or spiritual purposes.
Even though truffles qualify as a legal food in the Netherlands, they cannot be advertised as a medical treatment. The Dutch Health and Youth Care Inspectorate (IGJ) states that truffles may fall under the regulatory scope of the Medicines Act if medical claims are made. “In that case, we qualify the truffles as a medicine, for which no trade permit has been granted in the Netherlands”, an IGJ spokesperson declared .
Most entrepreneurs, aware of the existing regulation, avoid making explicit medical claims when advertising their services and try to use terms like “inner healing” and “personal development” instead. Many also warn that their ceremonies are not meant to substitute medical or psychotherapeutic care and make an effort to exclude clients with mental diagnoses and possible physical risks from participating through careful health screening.
This is, however, not always the case. The clinical director of a new truffle clinic recently declared to Dutch media: “We administer truffles to people in order to make them feel better and to overcome psychological disorders such as depression, anxiety and stress”. Others openly claim to provide “psychedelic-assisted therapy” on their websites and display the available scientific evidence to illustrate its efficacy in the treatment of depression, addiction or PTSD. We asked Nick (whose real name is not disclosed) about the apparent targeting of mental health patients on his retreat center’s website. “We are not pretending to treat or cure PTSD”, he assured, “we are acknowledging that there are people who have PTSD and that those clients that we have received (and not targeted) had very beneficial experiences”.

Interview with Dutch psychedelic researcher Tijmen Bostoen

The hype around psychedelics is sparking a race among startups to become pioneers of a new therapeutic or wellness market, the boundaries are not always clear. But the emergence of truffle therapy is not just about opportunistic entrepreneurship. The mainstreaming of psychedelics is also bringing some of the underground therapists to the surface and from their perspective, there might not be meaningful reasons to wait for approval and regulation. Peter (whose real name is not disclosed) has conducted truffle therapy for the last eight years and more recently decided to start advertising their services online. “Back then we also thought we were moving too fast but people were really searching for this. We just couldn’t wait. Regulation can be helpful, but for a lot of us who already walked that path it’s not that great, especially for the ones who believe more in alternative therapies”.
The lack of formal regulation governing the profession has led some psychedelic guides in the Netherlands to found the Guild of Guides. This professional association is developing its own ethical codes in order to ensure best practices during psychedelic sessions. Peter also acknowledges the importance of the guild in the self-regulation of psychedelic facilitators. When it comes to offering therapy, however, their guidelines are unequivocal: “Guides do not claim to be psychedelic therapists nor offer ‘therapeutic’ services when they lack the appropriate accreditation.”
Scientists’ call for caution
A number of Dutch researchers and therapists are currently working on trials investigating the safety and efficacy of psilocybin for patients with treatment-resistant depression. They are concerned about commercial providers rushing to open up the market even before the scientific evidence is established. Clinical psychologist Jan Mars, therapist at the University Medical Centre Groningen (UMCG), says: “I am not a supporter of this practice because we are still doing research right now and you don’t want to run ahead of the science”. Joost Breeksema, researcher at the UMCG and director of the OPEN Foundation, echoed similar concerns: “The main problem is that we don’t know yet if this can be done safely and if so, which patients might benefit and which may be more at risk. And we’re only talking about the treatment of depression, where clinical research with psilocybin is relatively advanced. Offering psilocybin truffles to treat PTSD is even more problematic, not just because of the nature of this disorder, but also because we lack solid research. I understand the need for better treatments, and the impatience of patients who’ve sometimes suffered for decades, but it’s unethical, unwise and irresponsible to experiment blindly with these powerful treatments.”
It is important to remark that most scientists and therapists see no harm in conducting truffle ceremonies with experienced guides outside the medical realm. Renske Blom, psychiatrist at GGZ Centraal and therapist at UMC Utrecht, noted: “Truffles are legally available in the Netherlands so they can be and are being offered for spiritual care, wellbeing and self-improvement”.
While there are signs to be hopeful about the potential of psychedelics for the future of mental health treatments, research has not yet offered conclusive evidence that would warrant safe and efficacious provision of psilocybin therapy. Two psilocybin trials so far have shown significant and long-term improvements for depression. However, these trials lacked placebo controls and the samples were pretty small. Several ongoing multisite trials with hundreds of participants will be able to give more reliable evidence about the therapeutic value of psilocybin. Nonetheless, these studies have not yet been completed and experts warn that it is precisely at this stage of drug development where most new pharmaceuticals fail. In the case of PTSD, larger studies are proving that MDMA-assisted psychotherapy may be useful, but not a single clinical trial has investigated psilocybin for this indication yet. In general, there are still a number of incognitas around safety, short- and long-term efficacy, relapse rates and the optimal amount of integration sessions.

Janis Phelps on training the first psychedelic therapists

One of the main concerns of researchers relates to the qualifications and therapeutic experience of these truffle providers. This is a complicated issue given that clinicians and researchers are still debating the adequate standards and training requirements for the certification of future psychedelic therapists. Some companies currently offering truffle therapy have a team of professionals with a background in mental health. In other cases, the psychotherapeutic and medical credentials of guides and their experience with disorders such as PTSD or depression are dubious.
The exposure of these sensitive populations to the intensity of the psychedelic experience can be risky if guides are not able to respond to the particular needs of psychiatric patients. In working with depression and psychedelics, Jan Mars emphasizes that “supporting a psychedelic journey is a humbling experience. You don’t know what is going to happen during the session. You can expect anything to happen,” and therefore, he adds, “It’s important that therapists know how to provide a safe environment. We still need much more experience and knowledge about how to work with patients who suffer from chronic psychological conditions. Trauma often lies beneath the surface and pops up during a session with psychedelics”. In regard to trauma therapy with these substances, Joost Breeksema adds: “Patients may relive traumatic moments, completely dissociate or become overwhelmed with fear and anxiety. This can be hard to handle even for an experienced therapist. Now imagine what happens with well-intended, but under-qualified and unprepared guides”.
Although these treatments are known to be generally safe in terms of toxicology and no serious adverse events are commonly reported in trials, their safety profile resides precisely in the close psychotherapeutic support and monitoring performed before, during and after psilocybin administration. Jan Mars hopes that in future clinical practice, “psychedelic journeys will be embedded in a safe and trusting therapeutic environment. These journeys are no magic bullets.”
In general, truffle providers understand the concerns of scientists, but they feel that the benefits of psilocybin treatment outweigh its risks. According to the clinical director of a truffle clinic, clients with depression may be thinking: “Damned! Science says that this can help me. It is not yet approved but there are places where it can be done safely so I am going to try”. From his own experience guiding sessions, Peter concluded that: “It all comes down to a balance between safety and effectiveness. We are all trying to find out, but at the moment psychedelic sessions do more to help people than to harm them”.
For psychiatric patients for whom other treatments have failed, this call for patience and caution may be difficult to accept. At the same time, they should be able to make informed decisions. Given the current exclusion criteria in psychedelic trials, researchers discourage patients with a history of personality or psychotic disorders from seeking these treatments at all. Jan Mars sends a piece of advice to those other patients without complex comorbidities who, despite potential risks, decide to seek truffle therapy: “Involve a loved one in the journey that you are about to embark on, for support before and after. Do some research on who is guiding it, what the setting will be like and whether there is enough time dedicated to the preparation of the session. Make sure that you feel you can trust the guide. If you have doubts, then there is probably a good reason for it, and it might not be a good idea.
The relation between retreat and research
Truffle therapists in the Netherlands definitely have clinical research on psilocybin as their reference of best practice. Nick explained: “We frame it in a therapeutic setting to optimize positive outcomes and keep clients safe”. Nonetheless, researchers remain skeptical about the degree to which truffle providers actually manage to screen out participants with mental diagnoses or maintain high standards of care. To be fair, even some research protocols could be criticized for including the minimal amount of preparation and integration sessions.

The biggest challenges for psychedelic science today

Besides the potential harm to patients, researchers also seem to be worried about the future of research itself. The controversial history of the field has made psychedelic scientists generally cautious about avoiding any kind of social backlash. An unfortunate incident with a patient could set back the progress made in the last years. Renske Blom added: “If a major incident happens in the context of these therapy sessions, inside or outside clinical trials, it could influence upcoming research as well”.
While acknowledging the importance of further research, Nick also stressed that “truffles were never researched. They cannot say that psilocybin session guides are too early. Actually, the research is late because more people trip on naturals than on lab-grade psilocybin”. Bearing in mind the likely pharmacological difference between the synthetic compound and whole truffles, the current research agenda may not represent the interests of truffle therapists. In other words, it is unclear whether research with pure psilocybin would ever be considered valid evidence to justify their practice. Joost Breeksema said: “We don’t really know what truffles contain because they haven’t been standardized or analyzed in the laboratory, but I do think that if psilocybin goes through the approval process, it is likely that people and investors will get interested in the whole product as well.”
Despite the rather marginal position of truffles in current research, some investigators have realized the potential role that the retreat ecosystem can play in psychedelic science. In collaboration with retreat centers, several research projects have administered questionnaires to participants to learn more about the effects of these substances and their ritual use on healthy people. These centers could also become a place where all kinds of alternative models of psychedelic care can develop. The rigid regulatory and scientific frameworks within which researchers operate may limit the possible treatment conditions. In contrast, retreats offer the chance to explore new experimental protocols such as group sessions or natural settings. Joost Breeksema said: “The retreats may offer an infrastructure that is better suited to the psychedelic experience than clinical hospital settings”.
Nick is enthusiastic about future collaborations: “We want to set up research at our centers and we would love to count on scientific organizations, so we can actually build up the science needed and move beyond this internal dialogue about truffle therapy.” Joost Breeksema adds: “If they do proper data collection and analysis, they can contribute to the body of knowledge about the potential effects and risks of psychedelics. There are definitely options for collaboration but it has to be done judiciously and cautiously.”
The medicalization of psilocybin appears to raise tensions among different stakeholders in the psychedelic field. In the eyes of researchers, the underground therapy scene and the booming industry around psychedelic medicine may entail risks for patients and for the public image of ongoing research. Hopefully, future collaborations between retreat centers and research teams may offer a way forward to generate the evidence needed for an eventual regulation of the medical, as well as the non-medical uses of psilocybin truffles. However, at this stage, the open commercialization of psychedelic therapy to potentially vulnerable patients may be an unwise step ahead.
Written by Alberto Cantizani López
Art by Anna Temczuk
*The names of all informants involved in the commercial provision of truffles as therapy have been omitted or replaced by pseudonyms

The Legitimation of Psychedelic Science: An interview with Danielle Giffort

“I am proud to have ‘killed’ government-authorized research on psychedelics.”
Timothy Leary, 1992

Most stories about the early psychedelic research in the 1960s tend to converge towards a common narrative: Timothy Leary, a rogue researcher turned LSD prophet, triggered the social backlash that would ultimately condemn psychedelics to decades of prohibition. In her book “Acid Revival”, sociologist Danielle Giffort explores the history of psychedelic science and how the controversial figure of Leary has shaped the path towards legitimacy for contemporary researchers. In this interview, we discussed Leary’s responsibility for the demise of the first wave, as well as the history of self-experimentation, controlled methodologies and spirituality in psychedelic science.

Dr Danielle Giffort – Assistant professor of Sociology at St. Louis College of Pharmacy

How did you become interested in the history of psychedelic science?
I have always been very interested in Science & Technology Studies (STS) work on non-knowledge or what’s sometimes called “scientific ignorance”, not in the sense of studying public ignorance of science but in the sense of studying what kind of knowledge is not produced in science and why is that the case.
Psychedelic science offered a really good case to study how a group of scientists rallies to bring their field back to life. I wanted to trace the trajectory of psychedelic science to understand its ebbs and flows from knowledge to nonknowledge and back again.
When I started this project, as a sociologist, I thought I would be writing a broad institutional story about how governments, science, and the media shaped this field. But as I interviewed the researchers doing this work, listened to their presentations at conferences, and read their published commentaries and research, I found that their explanation for what happened to their field was very different. They told me that Timothy Leary, the infamous Harvard psychologist turned countercultural guru, caused the demise of this field. The consistency with which he came up in my data was such that I ended up organizing my whole book around the story.
In your book, you argue that Leary represents the figure of the “Impure Scientist” for contemporary researchers. Can you elaborate on what you mean with this concept?
I argue that the researchers are not necessarily just talking about Leary in their stories but that he comes to symbolize a larger figure in the field. The impure scientist is a person who defies the norms and the boundaries of science. In each chapter, I show how Leary crossed different boundaries in ways that caused all sorts of problems for the field of psychedelic science. First, there’s the boundary between science and pseudoscience. In other words, I’m talking about the legitimacy of the methods researchers are using. Second, there’s the boundary between objectivity and subjectivity in science; in the case of psychedelic science, this boundary has to do with whether a researcher has personal experience with these substances and whether that spoils, so to speak, their objectivity. Third, I discuss the seemingly irreconcilable gap between spirituality and science, which comes up again and again in psychedelic therapy with its recurrent focus on mystical experiences. Finally, I cover the boundary between “mainstream” society and the counterculture.
But I also found evidence of other researchers that did quite similar things during the first wave of psychedelic science. That’s why I say Leary, as the impure scientist, is a figure. Even though many other researchers could be accused of the same behaviors, Leary becomes the fall guy because he is this easily identifiable person that they can all point to and say: “He did it, he crossed these boundaries and polluted the whole field”. Leary represents a bad expert that current researchers are really trying to push away from. Ostensibly, they do that by being the opposite of what the impure scientist was, what some have even dubbed the “Anti-Leary.”
You stress that the goal of the book is far from reassessing the historical responsibility of Leary in the failure of the first wave of psychedelic research. At the same time, after reading your book, readers may wonder what criticism he rightly deserves for his behavior.
I am explicit, as you said, about how the point of the book is not to ask whether this story is true. That is, whether Leary is really to blame or not. In the book, I am  more interested in studying how people use these subjective narratives and their accompanying performances to make sense of their situation and take action. So I asked myself, if psychedelic researchers are using this idea of the impure scientist to make sense of the situation, regardless of its truth, how does that interpretation influence what they do? 
Ultimately, I am not blaming Leary nor exonerating him because the reasons why psychedelic science became forbidden knowledge are multifaceted. If Leary had been a bit more reserved, would it have caused such a media spectacle and subsequent public backlash against psychedelic drugs? The stories suggest that might be the case, but the fact that there were other researchers at the time who were doing similar things, even before Leary came on to the psychedelic scene in 1960, also suggests that what happened to this field is not all about him. He was a part of it, for sure. But Leary, the government regulations, the media coverage, the scientific expectations, the cultural panic; they all contributed to what happened with psychedelic science.
In the end, the focus on Leary does serve a strategic purpose. Instead of blaming institutions like the FDA or DEA (in the US), which are necessary for this research to happen, the story blames an individual. While the narrative avoids making a more direct critique of institutional systems of power, at the same time it still allows researchers to get work done within the system, potentially making change from within, for example, getting psychedelic drugs rescheduled. 
You dedicate one chapter to the topic of objectivity and scientists’ self-experience with the drugs they study. This is still a contentious issue today when it comes to whether therapists should have personal experience with psychedelics to guide patients. Can you elaborate on this method of drug self-experimentation and how it has played out in the history of psychedelic science?
One of the first recommended uses for LSD was self-experimentation. The idea was that psychiatrists who took the drug themselves could understand what their schizophrenic patients were feeling because, at the time, LSD was thought to mimic endogenous psychosis. As such, it offered a tool for healthcare professionals to develop empathy towards their patients and a shared understanding of their mental health problems.
As many LSD researchers moved away from this “model psychosis” framework towards studying potential therapeutic uses, some investigators said that it was also important for therapists to take the substances themselves. The thinking was that if you have had a psychedelic experience, you can develop a kind of tacit, embodied knowledge that can help you as a healthcare provider know when to step in and offer support for your patient or when to back off and let them be. Here, self-experience was once again about empathy but also about patient safety. 
Not everyone self-experimented because it raised questions about objectivity. Some argued that if the researcher has had a psychedelic experience, it will  influence how they interpret their data or how they guide their participants through a psychedelic therapy session, potentially in a way that leads to a particular outcome.
Personal experience with psychedelic drugs continues to create dilemmas for researchers because objectivity is synonymous with legitimate science. The public wants you, the researcher, and all your values and opinions, to be detached from what you are studying so that I, as the consumer of knowledge, know that the knowledge produced from your research is credible. That is the public imaginary around science. So there is a desire among many psychedelic researchers to keep hush-hush about any personal experiences with these drugs to avoid accusations of being biased or being like Leary, but at the same time, these experiences are very meaningful for those who have had them. Like their predecessors, the researchers I spoke with agree that, although not strictly necessary, self-experimentation is important for patient safety and empathetic interactions. 

Should psychedelic guides keep spirituality out of the therapy room? – Interview with Daan Keiman

Spirituality has featured prominently in psychedelic research throughout its history. How would you evaluate the relation between spirituality and science in the field of psychedelic research?
Since the early days, spirituality has also been controversial in psychedelic therapy. Some people believed that spirituality wasn’t compatible with scientific inquiry. It would bring up questions, such as, “How do you objectively quantify a psychedelic-induced spiritual experience?” which then brings up larger scientific issues surrounding conceptualization and operationalization. In other words, how are we defining what we are studying and how are we measuring it? Answering these questions has been key to demonstrating scientific objectivity.
Despite such obstacles, we see this mystical discourse popping up again in the revival. Some research teams, like the group at Johns Hopkins, have embraced this approach, and they have worked to validate mystical experience questionnaires that they use to assess people’s experiences and outcomes. Neuroscientists are also using  brain scans to study the spiritual experiences induced by psychedelics, although some groups, such as the team at Imperial College in London, prefer the language of “ego dissolution” to describe them. If scientists can actually uncover these processes happening in the brain, then they can make the case that what happens when people take psychedelics is not simply a subjective experience. They can back up patient accounts with quantified questionnaires and brain scans. That kind of evidence could help legitimate psychedelic treatments further, as numbers and neuroscience hold a lot of weight in today’s scientific environment.
So far, it doesn’t seem like people are totally against the idea of mystical experiences in psychedelic science. Research on this exact topic is getting published in mainstream scientific journals, getting approval from advisory boards, and getting a lot of positive attention in the media. So, although it continues to create dilemmas for researchers on their road to legitimacy, I see this intertwining of spirituality and science unfolding a bit differently than it did in the first wave.
Findings from LSD research in the 60s are often dismissed because of the lack of rigorous methodologies. In the book you say that questions about aligning psychedelic therapy with the method of randomized controlled trials (RCT) remain in the renaissance. What methodological lessons do you think contemporary researchers have learnt from the first wave?
They learned that to be seen as legitimate researchers, they need to use controlled methodologies.The US-based researchers I spoke with regularly shared with me the arduous process of getting FDA approval, and how they need to submit proposals that include an experimental group, a placebo, and so on. So RCT methods have been legitimated institutionally, not just within scientific cultures. Looking at the past, researchers learned that they need to play that game for their studies to get approval, get funding, and get published.
But I think that today’s researchers are also careful to avoid past mistakes that happened when researchers who didn’t have a lot of experience doing LSD therapy focused too closely on sticking to the RCT model. The poor treatment outcomes observed in some of the studies of LSD therapy for alcoholism in the 1960s were not necessarily because the treatment didn’t work, but because researchers failed to optimize set and setting. One group of researchers, for example, gave LSD to patients, strapped them to a hospital bed and left them alone for hours. Based on what we know about the interactive effects between drugs, the mind, and the physical and social environment, it is not surprising that these patients consistently reported terrible LSD trips and that the drug was deemed not therapeutic by some researchers.
So I think that today’s researchers learned that controlled methodologies are legitimate and they need to use them, but at the same time, they recognize that an excessive focus on that step-by-step process isn’t a good fit for psychedelic therapy. That is why you see this merging of set and setting, such as preparing the treatment room and the patients to optimize the experience, while also having placebos and control groups, in much of today’s psychedelic research protocols.

The influence of society on the psychedelic experience – Interview with Ido Hartogsohn

At the OPEN Foundation, we try to foster interdisciplinary dialogue between the social and the medical sciences. How do you think that psychedelic researchers may benefit from reading your book?
I still can’t decide if I want to be a historian or a sociologist. But here is where my historian side comes out. Delving into the past can be very important for helping us understand how people act in the present. Regarding psychedelic research in particular, this means understanding not just cultural narratives about Leary or figures like him, but understanding, for instance, the institutional regulations in the first wave regarding scientific methods that changed how clinical research gets approved, conducted, and hence, legitimated. Knowing these contextual influences can change what researchers  do in the present in ways that can help them make this work happen.
From a sociological perspective, I hope that the book helps researchers and readers think about science not as insular but very much as a social endeavor. The production of scientific knowledge does not exist in a vacuum, and psychedelic science is a great example of this. As Ido Hartogsohn shows in his book “American Trip”, for example, in developing protocols for psychedelic therapy, researchers  not only have to take into consideration the setting of the therapy room itself, but the broader environmental factors that are shaping this research in the first place. They must navigate different social obstacles and opportunities, such as government regulations for clinical drug trials or public preconceptions about psychedelic drugs. Thinking sociologically about science and psychedelic drugs helps us take into consideration larger social factors that potentially affect this work, both in ways that can help and in
ways that can hinder psychedelic research.

Danielle Giffort: Author of Acid Revival: The Psychedelic Renaissance and the Quest for Medical Legitimacy (2020)
Art taken from the front cover of Acid Revival
Interview by Alberto Cantizani López

Should psychedelic guides keep spirituality out of the therapy room?

While the use of psychedelics has been closely entwined with spiritual practice, prominent voices in psychedelic research have called for the demystification of these substances and the adoption of more secular approaches to psychedelic therapy. I sat down with OPEN Foundation collaborator and psychedelic chaplain, Daan Keiman, to discuss the ethical issues that have been raised around the introduction of spiritual frameworks in psychedelic therapy sessions. From his experience facilitating psilocybin truffle ceremonies at one of the many legal psychedelic retreats in the Netherlands, he thinks that rather than secularize psychedelic guidance and integration, we should tackle these concerns through an interfaith approach. If therapists acknowledge that they are not “existentially neutral” about the nature of the psychedelic experience and its meaning, they should therefore reflect honestly with patients on their therapeutic relation and their respective existential views.
 
The risk of imposing religious beliefs
In a recent viewpoint article about the pitfalls of psychedelic medicine, researcher Matthew Johnson has raised concerns around the possibility of imposing religious beliefs on patients undergoing psychedelic therapy. Johnson warns therapists about the risks of using concepts from Eastern or indigenous spiritualities in integration sessions or even displaying particular religious icons in the therapy room. In his own words, “in addition to other concerns about conflating religious beliefs with empirically based clinical practice, the introduction of such religious icons into clinical practice unnecessarily alienates some people from psychedelic medicine, e.g., atheists, Christians, and Muslims. It will ultimately interfere with the mainstream adoption of these treatments.”
Daan shares some of these concerns given that psychedelics may put patients in particularly vulnerable states that must be handled with care and responsibility. “Under the effects of psychedelics, the suggestibility goes up significantly and we know that people often have noetic experiences: a feeling that something is being revealed to them that is incredibly true.” Although we know that these experiences are deeply mediated by the context in which they are used, their noetic quality feels as unmediated, as completely independent from the set and setting.
Therapeutic work with this kind of deeply felt experiences of truth is proving challenging for psychedelic researchers concerned about the ethics of inducing or validating profound metaphysical beliefs in patients. They worry that such revelations facilitated by the combination of drug and setting may turn psychedelic therapy into a form of non-consented spiritual conversion. Therefore, as Johnson argues, researchers and clinicians should adhere to a secular approach and refrain from introducing any “non-empirically verified beliefs” into their therapeutic protocols.
Daan agrees with the difficulties of introducing elements from particular spiritual traditions in pluralistic settings such as the truffle retreats that he facilitates. In fact, the Buddhist teachings and stories that he used to share with participants in preparation for their ceremonies did not always resonate with everyone’s worldviews. In one of these stories, the Buddha is seduced by the demon god Mara during meditation and, instead of ignoring his calls, he accepts them and invites the demon to tea. With this story, Daan would encourage psychedelic journeyers to confront challenging experiences: “invite your demons to tea, and see what you can learn from them”. However, he recounts an occasion on which a couple of Christian retreaters felt incredibly uncomfortable with the idea of inviting their demons to tea.
“Although I had been trained as an interfaith spiritual caregiver, I had wrongfully assumed that the prevailing clinical and therapeutic best practices, those underlying the Buddhist story, were universally applicable. The incident made me realize that they can come with ontological or theological assumptions”.

Daan Keiman, MA

Empirically verified frameworks of meaning
While discarding religious iconography and language appears as an easy solution, the distinction between belief and empirically based clinical practice is not always so straightforward. As Daan shows, the main psychotherapeutic frameworks used nowadays in psychedelic research are shaped by spiritual beliefs and practice. “If we look at ACT and other third-generation behavioral-cognitive therapies, we see that they are based on mindfulness. A lot of Buddhist insights deeply inform the ways people are encouraged to go into psychedelic experiences”. Transpersonal psychology and existential psychotherapy are other examples of how psychedelic therapy draws from traditions that have their own ontological assumptions.
Some in the psychedelic community have expressed their criticisms to Johnson’s article. “Something that a lot of people take issue with,” explains Dann, “is what comes across as yet another white man pretending that his secular psychotherapeutic perspective is the position of no-position; as if it is neutral, as if it doesn’t come with its own baggage and its own set of assumptions which are not empirically verified.” Daan acknowledges that Johnson is actually much more nuanced than how he is depicted by critics. However, he also thinks that secularizing psychedelic therapy might not be the best solution.
 
There are good reasons to be careful when introducing spiritual frameworks as meaning-making tools in integration sessions.  Yet ruling them out completely due to the lack of evidence to support them seems premature. Daan adds: “Let’s not pretend that psychotherapeutic approaches are neutral. They are deeply informed by certain assumptions. The interesting thing is that currently accepted approaches, like mindfulness-based cognitive therapy or Internal Family Systems, were not empirically verified before they were put into practice and researched. They were met with scepticism, and it took effort to research them and show their validity.”
Excluding all spiritually oriented elements from therapeutic and research protocols would only perpetuate their non-empirical status. Instead, perhaps more research should be dedicated to questions about the ideal therapeutic setting and the necessary competencies to accompany the meaning-making process of patients of diverse existential orientations. 
In regards to such questions, Dann believes that “spiritual traditions, alongside with the richness of shamanic approaches and their accompanying ontologies, might provide fruitful and wholesome insights, and could inform contemporary psychedelic-assisted psychotherapy; as long as they are presented as exactly that: spiritual narrative or practice, not ultimate truth.”

The influence of society on the psychedelic experience (Interview with Ido Hartogsohn)

In contrast to this proposal, Johnson’s article seems to “naively suggest that if we just wear a white coat and strip our protocols of anything that remotely smells like meaning, we will be fine”. However, meaning pervades every element of the therapeutic protocols, from psychometric tests to music playlists, driving the psychedelic experience in subtle ways. This is something that researchers are still struggling to deal with.
Current research about the psychological mechanisms of action of psychedelics is running into the problems of shaping people’s expectations as they prepare for a trip. Along these lines, Daan wonders “to what extent the flight instructions are not some sort of descriptive tool but actually a primer for the experience”. Yet, rather than a mere source of confusion, these feedback loops may help us better understand the interplay of drug, set and setting that determines psychedelic effects.
“We need a deeper understanding of how everything we do is endowed with meaning. Therefore, it is more useful to be transparent, reflect on the meaning of what we do and work towards a more patient-centered approach based on informed consent.”
 
From secular neutrality to interfaith positionality
Psychedelic researchers agree that therapists should empower patients to make sense of the metaphysical aspects of their experiences by themselves. “I am not against that idea,” says Daan, “but as a spiritual caregiver trained to talk about existential questions, I think you need particular competencies to discuss these issues with patients.”
Daan advocates the figure of the psychedelic chaplain, a guide who is fully equipped to help patients with the ontological shock that may be triggered by intense psychedelic experiences. In his view, “to have a psychotherapist helping you interpret those experiences from a purely secular standpoint might become very difficult and could actually harm the existential or spiritual integrity of the client.”
Instead of secularizing psychedelic therapy, Daan suggests  working within an interfaith approach that emphasizes the positionality of both therapist and patient. Deep awareness about the spiritual integrity of the patient and a clear agreement about the framework within which the therapist will guide the patient, therefore, become central in establishing trust in the therapeutic alliance. “Before you start to work with me, I am going to be honest about the fact that I am a Buddhist psychedelic chaplain. Even though I work with a client-centered interfaith approach, there are things that I am bringing into the psychedelic context which I cannot erase and which will influence your journey. If you are uncomfortable with this situation that we call “Daan”, then I might not be the right person to guide you.” 
This notion of positionality that Daan borrows from anthropology is aimed at promoting self-reflection and ensuring transparency in face of the potential ethical issues that may arise in situations where being neutral appears as a naive ideal. To Daan, this self-reflection is very much needed in psychedelic therapy given the position of power and authority that therapists and guides often hold in relation to their patients.
“It is very important that psychedelic psychotherapists are honest about the baggage that they carry in a much deeper way than just in terms of spirituality and ontology. Race, sex and gender play crucial roles in the power disparities between the guide and the person being guided. In the same way that Mathew Johnson identifies the risks of the spiritual orientations of therapists, we also need to become aware of the risks inherent to these power relations, by elucidating them, by articulating them and by reflecting on them with peers and supervisors.”
Should psychedelic therapists then keep their spiritual beliefs away from patients? Perhaps, a self-reflecting interfaith approach is better attuned to cultivate meaningful therapeutic encounters. Patients should have the last word about this.
Written by Alberto Cantizani López
Art by Anna Temczuk