From outwards bound to inward bound

One man's journey from adventure tourism to psychedelic therapy retreats

Scouting a rapid, Northern Norway, 2006

Rob Ó Cobhthaigh is a psychotherapist who co-founded Inwardbound, a psilocybin retreat centre. Before that, he spent two decades as an adventure sports guide. In this article, he explores the lessons that can be learnt from adventure sports for psychedelic assisted therapy. NB I haven’t been to Inwardbound so this is not an endorsement, nor has Rob paid me to print this article - I just thought Rob would have interesting insights on the theme of managing risk in extreme sports and psychedelics (which we explored last Friday). There are some extra ‘Tuesday Brunch’ links at the end of the article for paid subscribers. Over to Rob:

I spent 20 years working as an adventure sports guide.  In my early twenties, I was a whitewater guide on rivers like the Zambezi and White Nile in Africa. In my thirties I worked as a mountain leader, guiding trekking expeditions to Kilimanjaro,  Everest base camp, the Andes and the Himalayas. While it may seem that those working in such fields may be risk takers, and it may have been true about me in my early 20s, the reality is adventure sports guides are constantly assessing risk, and are in some ways hyper-attuned to risk.

For the past six years, as a psychotherapist and co-founder of Inwardbound psilocybin retreats in the Netherlands,  almost 1000 people have come through our retreat processes.  This article explores my perspective on risk from these differing viewpoints. While it may seem that these are very different worlds,  I believe there are a lot of similarities between managing risk in adventure sports and in psychedelic assisted therapy. 

My own personal story is one of outward bound to inward bound- at the age of about 30 due to a series life crises ( heartbreak, injuries and tragedies I witnessed in the outdoors) I began to look at more inward self-reflective practises such as meditation, yoga and therapy, which slowly and over time, led me to the work I am doing now, not in a planned way, but through the path of my own lived experience.  

As my time working as an outdoor guide was coming to an end, I began to be much more interested in adventure therapy than adventure sports. ‘Being in nature’ rather than ‘doing in nature’. This period coincided with my training as a psychotherapist and moving towards psychedelic assisted therapy.

 Since I was a child, there is something in me that was drawn to exploring the boundaries of my known world,  and to going first, more by accident than design, whether that was the first descent of a whitewater river in Iran, or setting up Ireland’s first psychedelic therapy organization. Why that is, I am not sure, but it is my nature, and I enjoy helping others explore their own personal limitations too and to grow beyond the boundaries of their known world. I do this work with psychedelics motivated by a belief, from my own lived experience and from what I have witnessed, that this work has the potential to relieve human suffering and improve people's lives.

Upper Zambezi 1998

On the nature of risk 

Life is inherently risky.  We make decisions every day to take risks,  and few would like to live in a zero risk world. Often, the most significant and rewarding achievements in our lives involve a degree of risk - falling in love, starting a business. But today we live in a very risk averse society. In other societies and cultures, through necessity, a higher degree of risk can be seen as acceptable.

An Ethiopian woman crossing a class 6 rapid on the Blue Nile with a new-born baby wrapped in her shawl. A fall here would have meant certain death for both of them. 

It is also true to say that as adventure sports guides or as psychedelic assisted therapists, we have an ethical duty of care to our clients. And so we also must protect ourselves and our clients, especially people who are vulnerable, from taking on too much risk. 

Some points:

1. Psychedelic-assisted therapy is inherently risky. 

There are certain risks with psychedelic assisted therapy that do not come, or are greatly lessened, in other forms of therapy. These risks include the risk of psychosis or spiritual emergency (kundalini awakening), Hallucination-Persistent Perception Disorder, headaches, nausea, anxiety, dissociation, having a disappointing or underwhelming trip, the increase levels of transference and projection,  ontological shock, the altering of metaphysical beliefs or spiritual beliefs, and the risk of being traumatized by a very challenging psychedelic experience. The more serious risks listed here are rare, but they do exist. 

Psychedelic-assisted therapy also has the potential to be, perhaps, more rewarding and beneficial than other forms of therapy. Therefore, we need to create a model of access that minimizes risks and maximizes benefits. We also need to take a critical attitude to what Timmy Davis of Psilocybin Access Rights calls “ a hypertrophied risk aversion”.

We witness this frequently on our retreats, where sometimes people have emotional breakthroughs and  process traumas that have been unprocessed for years or decades,  processing the ‘frozen present ’of trauma  as Dr Ivor Browne called it. We often see incredible transformations on our retreats. Physical transformations- literally people looking different afterwards, like a heavy weight had been lifted off them. The stories of transformation and rebirth and redemption. The deep, real, authentic gratitude. Giving voice to those whose voice had been lost or forgotten. An inner change from " a sense of hopelessness to a sense of hope", as one of our clients put it on a recent integration call.

The question, then, is how best to balance the risk/ reward ratio?  If psychedelic assisted has potentially life-changing therapeutic benefits,  what level of risk is ethically tolerable? 

Scouting a rapid on the Blue Nile, Ethiopian highlands 2004.

2.  We need, as a field, to accept the reality of these risks, not deny them or hide them,  and to learn how best to mitigate them.