Successfully treating C-PTSD with psychedelic therapy

A positive story, with some warnings

This Friday we’re featuring two case studies of people who experienced extended years-long difficulties after taking part in the same clinical trial of psilocybin therapy. It’s important that we also feature occasional success stories of psychedelic therapy – here is John, an entrepreneur in Israel who got in contact about successfully treating complex-PTSD through psychedelic therapy, what he learned through the process and what advice he would give. I interviewed John by email. EI doesn’t encourage or discourage psychedelic usage. We encourage informed decisions.

I suffer(ed) from complex PTSD as a result of childhood abuse (sexual and non-sexual). Two years ago, after ten years of unsuccessful talk therapy, I started the underground psychedelic-assisted therapy process with MDMA. 

What were your intentions and expectations of the treatment? 

I wanted to feel better about myself and be more open with others. I also had many issues around sexuality and wanted them to resolve. Complex PTSD is characterized by "emotional flashbacks" when one experiences very difficult feelings without a present-time reason after being triggered. I suffered from that a lot. I expected this to end or improve significantly. I thought that, however, the process would be faster and easier. 

How did you find the underground therapist, and how did you check out their credentials?  

It was in Israel, and I was referred to this one by my current nonpsychedelic (but informed) therapist, who is a clinical psychologist and Hakomi practitioner.  She has personally checked a few underground therapists and referred me to this one. I met her at her home (which has a treatment room) and felt I could trust her. It was important for me that she is not just a sitter but a therapist as well: she studied both Hakomi and psychedelic-assisted therapy (taught by underground California therapists who brought it to Israel).

Did the underground therapist guide the sessions well?

Guiding was more or less along the lines of the MAPS protocol, i.e., driven by what came up. Still, I want to stress that interactions with the therapist were VERY important, and I got some very important felt insights/progress from what she said when I talked to her in the session. 

How did the sessions go?

My “initiatory,” pre-therapy self-guided high-dose psilocybin journey, while mystical and ecstatic, caused intense paranoia and withdrawal. 

Once I started the guided MDMA process, I had a lot of challenging experiences and, what’s more important, challenging after-effects — including nightmares/panic attacks, trouble sleeping, and even fear of going to sleep because of the expectation of what would follow. Still, the most challenging of all was an increase in suicidal ideation, with intrusive thoughts of jumping on the train tracks and immense emotional pain (that felt very much physical).

What support did you have for the challenges?

I was supported through the process by two therapists — a clinical psychologist/hakomi practitioner who referred me for the treatment and the underground psychedelic therapist. At times, I felt so bad and was in such emotional pain I decided to have therapy sessions twice a week (no drugs, of course). 

How long did the process take and how much did it cost in total?

It was more or less two years, with around 8 MDMA sessions in total. I then had two guided psilocybin sessions. The total cost would be $5900. Note that all that time, I was still continuing therapy, with one meeting per week, and its cost is not included.

How did you feel at the end of that two years?

With time, all of the adverse effects resolved, and, as a result of the treatment, I no longer qualify for the C-PTSD diagnosis (self-assessed). I was also able to leave abusive, co-dependent relationships with my wife. The process has been truly transformative.

What advice would you give others?

Firstly, when engaging in that kind of work, it’s crucial to have professional, ongoing support, or it can be dangerous. A “guide” is not enough.

With the psychedelic therapist/guide, I was only doing preparatory and follow-up sessions. Real integration was with the clinical psychologist.

My guide was also a therapist, but not at that level of training. Still, I believe she'd be able to help me safely go through all of my stuff. My point is more about the consistent process of therapy — whatever happens in the session might be beneficial, but it's only a part. And therapy should be delivered by a qualified therapist. 

Any other advice?

I believe psilocybin shouldn’t be offered as a first line of treatment for most conditions; MDMA should be used in its stead. 

I believe that psilocybin is, to a huge extent, about getting a clear insight into your condition and mental processes. Such insight is not necessarily healing and can be totally overwhelming. I connected to the story of the woman with latent suicidality, who discovered it on the Compass trial and became openly suicidal as a result.

Did Compass minimize adverse experiences in its psilocybin trial?

MDMA, in contrast, provides immediate relief and improvement — you might deal with some very serious and tough stuff, but you come out of it stronger and more resourceful. At least it was like this in my case: in the very first (and most "powerful" session), through the interaction with the therapist, I got the "missing experience" of the "good mother," and that gave me the power to deal with the other stuff later on. At a certain point in time, I started to feel that the MDMA experience wasn't deep enough, and I did a session with the mushrooms. Since I had already learned to let go and sit with the pain while on the MDMA, I was able to go to the source of trauma and achieve a resolution. I don't think it would be possible the other way around. 

Besides, my psychedelic therapist believes that psilocybin can often lead to an experience unconnected to the personal story of a patient. It can be very interesting, but it's of secondary importance if we discuss therapy (and not spiritual practice), especially in the context of childhood trauma.

How do you view the adverse experiences that arose? As side effects or part of the process?

I believe that in cases of severe childhood trauma, these “adverse effects” are pretty much expected to occur, and it’s essential to inform the patients of the possibility that they would get worse before they get better. And to inform them that should that be the case, they are in for a quite long, challenging and expensive process.

In my case, I believe adverse effects were not caused by the treatment but were uncovered over the course. They receded with the increased depth of recollection, processing, and acceptance of the abuse that happened in the past.

Could you tell me whether there were specific things that helped with specific difficulties? For example what helped with the suicidality?

Being in contact with my therapist, psychotherapy. I just had to "be" with it, not alone, with support.  

And the sleep issues?

Working with breath was very helpful for sleep, anxiety, panic attacks, etc. 

Do you feel you had adequate information or expectations about the adverse effects?

No, I wasn't prepared. I was idealizing psychedelic therapy, and I was over-confident about my capacity to cope. I didn't expect suicidality to come up. And I thought that just a few sessions would be enough to completely heal. 

In my case, at the start of the treatment, I had a fragmented memory of the traumatic childhood events and didn’t think that these events were meaningful. I didn’t have suicidal attempts or pronounced ideation. To an outsider I was a successful adult. That brings us to the question of screening: it’s crucial to have a good assessment of the person’s condition to prepare for the possible outcomes. I don’t think a “guide” without proper therapeutic training can provide it. I believe that even a professional therapist can perform such an assessment only over several meetings.

Did you know about the childhood abuse before starting the therapy?

I knew about a small part of it and was downplaying its effects. 

Again, as a result of the treatment, I experienced profound healing and transformation, but it’s crucial not to advertise this process as a kind of easy solution. I firmly believe one has to be in therapy, and this therapy should last. 

Are you still in therapy with the Hakomi therapist?

Yes, I am. Now it's mostly for emotional support — I'm in the middle of a very challenging divorce and a career shift.  

Would you say psychedelic therapy is a high-risk form of treatment, given the increase in suicidality? 

I think it greatly depends on the process. Doing that without being in therapy for an extended period of time is definitely risky. But I believe that under supervision, it's not high risk at all. Obviously, a therapist should be qualified to work with trauma/abuse survivors and know how to deal with suicidality and PTSD symptoms.

Do you think your treatment could have been done better in any ways? 

I believe that I made a mistake trying to keep longer, "safer" intervals between the first sessions. I think the way MAPS does it (with one month between the sessions) is better—adverse after-effects have a chance to relieve themselves in subsequent sessions. So I just made myself suffer longer. Also, it would've been helpful to know in advance what might happen not only within the sessions but between them. My therapists didn't warn me, and I never read about such adverse effects at the time. 

I want to note that, as far as I know, there's currently no official research/treatment protocol in sight that would allow for the number of sessions I had. So it would be difficult or impossible to get them "above the ground."

After the paywall, is it bad journalism to focus on Elon Musk’s ketamine use, and how is the media doing on reporting on the benefits and risks of this increasingly-popular drug? Plus, a feature on Jorge Llano and allegations of abuse at his psychedelic Gestalt school in Colombia.