Psychedelics and therapy with Gestalt therapist, Mikko Karhulahti

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Reece Cox is a Berlin-based sound artist, DJ, and producer. Cox graduated with a BFA in Interdisciplinary Sculpture from MICA and has a cerebral approach to both club music and sound.

Last Updated on February 20, 2024 by It’s Complicated

During the last 20 years, psychedelic research has undergone a renaissance. For the fifth episode of the It’s Complicated podcast, Reece Cox speaks to Gestalt therapist Mikko Karhulahti about the implications of this psychedelic wave of especially psilocybin- and MDMA-assisted therapy.

A conversation on psychedelics and therapy

Reece Cox: In the 1950’s there was a new and promising field of research into a class of drugs which is, today, in need of no introduction – psychedelics. The findings of this time were greatly exciting and opened up new windows into what pharmaceuticals could be, yet the enthusiasm for these substances and their experiential properties leaked out of the institutional realm and into the general population, fueling the counterculture of the 60’s through figures like Timothy Leary.

There has been more than enough media coverage and portrayal of the psychedelic underground and it is somewhat beside the point of the episode to discuss this history, but it is important to note that the unregulated use of these substances from the ‘60s undoubtedly complicated the study of psychedelics in the decades to follow, although it is important to note that what happened… happened.

The majority of psychedelic research which was cancelled in nearly every major institution by the end of the 60s. In 1971 Richard Nixon declared Timothy Leary the most dangerous man in America, The War on Drug began, and in 76 Spring Grove State Hospital of Maryland – the last hold out for properly scientific, legal psychedelic research in the United States which had been quietly plugging away in the background during the psychedelic revolution – was finally forced to close.

It wasn’t until sometime in the 1990’s when research into psychedelics in accredited scientific institutions began again. And while this new beginning was rather quiet, the crest of the second wave has grown steadily – impressively so.

Thanks to more stringent research methods, incredibly tight federal regulations, and a generation of scientists dedicated to rescuing the trajectory of psychedelics from eternal illegality, we look towards a future where fully regulated and legal clinics might one day administer psychedelic treatments alongside regular therapy sessions for familiar psychic maladies such as chronic depression, substance abuse, eating disorders, and PTSD.

Despite the illicit reputations of psilocybin, LSD, ketamine, or MDMA, in our opinion, the more compelling story to tell is that all of these substance have been under serious review and consideration and put through numerous and ongoing clinical trials at institutions such as UCLA, Johns Hopkins Medical University, Imperial College London, UC Berkeley, amongst others, where they are being rigorously examined for their therapeutic and healing potentials. Yes, the government knows about it and yes, these are real scientists.

There is a constant outpouring of new publications from the research and possible directions of psychedelic therapies. For our contribution here today, I speak with a practicing therapist on the topic of how these new innovations and milestones in mental health and neuroscience could, someday, just maybe, change the very nature of the mental health field, and the way we think about treatment.

In my research leading up to this episode I couldn’t help but wonder; If we see a future where psychedelic therapies become mainstream and widely available, how deeply and immediately could any change be felt by the larger mental health industry and community?

After all there has been a steady influx of new research showing promise for the potentials of these substances for treating PTSD, depression, addiction, mania, and so on. All of which are conditions and disorders faced by therapists on a regular basis.

Even as I was editing this episode I saw a new study published in a peer reviewed journal about the potentials for LSD and psilocybin in the treatment of substance abuse disorders. Ketamine is now approved by the FDA in the US for medical use in the treatment of depression and MDMA has recently entered phase three clinical trials for treatment of PTSD.

The Multidisciplinary Association for Psychedelic Studies (or MAPS for short, founded by Rick Doblin, a prominent and influential figure in the field) – already envisions a future where there are legal and fully regulated clinics offering psychedelic therapies where talk therapists are hired to aid patients and clients through their psychedelic treatments via preliminary and follow up sessions where no drugs are taken. it may seem like science fiction – in the most literal sense of the phrase – but upon a close examination of the progress of psychedelic science one begins to wonder if such a world is just over the horizon.

The aforementioned therapist I’ll be speaking to here is Finish born, Berlin-based Gestalt therapist, Mikko Karhulati​​Mikko has followed the growth of the field of psychedelic research over the last decade or so, attending numerous conventions and retreats along the way and I wanted to speak with Mikko to get a practitioners perspective.

Reece Cox: As a psychotherapist and advocate for psychedelics, how do you see your job changing in the case psychedelics therapies become available for practitioners and clients?

Mikko Karhulahti: That’s a good question. It is hard to predict exactly what will happen. Regarding the non-profit organization, MAPS, which has been the advocate for MDMA for PTSD studies, they envision that there will be clinics or centers for psychedelic therapy with this kind of holistic approach. There would be professionals – psychiatrists, psychotherapists, psychologists, social workers – trained by MAPS to do this psychedelic therapy with different substances. For example, MDMA for PTSD, Psilocybin for treatment-resistant depression, and there are also a lot of other things, for example, ayahuasca, maybe ibogaine, maybe ketamine. Ketamine is already used in hospitals throughout the world for suicidal depression.

But I think what is certain is that we need to do much, much more research from different perspectives. Psychedelic therapy is really different from today’s psychiatric view of treating disorders or symptoms where people take drugs like SSRI’s or anxiety drugs every day for relief and to be functional. With psychedelics, the idea is to have one to two or even three psychedelic sessions which are integrated into therapy. For example, there are preparatory sessions in the MAPS MDMA trials. There are three preparatory sessions before the MDMA session which is much longer – I think six to eight hours – then, there are integrative sessions in between the psychedelic sessions.

What I like is that it could change how we perceive human suffering and human adaptations of disorders. We can’t just treat the symptoms. That’s like putting on a bandage.

RC: That seems to pose a different model of psychiatry, at least in the way that I might typically think about it. As you described, something like SSRIs for depression or lithium for bipolar are used as maintenance tools that are typically combined with talk therapies. The idea is that they are done consistently over a long period, or perhaps indefinitely.

What you’re describing for psychedelic therapies is a model of psychiatry where a problem is confronted in combination with a substance and talk therapies for a window of time, with the idea that you won’t have necessarily had to continue treatment.

MK: I think it’s a different mindset. To work with trauma or severe depression, there is no easy way out. You need to go through the pain and work with the suffering. That takes time, a lot of time, and a lot of growth and work. With these substances, we enable people to have these experiences in a safe environment with trained professionals who have perhaps had their own experiences as well, enabling them to touch upon the core issue, the root cause. In some sense, psychotherapy is aiming to do that, but it’s much, much slower, depending on the approach, of course. I think the outcome or goal is the same.

RC: Considering the newness of these approaches, the newness of the science, and also the unfortunate cultural baggage of the past with psychedelics, do you think there will be a lot of skepticism amongst newcomers?

MK: What happened in the ’50s and ’60s, of course, is baggage. The whole political movement and the decisions to make these substances schedule 1 drugs – meaning, that there’s no medicinal use for them – is still affecting the perception of them, especially the older generation. The new generation is a bit more open minded, and thanks to the internet we can compare this information with articles online. There are definite risks so there are exclusion criteria for every research design. The more research we do, the more we know these risks as well as the benefits. I hope over time as we have more evidence, not just clinical or neuroscience, but also through cohort studies and bigger samples, that we can start to say how these things function and for whom.

And, also what I love about the psychedelic research is that it’s not only psychiatrists or psychologists or neuroscientists, but it’s actually a really interesting group of people. There are sometimes biologists, sociologists, anthropologists, religious studies, consciousness studies, and so on. It’s quite a holistic way of understanding the psyche and consciousness.

RC: The spiritual and religious component of it is one that’s particularly interesting considering the scientific nature of the new culture and bodies of research that are being produced. I’ve noticed even in lectures by prominent researchers, people aren’t shying away from the spiritual component of psychedelics. I think this is important considering the history of psychedelics has largely been a spiritual history, even before coming to the West. Things like Ayahuasca or Psilocybin have long been spiritual

medicines. It would be a shame to see that lost, but it also creates a new kind of problem for science, because science is a materialist field. Especially chemistry, which is at the heart of psychiatry.

How do you be mystical without being mystical? How are these things going to be confronted? Maybe that’s a bit of an open question.

MK: It’s super interesting. In the trials for psilocybin, people tend to have this so-called mystical experience. Afterward, they take a questionnaire to assess it – what was an experience in that state. What is experienced in this state varies but I believe how one integrates that experience into daily life is the key. Maybe there will be some sort of new spiritualism which is not related to any specific religious institution, like in the states, also in Europe, certain religious institutions have formed around the use of Ayahuasca.

RC: Right, under U.S. federal law these substances are be protected, specifically and only for use by special religious groups.

MK: In the MAPS clinics we were discussing, if they someday exist, will not only be for people who have severe disorders and need treatment but may also be for personal growth as even religious use. The whole research movement now has been concentrated on the unique, individual experience. It interesting is to see if there will be group therapy.

I believe Rick Dobblin spoke about the cost – that for efficacy reasons and because of the costs, one MDMA outpatient, or the treatment for one patient, is around $50,000 in the United States – that’s a lot of money. If we can use small groups of, let’s say, six people who can have these treatment sessions together, that would be really interesting from the psychotherapeutic point in addition to making treatment less cost-prohibitive.

RC: Also, of course, this is an extremely complicated topic, but the future of insurance and these treatments is yet to be seen, especially if they offer such a unique model of how we typically think about psychiatry. In many countries, having insurance cover any kind of therapy, like talk therapy, can be quite difficult as it is.

MK: I believe MAPS has been talking with insurance companies who seem interested. What insurance companies want is to be as efficient as possible and to provide for treatments where efficacy is high. We don’t know yet, but if we can get early results, let’s say with mild to moderate PTSD clients in a group therapeutic environment, that would be great, of course. And during the years where these substances were illegal, many people continued practicing underground therapies. And this whole psycholytic therapy, which is designed more for group therapy settings, has been practiced all over the world.

RC: Psycholytic therapy? what is that exactly?

MK: “Psycholytic therapy” refers to low to moderate doses in psychedelic therapy. So, not one’s which will evoke the mystical experience discussed earlier. Implementing these substances in a group setting is something I would am quite curious about as a therapist.

RC: I think about the term “micro-dosing.” Does that accurately describe…?

MK: Micro-dosing is different. To my understanding, you might not feel the substance at all when microdosing. That makes it kind of complicated because, first of all, we are unique individuals. Doses are not universal if we talk about micro-dosing. And since we don’t see the effect of the substance, it might be a placebo effect.

RC: Looking at the vast amount of new, promising research that’s been coming out in droves for the last few years, one may guess that we could someday see the normalization of psychedelics used therapeutically – legitimately and legally. It’s like a second wave for psychedelics, except rather different than that of the ’60s. Do legal barriers left over from the war on drugs still pose issues for moving forward with psychedelic research?

MK: I hope that the developments made recently will be beneficial for moving forward. I think it’s important to continue to research so we know.

Right now many of these substances are schedule 1, meaning they have no medical value. We can see clearly that this is not the case. Hopefully, in the future, also in Europe, we will have more access to these substances for research – and eventually for everyone.

RC: By doing it properly.

MK: Yes, exactly.

RC: Because of how things panned out from the ’50s and into the ’60s, it sort of exists in this state of being a new/ old science. It had to be wiped away for all these decades and is now being picked up despite everyone having known about these substances for quite some time. It’s like it gets its second chance now. And, fortunately, it’s in the right hands it seems.

MK: Yeah. I believe the research of today has learned a lot from the mistakes of the ’50s and ’60s. Contemporary research designs are very well made and thought out. Safety is the most important thing. In some sense, I can see the history as a kind of gift, lighting the way for research today.

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