Interview with a Psychedelic Facilitator
Interviewee: Gisele Fernandes-Osterhold, MFT. Active in the mental health field for 20 years, Gisele has extensive training and clinical experience in trauma-informed psychotherapy, using an integrative approach that is rooted in Somatic, Humanistic and Transpersonal psychologies. Being an immigrant to the United States and a woman of color, Gisele holds a deep dedication to diversity and inclusion processes. Gisele’s personal approach to healing is rooted in her commitment to embodied spirituality, yoga, dance and indigenous traditions of her native Brazil. Besides her psychotherapy practice, Gisele serves as Director of Psychedelic Facilitation at UCSF’s TrPR Lab, mentor at the Center for Psychedelic Therapies and Research at CIIS, and clinical supervisor at the Sage Institute in Oakland.
Interviewer: Melinda Wang is a UCLA medical student who is currently on leave to assist with psilocybin clinical trials at TrPR at UCSF. She hopes to match into psychiatry as her medical specialty, and has a wide-ranging interest in mental disorders, psychedelics, altered states of consciousness, Buddhism, philosophy, altruism, diet/metabolism, and the combinatorial spaces of these areas.
Melinda: Thank you so much for agreeing to be interviewed today. I’m sure many will be able to get a peek into the world of psychedelic medicine, and learn in more intricate details what it means to be a psychedelic facilitator, especially for those with an interest in professionally developing in this field.
The first question I have for you is: psychedelic-assisted psychotherapy has recently received a lot of hype, among scientists and laypeople alike. What were your original motivations in entering this field?
Gisele: Thank you for interviewing me; it is my pleasure to be here. I have been working with people who suffer from trauma, anxiety, and depression for a long time. When providing long-term psychotherapy with traumatized individuals, despite using skills from sensorimotor psychotherapy or EMDR in a relational approach, sometimes traumatic experiences and developmental wounds are difficult to heal. When research trials began to show positive results with traumatized people using psychedelics, I was intrigued. I have also worked with grief and loss and the studies with psychedelics on existential anxiety in relation to end-of-life issues have also shown very promising results, so that has also been something that has motivated my interest in joining this research team and further applying my psychotherapeutic skills in conjunction with psychedelics.
Melinda: It’s fascinating that you’ve worked with so many different modalities for various indications. Which specific psychedelics do you work with?
Gisele: I work with ketamine and psilocybin – ketamine in private practice and psilocybin in research studies.
Melinda: Have you found ketamine or psilocybin to be more effective for certain indications than others in your own personal experience?
Gisele: I find both of them to be beneficial for depression and anxiety, and in strengthening and supporting the therapeutic process with issues of trust and attachment wounding for the processing of traumatic experiences.
Melinda: That's great. What does a dosing session and an integration session look like – can you describe it to us?
Gisele: To speak about the dosing session, it’s important to first put in context the importance of the preparation sessions. In preparation sessions, you will, in collaboration with the client, co-create the intentions for the session, and prepare the client for what they might experience and how they might receive support. That entails discussing their history, their goals for treatment, their understanding of the effects of psychedelic to be used, their relationship to spirituality and also the ways in which therapeutic touch may be used safely during the session. It’s during preparation, that we help the client anticipate what they may get in touch with. It can be helpful to use of the model of internal family systems during the prep sessions, in which we have the client acquaint with different parts of their psyche – some may be familiar whereas others may be disowned. This way, the client may be better prepared for the emergence of distressing contents during dosing.
During dosing sessions, a key principle is the client-centered approach - we believe in the inner healing intelligence of the client and in their ability to access the part of themselves that knows what’s important to heal. The psychedelic medicine can open up the part of the psyche that may be holding onto the pain or blocking change. We encourage the client to trust and follow their internal processes – during dosing sessions, we largely refrain from asking questions, from initiating conversation or guiding them towards a specific outcome. This is a very different therapeutic stance than a regular psychotherapy session, in which I may be very active in guiding the client and supporting them in navigating a traumatic memory step-by-step. In psychedelic-assisted psychotherapy, however, there is a switch in the psychotherapeutic stance, one in which the psychotherapist is attuned to the inner works of the client in a non-directive way.
During the integration session, we help the client re-work or reimagine specific life narratives and share about what they got in touch with while in an altered state of consciousness. The psychedelic experience often engenders a new sense of meaning, as well as shifts in worldviews, so it’s important to provide support on how they might incorporate these changes into existing paradigms as well as into their daily lives. This process may take weeks or months.
Melinda: Thank you for the comprehensive answer. I'm wondering what are some of the most challenging experiences you’ve had with clients and their experiences?
Gisele: Something that can be very challenging is what is referred to as the dissolution of the ego. When clients begin to feel a loosening of their sense of identity or their egoic defenses, or when they may have a sense that a part of them is dying, or that they themselves are dying, that can be quite scary and intense.
Melinda: So when a client does undergo this experience in which they feel like they’re losing tethering from this reality, and get quite anxious, what are some of the calming techniques you may use to try to ameliorate the fear?
Gisele: I remind them of my presence close to them, and that they are not alone. I offer therapeutic touch in a safe and supportive manner, like the holding of a hand, holding of the feet or using pillows and blankets to provide pressure or a sense of containment. I might encourage their emotional expression, whether it be their crying, screaming or using movement. I also might say something to inform them of their safety, such as reminding them that they are under the effect of the medicine and that is it temporary.
Melinda: Something I've heard that may work for certain people is telling them that: hey, you took a substance and it's working!
Gisele: Yes! I let them know that they’ve taken a substance, and that the effects are nonpermanent. Some people find that to be reassuring.
Melinda: To shift gears, there’s a buzz about the mysticism of psychedelics, which I know the Hopkins group studies. In your experience as a facilitator, how would you go about establishing alliance with a client who has a profound mystical experience that may not align with your beliefs, or may even run counter to your beliefs?
Gisele: Psychedelic-assisted psychotherapy, just like any other kind of psychotherapy, must be grounded in a frame of inclusion, diversity, and social justice. It's important that the clinician knows that the therapeutic space is a microcosm that may reproduce mechanisms of oppression and discrimination that happen in society, so not imposing a specific set of beliefs or assumptions is key. The clinician must be respectful and mindful, and embrace the clients processes however different from their own. Especially when working with psychedelics, I inquire into the client’s spiritual and religious background, so when a mystical or transpersonal experience occurs, I can be supportive in the ways in which they relate to the sacred.
Melinda: Yes that's absolutely vital – receiving the client without any evaluation of your own and putting the client on center stage.
Gisele: I think alongside a diversity, inclusion, and social justice model, a humanistic approach is a very important one - one that does not see the therapist as a superior authority but rather in an egalitarian relationship with the client. The therapist is not a healer, but rather a conduit to ignite the healing capacity inside the client. As mentioned earlier, we also do not interpret. We trust the process and get out of the way. We support the client in making meaning that comes from them. The history of psychotherapy did rely on interpretation, and I don't find that useful in my practice in general, and even less so with psychedelic-assisted psychotherapy. My approach is rooted in humanistic philosophy and psychology. It can be very empowering for people to create their own meaning based on their experiences and references versus being analyzed or offered interpretations of their experiences.
Melinda: That's beautiful. Especially on psychedelics, it can even invite a lot of dissonance in the client’s experience if you are to embody the protagonist. The next question I have is: what are some myths about psychedelic-assisted psychotherapy that you'd like to dispel?
Gisele: I love that question. The first myth is that psychedelics can treat anything. There's a lot of media hype since Michael Pollan’s book (How to Change Your Mind), and with research studies being close to FDA approval, there is a lot of sponsoring and corporate interests in making efforts to disseminate information about the potential for psychedelics as a treatment modality. There have been publications that show aspects of the work that are very promising. I hope for FDA approval and for psychedelics to be available for therapeutic use. Nevertheless, a lot of what is portrayed in the media does not show the full picture of what these treatments are about or the limitations in treatment outcomes.
Another myth is that psychedelics alone cure. Although psychedelics can have a transformative effect, or be fun when used recreationally, it is not a miracle cure. Some research shows that a psychedelic session may be one of the most meaningful experience of one’s life; I actually just heard that last week from a participant who is 65 years old. I believe him. But I also think to myself: OK, how is this going to sustain? What will happen a week, a month, 3 months from now? Will it begin to fade away? Will their old patterns, defenses, and habitual ways return? Ultimately, can psychedelics change you? Well, yes and no. Psychedelics alone wouldn’t do it - you must have a way to integrate the new learnings in order to sustain them. Only then can it be transformative in the long haul.
The other myth is that psychedelics can change the world by promoting evolution of consciousness – so while psychedelics can expand and elevate consciousness, it doesn’t mean that if psychedelics were to be given to everyone, we’d have a different world. For example, there was a hippie idea in the 1960s that, if we just added LSD to drinking water, people would undergo an awakening – that people would understand what life is truly about, that they’d infuse more harmony and unity into society, and see the damage that we’re causing to nature. While some may feel awakened to social and ecological consciousness while on psychedelics, very few people can sustain such openness and carry on concrete changes in both individual and collective ways.
Melinda: The Timothy Leary lore.
Gisele: For that, I’d bring up the QAnon leader Jake Angeli who invaded the White House in January 2021. This man calls himself a shaman in the psychedelic movement and I couldn’t see anything evolved about his consciousness. Additionally, abuse and transgressions in the psychedelic world have emerged in the underground movement, in research, and in traditional healing centers abroad. Financial or sexual gains are sometimes sought after. How can we understand this if we simply assume that psychedelics promote evolution of consciousness? Perhaps sometimes it inflates people’s sense of power and self-importance.
I believe that emotional, psychological, and relational work are all needed to evolve spiritually. Otherwise, it is spiritual bypassing or a false sense of grandiosity. We hear people report the feeling of expansion from psychedelics, and interpreting that expansion as power, secret knowledge or superiority over others. Psychedelic use alone without deep inquiry and deep personal/interpersonal engagement does not promote spiritual enlightenment or evolution of consciousness.
Melinda: That's fascinating. It’s interesting you bring up this notion of spiritual bypassing. There is some parallel between, for example, Buddhism and the practice of evolution of consciousness via psychedelics. Psychedelics is often purported to dissolve the ego under certain circumstances, but under other circumstances, it can also strengthen the ego, which is in parallel to spiritual bypassing. I think that paradox is at once intriguing and puzzling, and something that I have been thinking about.
The last question I have for you is: for those with future aspirations to become a psychedelic psychotherapist, what advice would you give?
Gisele: Assuming one already has psychology education and training, engage in your personal and interpersonal growth, cultivate a mindfulness practice, gain clinical experience by practicing psychotherapy without psychedelics, become familiar with transpersonal and mystical states, learn about the effects of psychedelics both pharmacologically and experientially, strive to contribute towards inclusion and diversity in your surroundings.
An aspiring therapist must do their due diligence in personal work. Psychedelic-assisted psychotherapy is very deep and powerful - one that requires self-regulation and self-care, awareness of your countertransference and projections, and partaking in your own healing, so that you may be fully available to the client’s processes. Further, it is helpful to have a practice, whether it be in meditation, yoga, dreamwork, breathwork, or others, that engages your somatic awareness and aspects of transcendence. Of course, read and stay up-to-date psychedelic news – in research, in society, in law, and in the arts.
Melinda: This concludes our interview. Thank you so much for spending time with me today. I've learned a lot and I hope the audience will have many takeaways as well.
Gisele: Thank you for the opportunity.
