Psychedelic Therapy with Renee Harvey
Anita Spooner interviews psychedelic therapist Renee Harvey.
A psilocybin-assisted therapy session at Johns Hopkins University
Renee Harvey is a highly experienced clinical psychologist who relocated from the UK to Australia to develop training in psychedelic-assisted psychotherapy (PAP). She has many years of experience as a lecturer, trainer, clinician and service developer within the mental health field. Her ideas on PAP training are featured in a recently published book chapter (Harvey, 2021) and in various talks and podcasts.
Prior to relocation, Renee was an Honorary Research Fellow and assistant guide in the Imperial College London trial researching psilocybin for treatment-resistant depression. She also facilitated the development of psychedelic interest groups and established and ran a psychedelic integration circle in Brighton.
Renee is currently assisting as a therapist on the psilocybin trials at St Vincent’s Hospital, Melbourne, aimed at the alleviation of depression and anxiety associated with life-threatening illness. She is also on the Clinical Advisory Board of Reset Mind Sciences, providing therapist training for their psychedelic research program. She also has a private practice in Melbourne with an emphasis on providing psychedelic integration.
Renee Harvey
Anita: Lovely to meet you Renee. What brought you to Australia, and what research projects have you been involved in since you've been here?
Renee: I came to Australia because my daughter fell in love with an Australian. I came at the beginning of 2020, just in time for lockdown. I'm currently working in private practice in Melbourne and am also a voluntary assistant therapist with the St Vincent's Hospital team led by Dr Margaret Ross and Dr Justin Dwyer, working with psilocybin for life-threatening illness. And there's quite a few other things in the pipeline, many involving training therapists. My background is in training therapists, specifically around doing psychedelic therapy.
Anita: How does this research build on the projects that you’ve done with Imperial College in the UK?
Renee: The research has just exploded worldwide, on all sorts of psychedelics for all sorts of conditions. Imperial College was one of the first, and I was extremely lucky to connect with some of the people running that research. I was an honorary assistant guide at Imperial with Dr Rosalind Watts, putting people with treatment-resistant depression through the protocols with psilocybin. I'm very grateful that I've had the opportunity to work there, and to be doing similar work here in Australia - it's been an amazing process of doors opening and opportunities. In London, as part of the Imperial group, the lead researchers – Rosalind Watts and Michelle Baker-Jones – started an integration group for people coming off trials, but also more widely open to others. I got involved in this group, and then started up a similar group in Brighton, where I lived. And of course, a lot started to happen – we had speakers come down, we had interest groups, and research.
The problem is that the treatment is very divisive. There is still a lot of prejudice and misinformation out there. You're very fortunate if you meet people that are open-minded and interested, enthusiastic and willing. Others just shut you out – it's far too threatening and risky, too extreme for them. But there are still a lot of projects starting up all over the place and there's going to be lots of opportunities to get involved in more research and teaching.
Anita: How did you first become interested in psychedelic-assisted therapy?
Renee: I've always been interested in altered states of consciousness. When I trained as a psychologist, the training was very conservative and mainstream. Ironically, way back in the beginning of my career, I was a lecturer at a university and one of the subjects I taught was on altered states of consciousness. We talked about things like meditation and hypnosis, but also these ‘dangerous things’ called psychedelic drugs. The textbooks and all the teaching in those times were based on misinformation that was put out by the people behind the war on drugs. I found myself actually teaching this nonsense. We were led to believe that LSD causes chromosomal damage, that you're going to go crazy and jump off buildings, that kind of thing.
When I emigrated to the UK I started working in services with people with more complex problems. It began to work on my mind that surely there has to be something more than the therapies currently available. I heard about how people were having interesting experiences with psychedelic medicines. People in my friendship group were encouraging me to try it. At the time I wasn’t willing to go anywhere near it - but they worked on me, and eventually, I had my own experience.
I think it's incredibly important for people that get into this field to have had an experience, to know what it's actually like. I was one of these people that had a mind-blowing experience that changed my life – all the stuff you read about in Michael Pollan's book – it really was such an interesting personal journey, such a growth point. And it seemed to me that it could be the answer to how we work with people with very complex problems. But knowing at the same time – it's not as easy as that – you can’t just go and take a bit of LSD and suddenly your life changes. I think people need a lot of nurturing and a lot of therapy around the experience.
“...you can’t just go and take a bit of LSD and suddenly your life changes. I think people need a lot of nurturing and a lot of therapy around the experience. ”
Anita: What are the legal and ethical regulations for psychedelic-assisted therapy in Australia and how do they differ from the UK?
Renee: I don't know too much about legislation. We've had several attempts, certainly in Australia, to change the scheduling with the TGA. There are some legitimate concerns around what we do there – it's an extremely complicated situation. The US has made more headway, especially the work that Rick Doblin has been doing with MAPS and getting MDMA closer to the approval process. And then of course there are all sorts of changes happening now in the law in Colorado and Oregon. They’re talking about opening clinics, but it's going to take a long time for them to roll that out. My understanding is that the UK is nowhere near as close to this stage. So although there are lots of research projects happening at Kings College, Imperial, Awakn Life Sciences, Beckley Foundation, COMPASS, etc., the position is very conservative in England still and I don't think we're close to getting the regulations to change.
Anita: I read an article that you co-authored ‘Translating Psychedelic Therapies From Clinical Trials to Community Clinics: Building Bridges and Addressing Potential Challenges Ahead’. Can you talk about the recommendations from that research – what strategies and safeguards support the rollout of psychedelic-assisted therapy in community clinics, and what kind of expertise, protocols, and standards of care are required?
Renee: It's a very complicated situation and there are many challenges ahead. There’s a split in the field between people who support the corporate rollout of clinics, and a ‘medical model’ if you will – to prescribe tablets in a similar way to antidepressant medication. And then on the other side, the extent to which people are going to focus on therapy alongside the treatment – this is even more important than the substance. So the challenge is going to be how we actually set these clinics up in an accessible way, because it's going to be very expensive to have that intensity of therapy.
Anita: What actions would support disadvantaged groups who don't have the financial or physical means to access this kind of treatment, if it was patented and expensive?
Renee: Are we going to get to a stage where Medicare will pay for people’s sessions, or where insurance companies will cover the cost? When people are prescribed an antidepressant, they do therapy, and you only get a certain number of sessions covered by Medicare or insurance. The expectation is that that’s supposed to fix things. But if you take an antidepressant, you're potentially on it for many years, perhaps for the rest of your life. Maybe you’ll have another bout of therapy. If you have a very severe problem, you may be in and out of hospital.
On the other hand, psychedelic-assisted therapy is a very condensed, expensive set of treatments, with the potential to actually fix the problem. It doesn't do so for everybody, and sometimes people have to come back and have boosters after a year or two. Can we convince the insurers and funding bodies that it's worth investing in intensive, expensive bouts of psychedelic treatment, for the sake of fewer expenses down the line?
I don't think we're anywhere near answering these questions. And I think it's very sad because in the meantime many people are desperate and they are doing desperate things – drawing on their life savings and flying to South America, and engaging in risky, potentially damaging behaviour.
“Can we convince the insurers and funding bodies that it’s worth investing in intensive, expensive bouts of psychedelic treatment, for the sake of fewer expenses down the line? ”
Anita: What about research into medical interactions and psychological effects – how much more research is required, and in what particular areas?
Renee: I think the complexities here are that on the one hand you've got informal use – people picking mushrooms in forests, growing them, and using them recreationally. And then you've got therapeutic use. And there’s a split within the therapeutic use – is it the substance or the therapy that makes a difference? Or do you need both? I'll talk more about this in my presentation at EGA’s Garden States conference.
It would be much easier to get the regulation through if you could simply specify a prescription dosage on a bottle. But how do you prescribe the therapy? And what model of therapy, and for how long? And then of course, what's not taken into account are factors like community support. These medicines were used traditionally within a community setting and we don't seem to be able to replicate that in a medical model.
The fundamental question comes down to what is it that helps people change? It's such a complex question. We know that one of the most important factors is the therapeutic relationship – personal contact, to be in a trusting relationship with a therapist who gets you, to support you and listen to you. How do you bottle that and prescribe it?
Anita: The article advocates for a national peak body, how would this work?
Renee: There’s been talk of an international regulatory body for some years now but that hasn't happened yet either. It would develop consensus on training models and treatment protocols.
Anita: What would an ideal model for psychedelic therapist training look like to you? And what kind of accreditation do you think would be appropriate for that to be rolled out?
Renee: Again, it's a tricky field. Good training courses will cover the basics: information, theory, scientific knowledge, as well as cultural history. This information is already widely available though. The key is therapeutic training and experience – to know the basic principles of how to conduct yourself ethically, with oversight by a professional body that has an ethics policy. On top of that baseline, I think you need 3-5 years of supervised therapy experience under your belt. The third thing is personal therapy. I think you have to have tried facing your own shadow, facing your own issues and working on yourself. When you've been through life experiences – suffering, losses, challenges – you often mature and gain an insight and understanding that no training will give you. And then hopefully, you've tried a psychedelic experience as well – but we can't insist on that because it's illegal in this country. But nothing gives you more insight than trying it yourself. So the training has to be intensely focused on clinical work rather than intellectual knowledge. You have to know who you are as a therapist.
Psilocybe subaeruginosa. A psychedelic, psilocybin-containing mushroom. Photo by Liam Engel.
Anita: How does set and setting affect people's anxiety leading up to and during the therapy, and what are the most important elements?
Renee: Set and setting are essential. All of the factors: the safety, the comfort, the music, and the care offered. The mindset and expectations you come in with are also important, and should not be too high – otherwise you’re probably in for a disappointment.
People talk about the placebo effect in a bit of a disparaging way. I think placebos are actually a valued asset – we should maximise them as much as possible.
There's a split here also about the notion that people have an ‘inner wisdom’ or an ‘inner healer’ – MAPS emphasises the ‘inner healer’. Some people cringe when you talk about an inner healer. These are vague and overlapping concepts but I don't think that any program or any treatment is going to work very effectively unless you harness these strengths, these abilities, instincts, whatever you want to call them. I believe it's wise to construct set and setting to maximise these, whatever your personal beliefs may be.
Anita: Do patients have any input or agency in the design of clinical settings – for instance, the music selection?
Renee: Generally in research settings they don't; it's the same for everyone. They can bring in objects of their own that make them feel comfortable. In terms of music selection, it’s tricky because if you give people free choice, they often choose music that's not conducive to therapy. Usually, there's a choice of two or three different playlists. There’s some wonderful playlists out there now – they’re constructed to guide you through the experience. People like Dr Mendel Kaelen have done a lot of research on this.
Anita: I'm curious about different modalities in integration therapy. Are you interested in somatic modalities like yoga, eco-psychology, or physical movement?
Renee: I don't do those therapies myself because I'm not trained in them. But I will certainly incorporate the suggestion to follow some kind of physical process and try to work with someone who can complement my skills. The integration should encapsulate something for your mind, your feelings, and your body. For a lot of people Holotropic breathwork is a very physically embodied experience. But it depends on what the person's interest is. The integration process should consider as many aspects of being human as possible. That involves art, creativity, as well as having fun and learning to play.
A cutting of San Pedro, the psychedelic, mescaline-containing cacti. Photo by Liam Engel.
Anita: You referred to some Jungian principles in your last presentation with Entheogenesis Australis. Could you talk about your engagement with his theories and how they might have informed your ideas or your practices in psychotherapy and integration?
Renee: I've had a long interest in transpersonal psychology. Jungian psychology gives you a strong appreciation of archetypal imagery and symbols. The way that Jungian psychology works with dreams is useful for integration work as well. The other thing about analytical psychology is that it looks at your life story – your whole story – and its meaning. It's about contextualising an experience within your life and what it means for you.
Anita: You also mentioned in that presentation that you don't believe in bad trips. I was wondering if you could elaborate on that, and the kind of insights people can have from such an experience?
Renee: I believe in the notion that whatever comes up for you is something that probably has meaning for you. As Bill Richards says, if you meet a monster, talk to it. Ask it what it wants from you, ask what it is teaching you. Whatever comes up is coming up from your own consciousness and doesn't have the capacity to harm you in any way – so see what you can learn. It could be something you really don't want to look at in yourself – but there's the therapeutic gold. That's how you become enlightened, you shine a light in the dark corners, you see things you really don't want to see. That's how you grow. That's how you become whole.
Anita: I’m interested in your thoughts about mystical experiences. How would you personally categorise one? What is its therapeutic value?
Renee: There's a lot of debate around Jung’s notions of the mystical. I know that he wrote that he wasn't in favour of psychedelic medicine. He favoured working through active imagination, seeking a numinous experience, and exploring the notion that there are other levels of awareness out there, beyond our everyday.
There are many ways to get the sense of a greater awareness, or a greater existence beyond yourself. Something that's very hard to put into words – something ineffable, something mysterious. And whichever way you want to label it, the findings from psychedelic therapy have been that when people access that level of awareness, they come back describing it as absolutely life-changing. Psychedelic therapies don’t always take you to that level, and they don’t always need to. But when they do, people describe it as amongst the most meaningful experiences of their lives.
Anita: And how are these notions received by the scientific community and your colleagues?
Renee: There's a lot of resistance and scepticism. A lot of researchers are trained very deeply in scientific method and don’t have any space for something mystical or beyond concrete reality at all. My approach is to say to people – whether or not you believe in it, other people do, and as therapists we have to respect where people are, and what they bring. What they bring in is their reality, and you work within the bounds of that. It's the same if you work with people with psychotic experiences or psychosis – it's very real to them – you've got to respect that and work with it.
I don't claim to understand everything. I formulated my own belief system over years based on my experience, and I don't wish to impose that on anyone.
“There are many ways to get the sense of a greater awareness, or a greater existence beyond yourself. Something that’s very hard to put into words – something ineffable, something mysterious. ”
Anita: In terms of integration and giving your patients a philosophical framework to make sense of the experience that they've had – do you lean towards more of a materialist, positivist framework, or would you integrate other understandings about say, the collective unconscious, or a spirit world? Do you introduce your patients to a variety of worldviews or do you focus more on a Western worldview of the phenomena that they encounter in an experience?
Renee: I see my job as a therapist to meet the person with what they bring into the room. I see myself as a catalyst, more than a teacher. I walk with them, I don't expect them to walk with me. If somebody comes in and says they're an atheist, who am I to say I think you're wrong? I don't see that as an ethical way to work with anyone. If people ask me what I believe, I would ask, ‘why is that important for you to know?’ And more often than not, it’s because they want to be sure that I'm not going to judge them.
Anita: Can you tell me about how psilocybin can help shift perspectives about death, and do you see any broader cultural ramifications for this kind of awareness?
Renee: My understanding from my limited experience so far is that psilocybin can take away all fear of death – it makes the death experience seem like it's part of life. I think it helps if you have some idea of survival after death. But even if you don't, there's some way in which it can put things in perspective. It seems to have this amazing capacity to remove anxiety. There have been a couple of instances I know of where people have had unpleasant experiences, but then reported afterwards that somehow the depression and anxiety have lifted. And they don't know how, they can’t explain to you why – somehow it's just gone.
Anita: What other positive changes have you observed after treatments?
Renee: If you go into it with an openness and a willingness to learn, you can potentially come out of it having changed fundamental aspects of who you are. If you go through an ego dissolution experience, you can come out of it with new self-knowledge. It can be very humbling, very grounding, and it can be life-changing.
I might just say there have also been negative changes I've seen in people too – people can get inflated and take on heroic notions of saving the world. There is also the issue of spiritual bypassing – chasing after the experience of the psychedelics without looking at yourself or making any real changes. And I saw an article recently that showed that psychedelics can solidify and intensify your political beliefs, for example.
Anita: What other principles or practices assist in long-term benefits after psychedelic treatment?
Renee: It definitely helps if you have the courage to make real changes in your life. When I normally work with people in therapy, I say “don't make big life changes”. You need to let things percolate, let them settle. But once you get that understanding, act on it. Do something concrete that changes your life. Robin Carhart-Harris uses a metaphor of a ski slope with a fresh fall of snow. After psilocybin, the tracks that you were skiing down disappear, so you can make new tracks. I think if you don’t do that, you’ve lost a wonderful, golden opportunity in your life. You may not want to be drastic and impulsive, but I think you should be open to the possibility that you can make change, and that's why I like one of the outcomes in these therapies: we see greater flexibility – people get more of a sense that change is possible.
Two psychedelic trees, both containing DMT. Mimosa tenuiflora, left and Acacia obtusifolia, right. Artwork by IzWoz.
