Psychedelic Chaplain
Applying the Spiritual Care Tools of Chaplaincy to Psychedelic-Assisted Therapy
Psychedelic-Assisted Therapy (PAT) is an emerging field with the potential to transform psychiatry and religion. Clients undergoing PAT frequently report mystical experiences, which have helped to alleviate the symptoms of post-traumatic stress disorder (PTSD) and depression.
My thesis is that the spiritual care tools that chaplains use in hospice care would improve outcomes for PAT clients. Chaplains would be helpful (and cost-effective) additions to licensed, integrated care teams administering PAT in a clinical setting.
This essay does not make a case for chaplains to administer PAT as solo-practitioners. Nor does the author endorse the use of psychedelics in any recreational context.
Background
In 2021, researchers at Johns Hopkins University performed a randomized clinical trial on psilocybin-assisted psychotherapy with 24 patients who were struggling with moderate-to-major depression, as indicated by a score of ≥ 17 on the GRID-Hamilton Depression Rating Scale (GRID-HAMD). (Zimmerman, et. al., pp. 384–388.)
Four weeks after a single dose of psilocybin, 71% of participants reported a significant decrease in depressive symptoms, as indicated by ≥ 50% decrease in GRID HAMD score. 54% of participants reported their depressive symptoms in remission, as indicated by a score of ≤ 7 on the GRID-HAMD scale. (Davis, et. al., pp. 1–9.)
Dr. Anthony Bossis, who studies psychedelics at NYU Grossman School of Medicine, told NPR in September 2023, “People taking these drugs often report what’s described as a mystical experience… The spiritual dimension of psychedelic treatment seems to be part of what makes the therapy therapeutic.”
If the spiritual experience of PAT is indeed partly responsible for its therapeutic value, then applying the tools of spiritual care could lead to improved outcomes for PAT clients, especially those who express interest in the spiritual aspects of the psychedelic experience.
The Spiritual Care Toolkit
In The American Book of Living and Dying, authors Richard Groves and Henriette Klauser describe several spiritual care tools that chaplains and other spiritual health providers employ in hospice care settings:
- Spiritual Health Survey
- Mantras and Centering Meditation
- Lectio Divina
- Spiritual Geography
Each of these tools (described below) has the potential to help clients negotiate the spiritual terrain of PAT at every stage of their journey — before, during, and after dosage sessions.
SPIRITUAL HEALTH SURVEY
The Spiritual Health Survey (see Appendix A) lets clients self-report their spiritual pain on a five-point scale. The survey comprises four questions, each one offering a window into the four dimensions of spiritual pain, which are:
- Meaning Pain — Clients struggling with depression or PTSD may lack motivation or feel their life lacks meaning and purpose. A sense of meaninglessness is often a particular concern for those approaching end of life.
- Forgiveness Pain — Forgiveness is a cardinal virtue in every religious tradition. Yet in hospice care settings, clients often report significant distress due to a lack of reconciliation felt toward themselves or others.
- Relatedness Pain — Feelings of alienation, lack of balance in relationships, or disconnectedness from loved ones are common sources of spiritual pain for hospice care clients.
- Hope Pain — Pain that is centered around Hopelessness can be difficult to recognize and difficult to treat with talk therapy alone. In the context of hospice care, hopelessness boils down to “a loss of will to live.” Outside of hospice care settings, chaplains and pastoral counselors should refer clients to psychiatric specialists if they determine that the client expresses or exhibits severe hopelessness. (Groves & Klauser, p. 43–53.)
In the Johns Hopkins study mentioned above, participants completed the GRID-HAMD survey up to five times during the 16-week study. (Davis, et.al., pp. 1–9.) The Spiritual Health Survey may not have the same clinical weight as GRID-HAMD, but it can give PAT providers valuable insights into the client’s spiritual pain.
MANTRAS AND CENTERING MEDITATION
Mantras and centering meditation can help PAT clients manage anxiety and other negative emotions as they explore the occasionally difficult (even frightening) landscape of the psychedelic experience.
In the Harvard webinar “What is Psychedelic Chaplaincy?”, spiritual health provider Daan Keiman encourages PAT clients to meditate using the secular mantra: “Trust, let go, be open.” The centering mode of meditation involves dividing a mantra between inhales and exhales, in this case:
Inhale: Trust, let go…
Exhale: Be open.
Clients who wish to embrace the spiritual or religious aspects of PAT may select a mantra from their preferred tradition, including:
- “Be still, and know that I am God.” (Psalm 46:10)
- “Kyrie Eleison” (Greek Orthodox liturgy)
- “Hear O Israel, The Lord Our God Is One” (Shema Yisrael, Deuteronomy 6:4)
- “Whatever may come to pass is the will of Allah.” (Muslim prayer)
- “Great Buddha of Compassion, be my guide.” (Buddhist prayer)
- “Om” (Hindu chant of supreme spiritual power)
LECTIO DIVINA
Literally “divine reading”, lectio divina is an ancient practice of meditating on short works of holy scripture. To avoid the appearance of proselytizing, I would extend the scope of this practice to include contemporary, secular verse as well as ancient text. The practice of lectio divina during a PAT session would involve five steps.
- Before any medication is administered, pray with the client to invoke the Holy Spirit (as the client understands it and in accordance with their faith tradition.)
- Invite the client to read aloud a short passage of scripture or poem.
- As the medication is being administered, invite the client to mediate silently, paying attention to their inner voice.
- Invite the client to select one word to guide them as they begin the dosage session — or throughout the day.
- Encourage the client to be grateful. (Groves and Klauser, p. 258.)
In lieu of religious scripture, I might offer clients “The Avowal”, a poem by Denise Levertov, which is deeply spiritual in its theme, yet ecumenical in its language.
As swimmers dare
to lie face to the sky
and water bears them,
as hawks rest upon air
and air sustains them,
so would I learn to attain
freefall, and float
into Creator Spirit’s deep embrace,
knowing no effort earns
that all-surrounding grace.
SPIRITUAL GEOGRAPHY
Spiritual Geography is a form of Life Review in which clients are invited to identify the three most stressful and the three most fulfilling events in life. When comparing their most stressful and most fulfilling moments, clients often discover that the best and the worst moments in life are connected. In one form of Spiritual Geography, clients are asked to fill in the blanks of a simple sentence six times.
MY BEST MOMENTS
At age ____, I felt ___________ because of __________________________.
At age ____, I felt ___________ because of __________________________.
At age ____, I felt ___________ because of __________________________.
MY WORST MOMENTS
At age ____, I felt ___________ because of __________________________.
At age ____, I felt ___________ because of __________________________.
At age ____, I felt ___________ because of __________________________.
Spiritual Geography encourages clients to view their positive and negative experiences as part of a complete whole. This exercise can help clients and caregivers make meaning out of painful transitions, giving clients better clarity regarding their priorities, relationships, and future prospects. (Groves and Klauser, pp. 252–256.)
Conclusion
If the psychedelic experience of PAT delivers therapy by bringing clients to new levels of spiritual awareness, then integrated PAT care teams should be prepared to address clients’ spiritual health, whether or not a chaplain or other spiritual health provider is present on the team. PAT providers should consider incorporating the tools of spiritual care to enhance the experience of clients before, during, and after dosage sessions.
Beyond PAT sessions, the spiritual health tools described above (and many others) contribute to the practice of spiritual formation for clients, helping to sustain their sense of meaning, connectedness, relatedness, and hope — long after the psychedelic effects wear off.
Appendix A: Spiritual Health Survey
For each question, please circle the option that best describes the way you feel today.
MEANING PAIN SCALE
- Life is filled with purpose and meaning.
- …
- I feel generally motivated.
- …
- Life has become meaningless.
FORGIVENESS PAIN SCALE
- I feel a deep sense of reconciliation toward myself and others.
- …
- There are no outstanding issues that are calling for forgiveness in my life.
- …
- I feel a strong sense of unforgiveness toward myself and/or another.
RELATEDNESS PAIN SCALE
- I feel strongly connected with the persons and things that matter most to me.
- …
- The most important areas of my life seem balanced.
- …
- I feel seriously alienated from someone/thing that is important to me.
HOPE PAIN SCALE
- I am filled with hope and optimistic.
- …
- I generally trust what the future holds for me.
- …
- I am experiencing deep depression and hopelessness.
References
The American Book of Living and Dying
By Richard F. Groves and Henriette Anne Klauser
Celestial Arts, Berkley, CA, 2009.
As Psychedelic-Assisted Therapy Grows, So Does Interest from a New Group: Chaplains
By Deena Prichep
NPR, September 24, 2023.
https://www.npr.org/2023/09/24/1201095225/as-psychedelic-assisted-therapy-grows-so-does-interest-from-a-new-group-chaplain
The Avowal
By Denise Levertov
The Collected Poems of Denise Levertov
New York City: New Directions, 2013.
Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial
By Davis AK, Barrett FS, May DG, Cosimano MP, Sepeda ND, Johnson MW, Finan PH, Griffiths RR
Journal of American Medical Association Psychiatry, May 1, 2021.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643046/
The Emerging Field of Psychedelic Psychotherapy
By Gregory S. Barber & Scott T. Aaronson
Current Psychiatry Reports, October 24, 2022.
https://pubmed.ncbi.nlm.nih.gov/36129571/
A New Era of Psychedelics in Oregon
By Mike Baker
New York Times, October 24, 2023.
https://www.nytimes.com/2023/10/23/us/oregon-psychedelic-mushrooms.html
Psychedelic Chaplaincy
Header artwork generated by Dall-E.
Copyright Bing, Microsoft Corporation, 2023.
Severity Classification on the Hamilton Depression Rating Scale
By Zimmerman M, Martinez JH, Young D, Chelminski I, Dalrymple K Journal of Affective Disorders, September 5, 2013.
https://pubmed.ncbi.nlm.nih.gov/23759278/
Spiritual Health Practitioners in Psychedelic Assisted Therapy
By Caroline Peacock
Emory University, March 5, 2023.
https://psychedelics.emory.edu/
Webinar: What is Psychedelic Chaplaincy?
By Jamie Beachy, Trace Haythorn, Daan Keiman, Rachael Petersen
Harvard Divinity School, March 8, 2021.
https://cswr.hds.harvard.edu/news/2021/03/08/video-what-psychedelic-chaplaincy
What Does Good Psychedelic Therapy Look Like?
By Dana G. Smith
New York Times, June 3, 2023.
https://www.nytimes.com/2023/06/03/well/mind/psychedelic-therapy.html
