One of the foundational elements of psilocybin therapy is addressing prior life events – including loss, distress, panic, violence, neglect and abandonment etc. These events and their memories – including the emotions and labels we attach to them – are often traumatic in nature. Unprocessed and unresolved prior traumas – whether ‘big T’ Trauma involving violence and threat to safety, or ‘little T’ trauma involving any other distressing or overwhelming event – are responsible for most of our clients’ current suffering, including outcome-type symptoms such as depression, anxiety, and self-medication through substance use or another type of addiction.

What is Trauma?

Trauma is not a universal event, in the sense that events are not intrinsically traumatic. It is our responses to adverse events which define that event as traumatic to us. Trauma is an event or set of events that happen to you which are so upsetting that it overwhelms your ability to cope. For many who experience an intensely traumatic event or time period, it has such a catastrophic effect that we separate our life timelines into before the trauma and after.

We may also fragment our life timelines by removing the traumatic memory, storing it in a separate place in the brain and thereby rejecting and repressing its presence in our day to day identity and memory constructs. Because the mind and spirit wish to be whole and integrated, this often causes cognitive and emotional dissonance and a deep-seated feeling that ‘something is wrong’.

Examples of trauma include, but are not limited to:

• Experiencing or witnessing physical, sexual, and emotional abuse;
• Childhood neglect; 
• Having a family member with a mental health or substance use disorder; 
• Experiencing or witnessing violence in the community or while serving in the military;
• Poverty including housing, warmth and/or food insecurity
• Systemic discrimination, such as is faced by BIPOC and LGBTQ+ communities

Working with and healing/releasing trauma involves working with the limbic system to release this stored/imprinted memory and association. You can’t think or journal your way out of healing from trauma – although those things help to understand them and begin to soften our spirits and minds toward processing. Traumatic events will continued be stored in the limbic system until they can be processed and released.

For some, this can be a frustrating experience. It can feel like the trauma or emotional demons exist inside a hidden room in our brains with no doors or windows through which to access it. Many recipients of psilocybin therapy have stated that while on psilocybin, it felt like a door to this room was created and opened, thereby allowing access and the ability to finally process and release the emotions stored there.

If you have trauma, or suspect you have trauma (sometimes trauma can happen before we are of an age to remember, or our minds can actually ‘black out’ the memories), working with a trauma-informed professional facilitator will be crucial.

A trauma-informed clinic, facilitator, or any other mental health provider will never ask “what’s wrong with you”. That is the purview of traditional western medicine – something must be ‘wrong’, and medicines and surgeries can ‘fix or cure it’. Such approaches take the healing out of your hands, leaving you helpless and at the mercy of the healthcare system.

A trauma-informed approach instead recognizes the innate wholeness of each human being – you are not broken – and it empathetically asks instead, “What happened to you? And how can we help you return to balance?”

A non trauma informed system tends to punish or blame adult actions. A trauma informed provider will still hold clients accountable for their adult actions, but will give them time and space to process what happened without adding extra guilt and shame. 

Core Elements of a Trauma-Informed Approach

• Patient empowerment: We utilize individuals’ strengths to empower them in their healing
• Choice: We inform clients regarding treatment options so they can choose the options they prefer (healing is always client-led, not led by us) 
• Collaboration: We maximize collaboration between our staff, clients, their families (if applicable and appropriate) and other healthcare providers on their team 
• Safety: We develop an environment and activities that ensure clients’ physical and emotional safety; and 
• Trustworthiness: We create clear expectations with clients about what proposed therapy/sessions/health coaching or other approaches entail, who will provide the services, and how program participation will play out

A trauma-informed psilocybin service center will be well-versed in creating a trusting, non-threatening environment. Feeling physically, socially, or emotionally unsafe may cause extreme anxiety in a person who has experienced trauma and can potentially lead to trigger, thereby putting at risk other individuals nearby who the triggered client may project these triggers onto. Thus, creating a safe environment is fundamental to successfully engaging clients, and also preparing them adequately which includes screening and a safety plan in case something goes wrong in-session.

Examples of creating a safe environment include: 

Physical Environment 

• Keeping parking lots, common areas, bathrooms, entrances, and exits well lit; 
• Ensuring that people are not allowed to smoke, loiter, or congregate outside entrances and exits; 
• Monitoring who is coming in and out of the building; 
• Positioning security personnel inside and outside of the building; 
• Keeping noise levels in waiting rooms low; 
• Using welcoming language on all signage; and 
• Making sure clients have clear access to the door and can easily exit if desired (except during psilocybin facilitation sessions).

Social-Emotional Environment 

• Welcoming clients and ensuring that they feel respected and supported; 
• Ensuring staff maintain healthy interpersonal boundaries and can manage conflict appropriately;
• Keeping consistent schedules and procedures; 
• Offering sufficient notice and preparation when changes are necessary; 
• Maintaining communication that is consistent, open, respectful, and compassionate; and
• Being aware of how an individual’s culture affects how they perceive trauma, safety, and privacy.

Clients need a voice in their own treatment planning and an active role in the decision-making process. In traditional medical/psychiatric care, clinicians often dictate the course of action without much opportunity for patient feedback or dialogue. In a trauma-informed holistic healing approach, clients are not only actively engaged in their care, they actually lead and own the process, with the medicine and the staff as supportive guides.

Traditional Trauma Treatment Approaches have included:

• Prolonged Exposure Therapy (PE Therapy) 
• Eye Movement Desensitization and Reprocessing
• Attachment, Self-Regulation and Competency (ARC)
• Trauma-Focused Cognitive Behavioral Therapy (CBT)

How Psychedelic Therapy Addresses Trauma

• Establishing baseline safety in ‘Setting’ – you are safe in this experience (this environment, these people, this medicine). Getting settled into the community, taking a small microdose to start, and building trust and confidence in your Facilitator are all steps to establish this safety.
• Honoring the emotions and experience from that place of safety
• Being able to finally process and release the overwhelming emotions from the altered state of consciousness that makes the trauma seem less overwhelming (often like you are looking at what happened as a bystander or different person, a witness)
• Deep acknowledgment that what happened to you is not your fault and should not be associated with self blame, guilt, shame, or self hatred
• Reinforcing messages of love and worthiness, of sacredness (human life, consciousness)
• Bringing the traumatic memories and emotions back into the integrated holistic timeline of one’s life (we often splinter them off as a fragment in an attempt to keep them separate from the rest of our life and memories, which represses them and often strengthens negative symptoms)

The end objective is for the client to accept that the trauma is something that happened to them, without the associated overwhelming emotions attached to that event(s). The goal is not to forget or erase the memory, but rather to see the trauma from a neutral point of view and apply any potential lessons, learnings or insights from what happened. This is one of the fundamental superpowers of psychedelic medicine, because it physically alters consciousness into a different and expanded state, often allowing clients to separate themselves from their prior emotions, thoughts and labels.

After a psilocybin therapy session, clients work on integrating their healing by learning loving self-discipline and loving reparenting of themselves, which builds feelings of safety, competence and underscores the message ‘I am worth effort’ and ‘I am worth showing up for’.

Psilocybin therapy sessions also increase feelings of connection vs disconnection – to family (partner, kids), community, friends, workplace/coworkers, nature and earth. It allows the brain to spend more time in Active Consciousness, and less time in Programmed/Autopilot Subconsciousness. And finally, it gives clients the empowerment via ‘having a choice’ of what to think, believe and feel, vs feeling stuck or helpless.

Trauma-Informed Psilocybin Facilitators – Must do their own Work

Psilocybin facilitators – just like health coaches, counselors, psychologists, etc – are human beings too. Many in the “helping professions” may have their own personal trauma histories – in fact, these experiences may have been what inspired them to help others. This makes them uniquely suited to understand and empathize with clients who are suffering with post-traumatic stress, depression, anxiety and addiction. But it also has the potential to be exacerbated by working with others who have experienced trauma. This is why it is crucial for psilocybin facilitators and other healers to have done their own trauma release and Shadow work before assisting others. Awareness and conscious boundaries are also essential to being able to provide high quality, compassionate care.

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It is also important to hire staff with personality characteristics well suited for trauma-informed work, namely empathy, non-judgment and collaboration, along with openness and as mentioned above, having done their own work and have a sense of boundaries in place (“this is what’s mine, this is what’s yours”).

Non-clinical staff are just as important in creating a safe environment. For example, front desk staff greeting people in a welcoming manner when they first walk into the building may help foster feelings of safety and acceptance, initiate positive relationships, and increase the likelihood that they will engage in treatment and return for future appointments.

One promising engagement strategy uses peer support workers — individuals with lived trauma experiences who receive special training — to be part of the care team. Based on their similar experiences and shared understanding, patients may develop trust with their peer support worker and be more willing to engage in treatment. Peer engagement is a powerful tool to help overcome the isolation common among individuals who have experienced trauma.

Trauma screening is important and there are two approaches to this topic: The first is to do up front/universal screening, and the second is to do later screening after building trust. The client should have the choice:

• I choose to provide information about prior trauma up front, so you can help me decide on the best healing path, OR
• I prefer not to provide the information up front and would rather provide this after getting to know you and building trust

Our Team chooses to avoid re-screening, after the initial background assessment. Re-screening increases the potential for re-traumatization and flashbacks. We don’t need to make clients talk about it over and over, we just need to make sure there won’t be any surprises during the psychedelic journey. Knowing what could potentially come up is key to helping clients prepare and feel confident in their safety planning. 

Preventing Secondary Traumatic Stress

Working with patients who have experienced trauma puts both clinical and non-clinical staff at risk of secondary traumatic stress. Defined as the “emotional duress that results when an individual hears about the firsthand trauma experiences of another,” secondary traumatic stress can lead to chronic fatigue, disturbing thoughts, poor concentration, emotional detachment and exhaustion, avoidance, absenteeism, and physical illness.

For this reason, all staff who may be involved in hearing about prior traumas should receive thorough training on trauma-informed care and be solid with their boundaries in order to avoid secondary trauma, projection, transference and counter-transference.

We hope this article has helped! It is our opinion at Fractal Health that addressing traumas of all kinds (including preparing for a known upcoming trauma such as death of self or a loved one) is the number one power and strength of psychedelic medicine. It allows clients to go to places of their minds and lives that would otherwise not be possible.