When Helping Goes Wrong

~Saj Razvi

 

I would like to take this opportunity to talk with you about an event that took place in 2015 that led me to forfeit my license to practice therapy in the state of Colorado. While the events I’m going to describe are particular to my situation, there are drivers and dynamics that are generalizable to the larger psychedelic and mental health communities (specifically to clinicians or people who provide any type of psychedelic guidance using these medicines). As awareness of psychedelic treatments grow, there will be a parallel growth in above ground and underground work to address deep suffering and the desperation that it brings, and I believe providers will face situations similar to mine. What I am about to describe is something I wish I had been able to speak publicly about when it happened but as you’ll see, that was not possible. However, years have passed and it seems timely to bring some light to these events. Being mindful of privacy and respectful to others involved in the situation, I will leave out identifying details.

 

The gist of the situation was that a community of people, some of whom had licenses such as doctors and therapists, were coming together to help a friend who suffered with severe debilitating depression through most of their adult life. Their previous psychiatric medication and therapy options had stopped working, and they had been struggling for months.

 

This person contacted me because of my background in the MDMA clinical psychedelic therapy trials. We met at a coffee shop, discussed their situation and I ended up sending them some online research links. I suggested they could apply to a trial if they wanted to explore a psychedelic treatment option although I had my serious doubts if they would be accepted into a PTSD trial for MDMA given that their symptoms were complicated and not easily traced to trauma. After a short time, they re-approached me asking if I would be willing to guide them through their own psychedelic session since the trial was not a workable option. I refused but suggested I could help them find a sitter, someone who was willing to work with them underground. This option didn’t pan out either and after a few months of increasingly upset and desperate phone messages from them, I agreed to another in-person meeting. What I saw gave me pause, their condition had changed from bad to worse. This person had gone off of most of their psychiatric meds because nothing was working, and they had started experimenting with psychedelics alone in the hope of finding something that could help. I felt I was in a situation with no easy answers. I could walk away and I was pretty convinced this person was sure to hurt themselves during or after one of these experiences, as evidenced by how desperately they were experimenting, or because of my years of experience in the clinical trial, I thought I could at least increase their chances of coming through this if I supported them during their psychedelic use. They were intending to continue trying different psychedelic options with or without me being there so I considered two things: 1) this appeared to be a harm reduction scenario and 2) whether their chances of making it increased if I was there versus not being there. My answer was a clear ‘yes’ and so I agreed to sit with them. 

 

We came up with three agreements, 1) they continued to work with their therapist which they were intending to do already 2) they kept their psychiatrist aware of whatever they were going to do with altering medications and what interactions could be had by adding in the psychedelic they wanted to use and 3) I asked that they tell no one that I was sitting for them because of how many other requests I would get. I had a full private practice, I was involved in the clinical trials and this was not something I wanted to be doing. I was clear this was not an ideal clinical situation, it was not a situation that anyone would have chosen to be in. I thought of this as a harm reduction situation. I did not admit this person into my practice because of the limited scope of what we were doing and they were maintaining their working relationship with their primary therapist. My job was to make sure nothing horrible happened during their psychedelic use and in the best case scenario, I was hopeful that we could increase their chances for a positive outcome. 

 

In retrospect, it was unclear to me how much desperation and suicidal ideation this person had. It did not seem significant when I inquired but I wonder if it was being downplayed for different reasons. What became evident in time is that this particular attempt to heal with psychedelics was this person’s last, best attempt in a long and difficult fight. This person ended up taking their own life after it became clear that even this course was not providing the relief they needed.  

 

If you have ever been in a family or a community where someone suicides, it is a bomb going off. There is a numb shock and frantic confusion followed by a natural and desperate need to re-establish a sense of order and meaning in the world. There is a strong need to protect people from the inevitable and impossible feelings of guilt that always, always arise. And yes, there is a need to assign blame and try to find a reason why someone would do such a thing. A complaint was made to the state licensing board about my role in this event along with another therapist that was involved. Incidentally, it was not the person’s family who made a report. The family knew the depth of the illness and the difficulty of the situation first hand; they were even involved in sitting for the person during their psychedelic work when I couldn’t be there.  

 

I would have contested this report but my situation was unique. I was still involved in the MDMA clinical research and it was still relatively early in these trials. There is a history that I was well aware of where past psychedelic research had been derailed because of problems associated with the researchers. I’m not at all certain if this would have happened, but I was terrified at the time that this situation could have been used politically to damage or even shut down the MDMA research. There was no possible way I was going to allow this situation to be used in that way. However slight the chance, my Colorado license was not worth possibly derailing MDMA approval. 

 

I did what I thought was the most ethical thing I could do at that moment. I voluntarily forfeited my license. I walked away without contesting anything and surrendered my license as that was the most severe penalty that the state licensing board could impose anyway. I was committed to avoiding any negative attention on the study. I would not have given up my license if I thought I could have responded to the complaint at the time or if something like this were to happen today. 

 

I say this as a cautionary tale to anyone who has seen the profound healing capacity of psychedelic work, and is choosing to operate either underground or undertake this healing path with less seriousness and training than it deserves. Even though I had my doubts going in about whether this would be helpful, the work that we accomplished over time ended up being pretty significant. Our work together ended up being some of the best, most technically precise and love filled work I have ever provided. At that point, I had over 10,000 therapy hours sitting with people, I had lots of clinical training, I had spent a few hundred hours working specifically with psychedelic medicine with very good supervision in the clinical trial. I was even relating the situation to my own therapist during this time which is to say, it was not a secretive, furtive undertaking. I was hopeful and proud to be able to help. Even with all of these solid pieces in place, it was not enough to achieve the outcome we all wanted. With all of my clinical training and the deep work we did, I didn’t see it coming at all. The truth is that just like physical disease, there are forms of mental illness that are terminal and no intervention is going to work 100% of the time.

 

I certainly brought my own personal blind spots to the situation that prevented me from seeing this. I repeatedly saw remarkable therapeutic movement on a weekly basis in the research setting; breakthrough progress that you don’t see in standard treatment became the norm and at a not so conscious level, it began to mean something about me. I assumed in my own hubris or arrogance that I could help anyone as long as we didn’t give up. There is a certain narcissistic delusion that I had, and that I think can be an issue for therapists working with psychedelic medicine because of how powerful the healing experience is. When you are in the room when someone feels love for the first time in their life, you kind of think it has something to do with you. Maybe not the first time but if world shifting breakthroughs on that level keep happening on a regular basis as you work with people, you're going to eventually think it’s you. The trick is that it does have something to do with you but it's not personal and only you who can pull this off. It's part of the natural goodness of things that competent, nurturing therapeutic connection mixed with psychedelic medicines generally seems to have this effect but it is easy to lose track of this. You especially won’t see it that way if you are coming to the table with your own ego wounding which I and many of us have. Your psyche will take this powerful experience and shape it to fit your own needs such as the need to be important, special, to be seen as good, or uniquely skilled. If you grew up with your own needs not being met and you have your own narcissistic deficits where you just don’t feel ok or good enough at a core level (basically a developmental narcissistic wound), your system will find a way to get these needs met through your identity as a psychedelic healer. (And yes, I should be using the first person in these last few sentences but I think this learning is for us as a community).   

This experience was personally devastating for me and has stayed with me for years. I found my mind going through our time together over and over again, looking to see what I missed. If I could have done something different. This person has shown up in my dreams and as intrusive images. I find myself trying to understand what drove them in their last days, and play out different conversations we could have had. This person lives in my psyche which is to say, I came away from this with my own pretty significant PTSD. I have spent many hours in my own therapy sessions working with the events. I have a dear friend who is a psychiatrist who lost three patients to suicide; this destroyed him personally and almost ended his career. This one removed me from life for a number of years. So yes, our involvement in this work and in people’s lives is serious. The repercussions in our own lives emotionally, energetically, relationally and otherwise, is deep.

 

Looking back upon that situation, I still see that there were no easy answers. What if I had said ‘no’ and done nothing to help at our second meeting, and this person suicided two weeks later? What if I fought for my license and somehow that was used to interrupt the MDMA research? I am not ashamed of the decisions I made to help this person even though I would make a different choice in retrospect, and I have no problems with the choice of not defending my license. I am fine with my personal ethics on both counts. 

 

What I’ve come to understand is that there are much larger forces dictating the course of our lives than we might want to acknowledge. Human beings helping human beings can be a messy business or simply not work even with clear intentions and even under the best of circumstances. This is even more the case when desperation and suffering are making decisions. I did not see the fullness or depth of this person’s fight with depression, but I have seen close loved ones put up the fight of their lives against illness for years. What I’ve come to understand is that when someone says ‘enough, I’m done’, that is their and only their choice to make. Most of us live a life where being here is not a question, it's not a choice we have to make affirmatively everyday, while for others, it is.

Lastly, the conclusion of this story for me is that I was fortunately able to regain my license to practice psychotherapy after a number of years. Even as the traumatic symptoms have resolved, I am left quite changed by these events. This experience will always be with me in some form. My hope is that my sharing of these events can benefit others as they enter the waters of psychedelic therapy. 

With much love to all involved, 

Saj